3/9/2008

Penilaian jantung janin

dengan USG
Azen Salim
Bagian Obstetri & Ginekologi
FKUI/RS Ciptomangunkusumo
Jakarta

Fetal echocardiography
„ Evaluation of the fetal heart is one of the more
diffi l tasks
difficult k for
f the
h physician
h i i or
sonographer. The incidence of congenital heart
defects is between 8 to 10/1,000
(1%). Congenital heart defects are the most
common of all birth defects and associated with
one of the highest mortality rates following
birth.

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Indikasi
„ a family history of congenital heart disease
„ an abnormal fetal heart rhythm
„ fetal heart abnormalities detected during a routine
pregnancy ultrasound scan
„ abnormality of another major organ system
„ insulin--dependent (type 1) diabetes mellitus
insulin
„ exposure to some drugs in early pregnancy.
pregnancy For
example, some anti-
anti-epileptic drugs can damage the
developing heart.
„ abnormal amniocentesis .

Kapan diperiksa Jantung Janin

„ The heart motion can be seen from about 6
weeks
k off gestation.
i However,
H details
d il off heart
h
structure cannot be seen until
„ 14 weeks gestation using scanning through the
vagina.
„ 18 weeks gestation using imaging through the
abdomen.
„ Sometimes, repeat examinations are needed.

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Pelaku pemeriksaan jantung janin

„ A limited cardiac evaluation is possible during
regular
l obstetric
b i scanning
i and d iis appropriate
i ffor
women at low risk. However, some women
should have a detailed fetal echocardiogram
performed by a physician who is specially
trained in fetal cardiac evaluation. They include
women at increased risk of having a baby with a
CHD or in whom a cardiac malformation is
suspected by the initial ultrasound study.

What conditions can be identified?

„ abnormalities of cardiac structure (CHD)
„ cardiac rhythm disturbances (or arrhythmias)
„ disorders of cardiac function

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Keterbatasan fetal echocardiography

„ Some heart abnormalities are not detectable

prenatally
ll even with
i h a ddetailed
il d expert
examination. These tend to be minor defects,
such as small holes in the heart, or mild valve
abnormalities. In addition, some cardiac defects
do not become evident until after birth

What are the implications of fetal

echocardiography?
„ The detection of a heart defect increases the risk of
finding other malformations in the child. A detailed
ultrasound of the rest of the fetus is necessary. Also,
amniocentesis to test the chromosomes may be
recommended.

„ A serious or even life-

life-threatening heart abnormality
may be identified
identified. It may have a significant impact on
the future of the child. You will want to discuss this
with your doctor.

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Continued

Currently only cardiac rhythm disturbances are being

treated before birth. In the future a number of
structural cardiac defects may be treated before birth.

In manyy cases of CHD diagnosed

g prenatally,
p y, it is
safest to deliver the pregnancy at, or near, the center at
which postnatal treatment will take place. This is
especially true if surgery will be required soon after
birth.

Who can counsel or advise me about cardiac

findings?
„ A perinatalogist or obstetrician can advise you about
the management of your pregnancy.

„ A pediatric cardiologist is in the best position to give

advice about the outlook for your child’s heart
problem.

„ A geneticist
i i can provideid iinformation
f i about
b a ffetus with
ih
an associated genetic syndrome, if present, and advise
about future pregnancies.

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 3/9/2008

Continued

A cardiac
di surgeon can give
i ddetails
il about
b surgical
i l
procedures that may be needed.

A nurse, who is familiar with heart disease in children,

can provide information about caring for a child with
congenital heart disease.
disease

Practice Bulletin no 58 tahun 2004 ACOG

Selain pemeriksaan 4CV, diperluas ke Outflow Tract

Detection rate 4CV 0 – 60%, tambahan OT menjadi 75% atau lebih

(DeVore)

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Penilaian 4CV

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Cara
„ 3VT
„ 4CV
„ 5OT

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Situs
„ Solitus
„ Ambigus
„ Inversus

Simetris
„ Kedua ventrikel
„ Kedua atrium
„ Katub Mitral dan triscuspud
„ Aksis

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Ritme
„ Gangguan supra atau ventrikuler
„ dll

Peranan 3D atau STIC

„ Analisa dari tiga sudut
„ Gerakan bisa diperlambat shg mempermudah
analisa
„ Gambaran 3 D bisa didapatkan

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Kelebihan USG 3D/4D

„ Mempunyai kemampuan menampilkan kelainan
j
jantung lebih
l bih b
baik
ik dib
dibandingkan
di k USG
konvensionil
„ USG 4D mempunyai kemampuan menampilkan
gerakan jantung yang menyimpang dan
penentuan lesi lebih tepat
p p

Peranan USG 3D/4D

„ Peranan USG 3D/4D merupakan pelengkap
pemeriksaan
ik baku
b k 2D
„ Gambaran multiplanar merupakan kelebihan
penentuan lesi lebih tepat
„ 3D/4D dapat mengamati gerakan jantung lebih
baik

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