Ch. 12 Fetal Chest and Cardiovascular System Flashcards
What structure can be seen located anteriorly in the upper mediastinum, it is best seen at the 3VV
Thymus gland
When is the optimal time to evaluate the fetal heart
between 18 and 22 weeks
List some congenital heart disease (CHD) risk factors
Family hx
maternal diabetes mellitus
teratogen exposure
chromosome abnormalities
Lupus
Increased NT measurement
Oxygenated blood from the placenta enters the fetus through the —–
Umbilical vein
The —– partially bypasses the liver to send oxygen-rich blood to the right atrium
Ductus venosus
The —– shunts some of the rt atrium blood directly into the lt atrium
foramen ovale
the —– allows oxygen-rich blood from the PA into the AoA to circulate throughout the fetus (bypasses the LUNGS)
Ductus arteriosis
Which atrium is the closest to the fetal spine
Left atrium
The apex of the heart should point how many degrees from midline to lt anterior chest wall
45 degrees +/- 20 degrees (Levocardia)
The flap of the foramen ovale opens into the
Left atrium
In what chamber of the heart is the moderator band located
Apex of Rt ventricle
Pulmonary veins enter the
Left atrium
Which AV valve is positioned more inferiorly or more apical than the other
The tricuspid valve
Where is the tricuspid valve located
between the rt atria and rt ventricle
Where is the mitral valve located
Between the lt atria and lt ventricle
Which view is used to identify the origin of the Aorta arising from the left ventricle
LVOT, left ventricular outflow tract
What cardiac view is used to identify the origin of the pulmonary trunk arising from the Rt ventricle
RVOT, Right ventricular outflow tract
T or F, the Aorta should always be larger in diameter compared to the Pulmonary artery
FALSE. The PA should have a 9% larger diameter compared to the aorta
Which cardiac view ensures the orientation of the outflow tracts
3VV
In the 3VT view, what colors should the ductus arteriosus and the aorta be?
The same color
What are the vessels seen arising from the AoA
The head and neck vessels. Brachiocephalic/Innominate, Lt carotid and Lt subclavian arteries
What is the Ductal arch view demonstrating
The ductus arteriosus traveling into the Ao
The most common cardiac defect postnatally
the most teratogen-associated fetal defect
and is associated with other cardiac anomalies 50% of the time
Ventricular septal defect (VSD)
What would a VSD show on color doppler (what type of flow)
Bidirectional flow
What is the most common type of ASD
Ostium secundum defect
Small right ventricle due to decreased blood flow out of the right ventricle. Pulmonary atresia with an intact IVS
Hypoplastic right heart syndrome
Sono finds of hypoplastic right heart syndrome
absent or very small rt ventricle on 4CH view, absent or small PA
List primary abnormalities associated with hypoplastic left heart syndrome
Aortic stenosis, Ao coarctation (80% of cases), Mitral and or Ao valve atresia
Condition in which the origins of the great vessels are transposed so the aorta arises from the RT ventricle and the pulmonary trunk arises from the LT ventricle
Transposition of the great arteries (TGA)
Sono finds of TGA
Correct left-right orientation is a MUST
outflow tracts demonstrate anomalous origin
parallel orientation of outflow tracts
Heart defect in which a single large vessel arises from the base of the heart (rather than separate outflow tracts) A VSD is usually present and 48% of fetuses have other non-cardiac anomalies
Common arterial trunk/ Truncus arteriosus
Heart defect in which all or part of the heart is located outside of the chest cavity
Ectopia cordis
What is ectopia cordis associated with?
Omphalocele in pentalogy of cantrell
Heart defect in which the pulmonary artery and Ao arise from the RT ventricle
Double outlet right ventricle
What is double outlet right ventricle associated with?
Other cardiac defects, maternal diabetes, maternal alcohol consumption
Cardiac tumors are rare but are most frequently
Rhabdomyomas
There is a strong association between rhabdomyomas and —–
Tuberous sclerosis
Heart defect in which there is a failure of the common AV orifice to separate into mitral and tricuspid valves, resulting in a defect in the Crux (center) of the heart
Atrioventricular (A-V) canal defect/ endocardial cushion defect
(associated with trisomy 21)
List the defects that make up Tetralogy of fallot
VSD, overriding aorta, stenosis of the RVOT/Pulmonary stenosis, and right ventricular hypertrophy
Malformation of the tricuspid valve with low insertion, resulting in a grossly enlarged RT atrium
Ebstein’s anomaly
What two things are ventricular hypertrophy most commonly associated with
Cardiac outlet obstruction, maternal diabetes
A variety of cardiac anomalies are associated with asplenia and polysplenia in what type of syndromes
heterotaxy syndromes
What is the normal heart rate range prior to 6 weeks
100-115 BPM
What is the normal fetal heart rate range
120-160 BPM
What is the correct placement of the M-mode cursor
The cursor should be placed through the atrium and ventricle
Arrhythmias are generally due to —–. they are associated with —-
Premature atrial contractions (PACs)
Maternal caffeine intake, cigarette smoking, alcohol use
Fetal tachycardia is defined as a heart rate greater than
180 BPM
Bradycardia is a heart rate less than or equal to
100 BPM
Bradycardia is associated with
Complete heart block
Bradycardia less than 80 BPM may be associated with
Fetal asphyxia
Most commonly diagnosed fetal intrathoracic abnormality
Pleural effusion aka Hydrothorax
The most common developmental abnormality of the diaphragm
Congenital diaphragmatic hernia (CDH)
What is the most common CDH and on which side does it occur most often?
Bochdalek hernia (85% of cases), LT side
What side does the Morgani hernia occur?
On the RT
Diaphragmatic hernias are associated with what condition as a result of pressure on the thoracic cavity
Pulmonary hypoplasia (you will also notice cardio-mediastinal shift, the most recognizable sono feature)
Sono finds of Congenital Diaphragmatic Hernias
fluid-filled bowel and especially the stomach in the chest at the level of the 4CH.
displaced heart from the LT chest toward the RT
Associated Polyhydramnios
Uncommon malformation in which a mass of non-functioning pulmonary tissue is separate from the lung
Pulmonary sequestration
Describe the blood flow in a pulmonary sequestration
This mass receives its blood supply from the systemic circulation (Ao) and does NOT communicate with the bronchial tree.
Sono finds of pulmonary sequestration
homo echogenic intrathoracic mass
color may show an arterial vessel arising from the Ao into the mass and NO pulmonary artery branch supplying the mass
hydrops fetalis (rare)
Unilateral condition characterized by the replacement of normal lung tissue with ABnormal tissue, which often include visible cysts. There are three types
Congenital pulmonary airway malformation (CPAM) aka Congenital Cystic Adenomatoid Malformation (CCAM)
Describe the types of CCAMs
Type 1- one or more LARGE cysts > or + 2 cm
Type 2- multiple small cysts <1-2cm
Type 3- multiple small cysts, too small to see on US so lung appears HYPERECHOIC
Sono finds of CCAMs
Non-pulsatile echogenic (w/solid and cystic components) mass in fetal lung
Lateral displacement of the heart
possible signs of hydrops fetalis(most common with CPAM type 2)
Associated polyhydramnios
