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4-камерный срез

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Срез через выносящий тракт левого желудочка

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Срез через выносящий тракт правого желудочка («симптом брюк»)

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Срез через дугу аорты и брахиоцефальные сосуды

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Этапы исследования четырехкамерного сердца плода

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Четырехкамерный срез: Видеопримеры

Ультразвуковая диагностика патологии миометрия

Ультразвуковая диагностика патологии миометрия

Channel: Профессор В.Изранов

Изранов

izranov

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БФУ им. И.Канта

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anatomy of the fetal heart and we will

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mainly analyze the structure in the second and third

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trimester, the

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structure in the first trimester very, so to

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speak, changes rapidly starting from the

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very early stages, this is a separate

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conversation that we will not touch on today

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in order to talk about

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ultrasound anatomy to us we need

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to imagine what kind of sections we

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can see in general, let’s try

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to figure out how these sections can

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pass,

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don’t be confused by the fact that this is almost a

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teenager

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or such a child does not look very much like an

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intrauterine one, but we deliberately

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straightened him out so that you can

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imagine him not in a state of flexion and

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in a state of

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normal vertical position and

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then imagine that by cutting almost transversely

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we will help to

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obtain four chambers for excision

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if we carry out this way it

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will be a cut along the long axis of the left

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ventricle you can’t honestly

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say that we are here on this in the picture

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below we practically cannot see the left

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ventricle because it is the right one, but

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nevertheless we raised doubts so that it

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coincides with the line of the left ventricle, but in a

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similar way this is almost a

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vertical line, it turned out to be a

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slice drawn through the long axis of the

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right ventricle, finally

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we turn even more towards the

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left shoulder

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we get a slice along the short axis of the

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ventricular cavity and look, the line has

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now passed quite high outside the

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main part of the heart at the level of large

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vessels, this is a slice through three vessels,

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these are the slices that we are now

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demonstrating due to the fact that they

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can, as it were, line up

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sequentially changing the direction of the a

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beam that seems to cut the heart, in

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fact there are many more slices and one

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of our tasks is

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to recognize them, so I specifically tried to

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make these black and white pictures in the same

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format as it more or less looks like on

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ultrasound and gene chambers and along the periphery the

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wall more or less hagen and or even

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hyperechoic here it is

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white or almost sulfur in the picture now let’s look at

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each of the main sections, here is the

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four-chamber section, it is the most

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recognizable, so to speak, and

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at one of our previous lectures we had a

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conversation about how to navigate the

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signatures

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on our scanners which are 95

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percent foreign production and

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all the signatures with the English abbreviation have connections with this,

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I deliberately

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did not insert the Russian

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abbreviation here but used the top which

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in almost all scanners one way or

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another will be recognizable my left

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ventricular the left ventricle the

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first right ventricular the right

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ventricle and the elevator

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atrium the left atrium and R.A. right

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atrium right atrium this is still

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separate outside the heart letter and it

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corresponds to the descending aorta blame the

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descending aorta

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is located outside the cut of the heart

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but it is also an

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important landmark for us in recognizing

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this is the next means by which we are

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trying to identify this cut through the

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outflow tract

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left ventricle abbreviation

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in English this is the

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standard input left ventricular out

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flow through the outflow tract of the left

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ventricle

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this is what it looks like it looks quite similar

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to the long axis a slice along the long axis of the

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heart of a healthy adult and

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look at what guidelines here for us

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again the

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left itself ventricle here it is left

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ventricular

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the right ventricle is separated from it by the

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interventricular septum of the atrium

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into the atrium, the left one which in this section

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often looks exactly like this is not visible

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with this separation from the regular

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mitral valve sometimes visible sometimes not, that

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is, we can often get such a section

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where the valve itself not noticeable in the same way

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and here is the letter and then this is the

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ascending aorta arta ascendant and here,

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too, we will not always see the valve sometimes

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it will be noticeable sometimes not one way or

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another, it is

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our eye that must get used to

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recognizing these sections; a special feature of the

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study of the anatomy of the heart is that

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that everyone there hiccups quite quickly with a

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speed in the second trimester from 120 to

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106

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10 beats per minute and the eye should catch

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these slices which slice we caught, yes, here’s

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an example

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look here not a very high speed

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approximately

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125 maybe 128 hardly more

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contractions per minute

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that we see this cavity of the left

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ventricle, this is what is indicated by lvl

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Hendrik in Linda and look, this is the

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outflow tract, this is where the blood exits

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into the aorta, in our case,

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here we come across the

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aortic valve, we see it, here it is in the middle and the

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left atrium flashes from time to time This is a rather long

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movie loop of about ten or more seconds,

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and therefore in some cases we do

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not see the atrium and the left one, and in

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some cases the slice is grabbed, the

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interventricular septum flashes here, separating the

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left ventricle

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from the right, we compare this with the right one with what

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we see here and in our particular

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case Now we see, in addition to the right

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ventricle, also in some sections, the

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left atrium, here it is, this is the left

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atrium, the right atrium said

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here, the right ventricle, here it is, the right

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atrium, that is, by itself,

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this section on the program corresponds to

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what is shown in the picture and another

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similar example

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perhaps even more similar to the picture

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that we have drawn in the upper part,

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and

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the ventricle itself and this is the outflow tract, so

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we exit into the aorta,

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this is arthas cent ans and the aortic valve flashes from time to

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time,

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and here we now see the mitral

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valve to which it opens its

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leaflets and

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in this case the left atrium lift

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the atrium here it will communicate

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with the left ventricle this is a slice of the

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outflow tract of the left ventricle we

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looked at it not only in the picture but also in the

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video loops now a slice through the outflow

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tract of the right ventricle sometimes this is a

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figurative name for a symptom of trousers

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savin in English it sounds and look,

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in fact, this is how it will look

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and look like the 2 trouser legs of a person who

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runs with bent knees fish the

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right ventricular

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and r.a. pride atrium here the atrium and

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ventricle are not shown as reported here

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because they are very often divided in this section

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without an image of the valve, but it is fundamentally

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important that in the center of this section we

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see a Mercedes model, that this is a

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cross section of the aorta, which has three

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valve leaflets and these are two trouser legs

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2 trouser legs of a person running forward we

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must find out where and what one

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of them is, it is

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designated like this r.p.

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and the Wright pulmonary artery is given the right

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pulmonary artery, I want you to

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carefully orient yourself here, this is

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what exactly it is, the right pulmonary

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artery comes close to the cross

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section of the aorta, that is, they are located

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next to each other, this is the left one,

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it touches the cross section of the

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aortic valve, and so on we recognize it, it means

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that the left one is engaged is the right

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pulmonary artery, if this person is running

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towards us,

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and with such a cross-section, then this is the right

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pulmonary artery,

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but what is it? in some very respectable books by very famous authors, there are errors where it is written that this is the left pulmonary artery, but it is logical if

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one is right and the other is left, why not, this is

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not the left pulmonary artery, this is the ductus of the

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arterioles, and we should well

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imagine this moment, look,

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who is sartorius,

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this is a feature of intrauterine blood circulation

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such that from the right

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ventricle the main part of the flow does not go

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to the lungs, which do not function, but

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directly to the descending aorta and this is,

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as it were, a continuous direct continuation, the

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outflow tract is

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single until it branches, and then this is an

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obvious direct continuation,

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this is the ductus arteriosus, but look, I

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drew a dotted line here, this is not

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labeled and this is the left pulmonary,

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strangely enough, but it’s practically not there either we see in

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our sections it is almost imperceptible to us, now

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I would like to see a picture from one

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absolutely wonderful textbook, not on

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ultrasound anatomy, just on

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anatomy, this is a textbook from a foreign country

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before anatomy grant and look, we see the

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right atrium into which the

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superior vena cava flows,

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we see that into the right atrium the

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inferior vena cava also flows into this part of the

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blood circulation of the fetus, so here

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the color reflects the direction of the flows,

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and look

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from the right atrium, the blood

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has penetrated into the right ventricle, it’s

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extremely important for us

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to orient ourselves here, look what

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[applause]

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this is the right ventricle of an

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adult and essentially this is how I am

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Now, with a pointer, I’m showing the direction of the

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direction of blood flow in the

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carrying tract of the right ventricle.

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Now I’ll open this right ventricle

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so that we can look inside and look.

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Now, I’ve now inserted the

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pointer in the direction of the

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outflow tract that we’ve

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drawn, and now I’ll take another helmet and

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push it through the right I’ll

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probably take the atrium into the tweezers to make it

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more demonstrative, I stick it from the

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right atrium through the tricuspid

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valve into the right ventricle. I want to

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clearly demonstrate and

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emphasize to you that these two axes go

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almost mutually perpendicular, but this is how the

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white pointer

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depicts the outflow tract and its

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immediate continuation.

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pulmonary trunk and the tweezers go to it

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at almost an angle of 90 degrees, that is, so to

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speak, the path of blood movement into the ventricle

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from the right atrium is in a completely

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different plane

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than the outflow tract and now the outflow

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tract means it has reached the top three with palms;

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analysis of the pulmonary trunk and further in an

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adult of a person, look at the pulmonary

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arteries, right and left,

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they are located but practically

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diverging, also completely in

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opposite directions,

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and the right one, which we see in our

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sections, it will go around the

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aorta, this is what we notice here in

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our diagram,

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the right one is located as if I am

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hugging the aorta, yes it is and and so I took it

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by the waist and this is such a

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landmark that we will always

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consider on this diagram which from the

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grant textbook we talked to you here the

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main flow of blood from the pulmonary trunk

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is directed to the ductus arteriole

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and then you see it reaches the descending

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aorta, look at how the right and left

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pulmonary arteries in this diagram

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they are located in relation to the ductus of arterioles,

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here they are on the completely

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opposite side of the fold, and we

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say that we always see the right

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one, and we practically don’t see the left one, it

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also exists, but we don’t see it,

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the artist in this textbook tried to

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depict

00:16:48

that the lungs are not breathing year, they

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contain less blood in the

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afferent vessels in the pulmonary arteries,

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but look really, the diameter of the

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ductus arteriosus and the right pulmonary artery is

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almost the same, there is no difference,

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they have the same diameter, the main

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blood goes here to the ductus arterius,

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but into the lung flow is almost the

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same in terms of the thickness of the vessels, the diameter of this

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vessel is one who is in the asus toilet, practically

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no different; a very interesting point;

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well, now a picture of an adult; yes, you

00:17:32

will learn the same thing; yes, this is also from the

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grant textbook; and look at the pulmonary

00:17:40

trunk of an adult, as in our diagram; is

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it in ours? divided into left

00:17:45

and right pulmonary arteries and they go at an

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angle of 180 degrees until

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they seem to diverge in a T-shape,

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but this gap there is something white

00:17:59

glittering, it should be busy whether the gaming

00:18:03

app Teresa to the

00:18:04

pulmonary ligament arterial which

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is the remnant of the ductus arteriosus and an

00:18:15

example of what we were talking about now,

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let's try to see these trousers in

00:18:25

this actual example, there are

00:18:29

several cuts at once, we come across

00:18:31

a little further, we will talk about a cut

00:18:33

through three vessels, it constantly

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catches our eye, yes, but find the trousers,

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this is right, engaged, yes this ductus

00:18:42

arterio zus and here is the left trouser leg and

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they are not visible in every frame on some

00:18:49

frames 3 vessels fall into the current on

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some particular outflow tract of the right ventricle

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yes but you see the right trouser leg yes this

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ductus arterio asus and flashes from time to time

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left trouser leg and what is the connection of

00:19:04

these vessels that form the next

00:19:10

section 3 vessels of means through three vessels and the

00:19:13

outflow tract

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we will talk again at the end and

00:19:17

look at the same same picture and now

00:19:20

just to put everything again I

00:19:22

remind you this is the right trouser leg and here

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it is here, here it is,

00:19:30

and the left trouser on which is the right

00:19:37

pulmonary artery, it hugs the

00:19:39

aorta, this is the aorta, then the right

00:19:48

ventricle itself, here it is, yes, this is the right

00:19:51

ventricle,

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perhaps one of the main tasks if we

00:19:54

want to look at the

00:19:55

fetal heart is to catch these sections

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that should be

00:20:01

remembered by us as diagram and distinguish them

00:20:05

in video examples, what is the difference between a person

00:20:09

and animals according to human perception there is

00:20:13

abstract thinking in animals there are no

00:20:16

animals if a dog sees even the

00:20:20

smartest dog drawn, but it will not

00:20:22

always understand that this is an image of a dog

00:20:24

and we see, which means we need to

00:20:29

use our advantages for this in order to

00:20:34

recognize from such a scheme and and in the shrinking

00:20:39

image in the video examples when we

00:20:43

look directly then with the fleet, I

00:20:53

want to draw your attention, look, we

00:20:55

have sections in the same plane and

00:20:58

the left pulmonary artery is completely

00:21:01

invisible, it is not visible,

00:21:04

it is difficult to answer the question why it is like

00:21:07

the rule is not visible I have no answer yes, but

00:21:10

the right is visible almost always and it

00:21:12

is part of this slice and the left

00:21:15

pulmonary artery does not fall into this slice the

00:21:17

next slice is a completely different

00:21:23

slice through the aortic arch and brachiocephalic

00:21:26

vessels

00:21:29

left ventricular

00:21:31

and the aortic arch emerges from it on the aorta comes out as

00:21:35

a stand with then an agreement, then

00:21:37

this is the descending aorta, the descendant of the

00:21:39

brachiocephalic vessels, these three are the

00:21:44

same picture, I return it one more time

00:21:46

so that these three vessels are here to

00:21:48

identify what it is, this is the

00:21:52

brachiocephalic artery or the three from the

00:21:55

brachiocephalic arteries, or in short with the

00:22:02

communist

00:22:03

sinistra and artery soup swore and there are

00:22:07

these three vessels in this

00:22:08

sequence and we

00:22:13

can clearly recognize them in this section, distinguish the

00:22:18

next section this is a section through the

00:22:22

arterial ductus ductus artorius,

00:22:24

you rightly tell me how it

00:22:26

differs from the previous section,

00:22:29

look at how it is sometimes also is called the

00:22:32

mug symptom,

00:22:33

how does it differ, that he does not have these

00:22:38

three brachiocephalic vessels, where did they

00:22:40

go, but the ductus arteriosus

00:22:43

flows into the descending aorta, so it

00:22:47

turns out that these vessels were somewhere

00:22:50

here, they were already outside

00:22:53

the cut because the ductus artorius

00:22:57

directly

00:22:59

connected us of the descending aorta, then the descending aorta, then the

00:23:02

descending one, and finally a section through three

00:23:08

vessels to which

00:23:12

a lot of attention is rightly now being given to

00:23:13

these three vessels,

00:23:17

they are depicted like this and

00:23:21

constitute the superior vena cava, the aorta and the

00:23:23

pulmonary trunk, we

00:23:27

will later touch on this issue in more detail, now

00:23:30

we have simply listed all vessels now the

00:23:33

next very serious question is the stages of

00:23:36

assessing heart sections,

00:23:41

studying the

00:23:43

fetal heart, this is largely

00:23:46

a question of studying by the method of exclusion, we

00:23:50

look and for ourselves each time we answer the

00:23:52

question is the norm not the norm? We ideally

00:23:56

always wait for the norm and for us this norm should

00:23:59

be good visual recognition and

00:24:01

how is it slightly different from it? We then

00:24:04

have to ask the next questions

00:24:06

what the nature of these changes is, what is

00:24:09

the threshold, and so on, and so where do we

00:24:12

start with the assessment of the 4th chamber section, you

00:24:16

know in the order according to which we are

00:24:21

now working, we are in every

00:24:23

ultrasound in the study of the fetus, they must

00:24:27

evaluate

00:24:28

four chambers for excision, this is why we are

00:24:31

now talking about it in detail

00:24:34

and means through three vessels, two sections,

00:24:37

extended echocardiography of the fetus

00:24:41

includes all other sections, too, and

00:24:43

if there is at least some suspicion, then we

00:24:45

need to look at everything else, but if everything

00:24:48

is perfect in these We can, as it were,

00:24:50

limit ourselves to this abroad,

00:24:53

now a guideline qi

00:24:56

guide has appeared for ultrasound doctors who

00:25:00

generally do ultrasound of the fetus in the

00:25:05

thirteenth year, which necessarily

00:25:08

require in every

00:25:11

strong study in addition to a cut through

00:25:13

three vessels through the aorta, the

00:25:15

outflow tract of the right

00:25:16

ventricle, the outflow tract of the left one and

00:25:19

that is, there and here it will

00:25:22

also appear a little earlier or a little later, and therefore,

00:25:24

on the outflow tract, to find the

00:25:27

trousers of a running man near the right ventricle, and the

00:25:31

left ventricle, which you and I also

00:25:33

looked at, we must always pay attention

00:25:36

and try to catch the eye and so on the

00:25:39

stages of the study 4 chambers of the

00:25:42

fetal heart first assessment of the location of the

00:25:45

fetal heart in relation to the quadrant

00:25:49

assessment of the location of the heart in relation to the

00:25:52

quadrants during a transverse scan of the

00:25:57

fetal chest mentally draw

00:26:01

two lines 1 in the sagittal direction the

00:26:02

other in the transverse direction, here we have a

00:26:07

rounded section of the chest under

00:26:10

normal conditions

00:26:13

to distinguish the anterior surface from

00:26:18

the back we focus on the spine,

00:26:20

even in the second trimester

00:26:24

it consists of three

00:26:28

points of ossification that are not connected to each other, this is how they

00:26:30

look

00:26:31

1 is located in the body, the larger one in the

00:26:33

center and 2 in the arches these are the smaller circles

00:26:40

that are smaller here at the back looking

00:26:44

ahead what if they are not they will grow together and

00:26:46

form spina bifida, but if everything is

00:26:50

normal, we just now see these three

00:26:52

points of ossification and

00:26:55

opposite the spine, strictly opposite, there

00:26:58

should be a chest on the sternum, we don’t

00:27:02

always see it, you have to look for it, it doesn’t

00:27:04

catch the eye just like that

00:27:06

automatically, you have to purposefully

00:27:08

look for it, but in order to find it It’s good for us

00:27:12

to imagine that this is a solid line

00:27:14

that goes from front to back and the

00:27:17

sagittal line connects in this

00:27:19

case the spine to the sternum,

00:27:21

so I’ve now drawn this with a detailed line

00:27:24

and as for the transverse line, it’s

00:27:31

just at right angles to it,

00:27:32

so I’ve drawn the transverse

00:27:35

line everything these two lines divide the section of the

00:27:41

chest into four quadrants, so

00:27:47

we will draw the heart, this is exactly

00:27:50

the four-chamber section that falls into this

00:27:52

section, and in this case, let's

00:27:54

sign where which surface is the

00:27:58

back surface the front surface

00:28:02

left side right side

00:28:10

I would expect you to ask why at this point

00:28:15

everything is depicted

00:28:18

not the way you and I would depict it in an adult,

00:28:22

but because the fetus

00:28:25

is positioned as it wants and most often

00:28:29

and best of all, when in the cephalic

00:28:32

presentation, if in the cephalic presentation,

00:28:35

then it will be like this, and if in the breech, then the

00:28:41

situation is different for this We’ll come back a little

00:28:44

later, but now we’re looking at the most

00:28:47

common, most common situation, and

00:28:52

normally the heart is located

00:28:55

predominantly in the anterior left

00:28:58

quadrant, so I

00:29:00

colored this anterior left quadrant; under normal conditions, the

00:29:04

heart is located in the anterior left

00:29:07

quadrant immediately behind, let’s say that the assessment of

00:29:11

this point 1 is extremely difficult

00:29:15

because position of the fetus at least 8 of the most

00:29:19

common ones, plus there are also more rare

00:29:24

transverse ones, which are even more

00:29:26

complicated, and each time we need to

00:29:30

find where what surface is where is right

00:29:33

where is left and therefore one of the

00:29:37

fundamental points here is

00:29:39

the position of the apex, so the normal

00:29:43

apex is thus located

00:29:45

between the sternum and the left side is the left

00:29:51

surface of the body so that

00:29:57

left and right are not confused, there is a

00:30:01

wonderful landmark, so I have

00:30:03

now drawn it x the gene structure that

00:30:07

is located next to the heart, this is the

00:30:10

stomach, it is

00:30:11

not absolutely round, as a rule, its

00:30:14

shape is such a slight absence but a

00:30:19

modified ellipse, this characteristic

00:30:25

appearance The greater lesser curvature is

00:30:28

formed quite early in the first

00:30:30

trimester, so this form is

00:30:32

immediately noticeable as a separate one. Let us immediately emphasize that

00:30:35

on the same section under normal

00:30:38

conditions we do not see the heart and stomach; we

00:30:42

must always change the plane a little,

00:30:46

but this is easy to do, that is, it is

00:30:48

literally in in a split second we can

00:30:50

see the stomach, that is, one of our

00:30:53

tasks when she saw the heart here is to

00:30:55

make sure that

00:30:57

the stomach is located here because it is

00:31:01

very often but is the main

00:31:04

landmark

00:31:05

so that left and right are not confused for

00:31:08

now we are not talking about all sorts of problems and

00:31:10

for the world for this a separate serious topic,

00:31:15

but under normal conditions the stomach is

00:31:19

a reference point, how can we distinguish between left and right,

00:31:24

if something is wrong, we say the position of the

00:31:29

apex is the main criterion,

00:31:33

which means that now we have

00:31:35

drawn the norm to the position of the apex

00:31:39

between the sternum and the left side of the body,

00:31:45

but here is the deviation from This

00:31:49

is immediately an anatomical deviation

00:31:51

mezzo cardia,

00:31:53

a situation when the position of the heart is changed in

00:31:57

such a way that the longitudinal axis lies in the

00:32:00

sagittal plane, the apex

00:32:02

is located opposite the sternum, and

00:32:04

so this is the mesa

00:32:08

cardia, that is,

00:32:14

at this stage, at the first stage of assessment,

00:32:17

we must exclude mesa cordi,

00:32:19

this is no longer the norm and an even rougher

00:32:23

situation is Dexter Cordier when the

00:32:25

heart is located mostly to the right

00:32:27

of the midline like this, this is

00:32:32

Dexter's cards, we need to

00:32:39

differentiate this at this very

00:32:41

first stage of

00:32:43

assessing the 4-dimensional section, everyone has assessed,

00:32:47

let's move on to the next stage of assessment,

00:32:51

assessment of the size of the heart in Normally, the heart

00:32:58

occupies no more than 1 3

00:33:00

cross-sections of the fetal chest,

00:33:04

if the heart occupies more than 1 3

00:33:08

cross-sections of the chest, then this

00:33:10

indicates cardiomegaly,

00:33:14

but the eye may not automatically notice this at first,

00:33:21

then we must directly and specifically measure the

00:33:25

diameters of the heart; there you can do it in different

00:33:28

ways, just start

00:33:30

Thus, the cross section along the short

00:33:33

axis and compare with the cross section of

00:33:37

the chest and see if it is one

00:33:40

third or it will be more or a much more

00:33:44

accurate way

00:33:45

if we doubt this is to do a tracing,

00:33:48

circle the entire heart, circle the

00:33:51

chest and see the area

00:33:57

by measuring the ratio it will be one third

00:34:01

or more next point, assessment of the

00:34:07

location of the heart axis is normal, the angle

00:34:12

between the axis of the fetal heart passing through the

00:34:15

aiming and interventricular

00:34:17

septum and the sagittal plane

00:34:20

is

00:34:22

about 45 degrees in the second half of pregnancy, so I

00:34:25

drew the axis, the

00:34:26

axis of the heart passes through me, the

00:34:29

ventricle and interventricular

00:34:31

septum, we drew it like this

00:34:34

this is the axis of the heart with which it is 45

00:34:38

degrees from the

00:34:41

sagittal plane, here the second line is

00:34:43

longer, the sagittal plane, and it

00:34:46

says 45-60 degrees up to 45, the average

00:34:50

situation, yes, but it can reach 60 and

00:34:53

strictly speaking, I just recently

00:34:55

came across a link that I will now show

00:34:58

in a few minutes what can and

00:35:00

go down lower down to 36, let’s say 3660,

00:35:06

these are acceptable values, if our eye

00:35:10

doubts automatically, we just need to

00:35:13

carry out these

00:35:15

functions for measuring angles, somewhere, they are

00:35:18

convenient, somewhere you need to go

00:35:20

deep enough into the menu, but at least

00:35:22

this mandatory point for assessing the heart axis

00:35:29

next position fourth point

00:35:32

comparative assessment of the size and

00:35:35

position of the atrium and ventricle

00:35:38

comparative assessment of the size and

00:35:40

position of the atria and ventricles here are

00:35:44

four chambers for excision

00:35:49

and here I specially drew a picture

00:35:53

that is commenting on it

00:35:56

so that we recognize the same

00:35:59

structures but before in total, the spine,

00:36:02

these three hyperechoic points, here they are,

00:36:05

yes,

00:36:15

normally the atria and ventricles of the fetus

00:36:19

are approximately the

00:36:22

same size until visually

00:36:26

comparable, it’s fair to say that the

00:36:30

atria are a little more square and the right

00:36:33

and left ventricles are a little more

00:36:35

conical, narrowed, but if we round

00:36:40

these are comparable

00:36:43

sizes in size right the ventricle

00:36:50

is located closer to the sternum,

00:36:53

then we have drawn the sternum,

00:36:55

we are trying to identify it here, here it is, this

00:36:59

is the sternum strictly opposite the

00:37:06

vertebrae, but seriously the vertebra, and in this

00:37:12

case we can sign that this is the right

00:37:14

ventricle,

00:37:15

the right ventricle is one of the ways

00:37:18

to determine it, so let’s say it is close to

00:37:22

the sternum, it is closer to the sternum right

00:37:24

ventricle

00:37:29

to identify the right ventricle

00:37:32

they use the so-called moderator

00:37:35

bundle; the moderator bundle is a

00:37:37

kind of muscle

00:37:40

surrounded by a detailed layer which is

00:37:43

endocardium that crosses the

00:37:47

right ventricle near the apex, look,

00:37:50

I just drew it on this

00:37:54

cavity of the right ventricle, this is

00:37:56

the moderator the bundle, try to

00:37:58

distinguish it here, it flickers on some sections

00:38:02

if I try to show it, a

00:38:05

time scale appears there and gets in the way,

00:38:08

find this moderator bundle with the eye

00:38:11

near the apex in the right ventricle,

00:38:13

it is noticeable, it allows you to distinguish that this is the

00:38:16

right ventricle before, since we

00:38:19

talked about a constant difficulty for us

00:38:21

that there is nothing signed there and the moderator

00:38:27

bundle allowed us to distinguish the right

00:38:30

ventricle and therefore the right atrium,

00:38:32

we will no longer confuse that this

00:38:34

atrium wire for the right

00:38:37

atrium is not looking for special landmarks,

00:38:39

but this is due to the fact that it is

00:38:42

located in connection with the right

00:38:46

ventricle

00:38:47

left ventricle it is located closer to the

00:38:50

slice of the spine, but if this is a slice of

00:38:52

the spine, then the left ventricle is clearly

00:38:54

closer to it than the left ventricle,

00:38:57

but the slice of the spine, as for

00:39:01

the atrium,

00:39:03

to identify the atrium,

00:39:06

they use visualization of the

00:39:09

foramen ovale valve, the foramen ovale valve

00:39:12

opens towards the left

00:39:16

atrium, please look

00:39:19

carefully now at I have now drawn this diagram of

00:39:23

this valve of the oval foramen,

00:39:26

here it is blinking and look, it

00:39:29

turns out that in the septum

00:39:33

we often see as if such a defect is the

00:39:36

oval foramen, but this

00:39:39

flap of the eyeglass opens into the left

00:39:43

atrium, tell me something is not very

00:39:45

visible here I agree with you, in this

00:39:47

section it is not noticeable, so I

00:39:49

inserted another example here of a video loop,

00:39:53

here you can perfectly see how the valve of the

00:39:58

foramen ovale opens into the left ventricle,

00:40:01

yes, these two sections are located

00:40:05

approximately in the same plane, the

00:40:07

heart is slightly changed

00:40:11

depending on what the position of the fetus is

00:40:13

slightly different, but the

00:40:16

valve of the foramen ovale is visible here

00:40:20

very clearly until the next point, the

00:40:27

descending aorta is located in front and to the

00:40:30

left of the spine closer to the left

00:40:32

atrium of the descending aorta,

00:40:35

please look at this diagram, I

00:40:39

’ll draw it now, here it is of the descending ora, it is to the left

00:40:42

of the sagittal plane close

00:40:45

to the spine

00:40:48

here it is on our program, here it is the

00:40:53

descending oorta,

00:40:55

it is close to the left atrium,

00:41:05

this part of the examination requires just

00:41:11

such a detailed

00:41:14

need to navigate with the

00:41:17

cameras,

00:41:18

not to confuse them and to accurately evaluate and

00:41:24

is one of such important parts of

00:41:30

the study of a 4-dimensional cross-section of the

00:41:34

fetal heart already after 5 minutes before

00:41:44

starting this lecture, I noticed that

00:41:47

I have such a slang inaccuracy of

00:41:51

four chambers on and the heart of the fetus, it

00:41:53

would be better to say which chamber

00:41:54

section is the heart of the fetus and there we will keep

00:41:59

in mind that it is more correct to talk about

00:42:02

the section, it is clear that a person has a heart 4-

00:42:05

chamber yes, but we get exactly this section or

00:42:08

slice, the next fifth point is the

00:42:13

exclusion of defects of the interventricular

00:42:17

septum,

00:42:18

we must directly and

00:42:20

purposefully exclude them; for this,

00:42:23

careful visualization of

00:42:25

the septum is required along its entire length from the

00:42:28

apex down to the base of the heart to the

00:42:36

basis map, if a defect is suspected,

00:42:39

it is necessary to achieve its visualization

00:42:41

in at least two planes, one of

00:42:44

which must pass at a right

00:42:46

angle to the septum; additional

00:42:50

diagnostic criteria for a

00:42:52

ventricular septal defect

00:42:53

if it is impossible to visualize it in the

00:42:56

mode

00:42:57

is the uneven movement of

00:42:58

various parts of the septum, and then the

00:43:03

final conclusion is made

00:43:06

using color circulation; the

00:43:12

next point is the assessment of the cross; the heart is so

00:43:18

very an interesting definition

00:43:27

that is interestingly little used in the

00:43:30

domestic literature abroad about the

00:43:33

cross of the heart it is said in almost

00:43:35

all publications

00:43:36

in our country it is often bypassed and

00:43:41

the valve on the sip of the tal connection the

00:43:44

connections between the valves and the

00:43:49

septum between the interatrial rod

00:43:52

ascertaining the normal position of the

00:43:55

atrioventricular valves we can

00:43:59

say that the asepta valve is different

00:44:01

the connection is the very center of the heart, this is how

00:44:04

I depicted this structure that makes up

00:44:08

the septum now, yes, you

00:44:12

remember that the

00:44:14

interventricular septum is more

00:44:18

massive and the interatrial septum is thinner

00:44:23

there and the number of layers

00:44:24

differs two in one place 3 in another

00:44:27

and at the interventricular septum where

00:44:32

it will turn into the world of the atrial

00:44:35

there is a small part which is called

00:44:38

the septum, I made a reservation, it is called fibrous

00:44:42

or membranous and the membranous and part

00:44:46

and let's label these structures mouse the

00:44:54

night part of the interventricular septum

00:44:56

and for us the muscular part between the night

00:44:59

septum so which is the thickest

00:45:02

then the fibrous part of

00:45:08

the box is located above that's where it is

00:45:11

this is the fibrous part that passes through and look, we

00:45:17

say that this is the very center of the heart

00:45:20

in this very place where the fibrous part

00:45:24

is located, the valve ossiptal

00:45:26

connection and the leaflets of the valves of the

00:45:30

otrivin secular right and left depart, how can you

00:45:33

tell in this picture where which is

00:45:36

which, look, I specially drew the

00:45:40

valve of the foramen ovale

00:45:43

then it will be clear that this valve of the

00:45:45

foramen ovale opens into the left

00:45:48

atrium, which means this is the left side of the

00:45:50

heart, here is the left atrium, here is the

00:45:52

left ventricle, and what is extremely important,

00:45:56

look at this

00:45:58

because the tricuspid valve is its

00:46:03

sexual cusp where the

00:46:06

apex of the heart is located, so it has not entered, it is in the

00:46:09

lowest part to the apex of the heart

00:46:13

is located at the bottom of our image and

00:46:17

I signed the second cusp m.k.

00:46:20

this is the mitral valve, its anterior

00:46:23

leaflet and look, their

00:46:26

place of attachment is located

00:46:28

on the fibrous part of the interventricular

00:46:31

septum in different places between them,

00:46:34

normally one or two millimeters in the fetus,

00:46:40

one or two millimeters should be between the

00:46:44

place of attachment of the tricuspid

00:46:47

valve and the

00:46:48

mitral interventricular septum, the

00:46:53

tricuspid valve

00:46:54

is located in this case more apical it is closer

00:46:58

to the apex

00:46:59

and the mitral valve is closer to the base of the

00:47:01

heart

00:47:05

at the same stage we need to exclude reflected

00:47:09

mitral and tycus pedal

00:47:11

valves since rise

00:47:15

is accompanied by a decrease in the movement of the

00:47:19

amplitude of movement of the leaflets or their complete

00:47:22

absence until we see these movements of the

00:47:25

leaflets

00:47:26

or not, this must be excluded such a factor

00:47:30

and so when we examine answering the

00:47:41

question whether it is normal in our case or not,

00:47:44

this location of fixation of the

00:47:47

bases of the valves of the chambers of the ventricular

00:47:50

septum is also an extremely

00:47:52

important point, since this is the heart and the

00:47:59

cross, the heart is the very center of the

00:48:03

organ, and all defects of the interventricular

00:48:06

septum are most often connected in one way or another

00:48:09

otherwise, with the social department, the membranous

00:48:13

department, he suffers almost

00:48:16

always further in the stages, we must

00:48:22

exclude in the

00:48:23

seventh point the following changes,

00:48:26

exclude changes in the endocardium, a

00:48:31

pathological increase in its echogenicity,

00:48:34

which may be associated with the fiber of the last deputy,

00:48:38

exclude changes in the myocardium

00:48:40

when there is

00:48:42

pathological thinning of it in some areas

00:48:45

or on the contrary, pathological thickening of the

00:48:47

wall and pericardium exclude the presence of

00:48:54

effusion in the

00:48:55

[music]

00:48:57

pericardial cavity, we must

00:49:00

state that all three

00:49:04

walls of the heart are not broken, there is no

00:49:08

pathological increase in thinning

00:49:10

or the presence of fluid,

00:49:18

now we return to the question of how the

00:49:23

position of the fetal heart depends

00:49:26

on the position of the fetus itself,

00:49:30

here it can be at least 8 of the most

00:49:38

common position of the fetus and

00:49:43

therefore, accordingly,

00:49:46

the position of the heart I am not obstetricians, I will remind you

00:49:52

that in addition to

00:49:53

the presentation of the head this is for in

00:49:56

there are also

00:49:58

concepts about position 1 position

00:50:04

is facing the left side and the right

00:50:14

opposition in the star to the right side of the

00:50:17

abdominal cavity of the fetus itself

00:50:20

and the view determined by the position of the

00:50:23

fetal spine,

00:50:25

if the spine or back of the fetus

00:50:28

is facing backwards, that is, towards the

00:50:31

mother’s spine, then they talk about one view,

00:50:34

this is the rear view, and if the back

00:50:39

or spine of the boat is facing the stomach, then these are the

00:50:41

front views, in this case, blame the

00:50:44

first position, the rear view, what

00:50:47

the position looks like the heart and now we see a

00:50:53

different position, this is the second position, also a

00:50:58

posterior view, the heart is located differently,

00:51:05

another first position, anterior view, this is also a

00:51:11

cephalic presentation, see how the

00:51:14

apex of the heart is turned down, also a

00:51:21

cephalic presentation, the

00:51:23

second position, anterior view, another difference

00:51:29

is this 4th position, both the heart and its fetus are on of

00:51:34

our sections for cephalic presentation

00:51:37

and now breech presentation

00:51:42

first position posterior view first position

00:51:50

anterior view

00:52:00

second position posterior view second position

00:52:09

anterior view for breech presentation

00:52:12

at least 8 classic positions plus

00:52:16

also for transverse and how to

00:52:21

navigate here there are several ways

00:52:27

there is a method that is associated with I

00:52:34

used it until recently

00:52:36

to imagine myself as a plow, how the

00:52:42

fetus is positioned in the

00:52:45

mother’s chew, and here I want

00:52:49

us to remember that the classic

00:52:57

section, if we draw it on the board, then

00:53:04

let’s say we get a section in an

00:53:12

adult when we do a scan of the

00:53:15

abdominal cavity or the thoracic spine

00:53:19

here in the back, but if we talk about the chest,

00:53:24

there is the sternum and then the heart we

00:53:28

expect the position to be like this, you will agree,

00:53:32

and I drew such a picture,

00:53:40

placing it in relation to, but let’s say

00:53:47

so

00:53:49

to an adult, according to, and

00:53:54

practically this position happens in which

00:53:58

case when the fetus is in the pelvic

00:54:01

presentation to

00:54:05

dependence further from its first or

00:54:12

second position, the degree of

00:54:18

position of the spine changes and we can

00:54:22

imagine ourselves in this way inside and then

00:54:27

orient ourselves where which side is

00:54:30

which chamber if the fetus is located in the

00:54:35

cephalic presentation, I now have the fetus

00:54:39

positioned in this way with its head down, then

00:54:42

in this In this case, we need to turn this and

00:54:51

then the turn of this position of

00:54:57

the spine is determined

00:54:59

directly by the position and the view,

00:55:03

this is not given automatically, it is necessary to

00:55:06

concentrate and for a long time, let’s say for

00:55:10

a few seconds, sometimes it

00:55:12

takes more time to try to

00:55:14

imagine oneself in the fetal position and in

00:55:22

order to painfully you can’t do this,

00:55:24

you can just keep before your eyes

00:55:26

this diagram where it’s all put together, and

00:55:31

since it’s almost impossible to do fetal ultrasound

00:55:37

without, say,

00:55:43

numerous diagrams of tables of reference

00:55:48

data, the most

00:55:52

convenient thing is to use an automated

00:55:54

workstation, I use for this purpose an

00:55:57

automated workstation of a doctor, an

00:56:00

ultrasound assistant in which it is right before

00:56:02

my eyes there is

00:56:03

opened looked immediately oriented,

00:56:11

but it is very useful to watch the video lectures

00:56:20

on this wonderful site, watch

00:56:22

Sonu world on take it in the

00:56:32

Internet search bar and you will find it is a dollar with a

00:56:36

Pretorius

00:56:37

absolutely when then a wonderful

00:56:40

lecture screening heart accordingly

00:56:46

guideline deputy in case of a high degree of risk and

00:56:53

[music]

00:56:55

basically the research I came across an

00:57:02

absolutely wonderful recommendation on

00:57:08

how to determine quickly in order

00:57:13

not to waste time for a long time, you need to remember

00:57:15

this simple rule: if the cephalic

00:57:18

presentation

00:57:20

is what our memory is oriented to,

00:57:23

if we saw the spine to the right

00:57:26

relative to the mother’s body,

00:57:28

then the right side of the fetus’s torso will be

00:57:31

below image

00:57:33

if the spine is on the left relative to the

00:57:37

mother’s body, then the left side of the

00:57:40

fetus’s body is below the image is easy enough

00:57:45

to remember, and then there are a few small

00:57:49

details so that it’s painful not to keep it

00:57:52

in mind during breech

00:57:54

presentation, it’s the other way around, yes, if the spine is

00:57:59

on the left, then the right side of the body will be

00:58:03

below the image, if the spine is

00:58:06

on the right, then the left part of the body is below the

00:58:09

image and twenty notes in the

00:58:11

transverse position if the head is on the right

00:58:13

the same as in the head exactly the

00:58:17

same rule applies in the

00:58:19

transverse position if the head is on the left

00:58:20

exactly the same as in the pelvic if we

00:58:25

work every day and look at this we need to

00:58:29

distinguish it without thinking about it

00:58:31

such an ideal guide, ideal advice and

00:58:37

very convenient,

00:58:39

well, now let's look at the video

00:58:43

examples and try to imagine how

00:58:47

well we have oriented ourselves with this.

00:58:52

In this case, look at the situation,

00:58:55

that this is a

00:58:56

cephalic presentation, we see

00:59:00

the spine here, here it is, this means this is a

00:59:06

posterior view, this is the first position and in this

00:59:11

case on the Internet the apex

00:59:14

is located near the sternum, this is

00:59:18

an image of the breast,

00:59:20

another example here is that the spine is the

00:59:33

sternum, here it is,

00:59:38

we see that this is also a cephalic

00:59:40

presentation, the first position is now a

00:59:44

front view, the spine has moved closer

00:59:49

to the mother’s belly

00:59:51

if in the first example it was closer to the

00:59:55

mother’s spine, now it

00:59:58

has shifted forward the position of the

01:00:01

other’s heart,

01:00:02

another example, look, this is already a breech

01:00:09

presentation, we see the spine here,

01:00:13

here it is up to the chest and, accordingly,

01:00:21

the top is located in such a way that

01:00:25

we can conclude that this is a breech

01:00:28

presentation, the first position is a rear view,

01:00:32

another similar picture practically,

01:00:37

but she’s just another recording from another

01:00:40

pregnant woman, yes, but this is the same breech

01:00:45

presentation, the first position is a posterior view, technically

01:00:52

when we look at the ultrasound of the fetal heart,

01:00:57

first of course we look like this at

01:01:00

a distance, remotely, and when the whole

01:01:03

body is hit,

01:01:04

otherwise we won’t be able to navigate the

01:01:06

sides and then ours the task is

01:01:08

to bring everything as close as possible and

01:01:10

examine every detail very closely,

01:01:14

while I remind you that for ultrasound of the

01:01:19

fetal heart it is necessary to narrow this

01:01:24

scan of the sector of the complex

01:01:28

sensor as much as possible until it is as

01:01:31

narrow as possible. We return to eating about assessing the tear

01:01:35

in the heart and now the section through three vessels

01:01:39

since we are still working on

01:01:45

our edematous order, then we

01:01:48

will finish with this section today,

01:01:50

but in principle we said that the

01:01:53

outflow tract from the left and

01:01:56

right ventricles are an additional object of

01:01:58

attention for us every time, so a section

01:02:01

through three vessels, this is a picture

01:02:05

similar to the one we have on mule

01:02:10

in front of us, what kind of vessels are these? 3 vessels,

01:02:16

I circled them now, number one is the

01:02:24

superior vena cava,

01:02:26

number two is the ascending aorta, and

01:02:30

number three is the

01:02:32

pulmonary trunk, every time we

01:02:37

get this section, and to get it you

01:02:40

need to use a four-chamber

01:02:44

slightly change the angle of inclination of the beam

01:02:50

towards the head of the fetus, that is, we got

01:02:55

four cameras on and approximately 30

01:02:57

degrees, change the angle of inclination towards the

01:03:00

head of the fetus automatically, it doesn’t

01:03:02

come across rarely, it comes across

01:03:04

automatically, you need to bring four cameras

01:03:06

to this, it’s not difficult to do this, and then

01:03:09

tilt the angle by 30 40 degrees towards the

01:03:17

head of the fetus and answer three

01:03:20

questions: 1, all 3 vessels

01:03:23

should be visible, three, second question, are the

01:03:29

vessels located at zero,

01:03:31

look, I drew this line now in

01:03:33

blue, they are located, and in this

01:03:37

example, they are also

01:03:40

normal, or the size of the vessels is very

01:03:43

similar a delicate question, look if you pay

01:03:46

close attention, number two

01:03:50

and number three are of

01:03:51

different diameters, but if you are even

01:03:55

more careful, notice number two is an

01:03:57

abortion from

01:03:58

round and number three is pulmonary trunk and

01:04:02

military, that is, it is not so much a different

01:04:04

diameter

01:04:05

as in a different plane, these two

01:04:12

vessels are located and therefore I

01:04:15

will repeat the same thing now by drawing

01:04:18

myself the superior vena cava a word

01:04:36

and how the snow woman increases to

01:04:41

each

01:04:43

more basal structure, but the pulmonary

01:04:50

trunk I directly purposefully

01:04:52

exaggerate this so that it is more noticeable, I made this wallpaper of the

01:04:56

bottom more

01:04:59

elongated than even in that picture and

01:05:01

then if you look exactly at this

01:05:04

size transversely like this,

01:05:08

you get the impression that like this the

01:05:12

lower vessel is a

01:05:14

tube with palm trees, analysis of a larger diameter,

01:05:18

but this is not a diameter as such because

01:05:20

in fact it is for them that

01:05:22

we shift a little and we will see further that it

01:05:26

actually stretches out like this

01:05:29

because if we Andrey

01:05:36

make a section, well, all these vessels

01:05:44

are cut, and if we make a section

01:05:47

in such a plane, then look,

01:05:50

the oorta will be strictly across or the night

01:05:54

trunk will be cut in the longitudinal direction, which is why

01:05:58

we must take into account that the

01:06:05

lower vessel of these three cochlear

01:06:08

trunks is visually perceived as a

01:06:11

larger size, it is nowhere in length, now

01:06:18

I have shown that

01:06:21

the section that we got

01:06:25

is located, as it were, at the level of the base of

01:06:29

these vessels, in fact, since we

01:06:32

can disassemble it on a mule by separating them,

01:06:35

and now look after all, even if in an

01:06:43

adult a small movement of the hand with

01:06:47

the sensor leads to the fact that the plane

01:06:49

changes greatly in the fetus, there are

01:06:52

enough minimal movements and we can go to a

01:06:55

slightly higher plane, the plane

01:06:57

which is now located even higher in the

01:07:04

direction of the cranial head and the head of the

01:07:09

fetus, and in this case, look the cross section

01:07:15

will look like this, these three vessels

01:07:18

will look different

01:07:22

3 vessel

01:07:25

three with palm trees analysis it seems to

01:07:30

branch, here I drew this, our

01:07:36

heart also branches, which is depicted here

01:07:43

is the heart of an adult and we are talking

01:07:47

about the fetus and we are saying that it

01:07:49

is immediate the continuation of the tube with

01:07:52

pullman Alice is the ductus of the arteriole with

01:07:54

this, this is the ductus of the arterioles, if

01:08:02

three are the pulmonary trunk, then its

01:08:05

immediate continuation

01:08:07

in front of three and is the ductus of the arteriole

01:08:13

with the batal duct, here it goes as the

01:08:17

main passage of the

01:08:19

pulmonary trunk itself after the

01:08:23

trunk ends and here this branch,

01:08:27

remember these are the same two trouser legs

01:08:31

that we saw before in the efferent

01:08:34

tract of the right ventricle, because the efferent

01:08:37

tract is it, yes this is the right

01:08:40

ventricle, from it it comes out and in this

01:08:42

case 3b

01:08:43

this is the palm artery on the leaf extra right

01:08:47

pulmonary artery which is located

01:08:50

we they said hugging the aorta

01:08:52

by the waist, that is, these are two

01:08:58

trouser legs, one of which

01:09:01

hugs the aorta,

01:09:03

this is the cross-section, we now come across a

01:09:19

specific example of the

01:09:36

night trunk of the aorta, the

01:09:39

superior vena cava, we answer three

01:09:44

questions in one line in one 3 vessels,

01:09:48

we see the dimensions correspond to what they were

01:09:52

talking about the upper the hollow smallest

01:09:55

oorta larger pulmonary trunk, taking into account

01:09:58

this and warriors and elongation,

01:09:59

and here you come across its bruka-

01:10:02

shaped further see the continuation,

01:10:05

yes, it will further be divided into the right

01:10:11

pulmonary branch

01:10:13

food who will be erased, this is already the ductus of the

01:10:15

arterioles the next example is another one

01:10:20

much more a close-up of

01:10:22

the one that was on top, this is from a

01:10:26

targeted examination, and then

01:10:28

after we have seen it, we should zoom in

01:10:31

as much as possible since in the bottom picture and

01:10:33

look at it in exactly this section of the

01:10:36

oorta, change the upper half of the

01:10:40

aortic vein and the pulmonary trunk from it is clear that it is

01:10:42

here in fact, it’s so wrong and

01:10:45

howls and continues further here is his trouser

01:10:48

and back and

01:10:49

branching one trouser leg went to hug the

01:10:53

aorta

01:10:54

this is the right pulmonary artery a 2 is a

01:10:58

continuation of the arterial artery itself

01:11:00

this will be the ductus arteriole su

01:11:07

another example is the same one that we

01:11:11

looked at several times slides

01:11:14

ago means through the outflow tract of the

01:11:17

right ventricle and through three vessels, that

01:11:20

is, in fact, these are two different sections,

01:11:23

but while the child is moving while we are holding the

01:11:28

sensor, everything is moving, now

01:11:32

let's find out and 3 vessels, here they are 1 2 3

01:11:37

and the upper half of the oorta is pulmonary trunk

01:11:43

upper half of the oorta pulmonary trunk

01:11:47

note that in some sections the oorta

01:11:50

appears to us in a round form, and in

01:11:53

others everything is displaced and it comes across

01:11:56

in such an elongated form, that is, we are already

01:11:59

passing through both the

01:12:01

ascending part and be

01:12:07

careful in this case this is the

01:12:11

ascending part of the aorta further strives

01:12:14

to connect with the ductus artorias, here

01:12:17

they will meet each other, the

01:12:19

ductus arterioles with this main

01:12:22

continuation meets with the aorta not with the

01:12:26

ascending part, this will be further, yes, but they

01:12:28

come into contact with each other here and

01:12:31

ultimately in the descending part will be

01:12:37

directly connected together

01:12:43

using the example of this last slide

01:12:46

that we are looking at now, I want to

01:12:50

emphasize that perhaps the main

01:12:53

difficulty is precisely the human

01:12:57

task to recognize in these constantly

01:13:00

changing frames those main sections

01:13:04

that we can draw schematically

01:13:08

before their eyes should

01:13:11

catch in these looped

01:13:15

images now, our cinema loops

01:13:18

that two different slices fall and one

01:13:22

slice through the outflow tract of the right

01:13:25

ventricle with two trouser legs is a symptom of

01:13:29

trousers and the second means through three

01:13:31

vessels and so they change constantly and

01:13:33

so in life we when we look we must

01:13:36

distinguish between the other and to identify them, this is a

01:13:43

hint for us to help

01:13:47

us remember what belongs to the

01:13:53

carrier tract and we just saw 3 vessels with you

Description:

Лекция для врачей цикла первичной переподготовки по ультразвуковой диагностике в БФУ им. И. Канта (г.Калининград). Запись 2017 г. Уважаемые врачи! Циклы первичной переподготовки по ультразвуковой диагностике (504 часа) под руководством профессора В.Изранова в БФУ им. И. Канта (г.Калининград) проходят ежегодно в сентябре – декабре и феврале - июне. Формы обучения очная и дистанционная. Контакты отделения ДПО БФУ им. И. Канта для записи на курсы: [email protected] [email protected] +7 911 866-66-77 Наши циклы НМО в 2021 г.: Ультразвуковая диагностика диффузной патологии печени https://nmfo-vo.edu.rosminzdrav.ru/#/... Ультразвуковая диагностика заболеваний поджелудочной железы https://nmfo-vo.edu.rosminzdrav.ru/#/... Ультразвуковая диагностика заболеваний желчного пузыря и желчевыводящих путей https://nmfo-vo.edu.rosminzdrav.ru/#/... Ультразвуковая диагностика заболеваний молочных желез https://nmfo-vo.edu.rosminzdrav.ru/#/... Ультразвуковое исследование печени. Проблемы нормы https://nmfo-vo.edu.rosminzdrav.ru/#/... С сентября 2021 г. открыты дополнительные циклы НМО: Основы эхокардиографии УЗИ в гинекологии УЗИ щитовидной железы

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