Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
Univentricular Atrioventricular Connection, Double Inlet Ventricle, and Tricuspid Atresia with Ventricular Septal Defect• UNIVENTRICULAR ATRIOVENTRICU Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2ULAR CONNECTIONUniventricular atrioventricular connection describes a group of cardiac malformations where the atrioventricular connection is completely or predominantly to a single ventricular chamber. Embryologically, this malformation is thought to result from failure of the development of the bu Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2lboventricular loop stage. Much debate still exists today on the various subclassifications of cardiac anomalies within this group and what should beEbook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
included or excluded (1-4). From a clinical point of view, a congenital heart defect with a univentricular atrioventricular connection, single ventricUniventricular Atrioventricular Connection, Double Inlet Ventricle, and Tricuspid Atresia with Ventricular Septal Defect• UNIVENTRICULAR ATRIOVENTRICU Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2mation, including univentricular heart, primitive ventricle, common ventricle, single ventricle, cor triloculare biatriatum, cor biloculare, dominant ventricle, and double inlet ventricle (DIV) (3). The classic Van Praagh classification (5), which was later modified by Hallermann et al. (6), describ Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2ed one or two atrioventricular valves that empty into a single ventricle and excluded mitral or tricuspid atresia (TA). Anderson’s simpler classificatEbook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
ion described a single ventricular mass with or without a rudimentary chamber and allowed for the inclusion of mitral or TA (7, 8). In Anderson’s clasUniventricular Atrioventricular Connection, Double Inlet Ventricle, and Tricuspid Atresia with Ventricular Septal Defect• UNIVENTRICULAR ATRIOVENTRICU Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2ion, three subgroups can be identified: double inlet, where two atria connect to a single ventricle through two patent atrioventricular valves; single inlet, where one atrium connects to a single ventricle through a single atrioventricular valve; and common inlet, where both atria connect to a singl Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2e ventricle through a single atrioventricular valve (1). The morphology of the ventricle is generally a left ventricular morphology with a rudimentaryEbook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
right chamber. On rare occasions, a right ventricular morphology with a rudimentary left chamber, or a ventricle of indeterminate morphology without Univentricular Atrioventricular Connection, Double Inlet Ventricle, and Tricuspid Atresia with Ventricular Septal Defect• UNIVENTRICULAR ATRIOVENTRICU Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2fied as univentricular atrioventricular connection. Table 19.1 lists several cardiac anomalies that may show a single ventricle on fetal echocardiography. Of those, DIV and TA with ventricular septal defect (VSD) have been commonly classified in the univentricular atrioventricular connection and wil Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2l be discussed in this chapter. Figure 19.1 represents four-chamber views in fetuses with different cardiac defects and a single ventricle anatomy.FigEbook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
ure 19.1: Spectrum of univentricular atrioventricular connection: four different fetal heart defects showing a “single ventricle” (V) in the four-chamUniventricular Atrioventricular Connection, Double Inlet Ventricle, and Tricuspid Atresia with Ventricular Septal Defect• UNIVENTRICULAR ATRIOVENTRICU Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2th absent left ventricle in mitral and aortic atresia. B: Fetus with a hypoplastic right ventricle in pulmonary atresia with intact septum. C: Common inlet single ventricle in a fetus with right isomerism and other complex anomalies and (D) double inlet ventricle. See text and Table 19.1 tor details Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2.TABLE19.1Cardiac Anomalies That May Show a Single Ventricle on Fetal Echocardiography•Hypoplastic left heart syndrome•Pulmonary atresia with intact sEbook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
eptum•Atrioventricular septal defect (large or unbalanced)•Single ventricle in right and left isomerism•Corrected transposition with tricuspid atresiaUniventricular Atrioventricular Connection, Double Inlet Ventricle, and Tricuspid Atresia with Ventricular Septal Defect• UNIVENTRICULAR ATRIOVENTRICU Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2on, Spectrum of Disease, and IncidenceDIV is considered a classic and most common form of univentricular atrioventricular connection (1). It is characterized by two normally developed right and left atria that connect via separate right and left atrioventricular valves to a common ventricle (Fig. 19 Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2.2). The most common form of DIV is a double inlet to a morphologic left ventricle, representing about 80%, and the anomaly is also called double inleEbook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
t left ventricle (DILV) (5). In Dll.v, a small underdeveloped right ventricle (not shown in Fig. 19.2) is commonly present and connects to the single Univentricular Atrioventricular Connection, Double Inlet Ventricle, and Tricuspid Atresia with Ventricular Septal Defect• UNIVENTRICULAR ATRIOVENTRICU Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2nd pulmonary arteries usually arise in D- or L-malposition, and depending on the looping, one or both vessels (double outlet) may commonly arise from the small outlet chamber. In cases where the bulboventricular foramen(septal defect) is restrictive, the corresponding arising vessel(s) from the remn Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2ant chamber may be diminutive (pulmonary stenosis or aortic coarctation). Other forms of DIV include a double inlet right ventricle, a DIV of mixed moEbook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
rphology, and a DIV of undetermined or undifferentiated morphology (5). DIV is rare and is found in 0.1 per 1,000 live births (9). The prevalence is mUniventricular Atrioventricular Connection, Double Inlet Ventricle, and Tricuspid Atresia with Ventricular Septal Defect• UNIVENTRICULAR ATRIOVENTRICU Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2icle. Note the presence of right (RA) and left (LA) atria, two patent atrioventricular valves, and both atria drain into a single ventricle. In most cases, the single ventricle is morphologically a left ventricle. A rudimentary ventricle can occasionally be seen (not shown in this scheme).Ultrasound Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2 FindingsGray ScaleThe four-chamber view is abnormal in DIV as it shows a single ventricle with a missing ventricular septum (Fig. 19.3). IdentifyingEbook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
the morphology of the single ventricle on ultrasound is based on the anatomic characteristic of the morphologic right and left ventricles as discussedUniventricular Atrioventricular Connection, Double Inlet Ventricle, and Tricuspid Atresia with Ventricular Septal Defect• UNIVENTRICULAR ATRIOVENTRICU Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2egular surface. Assessment ofatrioventricular valve anatomy and/or insertion of papillary muscles cannot be used to determine ventricular morphology in univentricular atrioventricular connection. Occasionally, the rudimentary right ventricle is seen in the four-chamber plane (Fig. 19.4) but in most Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2cases the septal defect (bulboventricular foramen) and the rudimentary right ventricle in DILV are often not visualized in the four-chamber plane butEbook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
in a more cranial plane, when an attempt to visualize the great vessels is made (Fig. 19.5). The rudimentary outlet chamber in DILV is more commonly lUniventricular Atrioventricular Connection, Double Inlet Ventricle, and Tricuspid Atresia with Ventricular Septal Defect• UNIVENTRICULAR ATRIOVENTRICU Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2malposition if the small outlet chamber is on the left side of the ventricle. When the small outlet chamber is localized on the right side, the great arteries arise either in D-malposition or are normally related with the pulmonary artery arising from the small outlet chamber (2). Outflow tract obst Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2ructions are recognized due to size discrepancy rather than flow disturbances, which may be absent. A narrow pulmonary artery suggests the presence ofEbook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
pulmonary stenosis or atresia, whereas a narrow ascending aorta may be associated with coarctation of the aorta or tubular aortic arch hypoplasia.FigUniventricular Atrioventricular Connection, Double Inlet Ventricle, and Tricuspid Atresia with Ventricular Septal Defect• UNIVENTRICULAR ATRIOVENTRICU Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2t (LA) atria and a single ventricle (SV) in A. B shows, in color Doppler, blood flow from the RA and LA through two respective atrioventricular valves into the SV. L, left.Figure 19.4: Four-chamber view in gray scale in a fetus with a double inlet ventricle. Note that the right (RA) and left (LA) at Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2ria drain through two distinct atrioventricular valves into the left ventricle (LV). There is a rudimentary right ventricle (RV) as an outlet chamberEbook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2
drained from the LV. L, left.Color DopplerColor Doppler may be misleading since two atrioventricular valves are patent and two color stripes are visuaUniventricular Atrioventricular Connection, Double Inlet Ventricle, and Tricuspid Atresia with Ventricular Septal Defect• UNIVENTRICULAR ATRIOVENTRICU Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2and color Doppler provides additional information on the patency of the left and right atrioventricular valves, flow across the VSD, and great vessels (Fig. 19.5), especially to detect stenosis or atresia (Fig. 19.7). Restrictive VSD, which may occur in this condition, is better evaluated using colo Ebook A practical guide to fetal echocardiography normal and abnormal hearts (3E): Part 2r Doppler.Gọi ngay
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