Fetal heart anomalies PT 2

Question 1

What are 2 main anomalies to consider when the LV appears smaller than RV?

Answer 1

1. Hypoplastic left heart syndrome

2. coarctation of the aorta

Question 2

Hypoplastic left heart syndrome?

Answer 2

• Consists of a small LV with aortic atresia and MV hypoplasia or atresia
• The LA may be small or normal in size
• aortic valve is an imperforate membreane
• acsending aorta and arch are most often hypoplastic

Question 3

Coarctation of the aorta?

• what is it?
• where does it occur?
• what is it due to?

Answer 3

• narrowing of the aortic lumen
• occurs between the insertion of the ductus arteriosus and lt subclavian artery
• due to a discrete shelf-like lesion in the aorta

Question 4

what is most likely an ethology with RV smaller than LV?

Answer 4

PULMONARY ATRESIA

Question 5

Pulmonary atresia?

Answer 5

• no flow from the RV through the pulmonary valve onto the main pulmonary artery
• main pulmonary artery may be normal in size or hypoplastic

Question 6

Enlarged right atrium (Ebstein’s anomaly)?’

• what is it?
• what view is it visualized in?

Answer 6

• Inferior displacement of the septal and posterior leaflets of the tricuspid valve
• Tv usually incompetent leading to RT atria enlargement
• seen in 4CH view

Question 7

ebstein’s anomaly may be associated with?

Answer 7

a variety of structural cardiocascular defect:

• Pulmonary atresia or stenosis
• arrhythmia
• chromosomal anomalies

Question 8

Overriding aorta?

Answer 8

• the aorta displaced more to the right side and positioned over a VSD instead of left ventricle (causing mixing of oxygenated and deoxygenated blood)
• disrupts normal continuity of the ventricular septum and the wall of the aorta

Question 9

what is a key structure to evaluate when an overriding aorta is seen?

Answer 9

pulmonary artery

Question 10

Tetralogy of Fallot accounts for what % of CHD?

Answer 10

10%

Question 11

What is the primary diagnosis to consider when overriding aorta is seen?

Answer 11

Tetralogy of Fallot

Question 12

Tetralogy of Fallot consists of? (6)

Answer 12

1. stenosis of the RVOT
   2 Hyplastic or stenotic pulmonary artery
2. Abnormality of the pulmonary valve or annulus
3. Infundibular stenosis (below the PA in the RV)
4. Ventricular septal defect
5. Overriding aorta

Question 13

What is tetralogy of Fallot?

Answer 13

• hypertrophy of the right ventricle
• happens after birth
• RV works against resistance to flow due to pulmonary stenosis

Question 14

What is the most important problem after birth associated with tetralogy of fallot?

Answer 14

systemic hypoxia

Question 15

Truncus arteriosus?

Answer 15

• rare and a more severe form of TOF
• a single blood vessel (truncus arteriosus) comes out of the right and left ventricle, instead of two normal vessels (pulmonary artery and aorta)

Question 16

normally what relationship to the aorta and pulmonary artery have?

Answer 16

aorta and pulmonary artery crisscross in their initial course as they exit the heart (normally Aorta arises from LV and PA from RV)

Question 17

in complete transposition of the great arteries what occurs?

Answer 17

the atrioventricular connection is normal but the aorta arises from the RV and the PA from the LV

Question 18

What can occur in transposition of the great arteries?

Answer 18

Usually there is no hemodynamic consequence in utero, although if pulmonary stenosis is present, congestive heart failure can occur.

Question 19

What is Double outlet right ventricle?

Answer 19

is a type of transposition abnormality where both great arteries connect to RV

Question 20

When does double outlet right ventricle occur?

Answer 20

• when the pulmonary artery and most of aorta arise from the RV
• VSD is usually also present, unless there are associated obstructing lesion, such as pulmonic or mitral stenosis

Question 21

consequence of double outlet right ventricle?

Answer 21

There is usually no hemodynamic consequence to the fetus. As in complete transposition, the normal crossing of aorta and PA is lost

Question 22

Echogenic intracardiac foci?

Answer 22

• described as “peas or golf balls”
• Appear to represent mineralization or calcification in the papillary muscle. (5% rate)
• The most frequent observation is a single focus in the LV (60% of the cases).
• The majority of fetuses with an echogenic focus in the heart will be normal.

Question 23

Echogenic intracardiac foci risk?

Answer 23

In isolated echogenic intracardiac focus, the risk of Tri-21 is 1%.

Question 24

what is frquently associated with Rhabdomyomas (intracardiac mass)?

Answer 24

• Tuberous sclerosis

Question 25

most common type of cardiac tumor in the fetus?

Answer 25

Rhabdomyomas

Question 26

rhabdomyoma on ultrasound?

Answer 26

- Cardiac tumours are generally isolated - While most are benign, they should be followed during gestation as CHF may occur if the tumour position obstructs inflow or outflow - Sonographically, cardiac masses are more echogenic than the ventricular myocardium.

Question 27

Congestive heart failure occurs when?

Answer 27

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

Question 28

Causes of fetal congestive heart failure? (6)

Answer 28

1. Fetal arrhythmias 2. Anaemia 3. Congenital heart disease with valvular regurgitation 4. Non-cardiac malformations such as diaphragmatic hernia or cystic hygroma 5. Twin-twin transfusion recipient volume and pressure overload 6. Atrioventricular fistula with high cardiac output

Question 29

definition of congestive heart failure?

Answer 29

Inability of the heart to deliver adequate blood flow to organs such as the brain, liver, and kidneys, is a common final outcome of many intrauterine disease states that may lead to fetal demise

Question 30

CHR- Fetal echocardiographic findings at an advances stage? (6)

Answer 30

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

Question 31

congestive heart failure abnormalities? (4)

Answer 31

1. cardiac/thoracic size 2. venous doppler 3. arterial doppler 4. hydrops

Question 32

what is venous doppler?

Answer 32

IVC and umbillical cord vein

Question 33

arterial doppler?

Answer 33

- Four valve Doppler - any leak of the valve should be evaluated further. - M-mode of the ventricular wall – Abnormal myocardial function

Question 34

PERICARDIAL EFFUSION - what is it? - whats concidered abnormal?

Answer 34

- refers to an accumulation of pericardial fluid in utero | - In order to be considered abnormal, pericardial fluid thickness should be greater than 2 mm

Question 35

What is pericardial effusion associated with? (5)

Answer 35

1. Hydrops 2. Fetal arrhythmia (fetal tachyarrhythmia) 3. Congenital cardiac anomalies : especially if large 4. Fetal cardiac tumours : e.g. fetal pericardial teratoma 5. Increased incidence of chromosomal anomalies (Trisomy-21)