Fetal Heart 2

Question 1

If the LV is smaller than RV, what two main anomalies could be considered?

Answer 1

hypoplastic lt. heart syndrome

coarctation of the aorta

Question 2

Hypoplastic left heart:

Answer 2

LV is usually severely underdeveloped
typically, MV is hypoplastic and aortic valve is an imperforate membrane
asc aorta and arch and often hypoplastic

Question 3

Coarctation of the aorta:

Answer 3

narrowing of aortic lumen occuring between the insertion of the ductus arteriosus and lt. SCA
lesser degree in LV size than HLHS
shelf like lesion in aorta

Question 4

Coarctation is mostly seen in what syndrome?

Answer 4

Turner’s

Question 5

If the RV is smaller than LV, what is likely the cause?

Answer 5

pulmonary atresia (but not always the case)

Question 6

Pulmonary atresia:

Answer 6

no flow through from the RV through the pulmonary valve into main pulmonary artery

Question 7

RV can also appear small in what anomaly?

Answer 7

Ebstein’s anomaly

Question 8

Enlarged RA (Ebstein’s anomaly):

Answer 8

inferior displacement of the septal and posterior leaflets of the TV
TV is incompetent which leads to enlarged RA
4CH view shows this

Question 9

What can Ebstein’s anomaly be associated with?

Answer 9

pulmonary atresia (valve does not form correctly)
arrhythmia
chromosomal anomalies

Question 10

Overriding aorta:

Answer 10

aorta is displaced more to the right and positioned over a VSD instead of LV causing a mixing of oxygenated and deoxygenated blood
disrupts the normal continuity of the ventricular septum and the wall of aorta seen in the view
VSD

Question 11

What is a key structure to visualize when scanning an overriding aorta?

Answer 11

PA

Question 12

What is the primary diagnosis when an overriding aorta is seen?

Answer 12

tetralogy of fallot

Question 13

Tetralogy of Fallot consists of what?

Answer 13

stenosis of RVOT
hypoplastic or stenotic PA
abnormality of the pulmonary valve or annulus
infundibular stenosis (below PA in RV)
VSD
overriding aorta 

*hypertrophy of RV

Question 14

Tetralogy of Fallot becomes a problem when?

Answer 14

after birth. Systemic hypoxia occurs

Question 15

Truncus arteriosus:

Answer 15

rare more severe form of TOF in which a single blood vessel comes out of the right and left ventricle

Question 16

What are the anomalies of the outflow tract?

Answer 16

transposition of the great arteries

double outlet right ventricle

Question 17

Transposition of the Great Arteries:

Answer 17

atrioventricular connection is normal, but the aorta arises from the RV and PA from LV
no hemodynamic consequence in utero unless pulmonary stenosis is present

Question 18

Double outlet right ventricle:

Answer 18

both great arteries connect to the RV
PA and most of aorta arise from the RV
VSD– unless there are obstructing lesions such as a pulmonic or mitral stenosis

Question 19

Where are echogenic intracardiac foci typically observed?

Answer 19

LV - 60%

Question 20

Intracardiac foci have an association with what?

Answer 20

risk of Tri21- 1%

Question 21

With an echogenic intracardiac foci, is the heart typically normal or abnormal?

Answer 21

normal

Question 22

Rhabdomyomas:

Answer 22

tuberous sclerosis is frequently associated with this
most are benign and isolated
can cause CHF if it obstructs inflow or outflow
typically more echogenic than ventricular myocardium

Question 23

What’s the most common type of cardiac tumor in the fetus (90%)

Answer 23

rhabdomyomas:

Question 24

Congestive heart failure:

Answer 24

occurs when the heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body

Question 25

Causes of CHF:

Answer 25

arrhythmias
anemia
congenital heart disease w/ valvular regurgitation
non-cardiac malformations such as diaphragmatic hernia or cystic hygroma
TTTS volume and pressure overload
arterioventricular fistula w/ high cardiac output

Question 26

What are the advanced findings of CHF?

Answer 26

cardiomegaly
valve regurgitation
venous congestion
fetal edema and effusions
oligohydramnios
preferential shunting of blood flow to the brain, heart, and adrenals in distressed fetus

Question 27

What is an abnormal pericardial fluid collection?

Answer 27

> 2mm

Question 28

What can pericardial effusion be associated with?

Answer 28

hydrops
fetal arrhythmia (tachyarrhythmia)
congenital cardiac anomalies
fetal cardiac tumors
increased incidence of chromosomal anomalies