‫ﺍاﻟﺠﻤﻌﻴﯿﺔ ﺍاﻟﻌﺎﻟﻤﻴﯿﺔ ﻟﻠﺘﺼﻮﻳﯾﺮﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻟﻠﺘﻮﻟﻴﯿﺪ ﻭوﺃأﻣﺮﺍاﺽض ﺍاﻟﻨﺴﺎء‬

‫ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﺍاﻟﺘﻄﺒﻴﯿﻘﻴﯿﺔ )ﺍاﻟﻤﺤﺪّﺛﺔ(‪ :‬ﺍاﻟﺘﺨﻄﻴﯿﻂ ﺍاﻟﺼﻮﺗﻲ ﻓﻲ ﻣﻌﺎﻳﯾﻨﺔ ﻗﻠﺐ ﺍاﻟﺠﻨﻴﯿﻦ‬

‫ﻟﺠﻨﺔ ﺍاﻟﻤﻌﺎﻳﯾﻴﯿﺮ ﺍاﻟﺴﺮﻳﯾﺮﻳﯾﺔ‬

‫ﺇإﻥن ﺍاﻟﺠﻤﻌﻴﯿﺔ ﺍاﻟﻌﺎﻟﻤﻴﯿﺔ ﻟﻠﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻷﻣﺮﺍاﺽض ﺍاﻟﻨﺴﺎء ﻭوﺍاﻟﺘﻮﻟﻴﯿﺪ ‪ ISUOG‬ﻫﮬﮪھﻲ ﻣﻨﻈﻤﺔ ﻋﻠﻤﻴﯿﺔ ﺗﺸﺠﻊ‬ ‫ّ‬
‫ﺍاﻟﻤﻤﺎﺭرﺳﺎﺕت ﺍاﻟﺴﺮﻳﯾﺮﻳﯾﺔ ﺍاﻟﺴﻠﻴﯿﻤﺔ‪ ،٬‬ﻭوﺍاﻟﺘﻌﻠﻴﯿﻢ ﻭوﺍاﻟﺒﺤﺚ ﻓﻲ ﻣﺠﺎﻝل ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺍاﻟﺘﺸﺨﻴﯿﺼﻲ ﻭوﺍاﻟﺮﻋﺎﻳﯾﺔ ﺍاﻟﺼﺤﻴﯿﺔ ﻟﻠﻨﺴﺎء‪.‬‬
‫ﺼﺺ ﻟﺠﻨﺔ ﺍاﻟﻤﻌﺎﻳﯾﻴﯿﺮ ﺍاﻟﺴﺮﻳﯾﺮﻳﯾﺔ ﺍاﻟﻤﻨﺒﺜﻘﺔ ﻋﻦ ﺍاﻟﺠﻤﻌﻴﯿﺔ ﻓﻲ ﺗﻄﻮﻳﯾﺮ ﺇإﺭرﺷﺎﺩدﺍاﺕت ﺗﻄﺒﻴﯿﻘﻴﯿﺔ ﻭوﺑﻴﯿﺎﻧﺎﺕت ﺗﻮﺍاﻓﻘﻴﯿﺔ ﺗﺸ ّﻜ ُﻞ‬ ‫ﻭوﺗﺘﺨ ّ‬
‫ﺗﻮﺻﻴﯿﺎﺕت ﺗﻌﻠﻴﯿﻤﻴﯿﺔ ﺗﺰ ّﻭو ُﺩد ﻣﻘ ّﺪﻣﻲ ﺍاﻟﺮﻋﺎﻳﯾﺔ ﺍاﻟﺼﺤﻴﯿﺔ ﺑﻤﻘﺎﺭرﺑﺔ ﺗﻮﺍاﻓﻘﻴﯿﺔ ﻟﻠﺘﺼﻮﻳﯾﺮ ﺍاﻟﺘﺸﺨﻴﯿﺼﻲ‪ .‬ﻭوﺗﻌﻜﺲ ﻫﮬﮪھﺬﻩه ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت‬
‫ﺃأﻥن ﺍاﻟﺠﻤﻌﻴﯿﺔ ﺑﺬﻟﺖ ﺟﻬﮭﺪﺍاً‬ ‫ﻣﺎ ﺗﺼﻨّﻔﻪﮫ ﺍاﻟﺠﻤﻌﻴﯿﺔ ﻓﻀﻠﻰ ﺍاﻟﻤﻤﺎﺭرﺳﺎﺕت ﻓﻲ ﺧﻼﻝل ﻓﺘﺮﺓة ﺇإﺻﺪﺍاﺭر ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت‪ .‬ﻭوﺑﺎﻟﺮﻏﻢ ﻣﻦ ّ‬
‫ﻱي ﻣﻦ‬ ‫ﻛﺒﻴﯿﺮﺍاً ﻟﻠﺤﺮﺹص ﻋﻠﻰ ﺃأﻥن ﺗﻜﻮﻥن ﻫﮬﮪھﺬﻩه ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﺩدﻗﻴﯿﻘﺔ ﻟﺪﻯى ﺻﺪﻭوﺭرﻫﮬﮪھﺎ‪ ،٬‬ﺇإﻻ ﺃأﻧّﻬﮭﺎ ﻻ ﺗﺘﺤ ّﻤﻞ ﻻ ﻫﮬﮪھﻲ ﻭوﻻ ﺃأ ّ‬
‫ﻣﻮﻅظﻔﻴﯿﻬﮭﺎ ﺃأﻭو ﺃأﻋﻀﺎﺋﻬﮭﺎ ﻣﺴﺆﻭوﻟﻴﯿﺔ ﺑﻴﯿﺎﻧﺎﺕت ﺃأﻭو ﺁآﺭرﺍاء ﺃأﻭو ﺗﺼﺮﻳﯾﺤﺎﺕت ﻏﻴﯿﺮ ﺩدﻗﻴﯿﻘﺔ ﺃأﻭو ﻣﻀﻠﻠﺔ ﺗﺼﺪﺭر ﻋﻦ ﺍاﻟﻠﺠﻨﺔ ﺍاﻟﻤﻌﻨﻴﯿّﺔ‪.‬‬
‫ﺃأﻥن ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﺍاﻟﻤﺬﻛﻮﺭرﺓة ﻏﻴﯿﺮ ﻣﻌﺪﺓة ﻟﺘﺸ ّﻜﻞ ﻣﻌﻴﯿﺎﺭرﺍاً ﻗﺎﻧﻮﻧﻴﯿﺎ ً ﻟﻠﺮﻋﺎﻳﯾﺔ ﺍاﻟﺼﺤﻴﯿﺔ ّ‬
‫ﻷﻥن ﺍاﻟﺘﻔﺴﻴﯿﺮﺍاﺕت ﻭوﺍاﻟﺘﺄﻭوﻳﯾﻼﺕت‬ ‫ﺫذﻟﻚ ّ‬
‫ﺇإﻥن ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﺍاﻟﻤﻌﺘﻤﺪﺓة ﺗُﻮ ّﺯزﻉع ﻣﺠﺎﻧﺎ ً ﺑﻌﺪ ﺍاﻟﺤﺼﻮﻝل‬‫ﺍاﻟﻜﺎﻣﻨﺔ ﻓﻴﯿﻬﮭﺎ ﻗﺪ ﺗﺘﺄﺛﺮ ﺑﻈﺮﻭوﻑف ﺍاﻟﻔﺮﺩد ﻭوﺍاﻟﻤﻮﺍاﺭرﺩد ﺍاﻟﻤﺘﻮﺍاﻓﺮﺓة‪ّ .‬‬
‫ﻋﻠﻰ ﺇإﺫذﻥن ﺍاﻟﺠﻤﻌﻴﯿﺔ‪)  .‬ﺍاﻟﺮﺟﺎء ﻣﺮﺍاﺟﻌﺔ ﺍاﻟﻤﻮﻗﻊ ﺍاﻟﺘﺎﻟﻲ ‪.(info@isuog.org‬‬

‫ﺍاﻟﻤﻘﺪﻣﺔ‬

‫ﻧﺳﺧﺔ ﻣﻧ ّﻘﺣﺔ ﻭوﻣﺳﺗﺣﺩدﺛﺔ ﻋﻥن ﻛﺗ ّﻳﯾﺏب ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﺍاﻟﺻﺎﺩدﺭر ﺳﺎﺑﻘﺎ ً ﻋﻥن ﺍاﻟﺟﻣﻌﻳﯾﺔ ﺍاﻟﻌﺎﻟﻣﻳﯾﺔ‬ ‫ً‬ ‫ﺗﺷﻛﻝل ﻫﮬﮪھﺫذﻩه ﺍاﻟﻭوﺛﻳﯾﻘﺔ‬
‫ﻟﻠﻣﻭوﺟﺎﺕت ﻓﻭوﻕق ﺍاﻟﺻﻭوﺗﻳﯾﺔ ﺣﻭوﻝل ﻣﺳﺢ ﺍاﻟﻘﻠﺏب ﻓﻲ ﻣﻧﺗﺻﻑف ﺍاﻟﺣﻣﻝل )‪ (1‬ﻭوﺗﻌﻛﺱسُ ﺍاﻟﻣﻌﺭرﻓﺔ ﺍاﻟﺣﺎﻟﻳﯾﺔ ﺑﺗﻘﻔﻲ ﺃأﻣﺭرﺍاﺽض‬
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‫ﺍاﻟﻘﻠﺏب ﺍاﻟﺧﻠﻘﻳﯾﺔ ﻗﺑﻝل ﺍاﻟﻭوﻻﺩدﺓة‪ .‬ﻭوﺗﻘﺗﺿﻲ ﺍاﻟﺗﻭوﺻﻳﯾﺔ ﺍاﻟﺟﺩدﻳﯾﺩدﺓة ﺍاﻟﺻﺎﺩدﺭرﺓة ﻋﻥن ﺍاﻟـ ‪ ISUOG  ‬ﺑﺈﺿﺎﻓﺔ ﺻﻭوﺭر ﻣﺳﺎﻟﻙك ﺍاﻟﺗﺩدﻓﻕق‬
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‫ﻭوﺻﻭوﺭر ﺍاﻟﺣُﺟﻳﯾﺭرﺍاﺕت ﺍاﻷﺭرﺑﻊ ﺇإﻟﻰ ﺍاﻟﻔﺣﺹص ﺍاﻟﺭرﻭوﺗﻳﯾﻧﻲ ﺫذﻟﻙك ﺃأﻥن ﻫﮬﮪھﺫذﻩه ﺍاﻟﻌﻣﻠﻳﯾﺔ ﺗﺩدﻋﻣﻬﮭﺎ ﺇإﺛﺑﺎﺗﺎﺕت ﻭوﺍاﺿﺣﺔ ﻭوﺗﻭوﺍاﺯزﻱي ﺍاﻟﻣﺑﺎﺩدﺉئ‬
‫ﺍاﻟﺗﻭوﺟﻳﯾﻬﮭﻳﯾﺔ ﺍاﻷﺧﻳﯾﺭرﺓة ﻭوﺍاﻟﺗﻭوﺻﻳﯾﺎﺕت ﺍاﻟﺻﺎﺩدﺭرﺓة ﻋﻥن ﺍاﻟﻬﮭﻳﯾﺋﺎﺕت ﺍاﻟﻣﻬﮭﻧﻳﯾﺔ ﺍاﻷﺧﺭرﻯى )‪.(2 to 5‬‬
‫ﺇإﻥن ﻣﺮﺽض ﺍاﻟﻘﻠﺐ ﺍاﻟﺘﺎﺟﻲ ﻫﮬﮪھﻮ ﺍاﻟﺴﺒﺐ ﺍاﻟﺮﺋﻴﯿﺴﻲ ﻟﻮﻓﻴﯿﺎﺕت ﺍاﻷﻁطﻔﺎﻝل ﺍاﻟﺮﺿﻊ‪ ،٬‬ﺑﻤﻌﺪﻝل ﻧﺤﻮ ‪ 4‬ﺇإﻟﻰ ‪ 13‬ﻁطﻔﻼً ﻣﻦ ﺑﻴﯿﻦ ﻛ ّﻞ‬ ‫ّ‬
‫‪ 1000‬ﻣﻮﻟﻮﺩد ﺣﻲ‪ .‬ﻭوﺑﻴﯿﻦ ﺳﻨﺘﻲ ‪ 1950‬ﻭو ‪ ،٬(6 to 8) 1994‬ﻭوﺭرﺩد ﻓﻲ ﺗﻘﺮﻳﯾﺮ ﻟﻤﻨﻈﻤﺔ ﺍاﻟﺼﺤﺔ ﺍاﻟﻌﺎﻟﻤﻴﯿﺔ ﺃأﻥن ‪%42‬‬
‫ﻣﻦ ﻭوﻓﻴﯿﺎﺕت ﺍاﻷﻁطﻔﺎﻝل ﺳﺒﺒﻬﮭﺎ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﻘﻠﺒﻴﯿﺔ )‪ .(9‬ﻭوﺃأﻳﯾﻀﺎ ً ﻛﺎﻧﺖ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﺒﻨﻴﯿﻮﻳﯾﺔ ﻟﻠﻘﻠﺐ ﻣﻦ ﺿﻤﻦ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت‬
‫ﺍاﻟﺘﻲ ﻓﻲ ﻣﻌﻈﻢ ﺍاﻷﺣﻴﯿﺎﻥن ﻟﻢ ﻳﯾﺘﻢ ﺍاﻟﻜﺸﻒ ﻋﻨﻬﮭﺎ ﻋﻨﺪ ﺍاﺟﺮﺍاء ﻓﺤﺺ ﺍاﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻗﺒﻞ ﺍاﻟﻮﻻﺩدﺓة )‪.(10,11‬‬
‫ﻗﺪ ﻳﯾﺤﺴّﻦ ﺍاﻟﻜﺸﻒ ﻋﻦ ﻣﺮﺽض ﺍاﻟﻘﻠﺐ ﺍاﻟﺘﺎﺟﻲ ﻗﺒﻞ ﺍاﻟﻮﻻﺩدﺓة ﻧﺘﺎﺋﺞ ﺍاﻷﺟﻨﺔ ﺫذﺍاﺕت ﺍاﻷﻧﻮﺍاﻉع ﺍاﻟﻤﺤﺪﺩدﺓة ﻣﻦ ﺍاﻵﻓﺎﺕت ﺍاﻟﻘﻠﺒﻴﯿﺔ‬
‫)‪ ،٬(12 to 16‬ﻭوﻟﻜﻦ ﺍاﻟﻜﺸﻒ ﻗﺒﻞ ﺍاﻟﻮﻻﺩدﺓة ﻳﯾﺘﻔﺎﻭوﺕت ﺑﺸﻜﻞ ﻭوﺍاﺳﻊ )‪. (17‬‬
‫ﻭوﻗﺪ ﻳﯾﻜﻮﻥن ﺳﺒﺐ ﻫﮬﮪھﺬﺍا ﺍاﻟﺘﻔﺎﻭوﺕت ﺍاﺧﺘﻼﻓﺎﺕت ﻓﻲ ﺧﺒﺮﺓة ﺍاﻟﻔﺎﺣﺺ ﻭوﺑﺪﺍاﻧﺔ ﺍاﻷﻡم ﻭوﺗﺮﺩدﺩد ﻣﺤﻮﻝل ﺍاﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ‬
‫ﻭوﺍاﻟﻨﺪﻭوﺏب ﻓﻲ ﺍاﻟﺒﻄﻦ ﻭوﻋﻤﺮ ﺍاﻟﺤﻤﻞ ﻭوﺣﺠﻢ ﺍاﻟﺴﺎﺋﻞ ﺍاﻟﺬﻱي ﻳﯾﺤﻴﯿﻂ ﺑﺎﻟﺠﻨﻴﯿﻦ ﻭوﻣﻮﻗﻊ ﺍاﻟﺠﻨﻴﯿﻦ )‪ .(18,19‬ﺍاﺳﺘﻤﺮﺍاﺭر ﺭرﺩدﺍاﺕت‬
‫ﺍاﻟﻔﻌﻞ ﺍاﻟﻘﺎﺋﻤﺔ ﻋﻠﻰ ﺍاﻟﺘﺪﺭرﻳﯾﺐ ﻣﻦ ﺍاﻟﻤﺘﺨﺼﺼﻴﯿﻦ ﻓﻲ ﺍاﻟﺮﻋﺎﻳﯾﺔ ﺍاﻟﺼﺤﻴﯿﺔ ﻭوﺍاﻟﺒﺪﺍاﻳﯾﺔ ﺍاﻟﻤﻨﺨﻔﻀﺔ ﻟﺤﺎﻻﺕت ﺗﺨﻄﻴﯿﻂ ﺻﺪﻯى‬
‫ﺍاﻟﻘﻠﺐ ﻭوﺳﻬﮭﻮﻟﺔ ﺍاﻟﻮﺻﻮﻝل ﺇإﻟﻰ ﻣﺘﺨﺼﺼﻴﯿﻦ ﻓﻲ ﻗﻠﺐ ﺍاﻟﺠﻨﻴﯿﻦ ﻫﮬﮪھﻲ ﻋﻮﺍاﻣﻞ ﻣﻬﮭﻤﺔ ﻗﺪ ﺗﺤ ّﺴﻦ ﻓﻌﺎﻟﻴﯿﺔ ﺑﺮﻧﺎﻣﺞ ﺍاﻟﻔﺤﺺ‬
‫ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ )‪ .(8,20‬ﻭوﻛﻤﺜﺎﻝل ﻭوﺍاﺣﺪ‪ ،٬‬ﺗﻀﺎﻋﻒ ﻣﻌﺪﻝل ﺍاﻟﻜﺸﻒ ﻋﻦ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﻘﻠﺒﻴﯿﺔ ﺍاﻟﻜﺒﻴﯿﺮﺓة ﺑﻌﺪ‬
‫ﺗﻨﻔﻴﯿﺬ ﺍاﻟﺒﺮﻧﺎﻣﺞ ﺍاﻟﺘﺪﺭرﻳﯾﺒﻲ ﻟﻤﺪﺓة ﺳﻨﺘﻴﯿﻦ ﻓﻲ ﻣﺮﻛﺰ ﻁطﺒﻲ ﻓﻲ ﺷﻤﺎﻝل ﺍاﻧﻜﻠﺘﺮﺍا )‪.(20‬‬

‫ﻭوﻗﺪ ﺗ ّﻢ ﺗﺼﻤﻴﯿﻢ ﺍاﻟﻔﺤﺺ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻟﻠﺠﻨﻴﯿﻦ ﻟﻜﺸﻒ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﻘﻠﺒﻴﯿﺔ ﺍاﻟﻰ ﺃأﻗﺼﻰ ﺣ ّﺪ ﻭوﺫذﻟﻚ ﺧﻼﻝل‬
‫ﺍاﻟﻔﺤﺺ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻟﺜﺎﻧﻲ ﻣﻦ ﻣﺮﺣﻠﺔ ﺍاﻟﺤﻤﻞ‪ .‬ﻭوﻳﯾﻤﻜﻦ ﺍاﺳﺘﺨﺪﺍاﻡم ﻛﺘﻴﯿّﺐ ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﻫﮬﮪھﺬﺍا ﻓﻲ ﺗﻘﻴﯿﻴﯿﻢ ﻓﺤﺺ ﺍاﻷﺟﻨﺔ‬
‫ﺍاﻟﻤﻨﺨﻔﻀﺔ ﺍاﻟﻤﺨﺎﻁطﺮ ﻛﺠﺰء ﻣﻦ ﺭرﻭوﺗﻴﯿﻦ ﺍاﻟﺮﻋﺎﻳﯾﺔ ﻗﺒﻞ ﺍاﻟﻮﻻﺩدﺓة )‪ .(23 to 25‬ﻭوﻳﯾﺴﺎﻋﺪ ﻫﮬﮪھﺬﺍا ﺍاﻟﻨﻬﮭﺞ ﺃأﻳﯾﻀﺎ ً ﻋﻠﻰ ﺗﺤﺪﻳﯾﺪ‬
‫ﺍاﻷﺟﻨﺔ ﺍاﻟﻤﻌﺮﺿﺔ ﻟﺨﻄﺮ ﺍاﻻﺻﺎﺑﺔ ﺑﺎﻟﻤﺘﻼﺯزﻣﺎﺕت ﺍاﻟﻮﺭرﺍاﺛﻴﯿﺔ ﻭوﻳﯾﻮﻓّﺮ ﻣﻌﻠﻮﻣﺎﺕت ﻣﻔﻴﯿﺪﺓة ﻟﺘﻘﺪﻳﯾﻢ ﺍاﻻﺳﺘﺸﺎﺭرﺍاﺕت ﻟﻠﻤﺮﻳﯾﻀﺔ‬
‫ﻭوﻹﺩدﺍاﺭرﺓة ﺍاﻟﺘﻮﻟﻴﯿﺪ ﻭوﺍاﻟﺮﻋﺎﻳﯾﺔ ﺍاﻟﻤﺘﻌﺪﺩدﺓة ﺍاﻹﺧﺘﺼﺎﺻﺎﺕت‪ .‬ﻭوﺳﻴﯿﺘﻄﻠّﺐ ﺍاﻻﺷﺘﺒﺎﻩه ﺑﻮﺟﻮﺩد ﺗﺸ ّﻮﻫﮬﮪھﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﺗﻘﻴﯿﻴﯿﻤﺎ ً ﺃأﻛﺜﺮ‬
‫ﺷﻤﻮﻟﻴﯿﺔ ﻋﺒﺮ ﺍاﺳﺘﺨﺪﺍاﻡم ﺗﺨﻄﻴﯿﻂ ﺻﺪﻯى ﺍاﻟﻘﻠﺐ ﻟﻠﺠﻨﻴﯿﻦ )‪.(26‬‬

‫ﺍاﻋﺘﺒﺎﺭرﺍاﺕت ﻋﺎﻣﺔ‬
‫‪  ‬‬

‫ﺑﻐﺾّ ﺍاﻟﻨﻈﺮ ﻋﻦ ﺍاﻟﻔﺎﺋﺪﺓة ﺍاﻟﻤﻮﺛّﻘﺔ ﺑﺸﻜﻞ ﺟﻴﯿّﺪ ﻟﺤﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻌﺔ ﻭوﻟﻠﻘﻄﺔ ﻁطﺮﻕق ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ‪ ،٬‬ﻳﯾﺠﺐ‬
‫ﺃأﺧﺬ ﺍاﻟﺤﺬﺭر ﻣﻦ ﻣﺨﺎﻁطﺮ ﺍاﻟﺘﺸﺨﻴﯿﺺ ﺍاﻟﻤﺤﺘﻤﻠﺔ ﺍاﻟﺘﻲ ﻳﯾﻤﻜﻦ ﺃأﻥن ﺗﻤﻨﻊ ﺍاﻛﺘﺸﺎﻑف ﻣﺮﺽض ﺍاﻟﻘﻠﺐ ﺍاﻟﺘﺎﺟﻲ ﻓﻲ ﺍاﻟﻮﻗﺖ‬
‫ﺍاﻟﻤﻨﺎﺳﺐ )‪ .(27 to 29‬ﻭوﻳﯾﻤﻜﻦ ﻟﻤﻌﺪﻻﺕت ﺍاﻟﻜﺸﻒ ﺃأﻥن ﺗﻜﻮﻥن ﺍاﻷﻣﺜﻞ ﻣﻦ ﺧﻼﻝل ﺇإﺟﺮﺍاء ﻓﺤﺺ ﺷﻌﺎﻋﻲ ﺷﺎﻣﻞ ﻟﻠﻘﻠﺐ‬
‫ﺃأﻥن ﺑﻌﺾ‬ ‫ﻭوﻣﻼﺣﻈﺔ ﺃأﻥن ﻟﻘﻄﺎﺕت ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻌﺔ ﻫﮬﮪھﻲ ﺃأﻛﺜﺮ ﻣﻦ ﻣﺠﺮﺩد ﻋﺪﺩد ﻟﻠﺤﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺒﻴﯿﺔ‪ ،٬‬ﻭوﻓﻬﮭﻢ ّ‬
‫ﺃأﻥن ﺣﺎﻻﺕت ﻣﻌﻴﯿﻨﺔ ﻣﻦ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت )ﻣﺜﻞ‬ ‫ﺍاﻵﻓﺎﺕت ﻻ ﻳﯾﺘﻢ ﺍاﻛﺘﺸﺎﻓﻬﮭﺎ ﺣﺘﻰ ﻣﺮﺣﻠﺔ ﻣﺘﺄﺧﺮﺓة ﻣﻦ ﻣﺮﺍاﺣﻞ ﺍاﻟﺤﻤﻞ‪ ،٬‬ﻭوﺍاﻹﺩدﺭرﺍاﻙك ّ‬
‫ﺗﺒﺪﻳﯾﻞ ﺍاﻟﺸﺮﺍاﻳﯾﻴﯿﻦ ﺍاﻟﻜﺒﻴﯿﺮﺓة ﻭوﺗﻀﻴﯿﻴﯿﻖ ﺍاﻷﺑﻬﮭﺮ( ﻗﺪ ﻻ ﺗﻜﻮﻥن ﻭوﺍاﺿﺤﺔً ﻣﻦ ﺧﻼﻝل ﺳﻄﺢ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻌﺔ ﻭوﺣﺪﻫﮬﮪھﺎ‪.‬‬
‫ﻓﻠﻘﻄﺔ ﺍاﻟﺤﺠﻴﯿﺮﺍاﺕت ﺍاﻷﺭرﺑﻌﺔ ﺍاﻟﻤﺴﺘﻜﻤﻠﺔ ﻟﻠﻘﻄﺔ ﻁطﺮﻕق ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻓﻲ ﻓﺤﺺ ﺍاﻟﻘﻠﺐ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ‬
‫ﻫﮬﮪھﻲ ﺧﻄﻮﺓة ﻣﻬﮭﻤﺔ ﻟﺘﺤﺴﻴﯿﻦ ﺍاﻟﻜﺸﻒ ﻋﻦ ﻣﺮﺽض ﺍاﻟﻘﻠﺐ ﺍاﻟﺘﺎﺟﻲ‪.‬‬

‫ﻋﻤﺮ ﺍاﻟﺤﻤﻞ‬

‫ﻳﯾﺠﺐ ﺇإﺟﺮﺍاء ﻓﺤﺺ ﺍاﻟﻘﻠﺐ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻓﻲ ﺍاﻟﻔﺘﺮﺓة ﺍاﻷﻣﺜﻞ ﻟﻠﺤﻤﻞ ﻣﺎ ﺑﻴﯿﻦ ‪ 18‬ﻭو‪ 22‬ﺃأﺳﺒﻮﻋﺎ ً‪ ،٬‬ﻭوﻋﻠﻰ‬
‫ﺍاﻟﺮﻏﻢ ﻣﻦ ﺫذﻟﻚ ﻓﺈﻥن ﺍاﻟﻜﺜﻴﯿﺮ ﻣﻦ ﺍاﻟﺒﻨﻴﯿﺎﺕت ﺍاﻟﺘﺸﺮﻳﯾﺤﻴﯿﺔ ﻳﯾﻤﻜﻦ ﺗﺼﻮﻳﯾﺮﻫﮬﮪھﺎ ﻭوﺭرﺅؤﻳﯾﺘﻬﮭﺎ ﺑﻮﺿﻮﺡح ﺣﺘﻰ ﻣﺎ ﺑﻌﺪ ‪ 22‬ﺃأﺳﺒﻮﻋﺎ ً‪.‬‬
‫ﻭوﻳﯾﻤﻜﻦ ﺗﺤﺪﻳﯾﺪ ﺑﻌﺾ ﺍاﻻﻧﺤﺮﺍاﻓﺎﺕت ﻓﻲ ﺧﻼﻝل ﺃأﻭوﺍاﺧﺮ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻭوﺃأﻭوﺍاﺋﻞ ﺍاﻟﺜﻠﺚ ﺍاﻟﺜﺎﻧﻲ ﻣﻦ ﻓﺘﺮﺓة ﺍاﻟﺤﻤﻞ‪ ،٬‬ﺧﺼﻮﺻﺎ ً‬
‫ﻟﺪﻯى ﻣﻼﺣﻈﺔ ﺯزﻳﯾﺎﺩدﺓة ﺳﻤﻚ ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ )‪ .(30 to 35‬ﻭوﻋﻨﺪ ﺇإﺟﺮﺍاء ﺍاﻟﻔﺤﺺ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻓﻲ‬
‫ﻓﺘﺮﺓة ﺍاﻟﺤﻤﻞ ﻣﺎ ﺑﻴﯿﻦ ‪ 20‬ﻭو ‪ 22‬ﺃأﺳﺒﻮﻋﺎ ً ﻳﯾﺼﺒﺢ ﺃأﻗ ّﻞ ﻋﺮﺿﺔ ﻟﻄﻠﺐ ﻓﺤﺺ ﺁآﺧﺮ ﻻﻛﻤﺎﻝل ﻫﮬﮪھﺬﺍا ﺍاﻟﺘﻘﻴﯿﻴﯿﻢ‪ ،٬‬ﻭوﻋﻠﻰ ﺍاﻟﺮﻏﻢ‬
‫ﻣﻦ ﺫذﻟﻚ ﻓﺈﻥن ﺍاﻟﻜﺜﻴﯿﺮ ﻣﻦ ﺍاﻟﻤﺮﺿﻰ ﻳﯾﻔﻀﻠﻮﻥن ﻣﻌﺮﻓﺔ ﻫﮬﮪھﺬﻩه ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﻜﺒﻴﯿﺮﺓة ﻓﻲ ﻣﺮﺣﻠﺔ ﻣﺒﻜﺮﺓة ﻣﻦ ﺍاﻟﺤﻤﻞ )‪.(36‬‬
 ‫ﺍاﻟﻌﻮﺍاﻣﻞ ﺍاﻟﺘﻘﻨﻴﯿﺔ‬
‫ﻣﺤﻮّﻝل ﺍاﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ‬

‫ﺳﺘﺴﺎﻋﺪ ﻣﺴﺎﺑﻴﯿﺮ ﺍاﻟﺘﺮﺩدﺩدﺍاﺕت ﺍاﻟﻌﺎﻟﻴﯿﺔ ﻋﻠﻰ ﺗﺤﺴﻴﯿﻦ ﻓﺮﺹص ﺍاﻛﺘﺸﺎﻑف ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﺪﻗﻴﯿﻘﺔ‪ ،٬‬ﻭوﺫذﻟﻚ ﻋﻠﻰ ﺣﺴﺎﺏب ﺍاﻟﺘﻘﻠﻴﯿﻞ ﻣﻦ‬
‫ﺍاﻻﺧﺘﺮﺍاﻕق ﺍاﻟﺴﻤﻌﻲ‪ .‬ﺣﻴﯿﺚ ﻳﯾﺠﺐ ﺍاﺳﺘﺨﺪﺍاﻡم ﺃأﻋﻠﻰ ﻣﺴﺘﻮﻯى ﻣﻤﻜﻦ ﻣﻦ ﻣﺤﻮّﻝل ﺍاﻟﺘﺮﺩدﺩدﺍاﺕت ﻟﺠﻤﻴﯿﻊ ﺍاﻟﻔﺤﻮﺻﺎﺕت‪ ،٬‬ﻣﻊ‬
‫ﺍاﻻﺩدﺭرﺍاﻙك ﺑﺎﻟﻤﻔﺎﺿﻠﺔ ﺑﻴﯿﻦ ﺍاﻻﺧﺘﺮﺍاﻕق ﻭوﺍاﻟﺤﻞ‪ .‬ﻭوﻗﺪ ﻳﯾﻮﻓﺮ ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺍاﻟﻤﺘﻨﺎﺳﻖ ﺻﻮﺭر ﻣﺤﺴﻨﺔ‪ ،٬‬ﺧﺼﻮﺻﺎ ً ﻟﺪﻯى ﺍاﻟﻤﺮﺿﻰ‬
‫ﺍاﻟﺬﻳﯾﻦ ﻳﯾﻌﺎﻧﻮﻥن ﺯزﻳﯾﺎﺩدﺓة ﻓﻲ ﺳﻤﺎﻛﺔ ﺟﺪﺍاﺭر ﺑﻄﻦ ﺍاﻷﻣﻮﻣﺔ ﻓﻲ ﺧﻼﻝل ﺍاﻟﺜﻠﺚ ﺍاﻷﺧﻴﯿﺮ ﻣﻦ ﻓﺘﺮﺓة ﺍاﻟﺤﻤﻞ )‪.(37‬‬
‫ﻣﻌﺎﻟﻢ ﺍاﻟﺘﺼﻮﻳﯾﺮ‬

‫ﻣﺎﺯزﺍاﻝل ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺑﺎﻟﺘﺪﺭرﺝج ﺍاﻟﺮﻣﺎﺩدﻱي ﺍاﻟﻤﻘﻄﻌﻲ ﻫﮬﮪھﻮ ﺍاﻷﺳﺎﺱس ﺍاﻟﻤﻌﺘﻤﺪ ﻓﻲ ﻓﺤﺺ ﻗﻠﺐ ﺍاﻟﺠﻨﻴﯿﻦ‪ .‬ﻭوﻳﯾﻨﺒﻐﻲ ﺑﺈﻋﺪﺍاﺩدﺍاﺕت‬
‫ﺍاﻟﻨﻈﺎﻡم ﺃأﻥن ﺗﺆﻛﺪ ﻣﻌﺪﻝل ﺇإﻁطﺎﺭر ﻋﺎﻟﻴﯿﺎ ً‪ ،٬‬ﻣﻊ ﺯزﻳﯾﺎﺩدﺓة ﺍاﻟﺘﺒﺎﻳﯾﻦ ﻭوﺩدﻗﺔ ﺍاﻟﻮﺿﻮﺡح‪ .‬ﻭوﻣﻊ ﺍاﺳﺘﻤﺮﺍاﺭر ﺍاﻻﻧﺨﻔﺎﺽض‪ ،٬‬ﻳﯾﺠﺐ ﺍاﺳﺘﺨﺪﺍاﻡم‬
‫ﺍاﻟﻤﻨﻄﻘﺔ ﺍاﻟﻤﺮﻛﺰﻳﯾﺔ ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺍاﻟﻮﺣﻴﯿﺪﺓة ﻭوﺣﻘﻞ ﺍاﻟﺼﻮﺭرﺓة ﺍاﻟﻀﻴﯿﻖ ﻧﺴﺒﻴﯿﺎ ً‪.‬‬
‫ﺍاﻟﺘﻘﺮﻳﯾﺐ ﻭو ﺗﻘﻨﻴﯿﺔ ﺍاﻟـ‪cine-loop‬‬

‫ﻳﯾﺠﺐ ﺗﻀﺨﻴﯿﻢ ﺍاﻟﺼﻮﺭرﺓة ﺣﺘﻰ ﻳﯾﻤﻠﺊ ﺍاﻟﻘﻠﺐ ﻋﻠﻰ ﺍاﻷﻗﻞ ﺛﻠﺚ ﺃأﻭو ﻧﺼﻒ ﺍاﻟﺸﺎﺷﺔ‪ .‬ﻭوﻳﯾﺠﺐ ﺍاﺳﺘﺨﺪﺍاﻡم ﻋﻨﺼﺮ ﺍاﻟـ‪cine-‬‬
‫‪ loop‬ﻟﻤﺴﺎﻋﺪﺓة ﺍاﻟﻮﻗﺖ ﺍاﻟﺤﻘﻴﯿﻘﻲ ﻟﺘﻘﻴﯿﻴﯿﻢ ﻫﮬﮪھﻴﯿﺎﻛﻞ ﺍاﻟﻘﻠﺐ ﺍاﻟﻄﺒﻴﯿﻌﻴﯿﺔ‪ .‬ﻣﺜﻼً‪ ،٬‬ﺍاﻟﺘﺄﻛﺪ ﻣﻦ ﺣﺮﻛﺔ ﻭوﺭرﻗﻴﯿّﺔ ﺻﻤﺎﻡم ﺍاﻟﻘﻠﺐ ﻓﻲ‬
‫ﺟﻤﻴﯿﻊ ﺃأﻧﺤﺎء ﺍاﻟﺪﻭوﺭرﺓة ﺍاﻟﻘﻠﺒﻴﯿﺔ‪ .‬ﻭوﻗﺪ ﻳﯾﺴﺎﻋﺪ ﺗﻜﺒﻴﯿﺮ ﺍاﻟﺼﻮﺭرﺓة ﻭوﺍاﺳﺘﺨﺪﺍاﻡم ﺍاﻟـ‪  cine-loop‬ﻋﻠﻰ ﺗﺤﺪﻳﯾﺪ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت‪.‬‬

‫ﻓﺤﺺ ﺍاﻟﻘﻠﺐ‬
‫‪  ‬‬
‫ﻧﻈﺮﺍاً ﺍاﻟﻰ ﺍاﻟﻮﻗﺖ ﺍاﻟﺬﻱي ﺍاﻧﻘﻀﻰ ﻣﻨﺬ ﻧﺸﺮ ﺩدﻟﻴﯿﻞ ﺍاﻟـ‪ ISUOG‬ﺍاﻷﻭوﻟﻲ )‪ ،٬(1‬ﻭوﺍاﻷﺩدﻟﺔ ﺍاﻷﺧﻴﯿﺮﺓة ﻣﻦ ﺍاﻟﻤﺎﺩدﺓة ﺍاﻟﻤﻄﺒﻮﻋﺔ‪،٬‬‬
‫ﻓﻴﯿﺠﺐ ﺍاﻵﻥن ﺃأﻥن ﻳﯾﺘﻀﻤﻦ ﺍاﻟﻔﺤﺺ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻟﻠﻘﻠﺐ ﺍاﻟﺤﺠﻴﯿﺮﺍاﺕت ﺍاﻷﺭرﺑﻌﺔ ﻭوﻟﻘﻄﺎﺕت ﻁطﺮﻳﯾﻖ ﺗﺪﻓﻘﺎﺕت‬
‫ﺍاﻟﻘﻠﺐ )‪.(38 to 46‬‬

‫ﻟﻘﻄﺔ ﺍاﻟﺤﺠﻴﯿﺮﺍاﺕت ﺍاﻷﺭرﺑﻌﺔ‬

‫ﻱي ﺧﻄﺄ ﻓﻲ ﻋﺪﺩد‬ ‫ﺗﺸﻤﻞ ﻟﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻌﺔ ﺗﻘﻴﯿﻴﯿﻤﺎ ً ﺩدﻗﻴﯿﻘﺎ ً ﻟﻤﻌﻴﯿﺎﺭر ﻣﺤ ّﺪﺩد ﺣﻴﯿﺚ ﻻ ﻳﯾﺠﺐ ﺍاﺭرﺗﻜﺎﺏب ﺃأ ّ‬
‫ﺍاﻟﺤﺠﻴﯿﺮﺍاﺕت ﺍاﻟﺒﺴﻴﯿﻂ‪ .‬ﻭوﺗﻈﻬﮭﺮ ﺍاﻟﻌﻨﺎﺻﺮ ﺍاﻷﺳﺎﺳﻴﯿﺔ ﻟﺤﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻌﺔ ﻓﻲ ﺍاﻟﺠﺪﻭوﻝل ﺭرﻗﻢ ‪ 1‬ﻭوﺍاﻟﺮﺳﻢ ﺍاﻟﺒﻴﯿﺎﻧﻲ ﺭرﻗﻢ‬
‫‪ 1‬ﻭو ‪ .2‬ﻭوﻟﺘﺤﺪﻳﯾﺪ ﻣﻮﻗﻊ ﺍاﻟﻘﻠﺐ‪ ،٬‬ﻣﻦ ﺍاﻟﻀﺮﻭوﺭرﻱي ﺗﺤﺪﻳﯾﺪ ﺃأﻭوﻻً ﺗﺠﺎﻧﺐ ﺍاﻟﺠﻨﻴﯿﻦ‪ ،٬‬ﺃأﻱي ﺗﻄﺎﺑﻖ ﺍاﻟﺠﺎﻧﺐ ﺍاﻷﻳﯾﻤﻦ ﻭوﺍاﻟﺠﺎﻧﺐ‬
‫ﺍاﻷﻳﯾﺴﺮ ﻟﻠﺠﻨﻴﯿﻦ‪ ،٬‬ﻟﻠﺘﺄﻛﺪ ﻣﻦ ﺃأﻥن ﺍاﻟﻤﻌﺪﺓة ﻭوﺍاﻟﻘﻠﺐ ﻛﻼﻫﮬﮪھﻤﺎ ﻳﯾﻘﻌﺎﻥن ﻓﻲ ﺍاﻟﺠﺎﻧﺐ ﺍاﻷﻳﯾﺴﺮ ﻟﻠﺠﻨﻴﯿﻦ‪ .‬ﻋﺎﺩدﺓةً ﺍاﻟﻘﻠﺐ ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻻ‬
‫ﻳﯾﻜﻮﻥن ﺃأﻛﺒﺮ ﻣﻦ ﺛﻠﺚ ﻣﺴﺎﺣﺔ ﺍاﻟﺼﺪﺭر‪ .‬ﻗﺪ ﺗﻜﺸﻒ ﺑﻌﺾ ﺍاﻟﻠﻘﻄﺎﺕت ﺣﺎﻓﺔ ﺻﻐﻴﯿﺮﺓة ﻣﻦ ﻧﺎﻗِﺺ ﺍاﻟﺼﱠﺪﻯى ﺣﻮﻝل ﻗﻠﺐ‬
‫ﺍاﻟﺠﻨﻴﯿﻦ‪ ،٬‬ﻭوﺍاﻟﺬﻱي ﻗﺪ ﻳﯾﻜﻮﻥن ﺧﻄﺄ ﻟﻼﻧﺼﺒﺎﺏب ﺍاﻟﺘﺎﻣﻮﺭرﻱي‪ .‬ﻭوﻋﺎﺩدﺓةً ﻳﯾﻤﺜﻞ ﺍاﻻﻛﺘﺸﺎﻑف ﺍاﻟﻮﺣﻴﯿﺪ ﻟﻬﮭﺬﺍا ﺍاﻟﻨﻮﻉع ﺍاﺧﺘﻼﻓﺎ ً ﻁطﺒﻴﯿﻌﻴﯿﺎ ً‬
‫)‪.(47,48‬‬
‫ﻳﯾﻘﻊ ﺍاﻟﻘﻠﺐ ﺃأﺳﺎﺳﺎ ً ﻓﻲ ﺍاﻟﺠﻬﮭﺔ ﺍاﻟﻴﯿﺴﺮﻯى ﻣﻦ ﺍاﻟﺼﺪﺭر ﻭوﻋﺎﺩدﺓةً ﻳﯾﺘﻮﺟﻪﮫ ﻣﺤﻮﺭرﻩه ﺍاﻟﻄﻮﻳﯾﻞ ﺍاﻟﻰ ﺍاﻟﻴﯿﺴﺎﺭر ﺑﺤﻮﺍاﻟﻲ ◦‪45±20‬‬
‫)‪) (49) (2SD‬ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪ .(1‬ﻳﯾﺠﺐ ﺍاﻻﻧﺘﺒﺎﻩه ﺟﻴﯿﺪﺍاً ﺍاﻟﻰ ﻣﺤﻮﺭر ﺍاﻟﻘﻠﺐ ﻭوﻣﻮﻗﻌﻪﮫ‪ ،٬‬ﺣﻴﯿﺚ ﺳﻴﯿﺘﻢ ﺗﻘﻴﯿﻴﯿﻤﻪﮫ ﺑﺴﻬﮭﻮﻟﺔ‬
‫ﺣﺘﻰ ﻭوﻟﻮ ﻛﺎﻧﺖ ﻟﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻻﺭرﺑﻌﺔ ﻻ ﺗﻌﻄﻲ ﺻﻮﺭرﺓة ﻣﺮﺿﻴﯿﺔ )‪ .(50‬ﻓﻴﯿﺠﺐ ﺍاﻻﺷﺘﺒﺎﻩه ﺑﻮﺟﻮﺩد ﺗﺸﻮﻫﮬﮪھﺎﺕت‬
‫ﻣﻮﻗﻌﻴﯿﺔ ﻋﻨﺪ ﻋﺪﻡم ﻭوﺟﻮﺩد ﻗﻠﺐ ﺍاﻟﺠﻨﻴﯿﻦ ﻭو‪ /‬ﺃأﻭو ﻣﻌﺪﺗﻪﮫ ﻓﻲ ﺍاﻟﺠﻬﮭﺔ ﺍاﻟﻴﯿﺴﺮﻯى‪ .‬ﻓﻤﺤﻮﺭر ﺍاﻟﻘﻠﺐ ﻏﻴﯿﺮ ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻳﯾﺰﻳﯾﺪ ﻣﻦ ﺧﻄﺮ‬
‫ﺗﺸﻮﻩه ﺍاﻟﻘﻠﺐ ﺧﺎﺻﺔً ﺗﻠﻚ ﺍاﻟﺘﻲ ﺗﻀﻢ ﻁطﺮﻳﯾﻖ ﺗﺪﻓﻘﺎﺕت ﺍاﻟﻘﻠﺐ‪ .‬ﻭوﻗﺪ ﻳﯾﺮﺗﺒﻂ ﻫﮬﮪھﺬﺍا ﺍاﻻﻛﺘﺸﺎﻑف ﺑﺨﻠﻞ ﺍاﻟﻜﺮﻭوﻣﻮﺳﻮﻣﺎﺕت‪ .‬ﻳﯾﻤﻜﻦ‬
‫ﺃأﻥن ﺗﻜﻮﻥن ﺍاﻹﺯزﺍاﺣﺔ ﻏﻴﯿﺮ ﺍاﻟﻄﺒﻴﯿﻌﻴﯿﺔ ﻟﻠﻘﻠﺐ ﻣﻦ ﻣﻜﺎﻧﻪﮫ ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻓﻲ ﺍاﻟﻴﯿﺴﺎﺭر ﺍاﻷﻣﺎﻣﻲ ﺑﺴﺒﺐ ﻓﺘﻖ ﺍاﻟﺤﺠﺎﺏب ﺍاﻟﺤﺎﺟﺰ ﺃأﻭو ﺁآﻓﺔ‬
‫ﺷﺎﻏﻠﺔ ﻟﻠﺤﻴﯿﺰ‪ ،٬‬ﻣﺜﻞ ﺗﺸﻮﻩه ﻏﺪﻭوﻣﺎﻧﻲ ﻛﻴﯿﺴﻲ ﻟﻠﺮﺋﺔ‪ .‬ﻗﺪ ﻳﯾﻜﻮﻥن ﻣﻮﻗﻊ ﺍاﻟﺘﺸﻮﻩه ﺛﺎﻧﻮﻳﯾﺎ ً ﺑﺎﻟﻨﺴﺒﺔ ﺇإﻟﻰ ﻧﻘﺺ ﺗﻨﺴﺞ ﺍاﻟﺮﺋﺔ‬
‫ﻭوﻋﺪﻡم ﺍاﻟﺘﺨﻠﻖ ﻟﺪﻯى ﺍاﻟﺠﻨﻴﯿﻦ‪.‬ﻭوﻛﺬﻟﻚ ﺍاﻧﺘﻘﺎﻝل ﻣﺤﻮﺭر ﺍاﻟﻘﻠﺐ ﺍاﻟﻰ ﺍاﻟﺠﻬﮭﺔ ﺍاﻟﻴﯿﺴﺮﻯى ﻗﺪ ﻳﯾُﺤﺪﺙث ﻣﻊ ﺍاﻧﺸﻘﺎﻕق ﺍاﻟﺒﻄﻦ ﺍاﻟﺨﻠﻘﻲ ﻟﺪﻯى‬
‫ﺍاﻟﺠﻨﻴﯿﻦ ﻭوﻗﻴﯿﻠﺔ ﺳﺮﻳﯾﺔ ﺃأﻭو ﻓﺘﻖ ﺳﺮﻱي ﻭوﻻﺩدﻱي‪.‬‬

‫ﻳﯾﺠﺐ ﺍاﻟﺘﺄﻛﺪ ﻣﻦ ﻣﻌﺪﻝل ﺩدﻗﺎﺕت ﺍاﻟﻘﻠﺐ ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻭوﺿﺮﺑﺎﺗﻪﮫ ﺍاﻟﻤﻨﺘﻈﻤﺔ‪ .‬ﻭوﻳﯾﺘﺮﺍاﻭوﺡح ﺍاﻟﻤﻌﺪﻝل ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻣﻦ ‪ 120‬ﺍاﻟﻰ ‪160‬‬
‫ﺿﺮﺑﺔ ﻓﻲ ﺍاﻟﺪﻗﻴﯿﻘﺔ ﺍاﻟﻮﺍاﺣﺪﺓة‪ .‬ﻟﻮﺣﻆ ﺑﻂء ﻗﻠﺐ ﻣﺘﻮﺳﻂ ﺑﺸﻜﻞ ﻋﺎﺑﺮ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻟﺜﺎﻧﻲ ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻟﻸﺟﻨﺔ‪ .‬ﻭوﺑﺎﻟﻨﺴﺒﺔ ﺇإﻟﻰ‬
‫ﺑﻂء ﺍاﻟﻘﻠﺐ ﺍاﻟﺜﺎﺑﺖ‪ ،٬‬ﺧﺼﻮﺻﺎ ً ﻟﻤﻌﺪﻝل ﺍاﻟﻘﻠﺐ ﺍاﻟﺬﻱي ﻳﯾﺒﻘﻰ ﺗﺤﺖ ‪ 110‬ﺿﺮﺑﺔ ﻓﻲ ﺍاﻟﺪﻗﻴﯿﻘﺔ ﺍاﻟﻮﺍاﺣﺪﺓة )‪ ،٬(51‬ﻳﯾﺘﻄﻠّﺐ‬
‫ﺗﻘﻴﯿﻴﯿﻤﺎ ً ﻣﻨﺎﺳﺒﺎ ً ﻣﻦ ﻗﺒﻞ ﺍاﺧﺘﺼﺎﺻﻲ ﻓﻲ ﻗﻠﺐ ﺍاﻟﺠﻨﻴﯿﻦ ﻭوﺫذﻟﻚ ﻟﺘﺠﻨّﺐ ﺍاﺣﺘﻤﺎﻝل ﻭوﺟﻮﺩد ﻛﺘﻠﺔ ﻓﻲ ﺍاﻟﻘﻠﺐ‪ .‬ﻭوﺍاﻟﺘﺒﺎﻁطﺆ ﺍاﻟﻤﺘﻜﺮﺭر‬
‫ﻓﻲ ﻣﻌﺪﻝل ﺿﺮﺑﺎﺕت ﺍاﻟﻘﻠﺐ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻟﺜﺎﻟﺚ ﻣﻦ ﻓﺘﺮﺓة ﺍاﻟﺤﻤﻞ ﻗﺪ ﻳﯾﻜﻮﻥن ﺑﺴﺒﺐ ﻧﻘﺺ ﺍاﻟﺘﺄﻛﺴﺞ ﻟﺪﻯى ﺍاﻟﺠﻨﻴﯿﻦ‪ .‬ﻭوﻋﺎﺩدﺓة ﻻ‬
‫ﻳﯾﺮﺗﺒﻂ ﺗﺨﻄﻲ ﺩدﻗﺎﺕت ﺍاﻟﻘﻠﺐ ﺍاﻟﻌﺮﺿﻴﯿﺔ ﺑﺘﺰﺍاﻳﯾﺪ ﺧﻄﺮ ﺍاﻹﺻﺎﺑﺔ ﺑﻤﺮﺽض ﺍاﻟﻘﻠﺐ ﺍاﻟﺒﻨﻴﯿﻮﻱي ﻓﻐﺎﻟﺒﺎ ً ﻣﺎ ﻳﯾﻜﻮﻥن ﺣﻤﻴﯿﺪﺍاً ﻭوﻳﯾﺰﻭوﻝل‬
‫ﺗﻠﻘﺎﺋﻴﯿﺎ ً‪ .‬ﻭوﻋﻠﻰ ﺍاﻟﺮﻏﻢ ﻣﻦ ﺫذﻟﻚ‪ ،٬‬ﻓﻘﺪ ﺗﺤﺪﺙث ﺑﻌﺾ ﺣﺎﻻﺕت ﺧﻠﻞ ﺍاﻟﻨﻈﻢ ﺍاﻟﺴﺮﻳﯾﺮﻱي ﺍاﻟﻬﮭﺎﻡم ﺣﻴﯿﺚ ﺗﻜﻮﻥن ﻣﺆﺷﺮﺍاً ﻟﺘﺨﻄﻴﯿﻂ‬
‫ﺻﺪﻯى ﻗﻠﺐ ﺍاﻟﺠﻨﻴﯿﻦ)‪ .(52 to 54‬ﻭوﺑﺪﻻً ﻣﻦ ﺫذﻟﻚ‪ ،٬‬ﻳﯾﻤﻜﻦ ﺗﻮﻓﻴﯿﺮ ﺍاﻹﻁطﻤﺌﻨﺎﻥن ﻋﻦ ﻁطﺮﻳﯾﻖ ﻓﺤﺺ ﺍاﻟﺘﺴﻤﻊ ﺩدﻭوﺑﻠﺮﺍاﻷﻛﺜﺮ‬
‫ﺷﻴﯿﻮﻋﺎ ً ﻭوﻓﺤﺺ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻣﻮﺟﻪﮫ ﻻﺳﺘﺒﻌﺎﺩد ﺍاﻷﻧﺼﺒﺎﺏب ﻭوﺍاﻟﺘﺄﻛﺪ ﻣﻦ ﺍاﻟﻠﻘﻄﺎﺕت ﺍاﻟﻄﺒﻴﯿﻌﻴﯿﺔ ﻟﻘﻠﺐ ﺍاﻟﺠﻨﻴﯿﻦ‪.‬‬
‫ﻗﺪ ﺗﺤﺪﺙث ﺣﺎﻟﺔ ﻋﺪﻡم ﺍاﻧﺘﻈﺎﻡم ﺩدﻗﺎﺕت ﺍاﻟﻘﻠﺐ ﺑﺸﻜﻞ ﺧﻔﻴﯿﻒ )<‪ 160‬ﺿﺮﺑﺔ ﻓﻲ ﺍاﻟﺪﻗﻴﯿﻘﺔ ﺍاﻟﻮﺍاﺣﺪﺓة( ﻋﻠﻰ ﺷﻜﻞ ﻁطﺒﻴﯿﻌﻲ‬
‫ﻣﺘﻔﺎﻭوﺕت ﺧﻼﻝل ﺣﺮﻛﺔ ﺍاﻟﺠﻨﻴﯿﻦ‪ .‬ﻣﻊ ﺫذﻟﻚ‪ ،٬‬ﻭوﻓﻲ ﺣﺎﻟﺔ ﻋﺪﻡم ﺍاﻧﺘﻈﺎﻡم ﺩدﻗﺎﺕت ﺍاﻟﻘﻠﺐ ﺍاﻟﻤﺴﺘﻤﺮﺓة )≤‪ 180‬ﺿﺮﺑﺔ ﻓﻲ ﺍاﻟﺪﻗﻴﯿﺔ‬
‫ﺍاﻟﻮﺍاﺣﺪﺓة( )‪ ،٬(55‬ﻳﯾﺠﺐ ﺇإﺟﺮﺍاء ﺗﻘﻴﯿﻴﯿﻢ ﺍاﺿﺎﻓﻲ ﻻﺣﺘﻤﺎﻝل ﻭوﺟﻮﺩد ﻧﻘﺺ ﺍاﻟﺘﺄﻛﺴﺞ ﻟﺪﻯى ﺍاﻟﺠﻨﻴﯿﻦ ﺃأﻭو ﻭوﺟﻮﺩد ﺣﺎﻟﺔ ﺃأﻛﺜﺮ‬
‫ﺧﻄﻮﺭرﺓة ﻣﺜﻞ ﺧﻠﻞ ﺩدﻗﺎﺕت ﺍاﻟﻘﻠﺐ ﺍاﻟﻤﺘﺴﺎﺭرﻋﺔ ‪.tachydysrhythmias‬‬

‫ﺗﺒﺪﻭو ﺍاﻟﺤﺠﻴﯿﺮﺗﺎﻥن ﺍاﻷُ َﺫذ ْﻳﯾﻨَﺘَﺎﻥن ﻣﺘﺴﺎﻭوﻳﯾﺘﻴﯿﻦ ﻓﻲ ﺍاﻟﺤﺠﻢ ﻭوﻳﯾﺠﺐ ﺃأﻥن ﺗﻔﺘﺢ ﺍاﻟﺜﻘﺒﺔ ﺍاﻟﺒﻴﯿﻀﺎﻭوﻳﯾﺔ ﺍاﻟﺴﺪﻳﯾﻠﺔ ﺍاﻟﻰ ﺩدﺍاﺧﻞ ﺍاﻷﺫذﻳﯾﻦ‬
‫ﺍاﻷﻳﯾﺴﺮ‪ .‬ﻳﯾﺠﺐ ﻋﻠﻰ ﺍاﻟﺤﺎﻓﺔ ﺍاﻟﺴﻔﻠﻴﯿﺔ ﻟﻠﺤﺎﺟﺰ ﺍاﻷﺫذﻳﯾﻨﻲ‪ ،٬‬ﻭوﺍاﻟﺘﻲ ﺗﺴﻤﻰ ﺑﺎﻟﺤﺎﺟﺰ ﺍاﻷﻭوﻝل‪ ،٬‬ﺃأﻥن ﺗﻜﻮﻥن ﻣﻮﺟﻮﺩدﺓة‪ .‬ﻭوﻫﮬﮪھﺬﺍا ﻣﺎ‬
‫ﻳﯾﺸﻜﻞ ﺟﺰءﺍاً ﻣﻦ ﺍاﻟﻨﻘﻄﺔ ﺍاﻷﺳﺎﺳﻴﯿﺔ ﻟﻠﻘﻠﺐ‪ ،٬‬ﻭوﻫﮬﮪھﻲ ﺍاﻟﻨﻘﻄﺔ ﺣﻴﯿﺚ ﻳﯾﻠﺘﻘﻲ ﺍاﻟﺠﺰء ﺍاﻟﺴﻔﻠﻲ ﻣﻦ ﺍاﻟﺤﺎﺟﺰ ﺍاﻷﺫذﻳﯾﻨﻲ ﺑﺎﻟﺠﺰء‬
‫ﺍاﻟﻌﻠﻮﻱي ﻣﻦ ﺍاﻟﺤﺎﺟﺰ ﺍاﻟﺒﻄﻴﯿﻨﻲ ﻭو ﺣﻴﯿﺚ ﺗﺪﺭرﺝج ﺍاﻟﺼﻤﺎﻣﺎﺕت ﺍاﻷﺫذﻳﯾﻨﻴﯿﺔ ﺍاﻟﺒﻄﻴﯿﻨﻴﯿﺔ‪ .‬ﻭوﻳﯾﻤﻜﻦ ﺭرﺅؤﻳﯾﺔ ﺍاﻷﻭوﺭرﺩدﺓة ﺍاﻟﺮﺋﻮﻳﯾﺔ ﻣﺘﺪﺍاﺧﻠﺔ‬
‫ﻣﻦ ﺍاﻷﺫذﻳﯾﻦ ﺍاﻷﻳﯾﺴﺮ‪ ،٬‬ﻭوﻋﻨﺪﻣﺎ ﻳﯾﻜﻮﻥن ﺫذﻟﻚ ﻣﻤﻜﻨﺎ ً ﻣﻦ ﺍاﻟﻨﺎﺣﻴﯿﺔ ﺍاﻟﺘﻘﻨﻴﯿﺔ‪ ،٬‬ﻓﻤﻦ ﺍاﻟﻤﺴﺘﺤﺴﻦ ﺗﺼﻮﻳﯾﺮ ﻋﻠﻰ ﺍاﻷﻗﻞ ﺃأﺛﻨﻴﯿﻦ ﻣﻦ‬
‫ﻫﮬﮪھﺬﻩه ﺍاﻷﻭوﺭرﺩدﺓة‪.‬‬

‫ﺍاﻟﺤﺰﺍاﻡم ﺍاﻟﻮﺳﻴﯿﻂ ﻫﮬﮪھﻮ ﺣﺰﻣﺔ ﻣﻦ ﻋﻀﻼﺕت ﺑﺎﺭرﺯزﺓة ﺗﺘﻘﺎﻁطﻊ ﻣﻊ ﺗﺠﻮﻳﯾﻒ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ‪ ،٬‬ﻭوﻳﯾﻤﻜﻦ ﺭرﺅؤﻳﯾﺘﻬﮭﺎ ﺑﺎﻟﻘﺮﺏب ﻣﻦ‬
‫ﺍاﻟﻘﻤﺔ ﺍاﻟﻘﻠﺒﻴﯿﺔ ﻭوﺗﺴﺎﻋﺪ ﻋﻠﻰ ﺗﺤﺪﻳﯾﺪ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ ﺍاﻟﻤﻮﺭرﻓﻮﻟﻮﺟﻲ‪ .‬ﺗﻈﻬﮭﺮ ﻗﻤﺔ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ ﻋﻠﻰ ﺃأﻧﻬﮭﺎ ﺳﻠﺴﺔ‬
‫ﻭوﺗﺸﻜﻞ ﺍاﻟﻘﻤﺔ ﺍاﻟﻘﻠﺒﻴﯿﺔ‪ .‬ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﻈﻬﮭﺮ ﻛﻼ ﺍاﻟﺒﻄﻴﯿﻨﻴﯿﻦ ﺑﺎﻟﺤﺠﻢ ﻧﻔﺴﻪﮫ ﻣﻦ ﺩدﻭوﻥن ﺃأﻱي ﺩدﻻﻟﺔ ﻋﻠﻰ ﻭوﺟﻮﺩد ﺳﻤﺎﻛﺔ ﻓﻲ‬
‫ﺍاﻟﺠﺪﺭرﺍاﻥن‪ .‬ﻭوﻋﻠﻰ ﺭرﻏﻢ ﺫذﻟﻚ ﻓﺈﻥن ﺍاﻟﺘﻔﺎﻭوﺕت ﺃأﻭو ﻋﺪﻡم ﺍاﻟﺘﻨﺎﺳﺐ ﺍاﻟﺨﻔﻴﯿﻒ ﻟﻠﺒﻄﻴﯿﻦ ﻗﺪ ﻳﯾﺤﺪﺙث ﻛﺎﺧﺘﻼﻑف ﻁطﺒﻴﯿﻌﻲ ﻓﻲ ﺍاﻟﺜﻠﺚ‬
‫ﺍاﻟﺜﺎﻟﺚ ﻣﻦ ﻣﺮﺣﻠﺔ ﺍاﻟﺤﻤﻞ‪ ،٬‬ﻭوﻋﺪﻡم ﺍاﻟﺘﻨﺎﺳﺐ ﺍاﻟﻮﺍاﺿﺢ ﺑﻴﯿﻦ ﺍاﻟﻴﯿﻤﻴﯿﻦ ﻭوﺍاﻟﻴﯿﺴﺎﺭر ﻓﻲ ﻓﺘﺮﺓة ﻣﻨﺘﺼﻒ ﺍاﻟﺤﻤﻞ ﻳﯾﺆﻛﺪ ﻋﻠﻰ‬
‫ﺿﺮﻭوﺭرﺓة ﺇإﺟﺮﺍاء ﺍاﻟﻤﺰﻳﯾﺪ ﻣﻦ ﺍاﻟﻔﺤﻮﺻﺎﺕت )‪(56‬؛ ﺍاﻵﻓﺎﺕت ﺍاﻟﻤﻌﻴﯿﻘﺔ ﻓﻲ ﺍاﻟﺠﺎﻧﺐ ﺍاﻷﻳﯾﺴﺮ‪ ،٬‬ﻣﺜﻞ ﺗﻀﻴﯿﻴﯿﻖ ﺍاﻷﺑﻬﮭﺮ ﻭوﺗﻄﻮﺭر‬
‫ﻣﺘﻼﺯزﻣﺔ ﺍاﻟﻘﻠﺐ ﺍاﻷﻳﯾﺴﺮ ﺍاﻟﻨﺎﻗﺺ ﺍاﻟﺘﻨﺴﺞ ﻫﮬﮪھﻲ ﺃأﺳﺒﺎﺏب ﻣﻬﮭﻤﺔ ﻟﻬﮭﺬﺍا ﺍاﻟﺘﻔﺎﻭوﺕت)‪.(57,58‬‬

‫ﻳﯾﺠﺐ ﺇإﺟﺮﺍاء ﻓﺤﺺ ﺩدﻗﻴﯿﻖ ﻟﻠﺤﺎﺟﺰ ﺍاﻟﺒﻄﻴﯿﻨﻲ ﻣﻦ ﺍاﻟﻘﻤﺔ ﺣﺘﻰ ﺍاﻟﻨﻘﻄﺔ ﺍاﻟﺮﺋﻴﯿﺴﻴﯿﺔ‪ ،٬‬ﻟﻠﺘﺄﻛﺪ ﻣﻦ ﻋﺪﻡم ﻭوﺟﻮﺩد ﺃأﻱي ﻋﻴﯿﻮﺏب ﻓﻲ‬
‫ﺟﺪﺍاﺭر ﺍاﻟﻘﻠﺐ ﺃأﺫذ ﺃأﻥن ﻛﺸﻒ ﻫﮬﮪھﺬﻩه ﺍاﻟﻌﻴﯿﻮﺏب ﻣﻤﻜﻦ ﺃأﻥن ﻳﯾﻜﻮﻥن ﺻﻌﺒﺎ ً‪ .‬ﻭوﻳﯾﻤﻜﻦ ﺭرﺅؤﻳﯾﺔ ﺍاﻟﺤﺎﺟﺰ ﺑﺸﻜﻞ ﺃأﻭوﺿﺢ ﻋﻨﺪﻣﺎ ﺗﺘﺠﻪﮫ‬
‫ﺯزﻭوﺍاﻳﯾﺎ ﺍاﻟﺘﻌﺮﺽض ﻟﻠﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻋﻤﻮﺩدﻳﯾﺎ ً ﺍاﻟﻴﯿﻪﮫ‪ .‬ﻭوﻋﻨﺪﻣﺎ ﻳﯾﻜﻮﻥن ﺷﻌﺎﻉع ﺍاﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻣﻮﺍاﺯزﻳﯾﺎ ً ﺑﺸﻜﻞ‬
‫ﻣﺒﺎﺷﺮ ﻟﺠﺪﺍاﺭر ﺍاﻟﺒﻄﻴﯿﻦ‪ ،٬‬ﻳﯾﻤﻜﻦ ﺍاﻻﺷﺘﺒﺎﻩه ﺑﺨﻠﻞ ﻛﺎﺫذﺏب ﺃأﻭو ﺯزﺍاﺋﻒ ﻭوﺫذﻟﻚ ﺑﺴﺒﺐ ﻭوﻗﻮﻉع ﺧﺎﺩدﻋﺔ ﺻﻮﺗﻴﯿﺔ ﺧﺎﻁطﺌﺔ ﺳﻬﮭﻮﺍاً‪ .‬ﻭوﻗﺪ‬
‫ﻳﯾﻜﻮﻥن ﻣﻦ ﺍاﻟﺼﻌﺐ ﺟﺪﺍاً ﺍاﻟﺘﺄﻛﺪ ﻣﻦ ﻭوﺟﻮﺩد ﻋﻴﯿﻮﺏب ﺻﻐﻴﯿﺮﺓة ﻓﻲ ﺍاﻟﺤﺎﺟﺰ )‪ 1‬ﺇإﻟﻰ ‪ 2‬ﻣﻠﻢ( ﺇإﺫذﺍا ﻓﺸﻞ ﺍاﻟﻔﺤﺺ ﺑﻨﻈﺎﻡم‬
‫ﺍاﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺑﺘﻮﻓﻴﯿﺮ ﻗﺪﺭر ﻛﺎﻓﻲ ﻣﻦ ﺍاﻟﺤ ّﻞ ﺍاﻟﺠﺎﻧﺒﻲ‪ ،٬‬ﺧﺼﻮﺻﺎ َ ﺃأﺫذﺍا ﻛﺎﻥن ﺣﺠﻢ ﺍاﻟﺠﻨﻴﯿﻦ ﻭوﻣﻮﻗﻌﻪﮫ ﻏﻴﯿﺮ‬
‫ﻣﺆﺍاﺗﻴﯿﻴﯿﻦ‪ .‬ﻭوﻣﻊ ﺫذﻟﻚ ﺗﻜﻮﻥن ﻣﻌﻈﻢ ﻫﮬﮪھﺬﻩه ﺍاﻟﺤﺎﻻﺕت ﺫذﺍاﺕت ﻣﻐﺰﻯى ﺳﺮﻳﯾﺮﻱي ﻣﺤﺪﻭوﺩد ﻭوﻣﻦ ﺍاﻟﻤﻤﻜﻦ ﺃأﻥن ﺗﺨﻀﻊ ﻷﻏﻼﻕق‬
‫ﺗﻠﻘﺎﺋﻲ ﻣﺤﻜﻢ)‪.(59,60‬‬

‫ﺍاﻟﺠﺪﻭوﻝل ﺭرﻗﻢ ‪ :1‬ﺗﻘﻴﯿﻴﯿﻢ ﻣﻮﻗﻊ ﺍاﻟﺠﻨﻴﯿﻦ‪ /‬ﺍاﻟﺘﺠﺎﻧﺐ ﻭوﻟﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻌﺔ‬

‫ﺍاﻟﻤﻮﻗﻊ ﻭوﺍاﻟﺠﻮﺍاﻧﺐ ﺍاﻟﻌﺎﻣﺔ‬ ‫•‬

‫ﺗﺠﺎﻧﺐ ﺍاﻟﺠﻨﻴﯿﻦ )ﺗﻄﺎﺑﻖ ﺍاﻟﺠﺎﻧﺐ ﺍاﻟﻴﯿﻤﻴﯿﻦ ﻭوﺍاﻟﺠﺎﻧﺐ ﺍاﻟﻴﯿﺴﺎﺭر ﻟﻠﺠﻨﻴﯿﻦ(‬
‫ﺍاﻟﻤﻌﺪﺓة ﻭوﺍاﻟﻘﻠﺐ ﻓﻲ ﺍاﻟﺠﺎﻧﺐ ﺍاﻟﻴﯿﺴﺎﺭر‬
‫ﻳﯾﺤﺘﻞ ﺍاﻟﻘﻠﺐ ﺛﻠﺚ ﺍاﻟﻤﺴﺎﺣﺔ ﺍاﻟﺼﺪﺭرﻳﯾﺔ‬
‫ﻏﺎﻟﺒﻴﯿﺔ ﺍاﻟﻘﻠﺐ ﻳﯾﻘﻊ ﻓﻲ ﺍاﻟﺼﺪﺭر ﺍاﻻﻳﯾﺴﺮ ﺍاﻟﻤﺤﻮﺭر ﺍاﻟﻘﻠﺒﻲ )ﺍاﻟﻘﻤﺔ( ﻳﯾﺘﻮﺟﻪﮫ ﺍاﻟﻰ ﺍاﻟﻴﯿﺴﺎﺭر ﻓﻲ ﺍاﺗﺠﺎﻩه◦‪45◦ ±20‬‬
‫ﻭوﺟﻮﺩد ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻌﺔ‬
‫ﺿﺮﺑﺎﺕت ﻗﻠﺐ ﻁطﺒﻴﯿﻌﻴﯿﺔ‬
‫ﻻ ﻭوﺟﻮﺩد ﻟﻸﻧﺼﺒﺎﺏب ﺍاﻟﺘﺎﻣﻮﺭرﻱي‬
‫ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻷﺫذﻳﯾﻨﻲ‬ ‫•‬
‫ﺃأُ َﺫذ ْﻳﯾﻨَﻴﯿﺎﻥن‪ ،٬‬ﻣﺘﺴﺎﻭوﻳﯾﺎﻥن ﺗﻘﺮﻳﯾﺒﺎ ﺑﺎﻟﺤﺠﻢ‬
‫ً‬
‫ﺛﻘﺒﺔ ﺑﻴﯿﻀﺎﻭوﻳﯾﺔ ﺳﺪﻳﯾﻠﻪﮫ ﻓﻲ ﺍاﻷﺫذﻳﯾﻦ ﺍاﻷﻳﯾﺴﺮ‬
‫ﺍاﻷﺫذﻳﯾﻨﻲ ﺍاﻟﺤﺎﺟﺰ ﺍاﻷﻭوﻝل ﺍاﻟﺤﺎﺿﺮ )ﺑﺎﻟﻘﺮﺏب ﻣﻦ ﺍاﻟﻨﻘﻄﺔ ﺍاﻷﺳﺎﺳﻴﯿﺔ(‬
‫ﺍاﻷﻭوﺭرﺩدﺓة ﺍاﻟﺮﺋﻮﻳﯾﺔ ﺍاﻟﺘﻲ ﺗﺪﺧﻞ ﺍاﻷﺫذﻳﯾﻦ ﺍاﻷﻳﯾﺴﺮ‬
‫ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﺒﻄﻴﯿﻦ‬ ‫•‬
‫ً‬
‫ﺍاﺛﻨﺎﻥن ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻨﺎﺕت‪ ،٬‬ﻣﺘﺴﺎﻭوﻳﯾﺎﻥن ﺗﻘﺮﻳﯾﺒﺎ ﺑﺎﻟﺤﺠﻢ‬
‫ﻻ ﺗﻀﺨﻢ ﻓﻲ ﺟﺪﺍاﺭر ﺍاﻟﺒﻄﻦ‬
‫ﺍاﻟﺤﺰﺍاﻡم ﺍاﻟﻮﺳﻴﯿﻂ ﻓﻲ ﻗﻤﺔ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ‬
‫ﺍاﻟﺤﺎﺟﺰ ﺍاﻟﺒﻄﻴﯿﻨﻲ ﺍاﻟﺴﻠﻴﯿﻢ )ﺍاﻟﻘﻤﺔ ﺍاﻟﻰ ﺍاﻟﻨﻘﻄﺔ ﺍاﻷﺳﺎﺳﻴﯿﺔ(‬
‫ﻮﺻﻞ ﺃأُ َﺫذﻳﯾﻨِ ﱞﻲ ﺑُﻄَﻴﯿﻨِ ّﻲ ﻭوﺍاﻟﺼﻤﺎﻣﺎﺕت‬
‫َﻣ ِ‬ ‫•‬
‫ﺍاﻟﻨﻘﻄﺔ ﺍاﻷﺳﺎﺳﻴﯿﺔ ﺍاﻟﻘﻠﺒﻴﯿﺔ ﺍاﻟﺴﻠﻴﯿﻤﺔ‬
‫ﺻﻤﺎﻣﺎ ﺍاﻷﺫذﻳﯾﻨﻴﯿﺔ ﺍاﻟﺒﻄﻴﯿﻨﻴﯿﺔ ﻣﻔﺘﻮﺣﺎﻥن ﻭوﻳﯾﺘﺤﺮﻛﺎﻥن ﺑﺤﺮﻳﯾﺔ‬
‫ﺗﻔﺎﺿﻞ ﺍاﻟﻤﻮﺍاﺯزﻧﺔ‪ :‬ﺗﻨﺪﺭرﺝج ﻧﺸﺮﺓة ﺍاﻟﺼﻤﺎﻡم ﺍاﻟﺜﻼﺛﻲ ﺍاﻷﻁطﺮﺍاﻑف ﻋﻠﻰ ﺍاﻟﺤﺎﺟﺰ ﺍاﻟﺒﻄﻴﯿﻨﻲ ﺍاﻷﻗﺮﺏب ﺍاﻟﻰ ﺍاﻟﻘﻤﺔ ﺍاﻟﻘﻠﺒﻴﯿﺔ ﻣﻦ ﺍاﻟﺼﻤﺎﻡم‬
‫ﺍاﻟﺘﺎﺟﻲ‬
‫ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﻈﻬﮭﺮ ﺍاﺛﻨﺎﻥن ﻣﻦ ﺍاﻟﺼﻤﺎﻣﺎﺕت ﺍاﻷﺫذﻳﯾﻨﻴﯿﺔ ﺍاﻟﺒﻄﻴﯿﻨﻴﯿﺔ )ﺍاﻟﺠﺎﻧﺐ ﺍاﻷﻳﯾﻤﻦ‪ ،٬‬ﺻﻤﺎﻡم ﺛﻼﺛﻲ ﺍاﻷﻁطﺮﺍاﻑف؛ ﺍاﻟﺠﺎﻧﺐ ﺍاﻷﻳﯾﺴﺮ‪،٬‬‬
‫ﺍاﻟﺼﻤﺎﻡم ﺍاﻟﺘﺎﺟﻲ( ﻣﻔﺘﻮﺣﻴﯿﻦ ﺑﺸﻜﻞ ﻣﻨﻔﺼﻞ ﻭوﻣﻦ ﺩدﻭوﻥن ﻋﻮﺍاﺋﻖ‪ .‬ﻭوﻗﺪ ﺃأﺩدﺭرﺟﺖ ﺍاﻟﻮﺭرﻗﻴﯿﺔ ﺍاﻟﺤﺎﺟﺰﻳﯾﺔ ﻟﻠﺼﻤﺎﻡم ﺍاﻟﺜﻼﺛﻲ‬
‫ﺍاﻷﻁطﺮﺍاﻑف ﻣﻊ ﺍاﻟﺤﺎﺟﺰ ﺍاﻷﻗﺮﺏب ﺍاﻟﻰ ﺍاﻟﻘﻤﺔ ﻋﻨﺪ ﻣﻘﺎﺭرﻧﺘﻪﮫ ﻣﻊ ﺣﺎﺟﺰ ﺍاﻟﺼﻤﺎﻡم ﺍاﻟﺘﺎﺟﻲ )ﺍاﻟﺘﻮﺍاء ﻁطﺒﻴﯿﻌﻲ(‪ .‬ﻭوﻗﺪ ﻳﯾﻜﻮﻥن‬
‫ﺍاﻟﺘﻮﺍاﻓﻖ ﺍاﻟﻐﻴﯿﺮ ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻟﻠﺼﻤﺎﻣﺎﺕت ﺍاﻷﺫذﻳﯾﻨﻴﯿﺔ ﺍاﻟﺒﻄﻴﯿﻨﻴﯿﺔ ﻣﻔﺘﺎﺣﺎ ً ﻟﻠﺘﺨﻄﻴﯿﻂ ﺍاﻟﺘﺼﻮﺍاﺗﻲ ﻟﻠﻌﺜﻮﺭر ﻋﻠﻰ ﺗﺸﻮﻫﮬﮪھﺎﺕت ﻗﻠﺒﻴﯿﺔ ﻣﺜﻞ‬
‫ﻋﻴﯿﺐ ﺍاﻟﺤﺎﺟﺰ ﺍاﻷﺫذﻳﯾﻨﻲ ﺍاﻟﺒﻄﻴﯿﻨﻲ‪.‬‬

‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪) :1‬ﺃأ( ﻳﯾﺘ ّﻢ ﺍاﻟﺘﺄﻛﺪ ﻣﻦ ﻣﻮﻗﻊ ﺍاﻟﺒﻄﻦ ﻋﻦ ﻁطﺮﻳﯾﻖ ﻟﻘﻄﺔ ﻋﺮﺿﻴﯿﺔ ﻟﺒﻄﻦ ﺍاﻟﺠﻨﻴﯿﻦ‪ .‬ﺑﻌﺪ ﺗﺤﺪﻳﯾﺪ ﺗﺠﺎﻧﺐ ﺍاﻟﺠﻨﻴﯿﻦ ﻣﻦ ﺧﻼﻝل ﻣﻮﻗﻌﻪﮫ ﻓﻲ ﺍاﻟﺮﺣﻢ‪ ،٬‬ﺣﻴﯿﺚ‬
‫ﻳﯾﺠﺐ ﺃأﻥن ﺗُﺤﺪﺩد ﻣﻮﻗﻊ ﺍاﻟﻤﻌﺪﺓة ﻓﻲ ﺍاﻟﺠﻬﮭﺔ ﺍاﻟﻴﯿﺴﺮﻯى ﻟﻠﺠﻨﻴﯿﻦ ﻣﻊ ﺍاﻷﺑﻬﮭﺮ ﺍاﻟﻨﺎﺯزﻝل )‪ (Aorta.D‬ﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻷﺟﻮﻑف ﺍاﻟﺴﻔﻠﻲ ﻓﻲ ﺍاﻟﺠﻬﮭﺔ ﺍاﻟﻴﯿﺴﺮﻯى ﻭوﺍاﻟﻴﯿﻤﻨﻰ ﻟﻠﻌﻤﻮﺩد ﺍاﻟﻔﻘﺮﻱي‬
‫ﻋﻠﻰ ﺍاﻟﺘﻮﺍاﻟﻲ‪ .‬ﻳﯾﻈﻬﮭﺮﻗﺴﻢ ﺻﻐﻴﯿﺮ ﻣﻦ ﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻟﺴﺮﻱي )‪) .(UV‬ﺏب( ﻣﻮﻗﻊ ﺍاﻟﻘﻠﺐ ﻭوﻣﺤﻮﺭرﻩه‪ :‬ﻣﻮﻗﻊ ﺍاﻟﻘﻠﺐ ﺃأﺳﺎﺳﺎ ً ﻓﻲ ﺍاﻟﺠﻬﮭﺔ ﺍاﻟﻴﯿﺴﺮﻯى‪ .‬ﺗﻮﺟﻪﮫ ﺍاﻟﻘﻤﺔ ﺍاﻟﻘﻠﺒﻴﯿﺔ ﺍاﻟﻰ ﺍاﻟﻴﯿﺴﺎﺭر‬
‫ﺑﺤﻮﺍاﻟﻲ ◦‪ 45±20‬ﺑﺎﻟﻨﺴﺒﺔ ﺇإﻟﻰ ﺍاﻟﻤﺤﻮﺭر ﺍاﻷﻣﺎﻣﻲ ﺍاﻟﺨﻠﻔﻲ ﻟﻠﺼﺪﺭر‪.‬ﺍاﻷﺫذﻳﯾﻦ ﺍاﻷﻳﯾﺴﺮ )‪ ،٬(LA‬ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ)‪ ،٬(LV‬ﺍاﻟﻴﯿﻤﻴﯿﻦ )‪ ،٬(R‬ﺍاﻷﺫذﻳﯾﻦ ﺍاﻷﻳﯾﻤﻦ )‪ ،٬(RA‬ﺍاﻟﺒﻄﻴﯿﻦ‬
‫ﺍاﻷﻳﯾﻤﻦ )‪.(RV‬‬

‫ﻟﻘﻄﺎﺕت ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ‬

‫ﺗﻌﺘﺒﺮ ﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮﻭوﺍاﻷﻳﯾﻤﻦ ﺟﺰ ًءﺍا ﻻ ﻳﯾﺘﺠﺰﺃأ ﻣﻦ ﺗﺼﻮﻳﯾﺮ ﻓﺤﺺ ﺍاﻟﻘﻠﺐ‬
‫ﺍاﻟﺠﻨﻴﯿﻨﻲ‪ .‬ﻣﻦ ﺍاﻟﻤﻬﮭﻢ ﺟﺪﺍاً ﺍاﻟﺘﺄﻛﺪ ﻣﻦ ﺍاﻟﺤﺎﻟﺔ ﺍاﻟﻄﺒﻴﯿﻌﻴﯿﺔ ﻟﻠﻮﻋﺎﺋﻴﯿﻦ ﺑﻤﺎ ﻓﻲ ﺫذﻟﻚ ﺇإﺗﺼﺎﻟﻬﮭﻤﺎ ﺑﺎﻟﺒﻄﻴﯿﻦ ﺍاﻟﻤﻨﺎﺳﺐ‪ ،٬‬ﻭوﺣﺠﻤﻬﮭﻤﺎ‬
‫ﻭوﻣﻮﻗﻌﻬﮭﻤﺎ ﺍاﻟﻨﺴﺒﻴﯿﻴﯿﻦ ﻭوﻓﺘﺤﺔ ﺍاﻟﺼﻤﺎﻡم ﺍاﻟﺸﺮﻳﯾﺎﻧﻲ ﺍاﻟﻤﻨﺎﺳﺒﺔ‪ .‬ﻭوﻓﻲ ﺣﺎﻝل ﻋﺪﻡم ﺍاﻟﺘﺄﻛﺪ ﻣﻦ ﺫذﻟﻚ ﻣﻦ ﺍاﻟﻤﺴﺘﺤﺴﻦ ﺇإﺟﺮﺍاء ﺗﻘﻴﯿﻴﯿﻢ‬
‫ﺇإﺿﺎﻓﻲ‪.‬‬

‫ﻳﯾﺘﻄﻠّﺐ ﻓﺤﺺ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻋﻠﻰ ﺍاﻷﻗ ّﻞ ﺗﺴﺎﻭوﻱي ﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﻜﺒﻴﯿﺮﺓة ﺗﻘﺮﻳﯾﺒﺎ ً ﻓﻲ ﺍاﻟﺤﺠﻢ ﻭوﺗﻼﻗﻴﯿﻬﮭﺎ ﻓﻲ‬
‫ﺍاﻟﺰﻭوﺍاﻳﯾﺎ ﺍاﻟﻘﺎﺋﻤﺔ ﻣﻦ ﻣﺼﺪﺭرﻫﮬﮪھﺎ ﻭوﺧﺮﻭوﺟﻬﮭﺎ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻟﺨﺎﺹص ﺑﻬﮭﺎ )ﻋﺒﻮﺭر ﺗﺒﺎﺩدﻟﻲ ﻁطﺒﻴﯿﻌﻲ‪ ،٬‬ﻣﻠﺤﻖ ﺭرﻗﻢ ‪ ،٬S1‬ﻻﺋﺤﺔ‬
‫ﺭرﻗﻢ ‪ .(1‬ﻓﺤﺼﺖ ﺩدﺭرﺍاﺳﺔ ﻭوﺍاﺳﻌﺔ ﻟﻠﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻟﻠﺘﻮﻟﻴﯿﺪ ﻋﻠﻰ ‪ 18000‬ﺟﻨﻴﯿﻦ )‪ (61‬ﺍاﻷﺩدﺍاء ﺍاﻟﻘﻴﯿﺎﺳﻲ ﻟﺪﻣﺞ‬
‫ﻟﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ ﻭوﺗﻘﻴﯿﻴﯿﻢ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﺣﻴﯿﻦ ﻳﯾﻜﻮﻥن ﺫذﻟﻚ ﺗﻘﻨﻴﯿﺎ ً ﻣﻨﺎﺳﺒﺎ ً ﻓﻲ ‪ 30‬ﺩدﻗﻴﯿﻘﺔ ﻣﻦ‬
‫ﺍاﻟﻔﺤﺺ ﺍاﻟﺮﻭوﺗﻴﯿﻨﻲ‪ .‬ﺍاﺭرﺗﺒﻄﺖ ﻣﻌﻈﻢ ﺍاﻟﻔﺤﻮﺻﺎﺕت )‪ (93%‬ﺍاﻟﺘﻲ ﺿﻤﺖ ﻟﻘﻄﺔ ﻣﻨﺎﺳﺒﺔ ﻟﺤﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ ﺑﺘﻘﻴﯿﻴﯿﻢ‬
‫ﻣﺮﺽض ﻟﻄﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ‪ .‬ﻛﺎﻧﺖ ﺍاﻟﻤﻌﺪﻻﺕت ﻏﻴﯿﺮ ﺍاﻟﻈﺎﻫﮬﮪھﺮﻳﯾﺔ ﻋﻠﻰ ﺍاﻟﺸﻜﻞ ﺍاﻟﺘﺎﻟﻲ‪ 4.2% :‬ﻟﻠﻘﻄﺔ ﻁطﺮﻳﯾﻖ‬ ‫ٍ‬
‫ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ‪ 1.6% ،٬‬ﻟﻠﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ ﻭو‪1.3%‬‬
‫ﻟﻜﻠ ّﻲ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ‪.‬‬

‫ﺗﻈﻬﮭﺮ ﻟﻘﻄﺔ ﺍاﻟﻤﻘﻄﻊ ﺍاﻟﻌﺮﺿﻲ ﺍاﻹﺿﺎﻓﻴﯿﺔ ﺟﻮﺍاﻧﺐ ﻣﺨﺘﻠﻔﺔ ﻟﻸﻭوﻋﻴﯿﺔ ﺍاﻟﻜﺒﻴﯿﺮﺓة ﻭوﺍاﻟﺘﺮﻛﻴﯿﺒﺎﺕت ﺍاﻟﻤﺤﻴﯿﻄﺔ ﺑﻬﮭﺎ‪ ،٬‬ﻟﻜﻨﻬﮭﺎ ﺟﺰ ًءﺍا‬
‫ﻣﻦ ﻣﺴﺢ ﻣﺘﻮﺍاﺻﻞ ﺑﺪ ًءﺍا ﻣﻦ ﻁطﺮﻳﯾﻖ ﺗﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ ﻭوﺗﺘﻀﻤﻦ ﻟﻘﻄﺔ ﺍاﻟﻮﻋﺎء ﺍاﻟﺜﻼﺛﻲ ﻭوﺍاﻷﻭوﻋﻴﯿﺔ‬
‫ﺍاﻟﺜﻼﺛﺔ ﻭوﺍاﻟﺮﻏﺎﻣﻰ )ﻣﻠﺤﻖ ﺭرﻗﻢ ‪ ،٬S1‬ﻻﺋﺤﺔ ﺭرﻗﻢ ‪ .(2‬ﺃأﺿﻴﯿﻒ ﻛﻞ ﻣﻦ ﺍاﻟﻮﻋﺎء ﺍاﻟﺜﻼﺛﻲ ﻭوﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﺜﻼﺛﺔ ﻭوﺍاﻟﺮﻏﺎﻣﻰ‬
‫ﻓﻲ ﺩدﺭرﺍاﺳﺔ‪  ‬ﺗﺸﻤﻞ ‪ 3000‬ﺣﺎﻟﺔ ﺣﻤﻞ ﻣﻨﺨﻔﻀﺔ ﺍاﻟﻤﺨﺎﻁطﺮ‪ ،٬‬ﺇإﻟﻰ ﻟﻘﻄﺔ ﻣﻌﺎﻳﯾﻴﯿﺮ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ ﻛﻮﻧﻬﮭﺎ ﺟﺰ ًءﺍا‬
‫ﻣﻦ ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺍاﻟﺮﻭوﺗﻴﯿﻨﻲ‪ .‬ﻛﺎﻥن ﻣﻌﺪﻝل ﺍاﻟﻮﻗﺖ ﻟﻠﺤﺼﻮﻝل ﻋﻠﻰ ﺍاﻟﻘﻄﺎﺕت ﺍاﻟﻘﻠﺒﻴﯿﺔ ﺃأﻛﺜﺮ ﻣﻦ ﻣﺠﺮﺩد ﺩدﻗﻴﯿﻘﺘﻴﯿﻦ ﻓﻲ ﺣﻴﯿﻦ ﺗﺄﺟﻞ‬
‫ﻓﺤﺺ ﺍاﻟﻘﻠﺐ ﻟﺪﻯى ﺛﻠﺚ ﺍاﻟﺤﺎﻻﺕت ﺇإﻟﻰ ‪ 15‬ﺇإﻟﻰ ‪ 20‬ﺩدﻗﻴﯿﻘﺔ ﻧﺘﻴﯿﺠﺔ ﻭوﺿﻌﺔ ﺍاﻟﺠﻨﻴﯿﻦ )ﺍاﻟﺸﻮﻛﺔ ﺍاﻷﻣﺎﻣﻴﯿﺔ( )‪.(46‬‬

‫ﻳﯾﺰﻳﯾﺪ ﺗﻘﻴﯿﻴﯿﻢ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻌﺪﻝل ﻛﺸﻒ ﺍاﻟﺤﺎﻻﺕت ﻷﺑﺮﺯز ﺗﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﻘﻠﺐ ﺃأﻛﺜﺮ ﻣﻦ ﺗﻠﻚ ﺍاﻟﻘﺎﺑﻠﺔ ﻟﻺﻧﺠﺎﺯز‬
‫ﻣﻦ ﺧﻼﻝل ﻟﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ ﻓﻘﻂ )‪ .(20,40,42,62,63‬ﻓﻠﺪﻯى ﺇإﺩدﺭرﺍاﺝج ﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ‬
‫ﻣﻦ ﺍاﻟﻤﺤﺘﻤﻞ ﺗﺤﺪﻳﯾﺪ ﺷﺬﻭوﺫذ ﺍاﻷﻣﺮﺍاﺽض ﺍاﻟﻘﻠﺒﻴﯿﺔ ﻛﺮﺑﺎﻋﻲ ﻓﺎﻟﻮ ﻭوﺗﻐﻴﯿﻴﯿﺮ ﻭوﺿﻊ ﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﻜﺒﻴﯿﺮﺓة ﻭوﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ ﺫذﺍاﺕت‬
‫ﻣﺨﺮﺟﻴﯿﻦ ﻭوﺍاﻟﺠﺬﻉع ﺍاﻟﺸﺮﻳﯾﺎﻧﻲ( )‪.(43 to 46, 64 to 69‬‬

‫ﺍاﻟﺘﺨﻄﻴﯿﻂ ﺍاﻟﺼﻮﺗﻲ‬

‫ﻳﯾﻮﻓﺮ ﺇإﺟﺮﺍاء ﻣﺴﺢ ﻣﺴﺘﻌﺮﺽض ﺃأﻭو ﻣﺎ ﻳﯾﻌﺮﻑف ﺑﺘﻘﻨﻴﯿﺔ ﺍاﻟﻤﺴﺢ ﻣﻊ ﺣﺮﻛﺔ ﺑﺈﺗﺠﺎﻩه ﺍاﻟﺮﺃأﺱس ﻟﻠﻤﺤﻮﻻﺕت ﻣﻦ ﺍاﻟﺒﻄﻦ ﺍاﻟﺠﻨﻴﯿﻨﻲ‬
‫)ﺑﻤﺴﺘﻮﻯى ﻣﻌﻴﯿﺎﺭر ﺍاﻟﻘﻄﺮ ﺍاﻟﺒﻄﻨﻲ(‪ ،٬‬ﻣﻦ ﺧﻼﻝل ﻟﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ ﻧﺤﻮ ﺍاﻟﻤﻨﺼﻒ ﺍاﻷﻋﻠﻰ‪ ،٬‬ﻁطﺮﻳﯾﻘﺔ ﻧﻈﺎﻣﻴﯿﺔ‬
‫ﻟﺘﻘﻴﯿﻴﯿﻢ ﺍاﻟﻘﻠﺐ ﺍاﻟﺠﻨﻴﯿﻨﻲ‪ ،٬‬ﻛﻤﺎ ﻳﯾﺆﻣﻦ ﺭرﺅؤﻯى ﻣﺨﺘﻠﻔﺔ ﻣﻦ ﺧﻼﻟﻬﮭﺎ ﻳﯾﻤﻜﻦ ﺗﺄﻛﻴﯿﺪ ﺍاﻟﺤﺎﻟﺔ ﺍاﻟﻄﺒﻴﯿﻌﻴﯿﺔ ﻟﻠﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ‬
‫ﺍاﻟﻘﻠﺐ‪ :‬ﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ ﻭوﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ‬
‫ﻭوﺍاﻟﻮﻋﺎء ﺍاﻟﺜﻼﺛﻲ ﻭوﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﺜﻼﺛﺔ ﻭوﺍاﻟﺮﻏﺎﻣﻰ )‪) (70‬ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ .(3‬ﻓﻴﯿﻤﻜﻦ ﺍاﻟﺤﺼﻮﻝل ﻋﻠﻰ ﻟﻘﻄﺔ‬
‫ﻟﻜﻦ ﺇإﻅظﻬﮭﺎﺭر ﻛﻞ ﻫﮬﮪھﺬﻩه ﺍاﻷﻣﻮﺭر ﻗﺪ ﻻ ﻳﯾﻜﻮﻥن ﺗﻘﻨﻴﯿﺎ ً‬
‫ﻟﻄﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻓﻲ ﺍاﻹﺧﺘﺒﺎﺭر ﺍاﻟﻤﺜﺎﻟﻲ ﺑﺴﻬﮭﻮﻟﺔ ﻧﺴﺒﻴﯿﺔ ّ‬
‫ﻣﻨﺎﺳﺒﺎ ً ﻟﺪﻯى ﻛﻞ ﺣﺎﻣﻞ ﺃأﺛﻨﺎء ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺍاﻟﺮﻭوﺗﻴﯿﻨﻲ‪ .‬ﻟﺬﺍا ﻳﯾﻌﺘﺒﺮ ﺍاﻹﻁطﻼﻉع ﻋﻠﻰ ﻛﻞ ﺗﻠﻚ ﺍاﻷﻣﻮﺭر ﺃأﻣﺮﺍاً ﻣﺮﻏﻮﺑﺎ ً ﻓﻴﯿﻪﮫ‪.‬‬

‫ﻳﯾﻤﻜﻦ ﺍاﻟﺤﺼﻮﻝل ﻋﻠﻰ ﻟﻘﻄﺔ ﻟﻄﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ ﻭوﺍاﻷﻳﯾﻤﻦ ﻣﻦ ﺧﻼﻝل ﺇإﻧﺰﻻﻕق ﺍاﻟﻤﺤﻮﻻﺕت‬
‫ﻧﺤﻮ ﺍاﻟﺮﺃأﺱس ﺍاﻟﺠﻨﻴﯿﻨﻲ )ﺗﻘﻨﻴﯿﺔ ﺍاﻟﻤﺴﺢ( )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ ،٬(4‬ﺑﺪ ًءﺍا ﻣﻦ ﻟﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ ﻟﻠﺤﺼﻮﻝل‬
‫ﻋﻠﻰ ﺍاﻟﺘﻌﺎﺑﺮ ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻟﻸﺑﻬﮭﺮ ﻭوﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﺍاﻷﺳﺎﺳﻲ ﻓﻲ ﻣﺼﺪﺭرﻫﮬﮪھﻤﺎ‪ .‬ﻳﯾﻤﻜﻦ ﻟﻘﻂ ﺃأﻳﯾﻀﺎ ً ﺗﻔﺎﺻﻴﯿﻞ ﺇإﻧﺸﻌﺎﺏب‬
 ‫ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي )ﻣﻠﺤﻖ ‪ ،٬S1‬ﻻﺋﺤﺔ ﺭرﻗﻢ ‪ 1‬ﻭو ‪ .(2‬ﻛﻤﺎ ﺗ ّﻢ ﻭوﺻﻒ ﺗﺒﺪﻳﯾﻞ ﺍاﻟﻄﺮﻳﯾﻘﺔ ﻟﺘﻘﻴﯿﻴﯿﻢ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ‬
‫ﻟﺪﻯى ﺍاﻟﺠﻨﻴﯿﻦ‪ :‬ﺍاﻟﺘﻘﻨﻴﯿﺔ ﺍاﻟﺪﻭوﺭرﺍاﻧﻴﯿﺔ )ﻣﻠﺤﻖ ‪ ،٬S2‬ﻻﺋﺤﺔ ﺭرﻗﻢ ‪ .(1‬ﺇإﻥن ﺍاﻟﻤﺤﻮﻻﺕت ﺃأﻭوﻻً ﻣﺪﺍاﺭرﺓة ﻣﻦ ﺟﻬﮭﺔ ﻟﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت‬
‫ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ ﻧﺤﻮ ﺍاﻟﻜﺘﻒ ﺍاﻟﻴﯿﻤﻴﯿﻦ ﺍاﻟﺠﻨﻴﯿﻨﻲ‪ .‬ﻗﺪ ﺗﻄﻠﺐ ﻫﮬﮪھﺬﻩه ﺍاﻟﺘﻘﻨﻴﯿﺔ ﺍاﻟﻤﻄﺒﻘﺔ ﺑﺴﻬﮭﻮﻟﺔ ﺣﻴﯿﻦ ﻳﯾﻜﻮﻥن ﺍاﻟﺤﺎﺟﺰ ﺑﻴﯿﻦ ﺍاﻟﺒﻄﻴﯿﻨﻴﯿﻦ‬
‫ﻋﻤﻮﺩدﻳﯾﺎ ً ﻋﻠﻰ ﺍاﻟﺤﺰﻣﺔ ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ‪ ،٬‬ﻣﻬﮭﺎﺭرﺍاﺕت ﻳﯾﺪﻭوﻳﯾﺔ ﺃأﻛﺜﺮ ﺑﻴﯿﻨﻤﺎ ﺗﺤﺴﻦ ﺇإﻅظﻬﮭﺎﺭر ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ‬
‫ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ ﻻ ﺳﻴﯿّﻤﺎ ﺍاﻟﻤﺘﻌﻠﻖ ﺑﺎﻹﺳﺘﻤﺮﺍاﺭر ﺍاﻷﺑﻬﮭﺮﻱي‪ .‬ﻛﻤﺎ ﺗﺴﻤﺢ ﺑﺈﻅظﻬﮭﺎﺭر ﺍاﻷﺑﻬﮭﺮ ﺍاﻟﺼﺎﻋﺪ ﺑﺄﻛﻤﻠﻪﮫ ﺑﺪﻻً ﻣﻦ ﺍاﻟﺠﺰء‬
‫ﺍاﻟﻘﺮﻳﯾﺐ ﻣﻨﻪﮫ ﻓﻘﻂ ﻛﻤﺎ ﻫﮬﮪھﻮ ﺍاﻟﺤﺎﻝل ﻣﻊ ﺗﻘﻨﻴﯿﺔ ﺍاﻟﻤﺴﺢ‪ .‬ﺣﺎﻟﻤﺎ ﻳﯾﺘﻢ ﺍاﻟﺤﺼﻮﻝل ﻋﻠﻰ ﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ‬
‫ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ ﻣﻊ ﻛﻠﺘﺎ ﺍاﻟﺘﻘﻨﻴﯿﺘﻴﯿﻦ‪ ،٬‬ﺗﺼﺒﺢ ﺍاﻟﻤﺤﻮﻻﺕت ﻣﺘﺠﻬﮭﺔ ﺑﺈﺗﺠﺎﻩه ﺍاﻟﺮﺃأﺱس ﺣﺘﻰ ﻳﯾﺼﺒﺢ ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﻣﺮﺻﻮﺩدﺍاً‬
‫ﺑﺈﺗﺠﺎﻩه ﻋﻤﻮﺩدﻱي ﻋﻠﻰ ﺫذﻟﻚ ﺍاﻟﺘﺎﺑﻊ ﻟﻸﺑﻬﮭﺮ‪.‬‬

‫ﻳﯾﻤﻜﻦ ﺍاﻟﺤﺼﻮﻝل ﻋﻠﻰ ﻟﻘﻄﺔ ﺇإﺿﺎﻓﻴﯿﺔ ﻟﻸﺑﻬﮭﺮ ﻭوﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﻣﻦ ﺧﻼﻝل ﺇإﻧﺰﻻﻕق ﺃأﻭو ﻣﻴﯿﻞ ﺍاﻟﻤﺤﻮﻻﺕت ﻧﺤﻮ ﺍاﻟﺮﺃأﺱس‬
‫ﺍاﻟﺠﻨﻴﯿﻨﻲ ﻣﻦ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ‪ .‬ﺗﺘﺠﺎﻭوﺏب ﻫﮬﮪھﺬﻩه ﺍاﻟﻠﻘﻄﺎﺕت ﻣﻊ ﻟﻘﻄﺔ ﺍاﻟﻮﻋﺎء ﺍاﻟﺜﻼﺛﻲ ﻭوﻟﻘﻄﺔ‬
‫ﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﺜﻼﺛﺔ ﻭوﺍاﻟﺮﻏﺎﻣﻰ ﺣﻴﯿﺚ ﺗﻈﻬﮭﺮ ﺍاﻟﻌﻼﻗﺔ ﺑﻴﯿﻦ ﺍاﻟﺸﺮﻳﯾﺎﻧﻴﯿﻦ ﻭوﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻷﺟﻮﻑف ﺍاﻟﻌﻠﻮﻱي ﻭوﺍاﻟﺮﻏﺎﻣﻰ‪ .‬ﻳﯾﻤﻜﻦ‬
‫ﺗﺼﻮﻳﯾﺮ ﻓﻲ ﻫﮬﮪھﺬﻩه ﺍاﻟﻤﺮﺣﻠﺔ ﺃأﻳﯾﻀﺎ ً ﺍاﻟﻘﻮﺱس ﺍاﻟﻤﺴﺎﻟﻲ ﻭوﺍاﻟﻘﻮﺱس ﺍاﻷﺑﻬﮭﺮﻱي )‪.(64 to 67‬‬

‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪ :2‬ﻟﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻌﺔ‪ .‬ﺗﺸﻤﻞ ﺍاﻟﻌﻨﺎﺻﺮ ﺍاﻷﺳﺎﺳﻴﯿﺔ ﻟﻠﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻻﺭرﺑﻌﺔ ﺍاﻟﻄﺒﻴﯿﻌﻴﯿﺔ ﻓﻲ ﻣﻧﺗﺻﻑف ﺍاﻟﺣﻣﻝل ﻣﻨﻄﻘﺔ ﻻ ﺗﺰﻳﯾﺪ‬
‫ﻋﻦ ﺛﻠﺚ ﻣﺴﺎﺣﺔ ﺍاﻟﺼﺪﺭر‪ ،٬‬ﻭوﺟﺎﻧﺒﻲ ﺍاﻟﻴﯿﻤﻴﯿﻦ ﻭوﺍاﻟﻴﯿﺴﺎﺭر ﻟﻠﻬﮭﻴﯿﺎﻛﻞ ﻣﺘﺴﺎﻭوﻳﯾﺔ ﺗﻘﺮﻳﯾﺒﺎ ً )ﺣﺠﻢ ﺍاﻟﺤﺠﺮﺓة ﻭوﺳﻤﺎﻛﺔ ﺍاﻟﺠﺪﺍاﺭر(‪ ،٬‬ﺛﻘﺒﺔ ﺑﻴﯿﻀﺎﻭوﻳﯾﺔ ﻭوﺍاﺿﺤﺔ ﻣﻊ ﺻﻤﺎﻣﻬﮭﺎ ﻓﻲ ﺍاﻷﺫذﻳﯾﻦ‬
‫ﺍاﻷﻳﯾﺴﺮ‪ ،٬‬ﻧﻘﻄﺔ ﺍاﻟﻘﻠﺐ ﺍاﻷﺳﺎﺳﻴﯿﺔ ﺍاﻟﺴﻠﻴﯿﻤﺔ ﻣﻊ ﺃأﻟﺘﻮﺍاء ﻁطﺒﻴﯿﻌﻲ ﻷﺛﻨﻴﯿﻦ ﻣﻦ ﺍاﻟﺼﻤﺎﻣﺎﺕت ﺍاﻷﺫذﻳﯾﻨﻴﯿﺔ ﺍاﻟﺒﻄﻴﯿﻨﻴﯿﺔ ﻭوﺣﺎﺟﺰ ﺑﻄﻴﯿﻨﻲ ﺳﻠﻴﯿﻢ‪ .‬ﻳﯾﺤﺪﺩد ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ ﺍاﻟﻤﻮﺭرﻓﻮﻟﻮﺟﻲ ﻣﻦ‬
‫ﺧﻼﻝل ﻭوﺟﻮﺩد ﺍاﻟﺤﺰﺍاﻡم ﺍاﻟﻮﺳﻴﯿﻂ ﻭو ﺍاﻟﺼﻤﺎﻡم ﺍاﻟﺜﻼﺛﻲ ﺍاﻷﻁطﺮﺍاﻑف‪ ،٬‬ﻭوﻳﯾﻨﺪﺭرﺝج ﻫﮬﮪھﺬﺍا ﺍاﻟﺼﻤﺎﻡم ﻣﻦ ﺍاﻟﻘﻤﺔ ﻧﺰﻭوﻻً ﻓﻲ ﺍاﻟﺤﺎﺟﺰ ﺃأﻛﺜﺮ ﻣﻦ ﺍاﻟﺼﻤﺎﻡم ﺍاﻟﺘﺎﺟﻲ )ﺍاﻟﺘﻮﺍاء ﻁطﺒﻴﯿﻌﻲ(‪ .‬ﺍاﻷﺑﻬﮭﺮ‬
‫ﺍاﻟﻨﺎﺯزﻝل )‪ ,(D.Aorta‬ﻳﯾﺴﺎﺭر)‪ ،٬(L‬ﺍاﻷﺫذﻳﯾﻦ ﺍاﻷﻳﯾﺴﺮ)‪ ،٬ (LV‬ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ )‪ ،٬ (LA‬ﻳﯾﻤﻴﯿﻦ )‪ ،٬(R‬ﺍاﻷﺫذﻳﯾﻦ ﺍاﻷﻳﯾﻤﻦ )‪.(RA‬‬

‫ﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ‪ .‬ﺗﺆﻛﺪ ﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ ﻭوﺟﻮﺩد‬
‫ﻭوﻋﺎء ﻛﺒﻴﯿﺮ ﻧﺎﺷﺊ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ ﺍاﻟﻤﻮﺭرﻓﻮﻟﻮﺟﻲ )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ .(5‬ﻳﯾﻨﺒﻐﻲ ﺇإﺫذﺍاً ﺗﺼﻮﻳﯾﺮ ﺍاﻹﺳﺘﻤﺮﺍاﺭرﻳﯾﺔ‬
‫ﺑﻴﯿﻦ ﺍاﻟﺤﺎﺟﺰ ﺍاﻟﺒﻄﻴﯿﻨﻲ ﻭوﺍاﻟﺠﺪﺍاﺭر ﺍاﻷﻣﺎﻣﻲ ﻟﻬﮭﺬﺍا ﺍاﻟﻮﻋﺎء‪ ،٬‬ﺍاﻷﺑﻬﮭﺮ‪ .‬ﻳﯾﺘﺤﺮﻙك ﺍاﻟﺼﻤﺎﻡم ﺍاﻷﺑﻬﮭﺮﻱي ﺑﺪﻭوﻥن ﻗﻴﯿﺪ ﻭوﻻ ﻳﯾﻨﺒﻐﻲ ﺃأﻥن‬
‫ﻳﯾﻜﻮﻥن ﻣﻜﺜﻔﺎ ً‪ .‬ﻓﻴﯿﻤﻜﻦ ﺗﻌﻘﺐ ﺍاﻷﺑﻬﮭﺮ ﻓﻲ ﻗﻮﺳﻪﮫ ﺣﻴﯿﺚ ﺗﻨﺸﺄ ﺛﻼﺙث ﺷﺮﺍاﻳﯾﻴﯿﻦ ﺇإﻟﻰ ﺍاﻟﺮﻗﺒﺔ‪ .‬ﻣﻊ ﺫذﻟﻚ ﻻ ﻳﯾﻌﺘﺒﺮ ﺗﺤﺪﻳﯾﺪ ﺃأﻭوﻋﻴﯿﺔ‬
‫ﺍاﻟﻘﻮﺱس ﺍاﻷﺑﻬﮭﺮﻱي ﺟﺰ ًءﺍا ﺭرﻭوﺗﻴﯿﻨﻴﯿﺎ ً ﻣﻦ ﺍاﻟﻔﺤﺺ ﺍاﻟﻘﻠﺒﻲ‪ .‬ﺗﺴﺎﻋﺪ ﻟﻘﻄﺔ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ ﻓﻲ ﺗﺤﺪﻳﯾﺪ‬
‫ﻣﺨﺮﺝج ﻋﻴﯿﻮﺏب ﺍاﻟﺤﺎﺟﺰ ﺍاﻟﺒﻄﻴﯿﻨﻲ ﻏﻴﯿﺮ ﺍاﻟﻤﺮﺋﻴﯿﺔ ﻓﻲ ﺍاﻟﻔﺤﺺ ﻟﺤﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ ﻓﻘﻂ‪.‬‬
‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ :3‬ﺍاﻟﻠﻘﻄﺎﺕت ﺍاﻟﺨﻤﺲ ﺍاﻟﻤﺤﻮﺭرﻳﯾﺔ ﻟﻠﺘﺼﻮﻳﯾﺮ ﺍاﻷﻣﺜﻞ ﻟﻠﻘﻠﺐ ﺍاﻟﺠﻨﻴﯿﻨﻲ‪ .‬ﺗﻈﻬﮭﺮ ﺍاﻟﺼﻮﺭرﺓة ﺍاﻟﻤﻠﻮﻧﺔ ﺍاﻟﺮﻏﺎﻣﻰ )‪ (Tr‬ﻭوﺍاﻟﻘﻠﺐ ﻭوﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﻜﺒﻴﯿﺮﺓة‬
‫ﻭوﺍاﻟﻜﺒﺪ ﻭوﺍاﻟﻤﻌﺪﺓة‪ ،٬‬ﻣﻊ ﺧﻤﺴﺔ ﺃأﺳﻄﺢ ﻟﻠﺘﻌﺮﺽض ﻟﻠﻤﻮﺟﺎﺕت ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺍاﻟﻤﺸﺎﺭر ﺇإﻟﻴﯿﻬﮭﺎ ﻓﻲ ﺍاﻟﻤﻀﻠﻌﺎﺕت ﺍاﻟﻤﻄﺎﺑﻘﺔ ﻟﻠﺼﻮﺭر ﺑﺤﺴﺐ ﺍاﻟﺴﻠﻢ ﺍاﻟﺮﻣﺎﺩدﻱي‪ ،٬‬ﻛﻤﺎ ﻫﮬﮪھﻮﻣﺸﺎﺭر ﺇإﻟﻴﯿﻪﮫ‪(I) .‬‬
‫ﻣﻌﻈﻢ ﺍاﻟﺴﻄﺢ ﺍاﻟﺬﻧﺒﻲ ﻣﻈﻬﮭﺮﺍاً ﺍاﻟﻤﻌﺪﺓة ﺍاﻟﺠﻨﻴﯿﻨﻴﯿﺔ )‪ (St‬ﻭوﺍاﻟﻤﻘﻄﻊ ﺍاﻟﻌﺮﺿﻲ ﻟﻸﺑﻬﮭﺮ ﺍاﻟﻨﺎﺯزﻝل )‪ (dAo‬ﻭوﺍاﻟﺸﻮﻛﺔ )‪ (Sp‬ﻭوﺍاﻟﻜﺒﺪ )‪ (II) .(Li‬ﻟﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ‬
‫ﻟﻠﻘﻠﺐ ﺍاﻟﺠﻨﻴﯿﻨﻲ ﻣﻈﻬﮭﺮﺓةً ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ ﻭوﺍاﻷﻳﯾﺴﺮ)‪ ،٬(LV , RV‬ﻭوﺍاﻷﺫذﻳﯾﻨﺘﻴﯿﻦ ﺍاﻟﻴﯿﻤﻨﻰ ﻭو ﺍاﻟﻴﯿﺴﺮﻯى )‪ ،٬(RA, LA‬ﻭوﺍاﻟﺜﻘﺒﺔ ﺍاﻟﺒﻴﯿﻀﻴﯿﺔ )‪ (FO‬ﻭوﺍاﻷﻭوﺭرﺩدﺓة ﺍاﻟﺮﺋﻮﻳﯾﺔ )‪(PV‬‬
‫ﻣﻦ ﺟﻬﮭﺔ ﺍاﻟﻴﯿﻤﻴﯿﻦ ﻭوﺍاﻟﻴﯿﺴﺎﺭر ﻣﻦ ﺍاﻷﺑﻬﮭﺮ ﺍاﻟﻨﺎﺯزﻝل )‪ (III) .(dAo‬ﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ ﻣﻈﻬﮭﺮﺓةً ﺍاﻟﺠﺬﺭر ﺍاﻷﺑﻬﮭﺮﻱي )‪ (Ao‬ﻭوﺍاﻟﺒﻄﻴﯿﻦ‬
‫ﺍاﻷﻳﯾﺴﺮ)‪ (LV‬ﻭوﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ )‪ (RV‬ﻭوﺍاﻷﺫذﻳﯾﻦ ﺍاﻟﻴﯿﻤﻨﻰ )‪ (RA‬ﻭوﺍاﻟﻴﯿﺴﺮﻯى )‪ ،٬(LA‬ﻭوﻟﻘﻄﺔ ﻟﻤﻘﻄﻊ ﻋﺮﺿﻲ ﻟﻸﺑﻬﮭﺮ ﺍاﻟﻨﺎﺯزﻝل )‪ (IV) .(dAo‬ﻧﻮﻋﺎ ً ﻣﺎ ﺑﺈﺗﺠﺎﻩه‬
‫ﺍاﻟﺮﺃأﺱس )ﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ( ﻣﻈﻬﮭﺮﺓةً ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﺍاﻷﺳﺎﺳﻲ )‪ (MPA‬ﻭوﺍاﻹﻧﺸﻌﺎﺏب ﻓﻲ ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﺍاﻷﻳﯾﻤﻦ )‪(RPA‬‬
‫ﻭوﺍاﻷﻳﯾﺴﺮ )‪ (LPA‬ﻭوﻣﻘﺎﻁطﻊ ﻋﺮﺿﻴﯿﺔ ﻟﻸﺑﻬﮭﺮ)‪ (Ao‬ﻭوﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي )‪ (MPA‬ﻭوﺍاﻟﻘﻨﺎﺓة ﺍاﻟﺸﺮﻳﯾﺎﻧﻴﯿﺔ ﻭوﺍاﻟﻘﻮﺱس ﺍاﻷﺑﻬﮭﺮ )ﻣﻦ ﺍاﻷﺑﻬﮭﺮ ﺍاﻟﺼﺎﻋﺪ ﺍاﻟﻘﺮﻳﯾﺐ ﺇإﻟﻰ‬
‫ﺍاﻷﺑﻬﮭﺮﺍاﻟﻨﺎﺯزﻝل(‪ (V) .‬ﻟﻘﻄﺔ ﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﺜﻼﺛﺔ ﻭوﺍاﻟﻘﺼﺒﺔ ﺍاﻟﻬﮭﻮﺍاﺋﻴﯿﺔ‪ .‬ﺗﻈﻬﮭﺮ ﻫﮬﮪھﺬﻩه ﺍاﻟﻠﻘﻄﺔ ﺑﺸﻜﻞ ﻭوﺍاﺿﺢ ﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻷﺟﻮﻑف ﺍاﻟﻌﻠﻮﻱي )‪ (SVC‬ﻭو ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي )‪(MPA‬‬
‫ﻭوﺍاﻟﻘﻨﺎﺓة ﺍاﻟﺸﺮﻳﯾﺎﻧﻴﯿﺔ )‪ (DA‬ﻭوﺍاﻟﻘﻮﺱس ﺍاﻷﺑﻬﮭﺮ)ﻣﻦ ﺍاﻷﺑﻬﮭﺮ ﺍاﻟﺼﺎﻋﺪ ﺍاﻟﻘﺮﻳﯾﺐ ﺇإﻟﻰ ﺍاﻷﺑﻬﮭﺮﺍاﻟﻨﺎﺯزﻝل( ﻭو ﺍاﻟﻘﺼﺒﺔ ﺍاﻟﻬﮭﻮﺍاﺋﻴﯿﺔ )‪ .(Tr‬ﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻷﺟﻮﻑف ﺍاﻟﺴﻔﻠﻲ )‪،٬(IVC‬‬
‫ﻳﯾﺴﺎﺭر)‪ ،٬(L‬ﻳﯾﻤﻴﯿﻦ )‪.Modified with permission from Yagel et al (29) .(R‬‬
‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ :4‬ﺗﻘﻨﻴﯿﺔ ﺗﺼﻮﻳﯾﺮﺍاﻟﻘﻠﺐ ﺍاﻟﺠﻨﻴﯿﻨﻲ‪ .‬ﻳﯾﺘﻢ ﺍاﻟﺤﺼﻮﻝل ﻋﻠﻰ ﻟﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ ﻣﻦ ﺧﻼﻝل ﺗﺼﻮﻳﯾﺮ ﻣﺤﻮﺭرﻱي ﻟﻠﺴﻄﺢ ﻋﺒﺮ ﺍاﻟﺼﺪﺭر‬
‫ﺍاﻟﺠﻨﻴﯿﻨﻲ‪ .‬ﺇإﻥن ﻣﻴﯿﻞ ﺍاﻟﻤﺤﻮﻻﺕت ﺑﺎﺗﺠﺎﻩه ﺍاﻟﺮﺃأﺱس ﻣﻦ ﻟﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ ﺇإﻟﻰ ﺍاﻟﺮﺃأﺱس ﺍاﻟﺠﻨﻴﯿﻨﻲ ﻳﯾﻌﻄﻲ ﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﺑﺎﻟﺸﻜﻞ ﺍاﻟﻤﺘﺴﻠﺴﻞ‬
‫ﺍاﻟﺘﺎﻟﻲ‪ :‬ﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ)‪ (LVOT‬ﻭوﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ )‪ (RVOT‬ﻭوﺍاﻟﻮﻋﺎء ﺍاﻟﺜﻼﺛﻲ‬
‫)‪ (3 VV‬ﻭوﻟﻘﻄﺔ ﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﺜﻼﺛﺔ ﻭوﺍاﻟﺮﻏﺎﻣﻰ )‪. (3VT‬‬

‫ﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ‪ .‬ﺗﺆﻛﺪ ﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ ﻭوﺟﻮﺩد‬
‫ﻭوﻋﺎء ﻛﺒﻴﯿﺮ ﻧﺎﺷﺊ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ ﺍاﻟﻤﻮﺭرﻓﻮﻟﻮﺟﻲ )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ :(6‬ﻳﯾﺼﺪﺭر ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﻋﺎﺩدﺓةً‬
‫ﻣﻦ ﻫﮬﮪھﺬﺍا ﺍاﻟﺒﻄﻴﯿﻦ ﻭوﻳﯾﺘﺠﻪﮫ ﺃأﻛﺜﺮ ﻧﺤﻮ ﺍاﻳﯾﺴﺮ ﺍاﻷﺑﻬﮭﺮ ﺍاﻟﺼﺎﻋﺪ ﺍاﻟﺨﻠﻔﻲ‪ .‬ﻋﺎﺩدﺓةً ﻣﺎ ﻳﯾﻜﻮﻥن ﺃأﻛﺒﺮ ﺑﻘﻠﻴﯿﻞ ﻣﻦ ﺍاﻟﺠﺬﺭر ﺍاﻷﺑﻬﮭﺮﻱي‬
‫ﺃأﺛﻨﺎء ﺍاﻟﺤﻴﯿﺎﺓة ﺍاﻟﺠﻨﻴﯿﻨﻴﯿﺔ ﻭوﻳﯾﺘﻌﺎﺭرﺽض ﻣﻊ ﺍاﻷﺑﻬﮭﺮ ﺍاﻟﺼﺎﻋﺪ ﻓﻲ ﺍاﻟﺰﺍاﻭوﻳﯾﺔ ﺍاﻟﻘﺎﺋﻤﺔ ﺗﻘﺮﻳﯾﺒﺎ ً ﻓﻮﻕق ﻣﺼﺪﺭرﻩه‪ .‬ﻏﺎﻟﺒﺎ ً ﻣﺎ ﻳﯾﻜﻮﻥن‬
‫ﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻷﺟﻮﻑف ﺍاﻟﻌﻠﻮﻱي ﻣﺮﺋﻴﯿﺎ ً ﻓﻲ ﻫﮬﮪھﺬﻩه ﺍاﻟﻤﺮﺣﻠﺔ‪ ،٬‬ﻛﻤﺎ ﻫﮬﮪھﻮ ﻅظﺎﻫﮬﮪھﺮ ﻓﻲ ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ .6‬ﻫﮬﮪھﺬﻩه ﺍاﻟﻘﻄﺔ ﺗﺸﺎﺑﻪﮫ‬
‫ﻟﻘﻄﺔ ﺍاﻟﻮﻋﺎء ﺍاﻟﺜﻼﺛﻲ ﺣﺴﺐ ﻳﯾﻮ ﻭوﺁآﺧﺮﻭوﻥن )‪.(64‬‬

‫ﻳﯾﺘﺤﺮﻙك ﺍاﻟﺼﻤﺎﻡم ﺍاﻟﺮﺋﻮﻱي ﺑﺪﻭوﻥن ﻗﻴﯿﺪ ﻭوﻻ ﻳﯾﻨﺒﻐﻲ ﺃأﻥن ﻳﯾﻜﻮﻥن ﻣﻜﺜﻔﺎ ً‪ .‬ﻳﯾﺜﺒﺖ ﺍاﻟﻮﻋﺎء ﺍاﻟﻨﺎﺷﺊ ﻣﻦ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ‬
‫ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﻓﻘﻂ ﺇإﺫذﺍا ﻛﺎﻥن ﻣﺘﺸﻌﺒﺎ ً ﺑﻌﺪ ﻣﺠﺮﻯى ﻗﺼﻴﯿﺮ‪ .‬ﻳﯾﺄﺗﻲ ﺍاﻟﻔﺮﻉع ﺍاﻷﻳﯾﻤﻦ ﻟﻠﺸﺮﻳﯾﺎﻥن‬
‫ﺍاﻟﺮﺋﻮﻱي ﺃأﻭوﻻً ﻣﻦ ﺛﻢ ﺍاﻟﻔﺮﻉع ﺍاﻷﻳﯾﺴﺮ‪ ،٬‬ﻟﻜﻦ ﻫﮬﮪھﺬﺍا ﺗﻘﺴﻴﯿﻢ ﻻ ﻳﯾﻤﻜﻦ ﺭرﺅؤﻳﯾﺘﻪﮫ ﺩدﺍاﺋﻤﺎ ً ﻧﺘﻴﯿﺠﺔ ﺍاﻟﻮﺿﻌﻴﯿﺔ ﺍاﻟﺠﻨﻴﯿﻨﻴﯿﺔ‪ .‬ﻳﯾﺘﺎﺑﻊ ﺍاﻟﺸﺮﻳﯾﺎﻥن‬
‫ﺍاﻟﺮﺋﻮﻱي ﺑﺸﻜﻞ ﺃأﻗﺼﻰ ﻧﺤﻮ ﺍاﻟﺠﺎﻧﺐ ﺍاﻷﻳﯾﺴﺮ ﻭوﻓﻲ ﺍاﻟﻘﻨﺎﺓة ﺍاﻟﺸﺮﻳﯾﺎﻧﻴﯿﺔ ﺍاﻟﻤﺘﺼﻠﺔ ﺑﺎﻷﺑﻬﮭﺮ ﺍاﻟﻨﺎﺯزﻝل )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ‬
‫‪ 6‬ﻭوﺍاﻟﻤﻠﺤﻖ ‪.(S1‬‬

‫ﻟﻘﻄﺔ ﺍاﻟﻮﻋﺎء ﺍاﻟﺜﻼﺛﻲ ﻭوﻟﻘﻄﺔ ﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﺜﻼﺛﺔ ﻭوﺍاﻟﺮﻏﺎﻣﻰ‪ .‬ﺇإﻥن ﺗﺼﻮﻳﯾﺮ ﻟﻘﻄﺔ ﺍاﻟﻮﻋﺎء ﺍاﻟﺜﻼﺛﻲ ﻭوﻟﻘﻄﺔ ﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﺜﻼﺛﺔ‬
‫ﻭوﺍاﻟﺮﻏﺎﻣﻰ ﺃأﻣ ٌﺮ ﻣﺮﻏﻮﺏبٌ ﻓﻴﯿﻪﮫ ﻭوﻳﯾﻨﺒﻐﻲ ﺍاﻟﻘﻴﯿﺎﻡم ﺑﻪﮫ ﺑﺎﻟﺮﻏﻢ ﻣﻦ ﺃأﻧﻬﮭﺎ ﻏﻴﯿﺮ ﻋﻤﻠﻴﯿﺔ ﻟﻠﺤﺼﻮﻝل ﻋﻠﻴﯿﻬﮭﺎ ﻟﺪﻯى ﻛﺎﻓﺔ ﺍاﻟﻤﺮﺿﻰ‪.‬‬

‫ﻳﯾﺤ ّﺪﺩد ﻣﻌﻴﯿﺎﺭرﺍا ﺍاﻷﺳﻄﺢ ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺛﻼﺛﺔ ﺗﺮﺍاﻛﻴﯿﺐ ﻭوﻋﺎﺋﻴﯿﺔ ﻭوﻋﻼﻗﺘﻬﮭﺎ ﺑﺒﻌﻀﻬﮭﺎ ﻭوﺍاﻟﻤﺴﺎﻟﻚ ﺍاﻟﻬﮭﻮﺍاﺋﻴﯿﺔ‬
‫)ﺍاﻟﺮﻏﺎﻣﻰ(‪ .‬ﻳﯾﺼﻒ ﻳﯾﻮ ﻭوﺁآﺧﺮﻭوﻥن )‪ (64‬ﻟﻘﻄﺔ ﺍاﻟﻮﻋﺎء ﺍاﻟﺜﻼﺛﻲ ﻟﺘﻘﻴﯿﻴﯿﻢ ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﻭوﺍاﻷﺑﻬﮭﺮ ﺍاﻟﺼﺎﻋﺪ ﻭوﺍاﻟﻮﺭرﻳﯾﺪ‬
‫ﺍاﻷﺟﻮﻑف ﺍاﻟﻌﻠﻮﻱي‪ ،٬‬ﺍاﻷﺣﺠﺎﻡم ﻭوﺍاﻟﻌﻼﻗﺎﺕت ﻟﻜﻞ ﻣﻨﻬﮭﺎ )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ .(7‬ﻳﯾﻨﺒﻐﻲ ﺇإﺫذﺍاً ﺑﺈﻳﯾﺠﺎﺯز ﺗﻘﻴﯿﻴﯿﻢ ﻋﺪﺩد‬
‫ﺍاﻷﻭوﻋﻴﯿﺔ ﻭوﺣﺠﻤﻬﮭﺎ ﻭوﺗﺨﻄﻴﯿﻄﻬﮭﺎ‪ .‬ﻣﻦ ﺍاﻟﻴﯿﺴﺎﺭر ﺇإﻟﻰ ﺍاﻟﻴﯿﻤﻴﯿﻦ‪ ،٬‬ﺍاﻷﻭوﻋﻴﯿﺔ ﻫﮬﮪھﻲ ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﻭوﺍاﻷﺑﻬﮭﺮ ﻭوﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻷﺟﻮﻑف‬
‫ﺍاﻟﻌﻠﻮﻱي‪ .‬ﺇإﻥن ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﻫﮬﮪھﻮ ﺍاﻟﻮﻋﺎء ﺍاﻷﻣﺎﻣﻲ ﺍاﻷﺑﺮﺯز ﻭوﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻷﺟﻮﻑف ﺍاﻟﻌﻠﻮﻱي ﻫﮬﮪھﻮ ﺍاﻟﻮﻋﺎﺉئ ﺍاﻟﺨﻠﻔﻲ ﺍاﻷﺑﺮﺯز‪.‬‬
‫ﻳﯾﺘﻘﻠﺺ ﻗﻄﺮ ﻛ ّﻞ ﻣﻨﻬﮭﻤﺎ ﻣﻦ ﺍاﻟﻴﯿﺴﺎﺭر ﺇإﻟﻰ ﺍاﻟﻴﯿﻤﻴﯿﻦ ﻓﻲ ﺣﻴﯿﻦ ﺃأﻥن ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﻳﯾﻜﻮﻥن ﺃأﻛﺒﺮ ﻣﻦ ﺍاﻷﺑﻬﮭﺮ‪ ،٬‬ﻭوﻳﯾﻜﻮﻥن ﻫﮬﮪھﺬﺍا‬
‫ﺍاﻷﺧﻴﯿﺮ ﺃأﻛﺒﺮ ﻣﻦ ﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻷﺟﻮﻑف ﺍاﻟﻌﻠﻮﻱي‪ .‬ﻗﺪ ﺗﻜﻮﻥن ﻟﺒﻌﺾ ﻣﻦ ﺍاﻟﺸﺬﻭوﺫذﺍاﺕت ﺍاﻟﻤﺮﺗﺒﻄﺔ ﺑﻠﻘﻄﺔ ﻁطﺒﻴﯿﻌﻴﯿﺔ ﻟﺤﺠﻴﯿﺮﺍاﺕت‬
‫ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ‪ ،٬‬ﻛﺘﻐﻴﯿﻴﯿﺮ ﻭوﺿﻊ ﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﻜﺒﻴﯿﺮﺓة ﻭوﺭرﺑﺎﻋﻴﯿﺔ ﻓﺎﻟﻮ ﻭوﺭرﺗﻖ ﺍاﻟﺮﺋﺔ ﻣﻊ ﻋﻴﯿﺐ ﺍاﻟﺤﺎﺟﺰ ﺍاﻟﺒﻄﻴﯿﻨﻲ‪ ،٬‬ﻟﻘﻄﺔ ﻏﻴﯿﺮ‬
‫ﻁطﺒﻴﯿﻌﻴﯿﺔ ﻟﻠﻮﻋﺎء ﺍاﻟﺜﻼﺛﻲ‪ .‬ﻳﯾﺼﻒ ﺑﺎﻟﺘﺎﻟﻲ ﻳﯾﺎﻏﻞ ﻭوﺁآﺧﺮﻭوﻥن )‪ (67‬ﻟﻘﻄﺔ ﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﺜﻼﺛﺔ ﻭوﺍاﻟﺮﻏﺎﻣﻰ ﺍاﻟﺘﻲ ﺗﻌﺘﺒﺮ ﺻﻮﺭرﺓة‬
‫ﺑﺈﺗﺠﺎﻩه ﺍاﻟﺮﺃأﺱس ﺣﻴﯿﺚ ﻳﯾﺼﻮّﺭر ﺑﺸﻜﻞ ﺃأﻓﻀﻞ ﺍاﻟﻘﻮﺱس ﺍاﻷﺑﻬﮭﺮﻱي ﺍاﻟﻤﺴﺘﻌﺮﺽض )ﻟﻘﻄﺔ ﺍاﻟﻘﻮﺱس ﺍاﻷﺑﻬﮭﺮﻱي( ﻭوﻋﻼﻗﺘﻪﮫ‬
‫ﺑﺎﻟﺮﻏﺎﻣﻰ‪ .‬ﻏﺎﻟﺒﺎ ً ﻣﺎ ﺗﻌﺮّﻑف ﺍاﻟﺮﻏﺎﻣﻰ ﺑﺤﻠﻘﺔ ﺳﻬﮭﻞ ﺗﺼ ّﻮﺭرﻫﮬﮪھﺎ ﺑﺎﻟﺼﺪﻯى ﻣﺤﻴﯿﻄﺔ ﺑﺤﻴﯿّﺰ ﺻﻐﻴﯿﺮ ﻣﻤﺘﻠﺊ ﺑﺴﺎﺋﻞ‪ .‬ﻳﯾﻘﻊ ﻛﻞ‬
‫ﻣﻦ ﺍاﻟﻘﻮﺱس ﺍاﻟﻘﻨﻮﻱي ﻭوﺍاﻷﺑﻬﮭﺮﻱي ﻓﻲ ﺟﻬﮭﺔ ﺍاﻟﻴﯿﺴﺎﺭر ﻣﻦ ﺍاﻟﺮﻏﺎﻣﻰ ﻭوﻳﯾﺮﺗﺒﻄﺎﻥن ﺑﺎﻷﺑﻬﮭﺮ ﺍاﻟﻨﺎﺯزﻝل ﻓﻴﯿﻜﻮﻧﺎﻥن ﻋﻠﻰ ﺷﻜﻞ”‪”V‬‬
‫)ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ .(8‬ﺇإﻥن ﺍاﻟﻘﻮﺱس ﺍاﻷﺑﻬﮭﺮﻱي ﻫﮬﮪھﻮﺍاﻟﻘﻮﺱس ﺍاﻷﻛﺜﺮ ﻗﺮﺑﺎ ﻟﻠﻘﺤﻒ ﻟﺬﺍا ﻳﯾﺘﻄﻠﺐ ﺗﺼﻮﻳﯾﺮ ﺍاﻟﻘﻮﺳﻴﯿﻦ ﻓﻲ‬
‫ﺁآﻥن ﻭوﺍاﺣﺪ ﺑﻌﺾ ﺍاﻟﺘﻌﺪﻳﯾﻼﺕت ﻟﻠﻤﺤﻮﻻﺕت ﺑﺸﻜﻞ ﺑﻌﻴﯿﺪ ﻋﻦ ﺍاﻟﺴﻄﺢ ﺍاﻟﻤﺘﻮﺍاﺯزﻱي ﻟﻠﻘﻄﺔ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ‪ .‬ﻗﺪ ﺗﺘﻴﯿﺢ‬ ‫ٍ‬
‫ﻟﻘﻄﺔ ﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﺜﻼﺛﺔ ﻭوﺍاﻟﺮﻏﺎﻣﻰ ﻛﺸﻒ ﺍاﻵﻓﺎﺕت ﻛﺘﻀﻴﯿّﻖ ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻷﺑﻬﮭﺮ ﻭوﺍاﻟﻘﻮﺱس ﺍاﻷﺑﻬﮭﺮﻳﯾﺔ ﺍاﻟﻴﯿﻤﻨﻰ ﻭوﻗﻮﺱس ﺍاﻷﺑﻬﮭﺮ‬
‫ﺍاﻟﻤﺰﺩدﻭوﺟﺔ ﻭوﺍاﻟﺤﻠﻘﺎﺕت ﺍاﻟﻮﻋﺎﺋﻴﯿﺔ‪.‬‬

‫ﺩدﻭوﺑﻠﺮ ﺗﺪﻓﻖ ﺍاﻟﻠﻮﻥن‬

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‫ﻋﻠﻰ ﺍاﻟﺮﻏﻢ ﻣﻦ ﺃأﻥن ﺍاﺳﺘﺨﺪﺍاﻡم ﺩدﻭوﺑﻠﺮ ﺗﺪﻓﻖ ﺍاﻟﻠﻮﻥن ﻻ ﻳﯾﻌﺘﺒﺮ ﺿﺮﻭوﺭرﻳﯾﺎ ً ﻓﻲ ﻫﮬﮪھﺬﺍا ﺍاﻟﺪﻟﻴﯿﻞ ﺍاﻟﻤﻮﺟﺰ‪ ،٬‬ﻟﻜﻦ ﻳﯾﺘﻢ ﺍاﻟﺘﺸﺠﻴﯿﻊ ﻋﻠﻰ‬
‫ﺃأﻥن ﻳﯾﺼﺒﺢ ﺍاﺳﺘﺨﺪﺍاﻣﻪﮫ ﻣﺄﻟﻮﻓﺎ ً ﻭوﺃأﻥن ﺗﺘﻢ ﺇإﺿﺎﻓﺘﻪﮫ ﺍاﻟﻰ ﺍاﻟﻔﺤﺺ ﺍاﻟﺮﻭوﺗﻴﯿﻨﻲ )‪ .(71‬ﻭوﻳﯾﺸﻜﻞ ﺭرﺳﻢ ﺧﺮﻳﯾﻄﺔ ﺗﺪﻓﻖ ﺍاﻟﻠﻮﻥن‬
‫ﺟﺰءﺍاً ﻻ ﻳﯾﺘﺠﺰﺃأ ﻣﻦ ﺃأﺩدﺍاء ﺗﺨﻄﻴﯿﻂ ﺻﺪﻯى ﺍاﻟﻘﻠﺐ ﻟﺪﻯى ﺍاﻟﺠﻨﻴﯿﻦ ﺣﻴﯿﺚ ﻻ ﻳﯾﻤﻜﻦ ﺍاﻻﺳﺘﻬﮭﺎﻧﺔ ﺑﺪﻭوﺭرﻩه ﻓﻲ ﺗﺸﺨﻴﯿﺺ ﻣﺮﺽض‬
‫ﺍاﻟﻘﻠﺐ ﺍاﻟﺘﺎﺟﻲ‪ .‬ﻛﻤﺎ ﻳﯾﻤﻜﻦ ﺍاﺳﺘﺨﺪﺍاﻡم ﺗﺼﻮﻳﯾﺮ ﺗﺪﻓﻖ ﺍاﻟﻠﻮﻥن ﻓﻲ ﺍاﻟﻔﺤﺺ ﺍاﻟﺮﻭوﺗﻴﯿﻨﻲ‪ ،٬‬ﺇإﺫذﺍا ﺍاﻋﺘﺒﺮ ﻋﺎﻣﻞ ﺍاﻟﺘﺸﻐﻴﯿﻞ ﻧﻔﺴﻪﮫ‬
‫ﻛﻔﻮءﺍاً ﺑﻤﺎ ﻳﯾﻜﻔﻲ ﻟﻴﯿﺸﻐﻠﻪﮫ‪ .‬ﻛﻤﺎ ﻳﯾﻤﻜﻦ ﻟﺮﺳﻢ ﺧﺮﻳﯾﻄﺔ ﺗﺪﻓﻖ ﺍاﻟﻠﻮﻥن ﺃأﻥن ﻳﯾﺴﻬﮭﻞ ﺗﺼﻮﻳﯾﺮ ﺍاﻟﺒﻨﻴﯿﺔ ﺍاﻟﻤﺨﺘﻠﻔﺔ ﻟﻠﻘﻠﺐ ﻭوﺗﺴﻠﻴﯿﻂ‬
‫ﺍاﻟﻀﻮء ﻋﻠﻰ ﺃأﻧﻤﺎﻁط ﺗﺪﻓﻖ ﺍاﻟﺪﻡم ﻏﻴﯿﺮ ﺍاﻟﻄﺒﻴﯿﻌﻴﯿﺔ‪ .‬ﻛﻤﺎ ﺃأﻧﻬﮭﺎ ﻗﺪ ﺗﻜﻮﻥن ﺃأﺩدﺍاﺓة ﻗﻴﯿﻤﺔ ﻟﺘﻘﻴﯿﻴﯿﻢ ﺗﺸﺮﻳﯾﺢ ﺍاﻟﻘﻠﺐ ﻟﺪﻯى ﺍاﻟﻤﺮﺿﻰ‬
‫ﺍاﻟﻠﺬﻳﯾﻦ ﻳﯾﻌﺎﻧﻮﻥن ﻣﻦ ﺍاﻟﺴﻤﻨﺔ ﺍاﻟﻤﻔﺮﻁطﺔ )‪ (72‬ﻭوﺑﺎﻹﺿﺎﻓﺔ ﺍاﻟﻰ ﺃأﻧﻬﮭﺎ ﻗﺪ ﺗﺤﺴﻦ ﻣﻌﺪﻻﺕت ﺍاﻟﻜﺸﻒ ﻋﻦ ﻣﺮﺽض ﺍاﻟﻘﻠﺐ‬
‫ﺍاﻟﺘﺎﺟﻲ ﺍاﻟﺮﺋﻴﯿﺴﻲ ﻓﻲ ﺣﺎﻻﺕت ﺍاﻟﺤﻤﻞ ﺍاﻟﻤﻨﺨﻔﻀﺔ ﺍاﻟﻤﺨﺎﻁطﺮ )‪.(46,73‬‬

‫ﺗﺘﻀﻤﻦ ﺇإﻋﺪﺍاﺩدﺍاﺕت ﺍاﻟﺪﻭوﺑﻠﺮ ﺍاﻟﻤﻠﻮﻥن ﺍاﻷﻣﺜﻞ ﺍاﺳﺘﺨﺪﺍاﻡم ﺻﻨﺪﻭوﻕق ﻟﻮﻥن ﺿﻴﯿﻖ )ﻣﻨﻄﻘﺔ ﺍاﻻﻫﮬﮪھﺘﻤﺎﻡم( ﻟﻤﺎ ﻟﺬﻟﻚ ﻣﻦ ﺃأﺛﺮ ﺃأﻛﺒﺮ‬
‫ﻋﻠﻰ ﻣﻌﺪﻝل ﺍاﻹﻁطﺎﺭر ﻭوﺗﺮﺩدﺩد ﺗﻜﺮﺍاﺭر ﺍاﻟﻨﺒﺾ ﺍاﻟﻤﻨﺎﺳﺐ ﻭوﺍاﻟﻠﻮﻥن ﺍاﻟﻤﻨﺨﻔﺾ ﺍاﻟﻤﺴﺘﻤﺮ ﻭوﺇإﻋﺪﺍاﺩدﺍاﺕت ﺍاﻟﻤﻜﺎﺳﺐ ﺍاﻟﻜﺎﻓﻴﯿﺔ‬
‫ﻟﻌﺮﺽض ﺍاﻟﺘﺪﻓﻖ ﻋﺒﺮ ﺍاﻟﺼﻤﺎﻣﺎﺕت ﻭوﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﺪﻣﻮﻳﯾﺔ )ﺃأﻧﻈﺮ ﺍاﻟﻰ ﺍاﻟﻤﻠﺤﻖ ‪.(S2‬‬

‫ﺗﺨﻄﻴﯿﻂ ﺻﺪﻯى ﺍاﻟﻘﻠﺐ ﻋﻨﺪ ﺍاﻟﺠﻨﻴﯿﻦ‬

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‫ﻳﯾﺠﺐ ﺇإﺟﺮﺍاء ﺗﺨﻄﻴﯿﻂ ﺻﺪﻯى ﺍاﻟﻘﻠﺐ ﻟﻠﺠﻨﻴﯿﻦ ﻓﻲ ﺣﺎﻝل ﺍاﻻﺷﺘﺒﺎﻩه ﺑﻮﺟﻮﺩد ﻣﺮﺽض ﺍاﻟﻘﻠﺐ ﺍاﻟﺘﺎﺟﻲ‪ ،٬‬ﺃأﻭو ﺇإﺫذﺍا ﻛﺎﻥن ﻣﺸﻬﮭﺪ‬
‫ﺍاﻟﺤﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻄﺒﻴﯿﻌﻴﯿﺔ ﺍاﻷﺭرﺑﻌﺔ ﻟﻠﻘﻠﺐ ﻭوﺗﺪﻓﻖ ﺍاﻟﻘﻨﻮﺍاﺕت ﺍاﻟﺪﻣﻮﻳﯾﺔ ﺍاﻟﻤﻮﺿﺢ ﺃأﻋﻼﻩه ﻻ ﻳﯾﻤﻜﻦ ﺍاﻛﺘﺸﺎﻓﻪﮫ ﻋﻨﺪ ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺃأﻭو‬
‫ﺣﺘﻰ ﻓﻲ ﺣﺎﻝل ﻣﻼﺣﻈﺔ ﻋﻮﺍاﻣﻞ ﺍاﻟﺨﻄﺮ ﺍاﻟﺘﻲ ﺗﺸﻴﯿﺮ ﺍاﻟﻰ ﺯزﻳﯾﺎﺩدﺓة ﻣﺨﺎﻁطﺮ ﺍاﻹﺻﺎﺑﺔ ﺑﻤﺮﺽض ﺍاﻟﻘﻠﺐ ﺍاﻟﺘﺎﺟﻲ ‪.‬ﻟﻠﻤﺰﻳﯾﺪ ﻣﻦ‬
‫ﺍاﻟﺘﻔﺎﺻﻴﯿﻞ ﻣﺮﺍاﺟﻌﺔ )‪ .(26‬ﻧﺴﺒﺔ ﻋﺎﻟﻴﯿﺔ ﻣﻦ ﺣﺎﻻﺕت ﻣﺮﺽض ﺍاﻟﻘﻠﺐ ﺍاﻟﺘﺎﺟﻲ ﺍاﻟﺬﻱي ﻳﯾﺘﻢ ﺍاﻟﻜﺸﻒ ﻋﻨﻬﮭﺎ ﻗﺒﻞ ﺍاﻟﻮﻻﺩدﺓة ﺗﺼﻴﯿﺐ‬
‫ﺍاﻟﻤﺮﺿﻰ ﻣﻦ ﺩدﻭوﻥن ﺃأﻱي ﻋﻮﺍاﻣﻞ ﺧﻄﺮﺓة ﺃأﻭو ﺣﺘﻰ ﺍاﻧﺤﺮﺍاﻓﺎﺕت ﺧﺎﺭرﺝج ﺍاﻟﻘﻠﺐ )‪(63‬؛ ﻭوﻣﻦ ﻫﮬﮪھﻨﺎ ﺗﺄﺗﻲ ﺃأﻫﮬﮪھﻤﻴﯿﺔ ﺍاﻟﻔﺤﺺ‪ .‬ﻭوﻣﻊ‬
‫ﺫذﻟﻚ ﻓﻴﯿﻔﺘﺮﺽض ﺑﺎﻟﻌﺎﻣﻠﻴﯿﻦ ﻓﻲ ﻣﺠﺎﻝل ﺍاﻟﺮﻋﺎﻳﯾﺔ ﺍاﻟﺼﺤﻴﯿﺔ ﺃأﻥن ﻳﯾﻜﻮﻧﻮﺍا ﻋﻠﻰ ﺩدﺭرﺍاﻳﯾﺔ ﺑﺒﻌﺾ ﺍاﻷﺳﺒﺎﺏب ﺍاﻟﺘﻲ ﺗﺪﻓﻊ ﺍاﻟﻤﺮﻳﯾﺾ‬
‫ﺍاﻟﻰ ﺇإﺟﺮﺍاء ﺗﻘﻴﯿﻴﯿﻢ ﺷﺎﻣﻞ ﻟﻠﻘﻠﺐ )‪ .(74‬ﻣﺜﻼً‪ ،٬‬ﺇإﺫذﺍا ﻛﺎﻥن ﺳﻤﻚ ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ ﺃأﻛﺜﺮ ﻣﻦ ‪ 3.5‬ﻣﻢ ﻓﻲ ﺧﻼﻝل ﻓﺘﺮﺓة ﺍاﻟﺤﻤﻞ‬
‫ﻣﺎ ﺑﻴﯿﻦ‪ 14‬ﻭو ‪ 11‬ﺃأﺳﺒﻮﻋﺎ ً ﻓﻬﮭﻮ ﻣﺆﺷﺮ ﻹﺟﺮﺍاء ﺗﻘﻴﯿﻴﯿﻢ ﻣﻔﺼﻞ ﻟﻠﻘﻠﺐ ﺣﺘﻰ ﺍاﺫذ ﺍاﻧﺨﻔﺾ ﺍاﻟﻘﻴﯿﺎﺱس ﻻﺣﻘﺎ ً ﺍاﻟﻰ ﺍاﻟﻤﻌﺪﻝل‬
‫ﺍاﻟﻄﺒﻴﯿﻌﻲ )‪.(75 to 78‬‬

‫ﻳﯾﺠﺐ ﻋﻠﻰ ﺍاﻟﻤﺘﺨﺼﺼﻴﯿﻦ ﺃأﺻﺤﺎﺏب ﺍاﻟﻘﺪﺭرﺓة ﻋﻠﻰ ﺗﺸﺨﻴﯿﺺ ﻣﺮﺽض ﺍاﻟﻘﻠﺐ ﺍاﻟﺘﺎﺟﻲ ﺃأﻥن ﻳﯾﻘﻮﻣﻮﺍا ﺑﺄﺟﺮﺍاء ﺗﺨﻄﻴﯿﻂ ﺻﺪﻯى‬
‫ﺍاﻟﻘﻠﺐ ﻟﻠﺠﻨﻴﯿﻦ‪ .‬ﺇإﺿﺎﻓﺔً ﺍاﻟﻰ ﺍاﻟﻤﻌﻠﻮﻣﺎﺕت ﺍاﻟﺘﻲ ﻳﯾﻘﺪﻣﻬﮭﺎ ﺍاﻟﻔﺤﺺ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺍاﻷﺳﺎﺳﻲ‪ ،٬‬ﻓﺈﻥن ﺗﺤﻠﻴﯿﻞ ﻣﻔﺼﻞ‬
‫ﻟﺒﻨﻴﯿﺔ ﺍاﻟﻘﻠﺐ ﻭوﻭوﻅظﻴﯿﻔﺘﻪﮫ ﻳﯾﺼﻒ ﺍاﻟـ ‪ ،٬situs visceroatrial‬ﻭوﺻﻼﺕت ﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻟﺮﺋﻮﻱي ﻭوﺍاﻟﺠﻬﮭﺎﺯزﻳﯾﺔ‪ ،٬‬ﻭوﺁآﻟﻴﯿﺔ ﺍاﻟﺜﻘﺒﺔ‬
‫ﺍاﻟﺒﻴﯿﻀﻮﻳﯾﺔ‪ ،٬‬ﻭوﺍاﺗﺼﺎﻝل ﺍاﻷﺫذﻳﯾﻨﻴﯿﺔ ﺍاﻟﺒﻄﻴﯿﻨﻴﯿﺔ ‪ ،٬‬ﻭوﺍاﻻﺗﺼﺎﻝل ﺍاﻟﺒُﻄﻴﯿﻨﻲ ﺍاﻟﺸﺮﻳﯾﺎﻧﻲ‪.‬‬

‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪ :5‬ﻟﻘﻄﺔ ﻁطﺮﻳﯾﻖ ﺍاﻟﺘﺪﻓﻘﺎﺕت ﻓﻲ ﺍاﻟﻘﻠﺐ ﻣﻦ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ )‪ :(LVOT‬ﺗُﻈﻬﮭﺮ ﻫﮬﮪھﺬﻩه ﺍاﻟﻠﻘﻄﺔ ﺍاﻟﺸﺮﻳﯾﺎﻥن ﻣﺘﺼﻼ ﺑﺎﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﺴﺮ )‪ .(LV‬ﻭوﻣﻦ ﺍاﻟﻤﻬﮭﻢ‬
‫ﺇإﺛﺒﺎﺕت ﺍاﻻﺳﺘﻤﺮﺍاﺭرﻳﯾﺔ ﺑﻴﯿﻦ ﺣﺎﺟﺰ ﺑﻴﯿﻦ ﺍاﻟﺒﻄﻴﯿﻨﻴﯿﻦ ﻭوﺍاﻟﺠﺪﺍاﺭر ﺍاﻷﻣﺎﻣﻲ ﻓﻲ ﻫﮬﮪھﺬﺍا ﺍاﻟﺸﺮﻳﯾﺎﻥن‪ ،٬‬ﺍاﻟﺘﻲ ﻛﺎﻧﺖ ﻓﻲ ﺍاﻟﻘﻠﺐ ﺍاﻟﻄﺒﻴﯿﻌﻲ ﺗﺘﻮﺍاﻓﻖ ﻣﻊ ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻷﻭوﺭرﻁطﻲ ‪.‬ﻻ ﻳﯾﻨﺒﻐﻲ‬
‫ﺳﻤﻴﯿﻜﺔ ﺍاﻟﺼﻤﺎﻡم ﺍاﻷﺑﻬﮭﺮﻱي ﻭوﻳﯾﻨﺒﻐﻲ ﺃأﻥن ﺗﻈﻬﮭﺮ ﻟﻔﺘﺢ ﺑﺤﺮﻳﯾﺔ ‪.‬ﻳﯾﺘﻢ ﺇإﻏﻼﻕق ﺍاﻟﺼﻤﺎﻡم ﺍاﻷﺑﻬﮭﺮﻱي ﻓﻲ )ﺃأ( ﻭو ﻣﻔﺘﻮﺣﺔ ﻓﻲ )ﺏب(‪.‬ﺍاﻷﻭوﺭرﻁطﻲ ﺃأﻱي ﺍاﻷﺑﻬﮭﺮ ﺍاﻟﻬﮭﺎﺑﻂ )‪،٬(D.Aorta‬‬
‫ﺍاﻷﻳﯾﺴﺮ )‪ ,(L‬ﺍاﻷﺫذﻳﯾﻦ ﺍاﻷﻳﯾﺴﺮ)‪ ،٬(LA‬ﺍاﻷﻳﯾﻤﻦ )‪ ،٬(R‬ﺍاﻷﺫذﻳﯾﻦ ﺍاﻷﻳﯾﻤﻦ )‪ ،٬(RA‬ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ )‪. (RV‬‬
‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪ :6‬ﻣﺸﻬﮭﺪ ﻟﻤﺨﺮﺝج ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ )‪ .(RVOT‬ﻳﯾﻈﻬﮭﺮ ﻫﮬﮪھﺬﺍا ﺍاﻟﻤﺸﻬﮭﺪ ﺍاﺗﺼﺎﻝل ﺍاﻟﻮﻋﺎء ﺍاﻟﺪﻣﻮﻱي ﺑﺎﻟﺒﻄﻴﯿﻦ ﺍاﻷﻳﯾﻤﻦ )‪ .(RV‬ﻓﻲ ﺍاﻟﻘﻠﺐ ﺍاﻟﻄﺒﻴﯿﻌﻲ‪ ،٬‬ﻫﮬﮪھﺬﺍا‬
‫ﺍاﻟﻮﻋﺎء ﻳﯾﻌﺒﺮ ﺍاﻷﺑﻬﮭﺮ ﺍاﻟﺬﻱي ﻳﯾﺸﺎﺭر ﺍاﻟﻴﯿﻪﮫ ﻋﻠﻰ ﺃأﻧﻪﮫ ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﺍاﻷﺳﺎﺳﻲ )‪ .(PA‬ﻻ ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﺘﻀﺨﻢ ﺍاﻟﺼﻤﺎﻡم ﺍاﻟﺮﺋﻮﻱي ﺑﻞ ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﻔﺘﺢ ﺑﺤﺮﻳﯾﺔ‪ .‬ﻓﻲ ﺍاﻟﺠﻬﮭﺔ )ﺃأ(‬
‫ﻳﯾﻤﻜﻦ ﺭرﺅؤﻳﯾﺔ ﺇإﻧﺸﻌﺎﺏب ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﻓﻲ ﺍاﻟﻔﺮﻋﻴﯿﻦ ﺍاﻟﺮﺋﻮﻳﯾﻴﯿﻦ ﻛﻼﻫﮬﮪھﻤﺎ‪.‬ﺍاﻟﺼﻤﺎﻡم ﺍاﻟﺮﺋﻮﻱي ﻣﻐﻠﻖ‪ .‬ﻓﻲ ﺍاﻟﺠﻬﮭﺔ )ﺏب(‪ ،٬‬ﺳﻄﺢ ﺍاﻟﺘﻌﺮﺽض ﻟﻠﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺻﻮﺗﻴﯿﺔ ﺃأﻛﺜﺮ‬
‫ﺭرﺃأﺳﻴﯿﺎ ً ﺑﻘﻠﻴﯿﻞ‪ .‬ﺗﻤﺖ ﺭرﺅؤﻳﯾﺔ ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي )‪ ،٬(PA‬ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﺍاﻷﻳﯾﻤﻦ )‪ (RPA‬ﻭوﺍاﻟﻘﻨﺎﺓة ﺍاﻟﺸﺮﻳﯾﺎﻧﻴﯿﺔ‪ (Aorta) .‬ﺍاﻟﺼﻤﺎﻡم ﺍاﻷﺑﻬﮭﺮﻱي‪ ،٬‬ﺍاﻷﺑﻬﮭﺮ ﺍاﻟﻨﺎﺯزﻝل‬
‫)‪ ،٬ (D.Aorta‬ﻳﯾﺴﺎﺭر)‪ ،٬ (L‬ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي ﺍاﻷﻳﯾﺴﺮ)‪ ،٬ (LPA‬ﻳﯾﻤﻴﯿﻦ )‪ ،٬(R‬ﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻷﺟﻮﻑف ﺍاﻟﻌﻠﻮﻱي )‪.(SVC‬‬

‫ﻳﯾﻤﻜﻦ ﺍاﺳﺘﺨﺪﺍاﻡم ﺗﻘﻨﻴﯿﺎﺕت ﺍاﻟﺘﺨﻄﻴﯿﻂ ﺍاﻟﺼﻮﺗﻲ ﺍاﻷﺧﺮﻯى ﻟﺪﺭرﺍاﺳﺔ ﻗﻠﺐ ﺍاﻟﺠﻨﻴﯿﻦ‪ .‬ﻣﺜﻼً‪ ،٬‬ﻳﯾﻤﻜﻦ ﻟﻤﻮﺟﺎﺕت ﺩدﻭوﺑﻠﺮ ﻓﻮﻕق‬
‫ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺃأﻥن ﺗﻘﻴﯿﺲ ﺳﺮﻋﺔ ﺗﺪﻓﻖ ﺍاﻟﺪﻡم ﺃأﻭو ﺗﺤ ّﺪﺩد ﺃأﻧﻤﺎﻁط ﺗﺪﻓﻖ ﻏﻴﯿﺮ ﻁطﺒﻴﯿﻌﻴﯿﺔ ﻋﺒﺮ ﺍاﻟﺼﻤﺎﻣﺎﺕت ﻭوﺩدﺍاﺧﻞ ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ‪.‬‬
‫ﻛﺬﻟﻚ ﻭوﺿﻊ ﺗﺨﻄﻴﯿﻂ ﺻﺪﻯى ﺍاﻟﻘﻠﺐ ‪ M-mode‬ﻫﮬﮪھﻮ ﻭوﺳﻴﯿﻠﺔ ﻣﻬﮭﻤﺔ ﻟﺘﺤﻠﻴﯿﻞ ﺿﺮﺑﺎﺕت ﺍاﻟﻘﻠﺐ ﻭوﻭوﻅظﻴﯿﻔﺔ ﺍاﻟﺒﻄﻴﯿﻦ ﻭوﺳﻤﺎﻛﺔ‬
‫ﺟﺪﺍاﺭر ﻋﻀﻠﺔ ﺍاﻟﻘﻠﺐ‪ .‬ﻓﺎﻟﺘﻘﻨﻴﯿﺎﺕت ﺍاﻟﺠﺪﻳﯾﺪﺓة ﺍاﻟﺘﻲ ﺃأﺻﺒﺤﺖ ﻣﺘﻮﻓﺮﺓة ﺑﺸﻜﻞ ﺃأﻭوﺳﻊ‪ ،٬‬ﻛﺪﻭوﺑﻠﺮ ﺍاﻷﻧﺴﺠﺔ ﻭوﻛﺤﺠﻢ ﺍاﻟﻤﻮﺟﺎﺕت‬
‫ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ )ﺛﻼﺛﻲ ﺍاﻷﺑﻌﺎﺩد )‪ / (3D‬ﺭرﺑﺎﻋﻲ ﺍاﻷﺑﻌﺎﺩد )‪ / (4D‬ﺍاﺭرﺗﺒﺎﻁط ﺍاﻟﺼﻮﺭرﺓة ﺍاﻟﻤﻜﺎﻧﻴﯿﺔ ﺍاﻟﺰﻣﺎﻧﻴﯿﺔ )‪،٬(STIC‬‬
‫ﻳﯾﻤﻜﻨﻬﮭﺎ ﺃأﻥن ﺗﻨﺪﻣﺞ ﺃأﻳﯾﻀﺎ ً ﻭوﺑﻄﺮﻳﯾﻘﺔ ﺗﻔﺼﻴﯿﻠﻴﯿﺔ ﺃأﻛﺜﺮ ﻣﻊ ﺍاﻟﺘﻘﻴﯿﻴﯿﻢ ﺍاﻟﺘﺸﺮﻳﯾﺤﻲ ﻭوﺍاﻟﻮﻅظﻴﯿﻔﻲ ﻟﻘﻠﺐ ﺍاﻟﺠﻨﻴﯿﻦ‪.‬‬
‫ﻭوﻗﺪ ﺗﺒﻴﯿّﻦ ﺃأﻥن ﺗﺨﻄﻴﯿﻂ ﺻﺪﻯى ﺍاﻟﻘﻠﺐ ﺍاﻟﺮﺑﺎﻋﻲ ﺍاﻷﺑﻌﺎﺩد ﻟﻠﺠﻨﻴﯿﻦ ﻳﯾﺴﺎﻫﮬﮪھﻢ ﻓﻲ ﺍاﻟﺘﻘﻴﯿﻴﯿﻢ ﺍاﻟﺘﺸﺨﻴﯿﺼﻲ ﻓﻲ ﺣﺎﻻﺕت ﺗﺸﻮﻫﮬﮪھﺎﺕت‬
‫ﺍاﻟﻘﻠﺐ ﺍاﻟﻤﻌﻘﺪﺓة ﺑﻤﺎ ﻓﻴﯿﻬﮭﺎ ﺗﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﻘﻠﺐ ﺍاﻟﺨﻠﻘﻴﯿﺔ ﺍاﻟﻨﺎﺩدﺭرﺓة ﻭوﺗﺸﻮﻫﮬﮪھﺎﺕت ﻗﻮﺱس ﺍاﻷﺑﻬﮭﺮ ﻭوﺍاﻟﻌﺎﺋﺪ ﺍاﻟﻮﺭرﻳﯾﺪﻱي ﺍاﻟﺮﺋﻮﻱي ﺍاﻟﺸﺎﺫذ‬
‫)‪ .(79 to 81‬ﻭوﺣﺎﻟﻴﯿﺎ ً ﻳﯾﺘﻢ ﺍاﺳﺘﺨﺪﺍاﻡم ﺃأﺳﺎﻟﻴﯿﺐ ﺍاﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺍاﻹﺿﺎﻓﻴﯿﺔ‪ ،٬‬ﻣﺜﻞ ﺗﻘﻔﻲ ﺍاﻟﺒﻘﻊ‪ ،٬‬ﻓﻲ ﺇإﻋﺪﺍاﺩدﺍاﺕت‬
‫ﺍاﻟﺒﺤﺚ ﻭوﻟﻜﻨﻬﮭﺎ ﻗﺪ ﺗﺼﺒﺢ ﺃأﺩدﺍاﺓة ﺳﺮﻳﯾﺮﻳﯾﺔ ﻣﻬﮭﻤﺔ ﻓﻲ ﺗﻘﻴﯿﻴﯿﻢ ﻭوﻅظﻴﯿﻔﺔ ﻗﻠﺐ ﺍاﻟﺠﻨﻴﯿﻦ‪.‬‬

‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪ :7‬ﻣﺸﻬﮭﺪ ﻟﻸﻭوﻋﻴﯿﺔ ﺍاﻟﺜﻼﺛﺔ )‪ .(3 VV‬ﻳﯾﻈﻬﮭﺮ ﻫﮬﮪھﺬﺍا ﺍاﻟﻤﺸﻬﮭﺪ ﺑﺸﻜﻞ ﻭوﺍاﺿﺢ ﺍاﻟﻌﻼﻗﺔ ﺑﻴﯿﻦ ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻟﺮﺋﻮﻱي )‪ (PA‬ﻭوﺍاﻷﺑﻬﮭﺮ )‪ (Aorta‬ﻭوﺍاﻟﻮﺭرﻳﯾﺪ‬
‫ﺍاﻷﺑﻬﮭﺮ ﺍاﻟﻌﻠﻮﻱي )‪ (SVC‬ﻓﻲ ﺍاﻟﻤﻨﺼﻒ ﺍاﻟﻌﻠﻮﻱي‪ .‬ﻭوﻣﻦ ﺍاﻟﻤﻬﮭﻢ ﺍاﻹﺷﺎﺭرﺓة ﺍاﻟﻰ ﺍاﻟﻤﺮﻛﺰ ﻭوﺍاﻻﻧﺘﻈﺎﻡم ﺍاﻟﺼﺤﻴﯿﺢ ﻟﻸﻭوﻋﻴﯿﺔ ﺍاﻟﺜﻼﺛﺔ ﺇإﺿﺎﻓﺔً ﺍاﻟﻰ ﺣﺠﻤﻬﮭﺎ ﺍاﻟﻨﺴﺒﻲ‪ .‬ﺍاﻟﺸﺮﻳﯾﺎﻥن‬
‫ﺍاﻟﺮﺋﻮﻱي‪ ،٬‬ﺍاﻟﻰ ﺍاﻟﻴﯿﺴﺎﺭر‪ ،٬‬ﻫﮬﮪھﻮ ﺃأﻛﺒﺮ ﺷﺮﻳﯾﺎﻥن ﺑﻴﯿﻦ ﺍاﻟﺸﺮﺍاﻳﯾﻴﯿﻦ ﺍاﻟﺜﻼﺛﺔ ﻭوﺍاﻷﻛﺜﺮ ﺑﺮﻭوﺯزﺍاً ﻓﻲ ﺍاﻟﻨﺎﺣﻴﯿﺔ ﺍاﻷﻣﺎﻣﻴﯿﺔ‪ ،٬‬ﻓﻲ ﺣﻴﯿﻦ ﺃأﻥن ﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻷﺟﻮﻑف ﺍاﻟﻌﻠﻮﻱي )‪ (SVC‬ﻫﮬﮪھﻮ ﺍاﻷﺻﻐﺮ‬
‫ﻭوﺍاﻷﻛﺜﺮ ﺑﺮﻭوﺯزﺍاً ﻓﻲ ﺍاﻟﺠﻬﮭﺔ ﺍاﻟﺨﻠﻔﻴﯿّﺔ‪ .‬ﺍاﻟﺼﻤﺎﻡم ﺍاﻷﺑﻬﮭﺮﻱي )‪ ،٬(Aorta‬ﺍاﻷﺑﻬﮭﺮ ﺍاﻟﻨﺎﺯزﻝل )‪.(D.Aorta‬‬

‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪ :8‬ﻣﺸﻬﮭﺪ ﺍاﻷﻭوﻋﻴﯿﺔ ﺍاﻟﺜﻼﺛﺔ ﻭوﺍاﻟﻘﺼﺒﺔ ﺍاﻟﻬﮭﻮﺍاﺋﻴﯿﺔ )‪ .(3VT‬ﺗﻈﻬﮭﺮ ﻫﮬﮪھﺬﻩه ﺍاﻟﻠﻘﻄﺔ ﺑﺸﻜﻞ ﻭوﺍاﺿﺢ ﻋﻼﻗﺔ ﺍاﻟﻘﻮﺱس ﺍاﻷﺑﻬﮭﺮ ﺍاﻟﻤﻌﺘﺮﺽض ﻣﻊ ﺍاﻟﻘﺼﺒﺔ‬
‫ﺍاﻟﻬﮭﻮﺍاﺋﻴﯿﺔ‪ .‬ﻭوﻓﻲ ﺍاﻟﻘﻠﺐ ﺍاﻟﻄﺒﻴﯿﻌﻲ‪ ،٬‬ﺍاﻟﻘﻮﺱس ﺍاﻷﺑﻬﮭﺮﻱي ﻭوﺍاﻟﻘﻮﺱس ﺍاﻟﻘﻨﻮﻱي ﻛﻼﻫﮬﮪھﻤﺎ ﻳﯾﻘﻌﺎﻥن ﻓﻲ ﺍاﻟﺠﺎﻧﺐ ﺍاﻷﻳﯾﺴﺮ ﻟﻠﻘﺼﺒﺔ ﺍاﻟﻬﮭﻮﺍاﺋﻴﯿﺔ‪ ،٬‬ﻋﻠﻰ ﺷﻜﻞ “‪ .”V‬ﻳﯾﺴﺎﺭر)‪ ،٬(L‬ﻳﯾﻤﻴﯿﻦ )‪،٬(R‬‬
‫ﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻷﺟﻮﻑف ﺍاﻟﻌﻠﻮﻱي )‪.(SVC‬‬
 Guideline Authors
 
J.   S.   Carvalho,   Royal   Brompton   Hospital,   London,   UK;   Fetal   Medicine   Unit,   St   George’s  
Hospital  &  St  George’s  University  of  London,  London,  UK  
L.   D.   Allan,   Harris   Birthright   Research   Centre   for   Fetal   Medicine,   King’s   College   Hospital,  
London,  UK  
R.  Chaoui,  Center  for  Prenatal  Diagnosis  and  Human  Genetics,  Friedrichstrasse  147,  Berlin,  
Germany  
J.   A.   Copel,Obstetrics,   Gynecology   and   Reproductive   Sciences,   Yale   University   School   of  
Medicine,  New  Haven,  CT,  USA  
G.   R.   DeVore,  Fetal  Diagnostic  Center,  South  Fair  Oaks  Ave,  Pasadena,  CA,  USA;  Department  
of   Obstetrics   and   Gynecology,   David   Geffen   School   of   Medicine   at   UCLA,   Los   Angeles,   CA,  
USA  
K.   Hecher,   Department   of   Obstetrics   and   Fetal   Medicine,   University   Medical   Center  
Hamburg-­‐Eppendorf,  Hamburg,  Germany  
W.   Lee,   Texas   Children’s   Pavilion   for   Women,   Department   of   Obstetrics   and   Gynecology,  
Baylor  College  of  Medicine,  Houston,  TX,  USA  
H.   Munoz,   Fetal   Medicine   Unit,   Obstetric   &   Gynecology   Department,   University   of   Chile,  
Santiago,  Chile;  Clinica  las  Condes,  Santiago,  Chile  
D.  Paladini,  Fetal  Medicine  and  Cardiology  Unit,  Department  of  Obstetrics  and  Gynecology,  
University  Federico  II  of  Naples,  Naples,  Italy    
B.   Tutschek,  Center  for  Fetal  Medicine  and  Gynecological  Ultrasound,  Basel,  Switzerland;  
Medical  Faculty,  Heinrich  Heine  University,  Dusseldorf,  Germany  
S.   Yagel,   Division   of   Obstetrics   and   Gynecology,   Hadassah-­‐Hebrew   University   Medical  
Centers,  Jerusalem,  Israel  
 
 
 
  Citation
 
 
 
These  Guidelines  should  be  cited  as:  ‘Carvalho  JS,  Allan  LD,  Chaoui  R,  Copel  JA,  DeVore  GR,  
Hecher   K,   Lee   W,   Munoz   H,   Paladini   D,   Tutschek   B,   Yagel   S.   ISUOG   practice   guidelines  
(updated):   sonographic   screening   examination   of   the   fetal   heart.   Ultrasound  Obstet  Gynecol  
2013;  41:  348–359.  
 
 
 
 
 
 
 
 
 
 
 
  
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SUPPORTING INFORMATION ON THE INTERNET

The following supporting information may be found in the online version of this article:
Appendix S1 Additional B-mode panels: outflow tracts
Appendix S2 Color flow panels

(Guideline review date: December 2015)

This document was translated and reviewed on behalf of SANA Medical NGO
(www.sanango.org) by: Reem S. Abu-Rustum, MD; Hassan Aji, MD and Alyda El Hage Nehme
(Technical Translator).