ফেটাল হার্টের স্বাভাবিক অ্যানাটমি ও স্ট্যান্ডার্ড ইকো ভিউসমূহ
🔹 Introduction
Fetal echocardiography হলো গর্ভের শিশুর হার্টের গঠন, সংযোগ ও কার্যকারিতা মূল্যায়নের একটি বিশেষ ultrasound technique।
👉 প্রধান উদ্দেশ্য:
- Congenital heart disease শনাক্ত করা
- Fetal circulation মূল্যায়ন
- Rhythm assessment
🔹 Objectives of Examination
✔ Cardiac situs নির্ণয়
✔ Chamber symmetry assessment
✔ AV ও VA connection assessment
✔ Great artery evaluation
✔ Rhythm assessment
🔹 Sequential Segmental Approach
Guideline অনুযায়ী fetal echo systematic sequence এ করতে হয়:
👉 Abdomen → Situs → 4 Chamber → Outflow Tracts → 3VT → Arches → Rhythm
🔹 1. Abdominal Situs View
Technique:
Transverse section of fetal abdomen
Structures:
✔ Stomach
✔ Descending aorta
✔ Inferior vena cava (IVC)
Normal Findings:
✔ Stomach left side
✔ Aorta left posterior
✔ IVC right anterior
Importance:
✔ Right-left orientation
✔ Situs determination
🔹 2. Four Chamber View
Most important screening view
Structures Visualized:
✔ Right atrium
✔ Left atrium
✔ Right ventricle
✔ Left ventricle
✔ Interatrial septum
✔ Interventricular septum
✔ Mitral valve
✔ Tricuspid valve
Normal Findings:
✔ Equal chamber size
✔ Intact septum
✔ Cardiac apex left side
✔ AV valve offset present
Detectable Lesions:
✔ AVSD
✔ Hypoplastic ventricle
✔ Large VSD
✔ Ebstein anomaly
🔹 3. Left Ventricular Outflow Tract (LVOT)
Structures:
✔ LV continuity with aorta
✔ Aortic valve
Importance:
✔ Confirms aorta from LV
Detectable Abnormalities:
✔ TGA
✔ DORV
✔ Aortic stenosis
🔹 4. Right Ventricular Outflow Tract (RVOT)
Structures:
✔ RV continuity with pulmonary artery
✔ Pulmonary valve
Importance:
✔ Crossing pattern assessment
Detectable Abnormalities:
✔ TOF
✔ Pulmonary atresia
🔹 5. Three Vessel View (3VV)
Structures:
✔ Pulmonary artery
✔ Aorta
✔ Superior vena cava
Normal Relation:
PA > Aorta > SVC
Importance:
✔ Great vessel size comparison
🔹 6. Three Vessel Trachea View (3VT)
Structures:
✔ Ductal arch
✔ Aortic arch
✔ Trachea
Normal:
✔ V-shaped confluence left to trachea
Importance:
✔ Arch abnormality detection
🔹 7. Aortic Arch View
Appearance:
✔ Candy cane shape
Structures:
✔ Ascending aorta
✔ Arch branches
✔ Descending aorta
Detectable Abnormalities:
✔ Coarctation
✔ Interrupted arch
🔹 8. Ductal Arch View
Appearance:
✔ Hockey stick shape
Structures:
✔ Pulmonary artery
✔ Ductus arteriosus
✔ Descending aorta
🔹 9. Bicaval View
Structures:
✔ SVC
✔ IVC
✔ Right atrium entry
Importance:
✔ Venous drainage assessment
🔹 10. Rhythm Assessment
Method:
✔ M-mode
✔ Doppler
Normal Heart Rate:
✔ 120–160 bpm
Detectable:
✔ Tachyarrhythmia
✔ Bradyarrhythmia
✔ AV block
🔹 Important Normal Parameters
| Parameter | Normal |
|---|---|
| Cardiac axis | 45° ± 20° |
| Heart size | <1/3 thoracic area |
| Rhythm | Regular |
| Chamber size | Balanced |
🔹 Common Pitfalls
❌ Only 4 chamber evaluation
❌ Ignoring outflow tracts
❌ Wrong fetal orientation
❌ Rapid incomplete scan
🔹 Key Learning Points
✔ Always start from abdomen
✔ Sequential approach essential
✔ Outflow tract assessment mandatory
✔ Normal anatomy recognition is fundamental
👨⚕️ ডা. মোহাম্মদ নিজাম উদ্দিন
এমবিবিএস, বিসিএস (স্বাস্থ্য), এমডি (কার্ডিওলজি)
কার্ডিয়াক ইন্টারভেনশনে পোস্ট ডক্টরাল ট্রেনিং
ফেটাল কার্ডিওলজি ও ইন্টারভেনশনে অ্যাডভান্সড ফেলোশিপ
সহযোগী অধ্যাপক ও সিনিয়র কনসালট্যান্ট (কার্ডিওলজি)
ক্লিনিক্যাল ও ইন্টারভেনশনাল কার্ডিওলজিস্ট
বাংলাদেশের অগ্রণী ফেটাল কার্ডিওলজিস্ট ও ফেটাল ইকোকার্ডিওগ্রাফি বিশেষজ
Topic:
Normal Anatomy of the Fetal Heart & Standard Echocardiographic Views
🔹 Introduction
Fetal echocardiography is a specialized ultrasound technique used to assess fetal cardiac anatomy, connections, function, and rhythm.
Objectives:
✔ Detect congenital heart disease
✔ Assess fetal circulation
✔ Evaluate cardiac rhythm
🔹 Sequential Segmental Approach
Standard systematic sequence:
👉 Abdomen → Situs → 4 Chamber → Outflow Tracts → 3VT → Arches → Rhythm
🔹 1. Abdominal Situs View
Structures:
✔ Stomach
✔ Descending aorta
✔ Inferior vena cava
Normal:
✔ Stomach left
✔ Aorta left posterior
✔ IVC right anterior
🔹 2. Four Chamber View
Structures:
✔ RA
✔ LA
✔ RV
✔ LV
✔ Septa
✔ AV valves
Normal Findings:
✔ Balanced chambers
✔ Intact septa
✔ Left-sided apex
✔ AV valve offset
🔹 3. Left Ventricular Outflow Tract (LVOT)
Structures:
✔ LV continuity with aorta
✔ Aortic valve
🔹 4. Right Ventricular Outflow Tract (RVOT)
Structures:
✔ RV continuity with pulmonary artery
✔ Pulmonary valve
🔹 5. Three Vessel View (3VV)
Structures:
✔ Pulmonary artery
✔ Aorta
✔ SVC
Normal:
PA > Aorta > SVC
🔹 6. Three Vessel Trachea View (3VT)
Structures:
✔ Ductal arch
✔ Aortic arch
✔ Trachea
Normal:
✔ V-shaped confluence
🔹 7. Aortic Arch View
Appearance:
✔ Candy cane shape
🔹 8. Ductal Arch View
Appearance:
✔ Hockey stick shape
🔹 9. Bicaval View
Structures:
✔ SVC
✔ IVC
✔ RA entry
🔹 10. Rhythm Assessment
Methods:
✔ M-mode
✔ Doppler
Normal Heart Rate:
✔ 120–160 bpm
🔹 Important Normal Parameters
| Parameter | Normal |
|---|---|
| Cardiac axis | 45° ± 20° |
| Heart size | <1/3 thorax |
| Rhythm | Regular |
| Chamber size | Balanced |
🔹 Common Pitfalls
❌ Only assessing 4 chamber
❌ Ignoring outflow tracts
❌ Wrong fetal orientation
❌ Incomplete scanning
🔹 Key Learning Points
✔ Always begin from abdomen
✔ Sequential approach is essential
✔ Outflow tract assessment mandatory
✔ Recognition of normal anatomy is the foundation of fetal echocardiography
👨⚕️ Dr. Mohammed Nizam Uddin
MBBS, BCS (H), MD (Cardiology)
Post Doctoral Training in Cardiac Intervention
Advanced Fellowship in Fetal Cardiology & Intervention
Associate Professor & Senior Consultant (Cardiology)
Clinical & Interventional Cardiologist
Pioneer Fetal Cardiologist & Fetal Echocardiography Expert