The Benefit of Infant Echocardiography Essay
The Benefit of Infant Echocardiography Essay
Advancement in echocardiography has offered a timely, comprehensive, and noninvasive identification of cardiac ailments. The risk factors related to the ailments vary across infants and they may be countered by using various echocardiographic tests. Those tests may include M-mode, Doppler technique, or cross-sectional techniques. The undertaking of the test occurs at specific times and includes various advantages and disadvantages. Nonetheless, the significance of the tests is admirable. The following capstone paper analyzes infant echocardiography in detail in the diagnosis of cardiac heart conditions. The paper further analyzes the risk factors, the benefits, and disadvantages of the test(s). In conclusion, the paper recommends the appropriate measures to be undertaken regarding the tests. The Benefit of Infant Echocardiography Essay.
There exist many cardiac heart disorders associated with newborns that if not treated may result in fatalities in the future. Therefore, it becomes essential to diagnose those illnesses straight after birth so that appropriate medication could be applied. In diagnosing the disorders, it is highly advised to employ the appropriate measures that do not endanger the newborn, which is the reason why echocardiography becomes a common test on infants. Echocardiography represents a harmless test that can be conducted on infants and adults to diagnose the existence of cardiac disorders in the body.
As contrasted to other imaging infant modalities, echocardiography is acknowledged as the first imaging modality in the diagnosis of both straightforward and convoluted congenital heart diseases. The modality further offers enough preoperative anatomic and physiologic data on the diagnosis of certain cardiovascular conditions before any operation is undertaken. Echocardiography is essential in diagnosing and recognizing heart ailments in infants as well as following up on the baby’s progress.
Therefore, echocardiography is considered the primary imaging modality for newborns in the identification of both simple and difficult congenital heart ailments.The Benefit of Infant Echocardiography Essay. In addition, the test provides a sufficient amount of preoperative physiologic and anatomic data for the treatment of such weaknesses as atrial septal, patent ductus, and septal defects. The capstone paper analyzes infant echocardiography in the diagnosis of cardiac heart conditions, the risk factors, the benefits, and disadvantages of the tests.
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Congenital Heart Diseases
According to Paul, Zaborowski, Moakes, & Sanjeevaiahal (2013), congenital heart ailments may exist as a collection of disorders that emerge when the heart and related features function not like they are intended. Congenital heart ailments represent the most current and mutual congenital defects and they have become the top reason for infant mortality from heart diseases (Qu et al., 2016).
Most ailments intensify the dangers of severe parental and newborn outcomes. However, improvements in echocardiography testing capabilities have increased the diagnosis of such disorders. Risk stratification for the expectant women with the disorders may be challenging, given the wide range of cardiac abrasions and hemodynamics. However, by using echocardiography tests, such dangers are identified and the correct measures are taken (Pillutla et al., 2016). The use of fetal echocardiogram has helped reduce the number of infants born with severe heart disorders. The risk elements of most infant cardiovascular conditions include the family account of the disease, genetic disorders, and some medications taken before delivery.
An echocardiogram presupposes a safe and painless ultrasound test that employs high non-radioactive frequency sound waves for observing the heart and detecting heart conditions. According to the U.S. The Benefit of Infant Echocardiography Essay. Department of Health and Human Services (2011), the test effectively creates and shows moving images of the heart. The echocardiographic tests in neonate and infants exhibit an extraordinary challenge due to the broad range of conceivable conditions and abnormalities and the inkling towards various lesions, necessitating distinctive imaging of entire arteries and veins and intracardiac structures.
With such a description, it becomes easy to identify illnesses that relate to the heart. Performance and analysis of the test in infants need a significant understanding of the pathologic composition of inherited heart conditions. The test is relatively more thorough than an average x-ray, making it an efficient tool for the appropriate identification of numerous heart illnesses. Being a standard identification method employed in the field of cardiology, the echocardiogram shows a great amount of data about the infant’s heart.
The Different Types of Echocardiography Tests
Several echocardiography tests are quite beneficial to the baby in the diagnosis of numerous heart conditions. The tests vary regarding their application and the intended results. The M-mode test represents the simplest form of echocardiography and creates a depiction of the heart that looks more like tracing rather than a real image of heart structures. In infants, the test is essential in determining heart organization – the dimension of the heart itself, the thickness of the heart linings, and the heart’s driving cavities. By using this test, abnormal heart conditions, such as enlarged heart and other common problems, are detected in infants.
The evaluation and analysis of blood flow through the baby’s heart structures and valves is determined by the use of the Doppler technique. Heart’s functioning is determined by the amount of blood pumped out with every heartbeat. Infant conditions, such as abnormal blood flow within the heart, may be diagnosed using the test. The Benefit of Infant Echocardiography Essay. The test is beneficial to babies in the identification of such conditions as an opening between the chambers of the heart, a condition with the heart valves, or the heart linings. Typically, the color Doppler is used as it simplifies the analysis of the method. Another test entails the cross-sectional techniques. All the techniques are essential in the imaging of cardiac anatomy thereby offering the necessary information.
The Test Process
Images of the child’s heart can be observed on a small screen while the process is being undertaken. The test is beneficial to the infant, as the infant is kept safe since the method is non-invasive, so no needles or probes are involved. The test is mainly a transthoracic echocardiogram. Generally, for an infant, sedation may be necessary before undertaking the procedure to allow the cardiologists to obtain a comprehensive study because the infant has to stay still during the process. In addition, milk and solids are usually discouraged from ingesting before the scheduled process.
The doctor places the hand-gripped transducer at various points of the chest to determine the overall parts of the heart. The right thing with the echocardiographic test is that it prompts specific changes in the clinical management of infants and therefore a reliable tool in the realm of neonatologists. It is through the test that infants identified with insignificant conditions are classified as having no structural heart abnormality.
On many occasions, the test is carried out immediately after birth. It should be noted that the test takes place in the health centers that have been equipped with the necessary technology. As mentioned before, heart conditions prevailing during birth are mostly treatable. However, if they are not treated, the condition grows into adulthood and poses a life risk to the child. The test benefits the infants by recognizing their suffering and averting possible agony when seeking for treatment on fully developed problems. In many cases, the main reason why experts conduct the test on infants is to distinguish whether the core coronary anatomy is ordinary or not usual. Nevertheless, the test benefits infants, as it can further be employed to facilitate the evaluation of infant physiology.
Normally, not only does the test have to be carried out in the event a baby is diagnosed with a problem but also when the practitioner or the parent thinks it is essential. The specialist can propose an echocardiogram test if he or she has reasonable suspicion that the problems associated with the chambers or valves of the infant’s heart are the causative factors for signs like chest pain or labored breath. Many specialists typically advise this analytical test procedure even to the adults as a part of yearly physical examinations since it can be a preemptive undertaking to counter any heart abnormality during its primary phases. The test is also beneficial when the parents are known to have a history of cardiac complications.
Advantages of Echocardiographic Test
The effects of echocardiography tests in the reliable and accurate identification of coronary conditions have led to increased awareness among the public in various aspects. Currently, there have been programs that have intensified the campaign on enhancing knowledge of the use of echocardiography tests in hospitals and for expectant mothers. The Benefit of Infant Echocardiography Essay. The increased awareness has been beneficial to the infants since now, the parents can request the test to determine the infants’ coronary conditions so that in the case of abnormalities, the treatment could commence immediately. The use of this test has led to the upsurge in the survival rates of infants with heart conditions since early and timely interventions yield positive results. Thus, the widespread use of the test has led to health safety in the population.
Another benefit associated with the test is related to the findings that the infant cardiovascular systems vary from those of fetal, pediatric, and mature patients (The American Heart Association, 2008). For an infant, the cardiovascular system has to transit successfully through abrupt changes in the cardiorespiratory structure, including the changes in lung capacity and submission, and variations in the right and left heart preload and afterload. The infant heart may also have to cope with various structural and assimilated illnesses at the period of growth. With the use of the test, detailed information relating to the conditions is availed and assessed and the proper treatment is commenced.
In addition, doctors usually use test images to evaluate the development and efficiency of the cure. They also use it when they conclude whether the treatment program requires revision or modifications to achieve optimum results. The benefits for infant lie in the fact that the best available care and alternatives are always at the doctors’ disposal, and the change in treatment can be instituted for the general wellbeing.
Open access echocardiography signifies an analytical service that is essential for infants as it enables general practitioners to acquire echocardiograms without transfer to a cardiologist. The factor is important since many of the referrals are needless as not all newborns may have cardiac disorders. If they do, the doctors are always in a position to manage the situations by using prevailing strategies. Many infants stop breathing immediately after delivery because their hearts fail to function appropriately. Although many infants born will be subject to a heart weakness, the use of a fetal test enables the improved infant survival levels after birth. When carried out, this test can always analyze whether the blood leaks backward through the heart valves or if the heart valves are very narrow. The Benefit of Infant Echocardiography Essay.
Several cardiac conditions can be diagnosed by this test in the infant. Such conditions include chest pain, heart murmur, aneurysm, pericarditis, valve conditions, congenital heart diseases, and congestive heart failure. Congenital heart conditions represent the most known reason for death among infants (Paul, Paul, & Mcallister, 2016). Sadly, not many parents realize after the delivery room that the newborn could have grave and protracted health issues. Others find out about the problems in several days or weeks, but it can be too late to avert the most serious complications.
Thus, fetal echocardiography becomes necessary if young life has to survive. According to numerous studies, there exist a significant number of adults with cardiac conditions than they have since birth, which translates to the fact that many children with the heart conditions survive to live to adulthood due to cures and interventions that are accessible soon after birth.
Chest pains in infants may result from various factors and may vary from coronary heart diseases, reflex esophagus, and neuritis among others. In such scenarios, it is always advisable for the health specialists to rule out the treatable conditions that show most of the presenting signs. A detailed echocardiogram becomes essential in this case since it is carried out to offer guidelines and identification of severe conditions or any other likely infection that may be harbored by the infant. The Benefit of Infant Echocardiography Essay.
The test is recommended for the first diagnosis, where there exists visible variation in the clinical status of the child. Therefore, it is not appropriate to overdo the test unless there is an apparent deteriorating variance in the condition of the baby based on the outcomes of the test. Echocardiogram becomes essential to the child as it guides and assists the doctor in effortlessly and accurately undertaking the diagnosis, evaluation, and assessment of the heart factors for any abnormality, infections, blood clots, and heart mummers among others. Thus, the test becomes beneficial in detecting various abnormalities.
By combining the tests, a pediatric cardiologist receives the relevant data regarding the anatomy and function of the infant’s heart. In addition, due to development in information transmission, echocardiography information can be exchanged between health care facilities, sometimes alleviating the necessity for an expensive patient transferal. When an infant is diagnosed with any heart complication, the test guides the heart surgery and intricate cardiac catheterizations.
The test is beneficial to babies as it offers an economical method for diagnosing the child with critical heart diseases. These conditions may be observed in a premature baby with a murmur that might be a patent ductus arteriosus or a baby with a dysmorphic syndrome and a murmur. In many instances, the test on babies is worth the cost since a clinical evaluation is unacceptably insensitive to severe conditions. The test offers a complete and definitive anatomic diagnosis, whereby so doing, it eliminates the necessity for additional procedures, whereas in others develops the scheduling and process of cardiac catheterization.
Another benefit to the infant is that numerous society clinics can treat neonates with mild or moderate respiratory diseases, but they lack the capability to handle children with cardiac conditions. The Benefit of Infant Echocardiography Essay.According to Paul, Paul, and Mcallister (2016), community practitioners can detect some of the disorders, where the initial infant test has not identified the anomalies due to the lack of murmurs or other abnormal findings at conception.
When introduced, echocardiography avoids unnecessary referrals and manages the conditions effectively. In addition, another advantage to the baby is that should a congenital cardiac condition be specified by echocardiographic results, data can be exchanged via phones or fax in the case of crises. The move ensures that the condition is catered for promptly, which helps save lives.
The test is essential to infants in determining their future health life. It is imperative to guarantee continued treatment for the babies with cardiac conditions since in so doing, the transition to adulthood is guaranteed. However, it is necessary to note that fetal echocardiograms concentrate specifically on the heart and it can overlook other abnormalities in other organs of the child. During the transition from fetus to infant, it becomes very rare to diagnose and detect abnormalities in the cardiovascular system of the baby. It is during this period that undetected conditions develop, which can put the baby at risk shortly after birth. The conditions can be treated and controlled if they are detected early. The Benefit of Infant Echocardiography Essay.
However, the late diagnosis has little or no effect on the well-being of the being and it may result in death. Therefore, echocardiography becomes essential in determining the condition of the infant and offers to the experts the time and strategy to counter the defects. Another benefit of the echocardiogram test to the child is that it does not require much preparation. In many cases, it only requires the baby not to be fed with drinks or food for just six hours before the process. The move is generally to allow maximum comfort during the activity and prevent the situations, for example, when an infant may be forced to vomit.
Risks Associated with Echocardiography Test
In regards to risks, echocardiograms are usually harmless as they are typically non-invasive and they only use radio waves to observe the heart structures and actions. However, several types of echocardiograms employ a different agent that can instigate allergic responses in some infants. A transesophageal echocardiogram represents a more offensive process as compared to others named earlier. Therefore, it is recommended not to undertake the procedure on the infants who have complications with their food pipes and those who have previously undergone radiotherapy (Connolly & Oh, 2011).
However, the transthoracic test comes with only slight discomfort when the transducer is pressed firmly against the chest and when the electrodes are removed from the skin. An echo cannot harm the infant or hurt and it has no side effects. The Benefit of Infant Echocardiography Essay.Therefore, it is advisable therefore that for vulnerable women and those whose tests detect prospective complications with their baby’s hearts may require returning to the practitioner for more follow-up visits to facilitate treatment because most heart conditions are treatable when identified at an early stage.The Benefit of Infant Echocardiography Essay.
Conclusion
In conclusion, infants are diagnosed with numerous heart conditions. It is essential to carry out the necessary test to diagnose the right condition to facilitate the proper treatment. Infant echocardiogram represents a unique ultrasound test that varies significantly from the traditional echocardiogram in mature individuals. A standardized procedure and expert abilities are essential in performing the test accurately. The test has proven beneficial to infants for diagnosing various life-threatening heart ailments and proposing the best possible treatment options.
The test is also cost-effective, thereby making it accessible to the children whose families’ financial background is average. In addition, the test is essential as it offers the right diagnosis thus alleviating the problems of inefficiency and inaccuracy where heart conditions are erroneously diagnosed. The test has no side effects and hence, it very safe to be carried out on infants. The Benefit of Infant Echocardiography Essay.
Three dimensional (3D) and four dimensional (4D) applications in the scanning of fetal heart has largely developed in the last ten years. No other organ or system has this progress so evident that as in the fetal cardiovascular system. Congenital heart disease (CHD) is the most common group of malformations in neonates, occuring in 8 per 1000 live births (1). In 2006 the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) published practice guidelines for the screening of CHD during the second trimester of pregnancy and outlined two levels for the screening of low risk fetuses for heart anomalies. The first level is the basic 4-chamber view and the second level is the extended basic scan which includes examination of the arterial outflow tracts (2). Also the term “fetal echocardiogram” refers to a detailed sonographic evaluation of the fetal heart which is performed by a specialist in prenatal diagnosis of CHD. The Benefit of Infant Echocardiography Essay.
There are several imaging modalities that can be used to evaluate the fetal heart anomalies, from M-mode techniques, to color Doppler and to the use of the new 3D/4D ultrasonography. The new technological development allows a real-time 3D/4D of the examination of the fetal heart (3). These ultrasound techniques can have a major contribution to the understanding of normal and abnormal fetal heart and can also extend the benefits of the prenatal cardiac screening. With the introduction of the so called “virtual planes” to fetal cardiac examination, we are able to obtain views of the fetal heart that are not generally accesible with the use of standard 2D examination (4). ❑
3D/4D TECHNIQUES IN FETAL CARDIAC EXAMINATION
There are three steps that must be followed when we are using 3D/4D fetal echocardiography: volume aquisition, volume display and volume manipulation.
Volume acquisition
The volume acquisition can be done either static 3D, either on-line 4D (direct volume scan), either spatiotemporal image correlation-STIC- (off-line 4D which is an indirect volume scan).
Spatio-temporal image correlation acquisition (STIC) is an automated volume acquisition with the array of the transducer by performing a slow single sweep, recording a single 3D data consisting of many 2D frames one behind the other. The volume of interest (VOI) is set for a period of time between 7.5 sec to 30 sec (usualy 10 sec), and a sweep angle between 20 to 40° (usually 25°). After this, the system processes the volume data and detect systolic peak which are used to calculate fetal heart rate. The systolic peaks define the heart cycle. The resultant 40 consecutive volumes represents a reconstructed complete heart cycle. One can extract from that volume acquisition any convenient plane we want, which means that from a single volume we can get the image of 4-chamber view, or 5-chamber view, or three vessels etc (5). In other words, the acquisition of a volume is realized in 2 steps: in the first step data are aquired by a single automatic volume sweep and in the second step the system analyzes the data in their spatial and temporal domains and processes a 4D sequence (Figure (Figure1).1). STIC can be used with gray scale, or color Doppler, or power Doppler, or B-flow fetal echocardiography (6).
The static 3D represents stored still images as a volume data set and we don’t have neither heart rate and neither motion. This technique is not used for assessing events connected with the heart cycle, or to myocardial wall or valve movement, but can be used to appreciate size and relationship of cardiac structures. The static 3D is used with uniform power Doppler or B-flow.
On-line 4D or direct volume scan, can be obtained only by using a 2D transducer with rapid acquisition of 20-30 volumes or with a matrix 3D transducer.
Volume display
After acquisition we can have the volume display in three different imaging modalities: gray-scale, color Doppler, or power Doppler. Each of these modalities can display 2 possible formats: multiplanar or volume-rendered.
The multiplanar format is the first system that allows simultaneous evaluation of several 2D planes. The rendered format can be displayed in the following applications: gray, color and glassbody (7).
In multiplanar reconstruction mode the screen is divided in four frames: A (upper left), B (upper right), C (lower left) and the fourth (lower right) is the rendered image. The Benefit of Infant Echocardiography Essay. Each of the three frames represents one of the three orthogonal planes of the volume. The reference dot represents the intersection of the three planes (Figure (Figure2).2). Moving the reference dot the operator manipulates the volume to display any plane within the volume. The operator can scroll through the volume and can obtain sequentially each of the five classic five planes of fetal echocardiography (7,8). The multiplanar analysis is reliable in assessing the different cardiac planes, in screening studies and in evaluating different anomalies (9,10). Color and power Doppler can be added to gray scale STIC technology, which can asses the hemodynamic changes during the cycle (11).
Besides the three plane of multiplanar mode, we can use also the tomographic mode in which we obtain a lot of parallel transverse views from a 3D/4D volume data set (Figure (Figure33).
Volume manipulation
Rendering surface mode is a mode of analysis of the aquired volume. The operator places the rendering box around the region of interest (ROI) within the volume in order to show a slice of that volume (Figure (Figure44).
When we have in the A frame a good four chamber view one possibility is that the operator can place the rendering box around the interventricular septum, and in the D frame we will see the rendered image of the interventricular septum the so called “en face ” view of the septum (9). We can determine if we want to see the septum from right to left or from left to right, depending where we place the green line (the active line or the rendered view direction) of the rendered box (Figure (Figure55).
Usually for rendering to be considered as “successful” the lateral view of the interventricular plane should display the entire septum and the foramen ovale, seen from the left ventricle. In another view “the base of the heart” (or the common atrioventricular plane-CAV plane), the rendered view direction is placed in the atria at the level of the valves and permit to see the “en face” view of both atrioventricular valves and semilunar valves, which is very helpful for diagnosing atrioventricular septal defect (12). So, for this plane to be considered as “successful” the rendered image had to clearly display all four cardiac annuli (Figure (Figure66).
Rendering of the volume data with color alone or the combination of gray-scale and color (the so called glass body mode) can give us information concerning the arrangement of the great vessels. The 3D power Doppler is directionless and is most effectively associated with 3D static scanning. 3D power Doppler reconstruct the blood vessels in the volume of interest (VOI) zone. 3D power Doppler reconstructs the vascular tree of the fetal abdomen and thorax (13), relieving the operator of the necessity to reconstruct a mental image of the anomalous vessel from a series of 2D planes. High definition power flow Doppler is the newest development in color Doppler applications and uses high resolution and a small sample volume to produce images with two colour directional information. It gives us information about vessels with very low velocity and has the advantage of showing flow direction. The Benefit of Infant Echocardiography Essay. So, it is used specially for very small vessels. It can be used with static 3D, with STIC and with glass body mode to produce high resolution image of vascular tree.
The rendering mode-transparent minimum is a display in which the heart and blood vessels are seen in a transparent projection, so that the structures that are anechoic are visualized in a 3D projection of black-appearing vessels.
The rendering mode-inversion display mode represents the minimum mode rendering information which is simply inverted, thus presenting the hipoechoic structures as echogenic solid and eliminating into black most of the surrounding tissue information (that is the fluid filled spaces such as the cardiac chambers now appear white while the myocardium has disappeared). In fetal echocardiography it can be applied to create digital casts of the cardiac chambers and vessels (14).
Advantages of 3D/4D examination of fetal heart
The main advantages of the examination 3D/4D versus 2D of the fetal heart are:
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Introduction of the virtual plane gives us views of the fetal heart not generally accessible with 2D approach.
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Storage of volumes of cardiac anomalies or of the normal heart for review of the findings or for a second opinion.
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For fetal heart screening.
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The time used for scanning is shorter for 3D examination (3-4 minutes).
There are a few disadvantages of the examination 3D/4D of fetal heart:
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We need a very good ultrasound machine.
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We need a special training to obtain 3D volume data sets (how to choose the appropriate slice thickness within the volume, the region of interest). The Benefit of Infant Echocardiography Essay.
Pitfalls of 3D/4D echocardiography
Fetal cardiac ultrasound using 3D/4D has some artifacts that are specific to 3D/4D acquisition and post-processing.
The quality of a STIC acquisition can be negatively modified by fetal body movement, by breathing mouvements, hiccups. The acquisition is improved when the fetus is quiet, and when we are using the shortest scan time. In the multiplanar display, in the B plane we can see the artifacts generate by fetal movement even though in the A-plane the acquisition is good. It is important to remember that the quality of the initial acquisition will affect all other stages of fetal heart evaluation.
The original angle at which the scan is performed is very important because can influence the quality of the planes aquired. Usually it is recommended that the sweep angle corresponds to the number of weeks of gestation (15).
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Shadows generate a specific problem for 3D/4D acquisition, because when we start scanning from the 2D plane acoustic shadows may not be apparent, but they may be present within the aquired volume block in 3D/4D. So, the fetal position with the spine up creates some problem of acquisition and the acquisition is easiest when the spine of the fetus is not in ventral position.
When we are using 3D rendering we can applicate some adjusting designed to smooth the image. These adjustings can lead to loss of data from the original scan, so when we are using 3D rendering we must use always in the same time with the A-plane 2D image for comparison.
In evaluating congenital heart disease Meyer-Wittkopf evaluated 3D cardiac volume sets and 2D diagnosed cardiac lesions and compared the views of the heart in both modalities. They concluded that 3D added some advantages in diagnosis (16). The Benefit of Infant Echocardiography Essay. Also most recently Benacerraf compared the acquisition and analysis for 2D and 3D examination of fetal anatomy scanning and concluded that 3D examination is superior in the accuracy of the diagnosis (17). The data obtained with 3D/4D fetal heart examination open new avenues for introducing fetal echocardiography programs to distant or poorly served medical areas (18). ❑
CONCLUSION
The STIC technique acquisition used in fetal echocardiography has the great advantage that allows obtaining imaging of a beating fetal heart and from a volume data set it is possible to obtain any plane within the fetal heart at anytime during the cardiac cycle.
Volume data display can be achieved in planes (single, multiplanar, tomographic), as a rendered 3D volume in surface, glass-body, minimum, or inversion modes.
Clinically 3D/4D fetal cardiac scanning can be used to store volumes of cardiac anomalies, as a tool for screening examinations and also in teaching courses (19,20). So, this technology has reached the stage when it is reproducible and added a real value in screening accuracy, but also it can be used in research to measure the volume of cardiac chambers and develop an approach to demonstrate cardiac anomalies . The Benefit of Infant Echocardiography Essay.
