Fetal heart. Present investigative means

Non invasive exploration of the fetal heart has been greatly facilitated by utilisation of high resolution echography using pulsed Doppler combined with B-scan. Investigation of the fetal heart in human medicine opens three important fields of interest. 1. (1) Better knowledge of fetal hemodynamics. 2. (2) Measurement of fetal heart function. 3. (3) Recognition of congenital heart disease. Acquisition of some fundamental knowledge is required for an ultrasonic approach to fetal echocardiography. Embryogenetic data lead to an understanding of the periods of vulnerability for each cardiac segment, whereas an understanding of physiology of the fetal circulation helps to explain the consequences of fetal congenital heart diseases and the methods used to evaluate fetal cardiac function. One section is devoted to the etiology of congenital heart disease. The most important cardiopathies encountered in cases of chromosomal anomalies and genetic disease as well as those due to environmental causes are presented so that the echographist may relate the examination to the clinical picture. In most instances the diagnosis of congenital heart disease is made by routine morphologic scanning of the fetal heart. Indications are given for the best orientation of the scans. All echographists should have precise knowledge of the echographic semeiology of the normal heart. When a cardiopathy or an anomaly of cardiac rhythm are recognized or suspected, the examination should be repeated with help of a cardiopediatrician so as to make an exact diagnosis and take the right decision. Study of fetal heart function is the most recent field for progress and covers in addition to the evaluation of congenital heart disease the development of new parameters allowing recognition of fetal jeopardy. Pulsed Doppler has already allowed the acquisition of interesting facts and certainly is one of the most exciting new inroads for progress in the field of fetal cardiology. L'exploration non invasive du coeur foetal s'est considérablement modifiée depuis l'apparition des appareils en temps réel de haute résolution et du Doppler pulsé couplé à une imagerie B. L'exploration du coeur foetal en clinique humaine ouvre trois centres d'intérêts. 1. (1) Physiologic de l'hémodynamique foetale. 2. (2) Evaluation de la fonction cardiaque foetale. 3. (3) Dépistage des cardiopathies congénitales. Un certain nombre de données d'ordre fondamental sont nécessaires à la prafique de l'échocardiologie foetale. I