Module 12 : Fetal Cardiac Abnormalities Flashcards
(73 cards)
1
Q
when does fetal heart development begin and what happens during that time
A
- 5 weeks
- paired heart tubes form and fuse into a dingle heart
2
Q
at what weeks do the heart chambers begin to develop
A
6-8 weeks
3
Q
at what week is the heart fully formed
A
- 10 weeks
4
Q
when can we start to detect fetal heart beat
A
5-6 weeks
5
Q
how does the blood flow from the placenta to the umbilical arteries
A
- placenta»_space; umB v»_space; left portal V»_space; ductus venosus»_space; IVC»_space; rt atrium»_space; foramen ovale»_space; lt atrium»_space; lt ventricle»_space; aorta»_space; iliac artery»_space; hypogastric artery»_space; umbilical artery»_space; placenta
OR
rt atrium»_space; rt ventricle»_space; pulmonary artery»_space; ductus arteriosus»_space; descending aorta»_space; hypogastric artery»_space; umbilical artery
6
Q
what are 4 clinical indications for a fetal echo
A
- abnormal fetal findings from a previous ultrasound
- family history of a congenital heart defect
- previous pregnancy wth a cardia abnormality
- maternal disease associated with heart defects
+ type 1 diabetes
7
Q
what are 7 fetal findings associated with heart defects
A
- 2 vessel cord
- congenital diaphragmatic hernia
- omphalocele
- thick nuchal fold or NT
- hydrops
- chromosomal abnormalities
- bradycardia
8
Q
what is the full fetal echo routine
A
- situs with stomach and 4 chamber heart
- 4 chamber heart
- outflow tracts
- 3 vessel view
- aortic and ductal arch
- short axis of ventricles and atria
- SVC and IVC
- pulmonary veins
- doppler (inflows, outflows, ductus arteriosis, foramen ovale)
- m-mode through an atrium and ventricle to rule out arrhythmias
9
Q
what are the 3 vessels in the 3 vessel view and what should be there respective sizes
A
- pulmonary artery (biggest or same as AO)
- aorta (bigger than SVC or same as PA)
- SVC (smallest)
10
Q
what are 2 differences between the aortic arch view and the ductal arch view
A
- aortic arch = three branches and candy cane
- ductal arch = no branches and hockey stick
11
Q
how many heart defects are ruled out with 4 chamber heart image and how many when 3 vessels are added
A
- 1/3
- 2/3
12
Q
between what weeks is fetal echo the best performed
A
20-22 weeks to term
13
Q
what is a normal heart rate for a fetus
A
120-160 is normal
+ 180 bpm in 1st trimester
14
Q
what is considered bradycardia in fetus
A
- < 100bpm
- due to heart block
15
Q
what is considered tachycardia in fetus
A
- > 200 bpm
+ decrease stroke volume
+ treated with digoxin to the mother
16
Q
what is the most common arrhythmia in fetus we see
A
- PAC
- usually benign
17
Q
what is an atrial septal defect
A
- partial or complete absence of interatrial septum
18
Q
is it easy or difficult to diagnose ASD on US and why
A
- difficult
- due to foramen ovale
19
Q
what should be the normal size of the foramen ovale
A
- no larger than aortic root
20
Q
what is the best view to asses IAS
A
- fetal subcostal
21
Q
what is a ventricular septal defect (VSD)
A
- complete or partial abscess of ventricular septum
22
Q
what is the most common cardiac anomaly
A
- ventricular septal defect
23
Q
how many VSDs are associated with other anomalies
A
- 50%
24
Q
what is the best view to asses VSDs
A
- subcostal 4 chamber and short axis of ventricle
25
what is the prognosis of VSDs
- good
| - many resolve on their own
26
what causes an atrioventricular septal defect AVSD
- when the endocardial cushions fail to fuse early in embryology
- end result is 1 common valve with 5 leaflets
- aka = AV canal or endocardial cushion defect
27
what is a common chromosomal abnormality that occurs with AVSD 50% of time
- T21
28
what is ebsteins anomaly and what is common ly associated with it
- apical displacement of the tricuspid valve into the right atrium
- hydrops and pulmonary stenosis and lithium ingestion
29
ultrasound appearance of ebsteins anomaly
- large right atrium
- apical displacement of tricuspid valve
- small right ventricle (dysplastic)
30
what is hypo plastic right ventricle
- secondary to pulmonary atresia with no VSD
| - extremely uncommon compared to hypo plastic left ventricle
31
what is the ultrasound appearance of hypoplastic right ventricle
- difficult to see in inner chamber
| - small or absent pulmonary artery
32
what causes hypoplastic left ventricle
- due to decreased flow into or out of the left ventricle
33
sonographic appearance of hypoplastic left ventricle
- small left ventricle
- aortic stenosis or atresia
- mitral valve atresia
- associated with coarctation of the aorta
- endocardial fibroelastosis (EFE) often seen as pregnancy progresses
34
what is endocardial fibroelastosis EFE
- from muscle hypertrophy
- myocardium is replaced by collagen and elastic tissue
- seen with hypoplastic heart syndromes
35
ultrasound appearance of EFE
- very thick echogenic and focally thick myocardium
36
what does EFE cause
- decreased cardiac function and congestive heart failure
37
What does tetralogy mean
- 4
38
What 4 things are wrong in tetralogy of fallot
- VSD
- aorta overriding ventricular septum
- hypertrophy of right ventricle
- pulmonary stenosis
39
What view is important to check with tetralogy of fallot
- 3 vessel view
40
What is truncus arteriosus
- single large vessel arising from the base of the heart
41
What structures are supplied by a truncus arteriosus
- coronary arteries
- pulmonary
- systemic circulation
42
Ultrasound appearance of truncus arteriosus
- VSD
- larger overriding aorta
- pulmonary artery origins will vary off the aorta
43
What is a double outlet right ventricle e
- aorta and pulmonary artery arise from the right ventricle e
- various positions of the aorta related to the pulmonary artery
- VSD is common
44
What two things is double outlet right ventricle associated with
- maternal diabetes
| - alcohol abuse
45
What is transposition fo the great vessels
- aorta arises from right ventricle
- pulmonary artery arises from left ventricle
- outflow vessels are parallel
46
- what are the 2 types of transposition of great vessel
- complete = D loop (D for dextro)
| - corrected = L loop (L for levo)
47
What is D loop transposition/ complete
- closed circuit
- right atrium to right ventricle
- oxygenated blood wont go to the head or the body
48
Ultrasound appearance of D loop transposition
- great. Vessels are parallel rather than crossing
| - VSD
49
Where does deoxygenated blood go to with D loop transposition
- RA >> RV >> Ao >> body/head
50
Where does oxygenated blood go with D loop transposition
LA >> LV >> pulmonary artery >> lungs
51
What is L loop transposition
- right ventricle is attached to the left atrium
| - normal pulmonary to systemic circulation (O2 gets to the right spots)
52
What structure should we look for with L loop transposition
- look for moderator band
53
Utrasound appearance of L loop transposition
- parallel great vessels
| - morphological right ventricle to morphological left atrium
54
Do patients present with symptoms and why
- usually asymptomatic throughout life then begin to show signs later in life
- right ventricle does not have the same pumping ability as left ventricle does
55
- what is coarctation of the aorta
- narrowing of the aortic lumen
| - usually at isthmus
56
Where is the isthmus in the aortic arch
- area between the lt subclavian artery and descending aorta
57
Ultrasound appearance of coarctation of aorta
- prominent right ventricle
- small left ventricle
- narrowing in the aorta
58
What two other anomalies is associated with coarctation of the aorta and what increases chance of this anomaly
- AVSD and VSD
| - maternal diabetes
59
Are cardiac tumors common or uncommon
- very rare
60
What is the most common cardiac tumors
- rhabdomyoma
| - cardiac hamartoma
61
Ultrasound appearance of cardiac tumors
- solid echogenic tumors usually of the ventricular septum
| - may obstruct outflows
62
- what are 4 differentials of cardiac tumors
- cardiac fibromyalgia
- hemangioma
- myxoma
- teratoma
63
What is cardiomyopathy and what does it result in
- muscle damage
| - altered cardiac function
64
What 4 things cause cardiomyopathy
- viral infection
- bacterial infection
- metabolic disease
- maternal type 1 diabetes
65
What is ecoptia cordis and what is it associated with
- heart outside of chest cavity
| - pentalogy of Cantrell
66
What characteristic must be met in order to diagnose an echogenic intracardiac focus (EIF) and what chromosomal anomaly is it associated with
- have to be as bright as bone
| - associated with Down syndrome
67
What are 3 other names for cardiosplenic syndromes
- isomerism
- situ ambiguous
- heterotaxia
68
What is a cardiosplenic syndrome and what are the affected organs
- symmetric development of normally asymmetric organs or organ systems
- liver, lungs, stomach, heart
- fetus has either two left sides or two right sides
69
What is polysplenia
- bilateral left sidedness
+ multiple spleens
+ left atrial isomerism (2 left atria)
+ 2left lungs
- midline liver
- IVC interruption (no IVC through liver)
+ renal to subhepatic segment to azygous vein to SVC
- hepatics empty into right atria
- heart points to right or is meso cardia (midline)
70
What is asplenia (ivenmarks syndrome)
```
- bilateral right sidedness
+ no spleen
+ right atrial isomerism
+ 2 right lungs
- midline liver
- bilateral SVC
```
71
Are heart defects with cardiosplenic syndromes worse with rt or lt isomerism
- rt isomerism (asplenia)
- extremely high incidence fo AVSD with asplenia
- almost any defect associated with heterotaxia
72
What are 5 common associated defects with isomerism
- transposition fo great arteries
- pulmonary stenosis or atresia
- common atrium
- total anomalous pulmonary venous return with asplenia
- complete heart block
73
Is it easy or hard to diagnosi isomerism on Ultrasound and what are 3 clues to help diagnose
- very hard
- interrupted IVC
- large azygous vein
- abnormal liver, stomach or heart position
