M.D. Abuhamad - A Practical Guide to Fetal Echocardiography: Normal and Abnormal Hearts (Abuhamad, A Practical Guide to Fetal Echocardiography)

A PRACTICAL GUIDE
TO FETAL ECHOCARDIOGRAPHY

NORMAL AND ABNORMAL HEARTS Second Edition

Alfred Abuhamad, MD

Professor of Obstetrics & Gynecology

Professor of Radiology

Chairman, Department of Obstetrics & Gynecology

Eastern Virginia Medical School

Norfolk, Virginia

Rabih Chaoui, MD

Professor of Obstetrics & Gynecology

Prenatal Diagnosis and Human Genetics Center

Berlin, Germany

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Library of Congress Cataloging-in-Publication Data

ISBN-13: 978-0-7817-9757-3

ISBN-10: 0-7817-9757-3

Abuhamad, Alfred.

A practical guide to fetal echocardiography : normal and abnormal hearts / Alfred Abuhamad, Rabih Chaoui. - 2nd ed.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-7817-9757-3

1. Fetal heart-Ultrasonic imaging. I. Chaoui, Rabih. II. Title.

[DNLM: 1. Fetal Heart-ultrasonography. 2. Heart Defects, Congenital-ultrasonography. 3. Ultrasonography, Prenatal-methods. WQ 210.5 A1651p 2010]

RG628.3.E34A28 2010

618.326107543-dc22

2009031203

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner.

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To our parents for their unwavering support and commitment to excellence throughout the years, and to

Sami and Nicole
Kathleen, Amin and Ella,

With love and admiration.

FOREWORD

F or a variety of reasons, when I was invited to write a brief foreword to this book, I could not say no. However, only after I received the chapter drafts did I realize what a bonus it was to have an advance copy in my hands, months before the book comes out. I often groan when I hear people say, when describing a novel, I couldnt put the book down, because the phrase is so over used. Well, this book messed up my whole weekend because I could not put it down.

Why? Because it encompasses not only what anyone in the field needs to know about various abnormalities of the fetal heart, but, most importantly, it tells the reader how to tweak the utmost information out of todays available equipment in order to screen for cardiac abnormalities and to pinpoint the exact problem if an anomaly is suspected. Each chapter is replete with helpful hints on how to optimize ones image, and how to utilize selectively M mode, pulse wave Doppler, color Doppler, 3-D technology (TUI, STIC, inversion mode, enhanced color flow, etc) in route to solving many diagnostic puzzles. To keep the reader on track, key points are summarized at the end of each chapter.

The book is laid out in a logical sequence, starting with general information on the epidemiology of cardiac defects and how to screen for them. Then there are two how-to and what to look for chapters on the four chamber view and outflow tracts, followed by chapters each on color Doppler, pulse Doppler, 3-D with its bells and whistles, and another on the use of fetal echocardiography in early gestation (to satisfy a new trend in prenatal diagnosis). The last chapters cover comprehensively virtually every cardiac abnormality a fetus can have, including cardiomyopathies and arrhythmias.

The authors form a formidable team of two of the best-known clinician/investigators who are recognized internationally for their work in fetal echocardiography and also in various other aspects of prenatal diagnosis. Dr. Chaoui trained in Europe, and Dr. Abuhamad spent his formative years in the United States. For years I have been impressed with the quality and depth of Dr. Chaouis contributions. My contact with Dr. Abuhamad has been first hand, starting from the first day he set foot in Yale as a fellow. On the second day, everyone in the division knew he would be one of the brightest stars in the field.

Fetal echocardiographers generally come into the field via one of two pathways: pediatric cardiology or perinatology (a few such as Benaceraff and Jeanty, who have roots in Radiology, are exceptions). Those pursuing the first pathway are immersed in all aspects of cardiac dynamics from the starttraining that is put into play daily in the care of children and, often, fetuses with cardiac abnormalities. Doctors Abuhamad and Chaoui arrived by the second routeone that requires self-education, rather than a formalized program. This is evident in the way we, the readers, are methodically taught in each chapter.

From my standpoint, this will become the ultimate text on the fetal heart. Actually, and I am reluctant to say this as an author of books that have had modest sales, this may be one of the very best ultrasound- related books aroundperiod!

John C. Hobbins, MD.

PREFACE

I t is with great pleasure that we introduce this second edition of A Practical Guide to Fetal Echocardiography: Normal and Abnormal Hearts