Fetal Cardiovascular Imaging: A Disease-Based Approach
This is the most recent and updated textbook on fetal cardiology in a specialty field that has come into its own over the past decade or so. Fetal cardiology, like many other imaging-intense fields, is a focused combination of knowledge base and imaging expertise. Meticulous attention to imaging detail and compulsive description of segmental anatomy are integral to accurate fetal cardiac diagnosis. This textbook highlights the importance of the knowledge base, and the imaging component, as well.
One of its most attractive features is that it uses a case discussion format in pictures to complete a clinical scenario in specific cardiac lesions. Each chapter is very conveniently divided into 3 parts: a didactic component, then a section to describe fetal echocardiographic findings, and then a conclusion with a case discussion tying it all together. Key echocardiographic features set up the framework for each lesion, and each chapter ends with imaging essentials that feed into supporting those key points. As such, this is an innovative format and an effective one that care providers can use for their first and subsequent fetal cardiac diagnosis. Interestingly, although all cardiologists are accustomed to the terminologies and implications of tetralogy of Fallot or transposition of the great vessels or double-outlet right ventricle, this textbook is likely to be equally appreciated by perinatologists and obstetricians and sonographers.
Although the introductory component of most chapters includes a little bit about embryology, etiology, and historical perspective, this is done very effectively and keeps the reader, for the most part, focused and paying attention to the bullet points. And, for all the next generation, or for those who have converted all their learning to computer-friendly formats, this is all available on-line with the purchase of the book.
The textbook has been authored by multiple contributors, most of whom are affiliated with the Children's Hospital of Philadelphia. As such, it is a distillation of institutional expertise from a premier pediatric cardiology and fetal cardiology center.
Certainly the model for fetal cardiac care that has been adopted by the institution, as elaborated in the chapter entitled “Prenatal Practice Care Model and Delivery of the Fetus with Cardiovascular Disease,” is a very useful one for centers looking to establish or improve on their fetal cardiac centers. This same chapter is a valuable one that brings objectivity, and the prospect of protocol, as well, to our varied approaches to prenatal care. The importance of a team-based approach combining specific roles of multiple providers in bringing about the best transition from fetal to neonatal life has been described in replicable detail. The following chapter on “Counseling and Support for the Family Carrying a Fetus with Cardiovascular Disease” is a well-written chapter that acknowledges the emotional challenges of a fetal cardiac diagnosis to the family, and to the care team, as well. Clarity and evidence-based objectivism are combined with a deep compassion that actually sets the tone for the entire book. As such, not only is this book a sound scientific text, but it also highlights the uniqueness and empathetic approach in this subspecialty. Many parts of this, and other chapters, as well, itemize components of a counseling process that is actually quite challenging.
There are multiple instances where it appears that the data/statistics mentioned in the book are not derived from peer-reviewed and referenced material, and, hence, relevant references are hard to find. Although newer technologies including fetal 3- and 4-dimensional echocardiography, and fetal magnetic resonance imaging, as well, have been introduced, the images included do not always clearly elucidate the anatomy being described. Also, newer modalities and techniques such as fetal tissue Doppler, strain and strain rate imaging, and speckle tracking for determination of fetal cardiac function have not been incorporated.
The text does have its share of typographic errors, but these, for the most part, do not impede understanding the sections in which they are located.
Fetal magnetic resonance imaging images are included, but some of them are difficult to interpret. There is some mention of myocardial deformation and mechanics, and a tight and well-rounded chapter on 3- and 4-dimensional fetal ultrasound is included. Only a brief mention is made of fetal intervention with regard to aortic stenosis in the chapter on fetal hypoplastic left heart syndrome. Because this is a potentially new field of which families and providers are increasingly aware, it would have been useful to include a quick review of the state of this field and case-selection recommendations. First-trimester screening is also getting more attention as the need for earlier diagnosis in high-risk pregnancies becomes more pertinent; this area could have been touched on in a more focused fashion in the book, along with recommendations, introduction to transvaginal fetal cardiac assessment, and limitations of this potential use.
Multiple short chapters (fetal teratomas, diaphragmatic hernias, cystic adenomatoid malformations, pulmonary and cerebral arteriovenous malformations) are very useful, sharply written topics that comprise a good number of referrals to a fetal cardiology clinic. Overall, this text book is highly recommended to the fetal cardiology, obstetrics, and perinatology communities of physicians and nursing staff as a one-stop for contemporary state of fetal cardiology, for a basic knowledge base, and reference, as well. Its strength is in the comprehensive yet concise layout of the chapters, the echocardiography-based delivery of information, well supported by plenty of screen images showing well-labeled anatomy.
Aarti H. Bhat, MD
Seattle Children's Hospital
David J. Sahn, MD, FAHA
Oregon Health & Science University
- © 2012 American Heart Association, Inc.