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DMST 315 OBGYN 3 > Fetal Cardiac Abnormalities > Flashcards

Fetal Cardiac Abnormalities Flashcards

(143 cards)

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1
Q

The heart begins to develop around how many weeks?

A

5 weeks

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2
Q

During the development time of the heart, paired heart tubes form and do what?

A

Fuse into a single heart

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3
Q

When does the chambers of the heart develop?

A

6-8 weeks

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4
Q

When is the heart fully developed?

A

10 weeks

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5
Q

What are three things in fetal circulation that we don’t generally have in the adult heart?

A
  1. Ductus venous
  2. Foramen ovale
  3. Ductus arteriosus
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6
Q

Which view rules out 1/3 of the cardiac defects?

A

Four chamber

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7
Q

If the cardiac outflows are included, then how many of the cardiac defects can be ruled out?

A

2/3

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8
Q

What are the vessels in three vessel views?

A
  1. PA
  2. Ao
  3. SVC
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9
Q

When is fetal echo best performed?

A

20-22 weeks to term

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10
Q

What does fetal screening of the heart allow? 2

A
  1. Alllows parental decisions and preparation
  2. Allows for potential medical intervention in utero and prepare for treatment post natally
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11
Q

Fetal screening has a huge impact for conditions with what? 3

A
  1. High risk of pre-operative mortality
  2. Risk of intrauterine fetal death
  3. Opportunity to intervene in utero
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12
Q

What are things that are high risk of pre-operative mortality? 2

A
  1. TGS
  2. Coarctation
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13
Q

What are risks of intrauterine fetal death? 2

A
  1. SVT
  2. Heart block
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14
Q

What are opportunities to intervene in utero? 2

A
  1. Arrhythmia
  2. Aortic and pulmonary stenosis
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15
Q

What are four indications for fetal echo?

A
  1. Abnormal fetal findings from previous ultrasound
  2. Family history of congenital heart defect
  3. Previous pregnancy with a cardiac abnormality
  4. Maternal diseases associated with heart defects (type 1 diabetes)
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16
Q

What are some fetal findings associated with heart disease? 9

A
  1. 2 vessel cord (IUA)
  2. Congenital diaphragmatic hernia
  3. Omphalocele
  4. Thick nuchal fold or NT
  5. Persistent right umbilical vein
  6. Hydrops
  7. Chromosomal abnormalities
  8. Bradycardia
  9. Tachycardia
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17
Q

What is the fetal echo routine? 8

A
  1. Establish situs with stomach and heart
  2. 4 chamber heart view
  3. Outflow tracts
  4. 3 vessel view
  5. Aortic arch and ductal arch
  6. Short axis of ventricles and atria
  7. SVC and IVC
  8. Pulmonary veins
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18
Q

What does normal Abdominal situs look like? 5

A
  1. Stomach bubble on left
  2. Desc. Aorta on left
  3. IVC anterior and to the right of the aortic
  4. Liver on the right
  5. Spleen behind the stomach on the left
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19
Q

What is the process of the cine clip of the fetal heart exam? 3

A
  1. Beginning at the level of the AC
  2. Slowly sweep Cephalic on the fetus
  3. Demonstrating anatomy (stomach, 4 chamber view, LVOT, RVOT, 3 vessel view)
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20
Q

When setting up the cine clip, what needs to be demonstrated at the level of the AC?

A

Demonstrate the fetal stomach to confirm situs

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21
Q

How long is a cine clip of the heat echo routine?

A

6-12 seconds

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22
Q

What is the top tip for fetal heart imaging?

A

Use fetal echo preset if available

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23
Q

Besides fetal echo present, what is some tips for fetal heart imaging? 5

A
  1. Use the highest frequency possible for your patient
  2. Reduce depth
  3. Narrow sector width/ colour box
  4. Reduce dynamic range
  5. Zoom
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24
Q

What is an acrynoym to help remember 4CH heart?

A

PASSSS

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25
What does PASSSS stand for?
1. Position: 2/3 in the left chest 2. Axis: 45 degrees from midline 3. Size: 1/3 of the chest 4. Symmetry: RA=LA, RV=LV 5. Septa: FO, IVS 6. Squeeze: Qualitative assessment
26
In the fetal heart, the aorta arises from where?
Left ventricle
27
How does the aorta course in the LVOT?
Left to the right first
28
What is the aortic wall continuous with?
Septum
29
Does the aorta bifurcate?
No
30
What should the aortic valve look like? 2
Thin and mobile
31
In the fetal heart, the pulmonary artery arises from where?
Right ventricle
32
The fetal pulmonary artery courses how?
Anterior and to the left
33
Does the Pulmonary artery bifurcate?
Yes, we must see it bifurcate
34
What does the pulmonary valve look like?
Thin valve and mobile
35
What does the RVOT cross?
The LVOT at right angles
36
What is included in three vessel view?
From left to right and anterior to posterior: 1. Pulmonary artery 2. Aorta 3. SVC
37
In three vessel view, how similar is the PA and the aorta visually?
PA similar size or larger
38
In the 3 vessel view, the SVC and the aorta compare how visually?
SVC is smaller than aorta
39
In the three vessel view, What vessels dive together to left of the trachea?
Aorta and PA
40
What is the sizing order of three vessel view?
PA>AO>SVC
41
What does fetal short axis view demonstrate? 4
1. Right and left atria 2. Right ventricle 3. Pulmonary artery 4. Ductus arteriosis encircling the aorta
42
What does the aortic arch look like?
Candy cane
43
What are the three vessels in the aortic arch?
1. Brachiocephalic 2. Left common carotid artery 3. Left subclavian artery
44
What does the ductal arch look like?
Hockey stick
45
What is the ductal arch?
When the right ventricle with ductus join the aorta
46
What does the SVC and the IVC do in the fetal heart?
Bring deoxygenated blood back from the body to the right atrium
47
What is the SVC-IVC alternative name?
Longhorn view
48
How many pulmonary veins do we usually see in fetal echo?
2 pulmonary veins
49
What is included in the fetal echo routine in terms of doppler? 4
1. Inflows 2. Outflows 3. Ductus arteriosus 4. Foramen ovale
50
What are four tips for pulsed doppler in the fetal routine?
1. Line up the flow - parallel 2. Place sampling gate after the valve 3. >1m/s consider stenosis 4. Useful in rhythm assessment
51
What is the normal colour scale velocity for fetal valves, IVS, and venous structures? 3
1. Valves: 50-80 cm/s 2. IVS: 30-40cm/s 3. Venous structures: ~20 cm/s
52
When determining the aortic arch, how do we determine the vessels?
We must determine which direction the Descending aorta and ascending aorta are
53
In the fetal heart, M mode is done through what?
Atrium and ventricle usually done in a four chamber view
54
What does M-Mode confirm in fetal echo? 3
1. Viability 2. Arrhythmias 3. Abnormal rhythms
55
What are some arrhythmias that can be seen with M-mode? 2
1. Heart blood 2. Are the ventricles and atria contracting at the same time
56
What are some abnormal things that we can see in M-mode?
Premature atrial contractions
57
Premature atrial contractions determined in M- mode may include what? Is it malignant or benign?
1. May preclude tachycardia 2. Generally benign
58
What is considered normal in terms of BPM in fetal echo?
1. 120- 160 is normal 2. Up to 180 in 1st trimester is normal
59
What is considered bradycardia in fetal echo?
<100 bpm
60
What usually causes bradycardia in fetal echo?
Heart block
61
What is considered tachycardia in fetal echo?
>180
62
What causes tachycardia in fetal echo?
Decrease in stroke volume
63
Fetal tachycardia is treated with what?
Digoxin to the mother
64
What happens to the mothers heart with digoxin?
Mothers heart will respond to the medication as well
65
What is a ASD?
Partial or complete absence of interatrial septum
66
How difficult is it to diagnose ASD?
Difficult due to the normal foramen ovale
67
How big should the Foramen Ovale be?
No larger than the aortic root
68
What is a VSD?
Complete or partial absence of ventricular septum
69
What is the most common cardiac anomaly in fetal echo? How much are associated with VSD?
1. VSD 2. 50%
70
What views do we use to view VSDs?
Subcostal (horizontal) 4 chamber and short axis of ventricle the best views
71
What is the prognosis of VSD? Why?
1. Good 2. May close on its own
72
When does AVSD occur in utero?
When the endocardial cushions fail to fuse early in embryology
73
The fetal heart starts with a common ventricle and common atrium that communicates through what?
The AV Canal
74
What is the end result of a ASVD?
1 common valve with 5 leaflets
75
What is absent in ASVD?
MV and TV
76
What is another name for AVSD?
AV canal or endocardial cushion defect
77
50% of fetuses with ASVD have what disorder?
T21
78
What is Ebsteins anomaly?
Apical displacement of the TV into the right ventricle
79
What is the sonographic appearance of ebstein’s anomaly? 3
1. Large Right atrium 2. Apical displacement of TV 3. Small right ventricle (dysplastic)
80
What is hypoplastic right ventricle secondary to?
Pulmonary atresia without a VSD
81
What is the sonographic appearance of a hypoplatic right ventricle? 2
1. Difficult to see inner chamber 2. Small or absent pulmonary artery
82
What does hypoplastic left ventricle cause in terms of flow in the LV?
Decreased flow into or out of the left ventricle
83
What is the sonographic appearance of hypoplastic left ventricle? 3
1. Small left ventricle 2. **Aortic stenosis or atresia** 3. **Mitral valve atresia**
84
What condition is hypoplastic left ventricle associated with?
Coarctation of aorta
85
What is often seen with hypoplastic left ventricle as pregnancy progresses?
Endocardial fibroelastosis (EFE)
86
How does someone get endocardial fibroelastosis (EFE)?
From muscle hypertrophy
87
What happens with endocardial fibroelastosis (EFE)?
Myocardium is replaced by collagen and elastic tissue
88
What does EFE look like? 2
1. Very echogenic 2. Focally thick myocardium
89
What syndromes is EFE seen with?
Hypoplastic heart syndromes
90
What does EFE cause?
Deceased cardiac function and congestive heart failure
91
What does Tetralogy of fallout mean?
Four things are going wrong in the heart
92
What four things that are seen with Tetralogy of fallout?
1. VSD 2. Aorta overriding ventricular septum 3. Hypertrophy of right ventricle 4. **Pulmonary stenosis**
93
What is Truncus Arteriosus?
Single large vessels arising from the base of the heart
94
What does the truncus arteriosus supply? 3
1. Coronary arteries 2. Pulmonary 3. Systemic circulation
95
What are things that are seen sonographically with Truncus arteriosus? 3
1. VSD 2. Large overrriding aorta 3. Pulmonary artery origins will vary off the aorta
96
What does double outlet right ventricle mean?
Aorta and pulmonary arteries arise from the right ventricle
97
In terms of double outlet right ventricle, variants positions of aorta is related to what?
Pulmonary artery
98
What is common to see in double outlet right ventricle?
VSD
99
What conditions is double outlet right ventricle associated with? 2 (etiology)
1. MATERNAL DIABETES 2. ALCOHOL ABUSE
100
What is transposition of the great vessels? 3
1. Aorta arses from right ventricle 2. Pulmonary artery arises from the left ventricle 3. Outflow vessels are parallel
101
What are the two types of transposition of the great vessels?
1. Complete (D loop) 2. CORRECTED (L for Levo)
102
What kind of circuit is complete D loop transition?
Closed circuit (80%)
103
What happens with the flow of the right atrium of complete D Loop transposition?
Right atrium to right ventricle
104
What does complete D loop transposition look like sonographically? 2
1. Great vessels are parallel rather than crossing normal 2. May have VSD
105
What is seen with the complete L loop transposition? (Chambers)
Right ventricle is attached to left atrium
106
What do we look for with L loop transposition?
Look for moderator band to identify right ventricle
107
What is pulmonary and systemic circulation like in terms of L Loop transposition (corrected)?
Normal
108
What is the sonographic appearance of L-loop transposition (corrected) 2
1. Parallel great vessels 2. Morphological right ventricle to morphological left atrium
109
Is L loop transposition asymptomatic or symptomatic?
May be asymptomatic throughout life or begin to show signs of heart failure in hid life
110
What is the coarctation of aorta? Where is it normally located?
1. Narrowing of the aortic aortic lumen 2. Usuallly at the isthmus
111
What does coarctation of the aorta look like sonograpically? 3
1. Prominent right ventricle 2. Small left ventricle 3. Narrowing in the aorta
112
What is coarctation of aorta associated with? 3
1. AVSD 2. Bicuspid AV 3. VSD
113
What increases the incidence of coarctation of the aorta?
Increased incidence in moms with diabetes
114
What is ectopia cordis?
Heart outside of the chest cavity
115
What is ectopia cordis assocaited with?
Pentalogy of Cantrell
116
What are things that are seen with pentalogy of Cantrell?5
1. Absent lower sternum 2. Defect in anterior diaphragm 3. Defect in pericardium 4. Omphalocele 5. Ectopic cordis
117
Cardiospelnic syndromes are also known as what? 3
1. Isomeriusm 2. SItu ambiguous 3. Heterotaxia
118
What is cardosplenic syndromes?
Symmetric development of normally asymmetric organs or organ systems
119
What organs are affected with cardosplenic syndrome? 4
1. Liver 2. Lungs 3. Stomach 4. Heart
120
So what would we see with cardosplenic syndromes?
Fetus either has two left sides or two right sides
121
What is seen with polysplenia? 5
1. Bilateral left sidedness 2. Midline liver 3. IVC interruption 4. No IVC through the liver 5. Dextro or mesocardia
122
What are some examples of bilateral left sidedness with polysplenia? 3
1. Multiple spleens 2. **Left atrial isomerisum (2 left atria)** 3. 2 leafy lungs
123
Label
B. ASD C. Pulmonary stenosis D. VSD E. Coarctation F. Tetralogy of fallout G. Endocardial cushion defect H. D loop transposition I. PDA
124
How common are cardiac tumors in utero?
Rare
125
What is the most common cardiac tumor in utero?
Rhabdomyoma or cardiac hamartoma
126
What does cardiac tumors look like?
Solid echogenic tumors usually of the ventricular septum
127
What might cardiac tumors do?
Obstruct outflows
128
What is the DDX for cardiac tumors? 4
1. Cardiac fibroma 2. Hemangioma 3. Myxoma 4. Teratoma
129
What is cardiomyopathy?
Muscle damage
130
What is cardiomyopathy results in?
Altered cardiac function
131
What is cardiomyopathy caused by? 4
1. Viral infection 2. Bacterial infection 3. Metabolic disease 4. Maternal Type 1 diabetes
132
In terms of Polysplenia with IVC interruption, what what is perfusion like?
Renal to subhepatic segment into azygous vein to SVC
133
With No IVC through the liver what happens to the hepatic veins?
Hepatic veins empty into the right atria
134
What is asplenia also known as?
Ivenmark’s syndrome
135
What is seen with Asplenia? 3
1. Bilateral Right sidedness 2. Midline liver 3. Bilateral SVC
136
What does bilateral right sidedness mean in terms of asplenia? 2
1. No spleen 2. Two right lungs
137
In terms of heart defects with cardiosplenic sydrome, defects of which side are worse?
Defects of the heart asplenia (right sided)
138
Heart defects with cardiospelnic syndrome mean there is a extremely high incidence of what with asplenia?
AVSD
139
Almost any defect with cardiosplenic syndrome can be associated with what?
Heterotaxia
140
What are commonly associated cardiac defects with cardiosplenic syndrome? 5
1. Transposition of great arteries (TGA) 2. Pulmonary stenosis or atresia 3. Common atrium 4. Total anomalous pulmonary venous return with asplenia 5. Complete heart block
141
What is Total anomalous pulmonary venous return mean in terms of blood flow?
Oxygen rich blood returns to the right atrium instead of the left.
142
How difficult is it to diagnose cardiosplenic syndrome with ultrasound?
Extremely difficult to diagnose in the fetus
143
What are some clues that may help us diagnose cardiosplenic syndromes on ultrasound? 3
1. Interrupted IVC 2. Large Azygous vein 3. Abnormal presentation/ position of liver, heart and spleen

DMST 315 OBGYN 3 (21 decks)

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