Ch. 35 & 36 Flashcards
(210 cards)
1
Q
Caudal region of the primitive heart
A
Sinus venosus
2
Q
Primitive atrium develops into
A
Left and right atria
3
Q
Primitive ventricle develops into the
A
Left ventricle
4
Q
Bulbous cord is develops into the
A
Right ventricle
5
Q
Truncus arteriosus dilates to form
A
Aortic sac from which the aortic arches arise
6
Q
Sinus venosus initially this is a separate chamber that opens into the
A
Right atrium
7
Q
Sinus venosus receives all blood returning to the heart from
A
Common cardinal veins
Vitelline veins
Umbilical veins
8
Q
The left horn of the sinus becomes the
A
Coronary sinus
9
Q
The right horn is incorporated into _, this forms the _
A
The wall of the right atrium
Smooth portion of the adult right atrial wall
10
Q
The right half of the primitive atrium persists as the
A
Right auricle
11
Q
Left atria is formed by
A
Incorporation of the primitive pulmonary vein
12
Q
4 pulmonary veins eventually enter the _ from the _
A
Left atrium
lung
13
Q
The smooth wall of the left atrium is formed from the _
A
Absorbed pulmonary vein
14
Q
The left atrial appendage (_) is from the _
A
Left auricle
Primitive heart
15
Q
Division of the 4CH occurs during _ of fetal development
A
4th & 5th weeks
16
Q
Endocardium cushions develop in _ region of the heart
A
Atrioventricular
17
Q
The cushion grows toward each other and fuse to divide the _
A
Atrioventricular canal into right and left canals
18
Q
The foramen oval is an opening between
A
The free edge of the septum secundum
and the dorsal wall of the atrium
19
Q
The left ventricle is formed from the
A
Primitive vein
20
Q
The right ventricle is formed from
A
Bulbous cordis
21
Q
The interventricular septum begins as
A
A ridge in the floor of the primitive ventricle and slowly grows toward the endocardial cushion
22
Q
Foramen ovale allows communication from _ to the _
A
right atrium to the left atrium
23
Q
Ductus arteriosus allows fetal circulation to bypass the _
A
Lungs
24
Q
Ductus arteriosus allows communication from the _ to the _
A
Pulmonary trunk
Descending aorta
25
Ductus venosus allows fetal circulation to bypass
The liver
26
Ductus venosus: flow passes from _ through the ductus venosus to the _ and then _
Umbilical vein
IVC
Right atrium
27
After birth, fetal lungs begin to function. The omission of placenta circulation causes an immediate fall in _
Blood pressure in the newborns IVC and right atrium.
28
After birth, as lungs expand with air, there is a fall in _. This causes an increase in _
Pulmonary resistance
| Pulmonary blood flow and progressive thinning of the wall of the pulmonary artery.
29
Pressure in the _ becomes higher than the _. This causes _
Left atrium
Right atrium
The foramen ovale to close
30
First shunt to close after birth
Foramen ovale
31
If the foramen ovale does not close after birth
Patent foramen ovale
32
The ductus arteriosus usually constricts _ after birth, once _
24-48hrs
| Left sided pressure exceeds right sided pressure
33
There is a small shunt from the _ to the _ until _
Aorta
Pulmonary artery
The left and right sided pressures adjust to neonatal life
34
Ductus arteriosus turns into the _ in the neonate.
| If communication persisist _
Ligamentum arteriosum
| Patent ductus arteriosus
35
Umbilical arteries also constrict after birth to _
Prevent blood loss from the newborn
36
Umbilical vein may
Remain patent for some time after birth
37
Normal HR
120-160bpm
38
Bradycardia _bpm
<100
39
Tachycardia _bpm
>200
40
Umbilical arteries go _
Around the bladder
41
Indicators for fetal echo
```
IUGR
Cardiac arrhythmias
Abn. amnio
Abn. HR
Hydrops fetalis
Thickened NT
```
42
Extracardiac abnormalities are assoc. w/
Congenital heart block
43
Echo: maternal factors
Previous child with congenital heart disease
Parent with congenital heart disease
Maternal diseases affecting fetus (diabetes, lupus, drug/alc. use)
44
Echo: Fetal US landmarks
Fetal position
Fetal thorax
Apex of heart
45
Echo: When fetus is in a difficult position
Ask mother to change positions
| Have mother go to the restroom
46
Normal cardiac study should include the following views
o4 chambers
oOutflow tracts [RVOT, LVOT]
oOblique long-axis view for aortic arch and ductus arteriosus
47
The most commonly acquired view of the fetal heart
4CH
48
4-chamber view anatomy
```
▪Right atrium & ventricle [with moderator band]
▪Tricuspid valve
▪Left atrium & ventricle
▪Mitral valve
▪Interventricular septum
▪Interatrial septum
▪Foramen ovale
▪Pulmonary veins as they enter the left atrium
```
49
Moderator band can be used to locate the
Rt ventricle
50
Most anterior chamber
Rt ventricle
51
Most posterior chamber
Left atrium
52
The _ side of the heart is slightly larger in utero
Right
53
In utero the foramen ovale opens toward the _, as the pressure is slightly _ in the right atrium
Left atrium
| Greater
54
After birth the pressure in the _ heart forces the foramen to close
Left
55
Failure of the foramen to close results in
defect in the atrial septum
56
_ valve is slightly inferior to the _ valve
Tricuspid
| Mitral
57
The IVC and SVC can be seen entering the _
Right atrium
58
Junction of the interatrial and intraventricular septa, AV valves, and the 4 chambers
Crux
59
Five chamber view allows for the _
aortic flow to be recorded leaving the left ventricle
60
For 5CH, the transducer position is _
Slightly anterior to the 4CH
61
Criss-cross view, as the transducer is angled from the aorta slightly left
Pulmonary artery may be seen as it arises from the right ventricular outflow tract
62
Criss cross view: Pulmonary artery is normally _ and to the _ of the aorta
Anterior
| Left
63
Criss cross view allows visualization of _
The normal relationship of the pulmonary artery and aorta to one another
64
Great vessels
Pulmonary artery and aorta
65
The “sweep” from the aorta to the pulmonary artery is called the_ view
Criss cross
66
LVOT: The origin of the aorta is identified arising from the
Left ventricle
67
Best view to obtain septal defects
LVOT
68
LVOT: Evaluate size of
▪Right & left ventricles
▪Right & left atriums
▪Thickness of interventricular septum
▪Continuity of interventricular septum
69
LVOT allows you to evaluate for _
A septal defect
70
LVOT: _ may not be detected with US
Small defects
71
Short axis view
RVOT
72
Long axis view
LVOT
73
For RVOT, from LVOT, rotate transducer _degrees in a _ direction
90
| Cephalic
74
RVOT: Visualize the _ of the _ into the right and left pulmonary arteries
Bifurcation
| Main pulmonary artery
75
RVOT: Demonstrates the normal relationship of the pulmonary artery as it lies _
Anterior and to the right of the aorta
76
Normally the RVOT and PA “drape” _ to the circular aorta
Anterior
77
Oblique view
Ductal/aortic views
78
Angulation of the transducer to oblique longitudinal plane provides visualization of this aortic anatomy:
Root of the aorta
Ascending aorta
Arch
Descending aorta
79
For oblique views, find the fetal spine in sagittal plane and angle _ to find the _ & _
Slightly inward toward the chest
| Aortic & ductal arches
80
Aortic Arch: The three head and neck branch arteries arise from the perfect curve of the aortic arch as they
Ascend into the fetal head
81
3 head and neck branch arteries
Innominate (brachiocephalic)
Left common carotid
Left subclavian
82
Appearance of the aortic arch
Candy cane
83
Ductal Arch: Transducer is angled
inferior from the aortic arch
84
Ductal Arch: Arch type pattern represents
patent ductus arteriosus
85
Ductal arch: Ductus is slightly _ than the aortic arch
Larger
86
Ductal arch appearance
Hockey stick
87
Ductal arch: Does not have _ arising from its wall like the aortic arch
Head and neck vessels
88
Ductal arch: SVC/IVC emptying into the _
Right atrium
89
The most common types of congenital heart disease
Ventral septal defect
Atrial sseptal defects
Pulmonary stenosis
90
Most common single cardiac anomaly
Ventral septal defect
91
Influencing factors of congenital heart disease
Environmental
Chromosomal
Hereditary
92
Fetal echo helps to establish the
presence and severity of the cardiac abnormality
93
Indications for Sonographic detection of congenital heart disease
```
CHRISTMAS
Concordance & contractility
Hydrops
Risk factors & rhythm
Incorrect size (LGA/SGA)
Symmetry
Tetralogy of Fallot, transposition, tricuspid atresia, truncus arteriosus
Masses & mobility
Aneuploidy
Situs
```
94
Common occurrence of _ with congenital heart disease
Chromosomal abnormalities
95
Majority of CHD have _
Trisomy 21
| Followed by 13, 18, and Turners
96
Certain cardiac abnormalities are more likely to be associated with chromosomal defects, such as
```
Atrioventricular septal defect [ASD]
Tetralogy of Fallot
Double outlet right ventricle
Coarctation of the aorta
*Hypoplastic left heart
```
97
Malformations of the _ side of the heart are rarely assoc. w/ karotypic abn.
Right
98
*Mother who had a child with _ heart abnormality has significantly higher risk of delivering another child with a form of _ heart disease
Left
| Left
99
Risk for heart disease _ with each pregnancy
Increases significantly
100
*_is the most common severe congenital abnormality
Congenital heart disease
101
CHD: _ of these are _
Half
| Minor
102
CHD: may be corrected with _
Surgery
103
CHD: Other half (not minor) is responsible for more than _ of the deaths from congenital abnormalities in childhood
Half
104
Prenatal Evaluation of Congenital Heart Disease: Several cardiac abnormalities may be detected with the _
4CH but many will be missed with only this view
105
Dextrocardia: _ with the apex pointing to the _
Heart is in the right side
| Right
106
Dextrocardia is assoc. w/
Normal visceral situs
| Situs inversus
107
Dextroposition: Heart is in the _ with the apex pointing
Right side of the chest
| Medially/left
108
Dextroposition: Usually found with intrinsic factors such as
Diaphragmatic hernia or hypoplasia of the right lung
109
Levocardia:
Both normal position of the heart in the left chest & when visceral/partial situs abnormalities are present
110
Levocardia is assoc. w/
Normal situs
| Situs inversus
111
Levoposition
Heart is displaced further toward the left chest
112
Levoposition is assoc. w/
Space occupying lesion that would shove the heart more towards the left (diaphragmatic hernia)
113
Mesocardia
Cardiac apex is pointing toward the middle of the chest. Heart is usually more midline
114
Mesocardia is assoc. w/
Extracardiac mass
| Lung abnormalities
115
Cardiomyopathy
Disease of myocardial tissue in the heart
116
Causes of cardiomyopathy
▪Exposure to virus or bacteria leading to infection
▪Errors of metabolism
▪Endocardial fibroelastosis
117
Myocarditis: characterized by
necrosis & destruction of myocardial cells and inflammatory infiltrate
118
Viral cardiomyopathy AKA
Myocarditis
119
All 4 chambers dilated and thinning of myocardial walls
Viral cardiomyopathy
120
Myocarditis: Severely decreased cardiac functionleadingto
▪congestive heart failure
| ▪Bradycardia ▪Death
121
Myocarditis prognosis
Poor
122
Pericardial effusion
Abnormal collection of fluid surrounding the epicardial layer of the heart
123
Pericardial effusion: in the 4CH view, *normal hypoechoic area in the peripheral part of the epicardial/pericardial interface should be
2mm or less
124
Pericardial effusion:
| *Separation of greater than _mm may be associated with _
2
| Hydrops
125
3 types of septal defect
Atrial septal defect [ASD]
Ventricular septal defect [VSD]
Atrioventricular septal defect [AVSD]
126
Atrial Septal Defect creates a communication between the
Right and left atrium
127
3 common forms of ASD
Osteum secundum
Osteum primum
Sinus venosus
128
Osteum Secundum:
_ common
Defect in _
Most common, yet most difficult to see.
The central atrial septum near foramen ovale
129
Osteum primum is assoc. w/
Trisomy 21
130
Sinus venosus: Near the _
| _ common
Entrance of the SVC to the right atrium
| Least
131
ASD is _ in utero, because _, unless _
not always diagnosed in utero
Foramen ovale
Part of the intra-atrial septum is missing
132
Failure of the foramen ovale to close may cause
ASD
133
Color flow helpful in detecting
ASD
134
Most common congenital lesion of the heart
VSD
135
VSD accounts for _% of all structural heart defects.
30
136
VSD: Defects smaller than _ are not detected by ultrasound
2mm
137
VSD prognosis
Good
138
VSD is assoc. w/
▪Tetralogy of Fallot
▪Single ventricle
▪Transposition of the great arteries
▪Endocardial cushion defect
139
Atrioventricular septal defect AKA
Endocardial cushion defect and AV canal malformation
140
Defect in the atrial & ventricular septum–failure of the common AV orifice to separate into mitral and tricuspid valves
Atrioventricular septal defect
141
Atrioventricular septal defects are subdivideed into
Complete
Incomplete
Partial
142
Atrioventricular septal defects are assoc. w/
Downs
Asplenia
Polysplenia
143
Tricuspid atresia _ causing _
Interruption of the growth of tricuspid leaflets
| Valve to be hypoplastic or atretic
144
Tricuspid atresia: in the 4CH
Large dilated left ventricular cavity
Small, underdeveloped right ventricular cavity
Echogenic tricuspid annulus is seen with no valvular movement
Mitral valve is clearly the dominant atrioventricular valve
145
Ebstein’s Anomaly
*Abnormal displacement of the septal leaflets of the tricuspid valve toward the apex of the right ventricle-(low insertion)
146
Ebstein anomaly: _ is usually massively dilated
Right atrium
147
Ebstein anomaly: abn. function of the right side of the heart is related to the following 3 factors:
Malformed tricuspid valve
Atrialized portion of the right ventricle
Reduced capacity of pumping portion of right ventricle
148
Hypoplastic right heart
Right heart is underdeveloped
| due to obstruction of RVOT secondary topulmonary stenosis
149
Hypoplastic right heart: small _
RV, RA, and tricuspid valve
150
Hypoplastic Left Heart Syndrome
Small hypertrophied left ventricle with aortic &/or mitral atresia
151
Hypoplastic left heart is a _ condition
Autosomal recessive
152
Hypoplastic left heart: Overload of _ may lead to_ with _
Right ventricle
Congestive heart failure
Pericardial effusions and hydrops
153
Hypoplastic left heart: small left ventricle due to
Blood cannot fill LV to provide volume
Aortic stenosis
Mitral &/or aortic valve atresia
154
Hypoplastic left heart is considered _ but prognosis has _
Lethal
| improved with cardiac transplant
155
*Most common form of cyanotic disease in infants & children
Tetralogy of Fallot
156
Tetralogy of Fallot: severity varies according to
degree of pulmonary stenosis present
157
Tetralogy of Fallot consists of 4 abn. (sonographically)
VSD
Over-riding aorta
Pulmonary stenosis
Right ventral hypertrophy
158
Large septal defect with severe pulmonary stenosis
| “Blue baby” at birth
Cyanotic disease
159
Large septal defect with mild to moderate pulmonary stenosis
Acyanotic disease
160
Tetralogy of Fallot is assoc. w/
Trisomy 13, 18, 21
| other congenital cardiac malformations
161
If aorta overrides over 50%
*Called double-outlet right ventricle
| Means that both great vessels arise from the right side of the heart
162
*Most common form of RVOT obstruction is _
Pulmonary valve stenosis
163
Pulmonary stenosis: abn. cusps become
Thickened
164
Pulmonary stenosis: main pulmonary artery may be
Hypoplastic
165
Pulm. stenosis: assoc. w/
other cardiac anomalies
166
Pulm. stenosis is _ to diagnose
Very difficult
167
*Transposition of the Great Arteries
Aorta is abnormally connected to the RV and the pulmonary artery is abnormally connected to the LV
168
Transposition of great arteries: In fetal heart
no hemodynamic compromise is seen when the great arteries are transposed
BUT, after birth, the problem occurs due to inadequate mixing of oxygenated & deoxygenated blood
169
Prognosis of transposition of great arteries
Good with surgical intervention
170
Transposition of great arteries is assoc. w/
ASD
| Anomalies of the atrioventricular valves Underdevelopment of the right or left ventricles
171
Transposition of great arteries: _ is key in imaging the great arteries & their relationship
RVOT
172
Transposition of great arteries: RVOT, pulmonary artery & bifurcation should be seen _ to the aorta. In transposition this relationship _
anterior to the aorta
| Is not present
173
Transposition of great arteries: LVOT: Normal criss-cross pattern seen when sweeping from LVOT to RVOT With transposition this
is not possible
174
Transposition of great arteries: LVOT: The great arteries are seen _ because
Parallel to each other
They both arise from the ventricles
175
Truncus Arteriosus
*Heart lesion which only 1 great artery arises from the base of the heart
176
Truncus arteriosus: from single great artery arises the
Pulmonary truck
Systemic arteries
Coronary arteries
177
Truncus arteriosus is assoc. w/
Mitral atresia
Atrial septaldefect [ASD]
Univentricular heart
Aortic arch abnormalities
178
Prognosis of truncus arteriosus _, fetal usually develops _
Poor
▪Congestive heart failure
▪Pericardial effusion
▪hydrops
179
Ultrasound: Truncus arteriosus
Abnormal, large, single great vessel arising from the ventricle
180
Coarctation of the Aorta
Shelf-like lesion in the isthmus of the arch.
| Narrowing/kinking in the aorta
181
Coarctation of aorta: Assoc. intracardiac malformations are present in _% of cases
90
182
Cardiac malformations assoc. w/ coarctation of the aorta
▪Aortic stenosis
▪Aortic insufficiency ▪Septal defects ▪Transposition of great arteries
▪Truncus arteriosus
▪Double-outlet right ventricle
183
Coarctation of the aorta is _ to diagnose in fetus. Blood flow may _. After delivery, _
Difficult
Still be flowing into the arch
This will be very evident
184
Cardiac tumors are
Very unusual
185
Most cardiac tumors are
Benign and isolated
186
Most common cardiac tumor
Rhabdomyoma followed by teratoma
187
Cardiac tumors: _ are malignant
<10%
188
Rhabdomyoma tends to be
Multiple and involve the septum
189
Rhabdomyoma is assoc w/
Tuberous sclerosis
190
Rhabdomyoma: Fetus becomes _ when tumor_
Symptomatic
| Becomes large enough to obstruct one of the outflow tracks
191
Rhabdomyoma leads to
Congenital heart failure
Pericardial effusion
Hydrops
Death
192
Rhabdomyoma: Prognosis depends on
Size
Location
Histologic type
193
Rhabdmyoma is best seen in
4CH
194
Single Ventricle
2 atrium _
| 1 ventricle
195
Single ventricle: 1 ventricle receives
Both mitral and tricuspid valves. Both are patent
196
Single ventricle: the right or left AV connection _
May be absent
197
Single vent.: Great arteries _. Aorta arises above _
May be transposed
| A small outlet chamber
198
Single vent.: Pulmonary stenosis _
may or may not exist
199
Ectopia Cordis
Abnormal development of the heart outside of the chest
200
Ectopia cordis is assoc. w/
```
Facial & skeletal deformities
Ventral wall defects[omphalocele]
CNS malformations [meningocele, cephalocele]
•Cardiac anomalies include:
Tetralogy of Fallot
Transposition of the great arteries
```
201
Prognosis of ectopia cordis
Very poor
202
Premature Atrial & Ventricular Contractions: called
PAC's and PVC's
203
Premature Atrial & Ventricular Contractions results from
An immature heart
204
Premature Atrial & Ventricular Contractions
Ectopic premature contraction
205
Premature Atrial & Ventricular Contractions: Atrium & ventricle may both experience
extrasystoles & ectopic beats
206
Echogenic intracardiac focus
An echogenic structure in the heart that is bright as bone
207
EIF: seen in the
Left ventricle of the heart
208
EIF is thought to represent
calcification of the papillary muscle or chordae tendineae (puts pressure on valves to keep closed)
209
EIF may be
Normal or linked with trisomy 21
210
How would you tell EIF from the moderator band
EIF is on the left (MB on right)
| EIF will be bright as bone
