Flashcards in Fetal Circulation Deck (55):
________ and _______ sections are used to evaluate the fetal thorax and fetal breathing movements and the overall size and shape.
The fetal _______ should occupy approximately one third of the thoracic cavity.
The fetal heart is located in the ________ part of the chest with the apex pointing to the _______.
The _______ are deflated during fetal life and appear as ______, _________ structures, and slightly more echogenic in the liver.
When is the optimal time to evaluate the fetal heart.
Between 18 and 24 weeks gestation.
Its useful in diagnosing:
Structural heart abnormalities
Coarctation of the aorta
Oxygenated blood from the placenta and the mother enters the fetus through the _______, ________.
All veins pre and poste natally blow back to the _____ of the heart.
In prenatal life, this oxygenated blood is shunted from the right artrium to the left atrium via the patent ____________.
foramen of ovale
From the _______ of the heart, the blood flows into the left ventricle and then out through the aorta.
From the aorta, the fetal ____ vessels are feed first including the _______ vessels.
True or False. Does blood always go from the right atrium to the right ventricle.
In the fetus this is _____ blood because the veins of the fetus go back to the right atrium.
From the right atrium, some ________ blood is pumped then into the right ventricle and out through the ___________.
True or False. The fetal lungs have oxygen.
False. The lungs have no oxygen.
What is the shunt called that goes from the pulmonary artery to the aorta.
How does the blood flow through the fetal heart?
* 60% of right atrial blood passes through the foramen ovale into the left atrium of the heart and eventually into the left ventricle
* Then followed by the brain
* Then followed by the lower extremities.
_____ of the right atrial blood enters the right ventricle from the right atrium.
____ of main pulmonary artery blood bypasses the lungs and goes into systemic circulation via the ductus arteriosus.
Only _______ of right ventricular blood actually reaches the lungs. The small amount helps the lungs to develop prenatally.
From the _______, blood goes to the fetal abdomen and lower extremities and, eventually, the partially deoxygenated blood goes out back to the mother through the paired umbilical arteries.
The ___ ____ ______ of the heart is the single most important image of the fetal heart.
four chamber view
****Done with all level I ultrasound of the fetus.
Which ventricle is the most anterior ventricle.
What structure may you see in the right ventricle of the heart and must not be mistaken for a mass?
How can you tell if the orientation of both the heart and stomach are consistent?
The apex of the heart points to the fetal left side and the apex of the heart is pointing to the same side as the stomach bubble.
The axis of the heart is oriented ____ towards the left side of the fetal thorax.
On ultrasound you must show the dividing line between the ventricles called the __________.
***must show it is completely intact and extends from the apex of the heart to the valve planes.
The ____ ____ can be seen in the sagittal/oblique plane as a candycane.
The ______ _____ looks like a hockey stick and arises more anterior to the heart.
Axial view of the great vessels can be identified with the pulmonary artery most _____, aorta in the ______, superior vena cava slightly _____ and slightly to the right of midline.
The most common defect postnatal and is caused by incomplete closure of the interventricular septum and failure of the membranous part of the septum. These are the most teratogen associated fetal defect and are associated with other cardiac anomalies about 50 % of the time. On ultrasound imaging, you will see an opening between the two ventricles on the 4 chamber view.
Ventricular Septal Defect or VSD
Are very difficult to identify prenatally because, there is a patent foramen ovale.
Atrial septal Defect / ASD
Occurs because of pulmonary atresia with an infant intact interventricular septum. On ultrasound, you will see a very small or an absent right ventricle of the heart on the four chamber view. You will also see an absent or very small pulmonary artery.
Hypoplastic right heart syndrome
On ultrasound, an absent or very small left ventricle and hypoplastic or atretic mitral valve and aorta.
Hypoplastic left heart syndrome
This abnormality, the pulmonary outflow tract originates from the left ventricle instead of the right and, the aorta originates from the right ventricle instead of the left ventricle. On ultrasound findings, the great vessels are oriented in a parallel orientation. This is a very difficult prenatal diagnosis.
Transposition of the great arteries, also called trans position of the great vessels.
A single large vessel arises from the base of the heart rather than two separate outflow tracts. there is usually a ventricular septal defect and 48 % of these babies have other, non-cardiac anomalies.
All or part of the heart is located outside of the chest cavity. Associated with intracardiac anomalies and omphalocele in pentalogy of Cantrell. Ultrasound diagnosis is made by seeing a soft tissue mass outside of the thorax which exhibits cardiac activity.
Both the pulmonary artery and aorta arise directly from the right ventricle. This abnormality is associated with maternal diabetes and with excessive maternal alcohol consumption.
Double outlet right ventricle / DORV
What are the rare cardiac tumors?
*prognosis depends on the size and location as well as other associated anomalis.
This has a big ventriclular septal defect and atrial septal defect because of failure to separte also into the mitral and tricuspid valves. There is a big defect in the center of the heart. Is associated with Trisomy 21.
Atrioventricular canal defect = Endocardio cusion defect
What are the 4 abnormalities of Tetrology of Fallot?
1. Ventriclular septal defect
2. Overriding aorta
3. Stenosis of the right outflow tract (pulmonary atresia.)
4. right ventricular hypertrophy
Malformation of the tricuspid valve with low insertion resulting in grossly enlarged right atrium.
Associated with cardiac outlet obstruction and maternal diabetes.
Asplenia and polysplenia are defects of lateraliztion in which symmetric development of normally asymmetric organs or organ systems occur. A variety or cardiac anomalies are associated with asplenia and plysplenia.
Cardio splenic syndrome
What is the normal fetal heart rate?
120 - 180 beats per minute
**In first trimester you may have intermittent periods of bradycardia, slow heart rate less than 120 beats/min. In the very early first trimester you may have periods of acardia or no heartbeat which is uncommon.
Irregular heart rhythm. Most often due to premature ventricular contractions or premature atrial contractions. Associated with maternal caffeine intake, cigarette smoking, and alcohol use.
What mode should only be used for fetal heart rate?
True or False. It is ok to use fetal Doppler to calculate heartbeat.
False. Please never use fetal Doppler to calculate heartbeat.
A fetal heartbeat greater than 180 bpm. These have a good prognosis and are treated in utero with various medications to the mother.
Prolonged fetal heart rate less than 100 bpm. Is associated with complete heart block. Related to an increase in intrauterine pressure. Below 80 bpm associated with fetal asphyxia or suffocation. May warrant early delivery in a fetus.
Most commonly diagnosed fetal intrathoracic abnormality. Seen with other abnormalities, especially fetal hydrops. You will see fluid in one or both sides of the thoracic cavities.
Pleural effusion also called hydrothorax.
Most common developmental abnormality of the diaphragm. It is on the left side in 85 % of cases. On ultrasound, if the hernia is big enough, it can cause pulmonary hypoplasia and mediastinal shift.
Congenital diaphragmatic hernia
A unilateral condition, characterized by replacement of normal lung tissue by abnormal tissue often including cysts.
Congenital cystic adenomatiod malformation also called CCAM
CCAM (congenital cystic adenomatiod malformation) accounts for ____ of lung malformations.