英文版美国医学超声协会胎儿超声心动图操作指南FetalEchoaiumsmfm

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mature womenAIUM Practice Guideline for the Performance of Fetal Echocardiography
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© 2010 by the American Institute of Ultrasound in Medicine
I. Introduction
Congenital heart dia is a leading cau of infant mor-bidity and mortality from birth defects, with an estimated incidence of 6 per 1000 live births for moderate to vere forms.1,2Accurate prenatal diagnosis offers potential clini-cal benefit with regard to infant outcomes, especially in tho cas that are likely to require prostaglandin infu-sion to maintain patency of the ductus arteriosus.3–5Fetal echocardiography is broadly defined as a detailed sono-graphic evaluation that is ud to identify and characterize fetal heart anomalies before delivery. This specialized diagnostic procedure is an extension of the “basic” and “extended basic” fetal cardiac screening guidelines that have been previously described for the 4-chamber view and outflow tracts.6,7 It should be performed only when there is a valid medical reason, and the lowest possible ultrasonic exposure ttings should be ud to gain the necessary diagnostic information. In some cas, addi-tional or specialized examinations such as the inclusion of color Doppler sonography may be necessary. While it is not possible to detect every abnormality, adherence to the following guideline will maximize the probability of detecting most cas of clinically significant congenital heart dia.
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II. Qualifications and Responsibilities of Personnel
See the AIUM Official Statement Training Guidelines
for Physicians Who Evaluate and Interpret Diagnostic Ultrasound Examinations and the AIUM Standards and Guidelines for the Accreditation of Ultrasound Practices. III. Indications
Indications for fetal echocardiography are often bad on a variety of parental and fetal risk factors for congenital heart dia.8,9However, most cas are not associated with known risk factors. Common indications for a detailed scan of the fetal heart include but are not limited to: Maternal Indications
•Autoimmune antibodies, anti-Ro (SSA)/anti-La (SSB);
•Familial inherited disorders (eg, Marfan syndrome);
•First-degree relative with congenital heart dia;
•In vitro fertilization;
•Metabolic dia (eg, diabetes mellitus and phenylketonuria); and
•T eratogen exposure (eg, retinoids and lithium).
Fetal Indications
tpo小站•Abnormal cardiac screening examination;•Abnormal heart rate or rhythm;
•Fetal chromosomal anomaly;
•Extracardiac anomaly;
•Hydrops;
•Incread nuchal translucency;•Monochorionic twins; and
•Unexplained vere polyhydramnios.
IV. Written Request for the Examinationicu是什么意思
The written or electronic request for an ultrasound examination should provide sufficient information to allow for the appropriate performance and interpretation of the examination.
A request for the examination must be originated by a physician or other appropriately licend health care provider or under their direction. The accompanying clinical information should be provided by a physician or other appropriate health care provider familiar with the patient’s clinical sit
uation and should be consistent with relevant legal and local health care facility requirements. V. Specifications of the Examination
The following ction details recommended and optional elements for fetal echocardiography.
A.General Considerations
Fetal echocardiography is commonly performed
between 18 and 22 weeks’ gestational age. Some
forms of congenital heart dia may even be rec-ognized during earlier stages of pregnancy.10
Optimal views of the heart are usually obtained
when the cardiac apex is directed toward the anteri-or maternal wall. Technical limitations (eg, maternal obesity or prone fetal position) can make a detailed heart evaluation very difficult becau of acoustic
shadowing, especially during the third trimester.
It may be necessary to examine the patient at a
different time if the heart is poorly visualized. The
examiner can optimize sonographic images by
appropriate adjustment of technical ttings, such
as acoustic focus, frequency lection, signal gain,
image magnification, temporal resolution, harmon-ic imaging, and Doppler-related parameters (eg,
velocity scale, frequency wall filter, and frame rate).
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Effective February 5, 2010—AIUM PRACTICE GUIDELINES—Fetal Echocardiography 1
B. Cardiac Imaging Parameters: Basic Approach The fetal echocardiogram is a detailed evaluation of cardiac structure and function. This method typically involves a quential gmental analysis of 3 basic areas that include the atria, ventricles, and great arteries and their connections.11–13A gme
ntal analysis includes an asssment of the following connections and their relationships:
•Atrial arrangement (situs);
•Atrioventricular junction between the atria and ventricles;
•Ventriculoarterial junction between the ventricle and arterial outflow tracts.
Each anatomic gment can be further evaluated for associated anomalies such as cardiac malposition, atrial isomerism, aortic override, an atrial ptal defect, a ventricular ptal defect, myocardial hyper-trophy, abnormal systemic and pulmonary venous connections, a restricted foramen ovale mechanism, ventricular disproportion, coarctation, and abnormal development of mitral or tricuspid valves.
C. Gray Scale Imaging (Recommended)
Key scanning planes can provide uful diagnostic information about the fetal heart (Figures 1–3).14–19 The following cardiac images should be obtained:•Four-chamber view;
•Left ventricular outflow tract;thereafter
•Right ventricular outflow tract;
•Three-vesl and trachea view;
•Short-axis views (“low” for ventricles and “high” for outflow tracts);
•Aortic arch;
•Ductal arch;
•Superior vena cava; and
•Inferior vena cava.
D. Doppler Sonography (Optional but
Recommended for Suspected Cardiac
Flow Abnormalities)
Spectral, continuous wave, color, and/or power Doppler sonography can be ud to evaluate the following structures for potential flow or rhythm disturbances20–23:•Pulmonary veins;
•Foramen ovale;
•Atrioventricular valves;
•Atrial and ventricular pta;
•Aortic and pulmonary valves;
•Ductus arteriosus; and
•Aortic arch.
E. M-Mode Echocardiography (Optional but
Recommended for Cardiac Rate or Rhythm
Abnormalities)
M-mode echocardiography displays moving struc-tures along a thin sampling line over time. The high temporal resolution makes it uful for the asss-ment of ventricular contractility. Cardiac rhythm disturbances can be characterized by establishing
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an atrial rate, ventricular rate, and their relationship
to each other. Alternative approaches, bad on puld wave or tissue Doppler sonography, have also been ud for evaluating fetal heart dysrhythmias.24
F. Cardiac Biometry (Optional but Can Be
Considered in the Prence of Structural
Anomalies)
Normal ranges for fetal cardiac measurements have been published as percentiles and z scores that are bad on gestational age or fetal biometry. Individual measurements can be determined from M-mode or
2-dimensional images, and they include the follow-
ing parameters22,25–31:
•Aortic and pulmonary artery diameters at the level of the valve annulus;圣诞节快乐的英文
•Aortic arch and isthmus diameter measurements;•End-diastolic ventricular dimensions just inferior to the atrioventricular valve leaflets; and •Thickness of the ventricular free walls and interventricular ptum just inferior to the
atrioventricular valves.
•Additional measurements may be taken if warranted, including:
•Systolic dimensions of the ventricles;•Transver dimensions of the atria; and •Diameter of branch pulmonary arteries.
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Effective February 5, 2010—AIUM PRACTICE GUIDELINES—Fetal Echocardiography 2
G. Complementary Imaging Strategies (Optional)
Other adjunctive imaging modalities, such as 3- and
4-dimensional sonography, have been ud to evalu-ate anatomic defects and to quantify fetal hemody-
namic parameters, such as cardiac output. Doppler
sonography and speckle-tracking technologies have
also been described for ventricular strain and
myocardial performance index measurements.32–39
VI. Reporting and Documentation
Adequate documentation is esntial for high-quality patient care. There should be a permanent record of the fetal echocardiographic examination and its interpreta-tion. Images of all appropriate areas, both normal and abnormal, should be recorded. Variations from normal size should be accompanied by measurements. Images should be labeled with the patient identification, facility identification, examination date, and side (right or left) of the anatomic site imaged. An official interpretation (final report) of the diagnostic findings should be included in the patient’s medical record. Retention of the ultrasound examination should be consistent both with clinical needs and with relevant legal and local health care facility requirements. Reporting should be in accordance with the AIUM Standard for Documentation of an Ultrasound Examination.40–42
VII. Equipment Specifications
A sonographic examination of the fetal heart should be conducted using a real-time scanner. Sector, curvilinear, and endovaginal transducers are ud for this purpo. The transducer or scanner should be adjusted to operate at the highest clinically appropriate frequency, realizing that there is a trade-off between resolution and beam penetration. With modern equipment, fetal imaging studies performed from the anterior abdominal wall can usually u frequencies of 3.5 MHz or higher, while scans performed from the vagina should be performed using frequencies of 5 MHz or higher. Acoustic shadowing and maternal body habitus may limit the ability of higher-frequency transducers to provide greater anatomic detail for the fetal heart.VIII. Quality Control and Improvement,
gunlockSafety, Infection Control, and Patient
Education
Policies and procedures related to quality control, patient education, infection control, and safety should
小学考试成绩查询be developed and implemented in accordance with the AIUM Standards and Guidelines for the Accreditation of Ultrasound Practices.
Equipment performance monitoring should be in accordance with the AIUM Standards and Guidelines
for the Accreditation of Ultrasound Practices.
IX. ALARA Principle
The potential benefits and risks of each examination should be considered. The ALARA (as low as reasonably achievable) principle should be obrved when adjusting controls that affect the acoustic output and by considering transducer dwell times. Further details on ALARA may be found in the AIUM publication Medical Ultrasound Safety. Acknowledgments
This guideline was developed by a Fetal Echocardiography T ask Force under the auspices of the AIUM Clinical Standards Committee (David M. Paushter, MD, Chair) in collaboration with the American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) according to the process described in the AIUM Clinical Standards Committee Manual. The American College of Radiology (ACR) has endord this document. Appreciation is particularly extended to Kathi Keaton Borok, BS, RDMS, RDCS, for administrative assis-tance during the development of this document and to Victoria Webster, MA, RT(MR), CNMT, RDMS, for d
evelop-ment of the illustrations.
Fetal Echocardiography Task Force
Task Force Chair
februaryWesley Lee, MD
AIUM
Julia Dro, BA, RT, RDMS, RVT, RDCS
Joph Wax, MD
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Effective February 5, 2010—AIUM PRACTICE GUIDELINES—Fetal Echocardiography 3

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