Ch. 27 The Fetal Heart and Chest Flashcards
The embryonic heart begins as _____ tubes. These two tubes ultimately fuse and fold to form into _____ chambers, two atria and two ventricles.
two; 4
The heart begins to contract at __ to ___ days of gestation. It is initially recognized by its motion, which can be seen adjacent to the secondary ________, often before an embryo is distinguishable.
36 to 37; yolk sac
A heart rate using _______ should be sonographically obtainable with endovaginal (EV) imaging when the crown rump length (CRL) measures __ to __ mm.
M-mode; 4 to 5
a method of fetal monitoring with sonography to produce a numeric scoring system that predicts fetal well-being
biophysical profile
During a biophysical profile assessment in the third trimester, an average fetal heart rate is _____ beats per minute (bpm), with a range of _____ to _____ bpm considered normal after the first trimester
150; 110 to 180 bpm
An elevation in fetal heart rate is termed ________, whereas a decrease is referred to as _________
tachycardia; bradycardia
The heart, which is fully formed by ___ weeks, is imaged most often in a cross-sectional or axial view of the fetal chest, just ______ the fetal stomach.The apex of the heart will be angled to the ______ of the midline, with the base closest to the spine.
10; above; left
The normal fetal heart will fill approximately _______ of the fetal chest, with its apex forming a_______ angle with the fetal spine. The chamber closest to the fetal spine is the _____atrium. If it is suspected that the heart is enlarged, then a ____________ratio can be obtained.
one-third; 45-degree; left; cardio/thoracic diameter
The four-chamber view can be used to evaluate the separation of the chambers, structures called _______. The two atria are separated by the _____ septum, and the two ventricles are separated by the ______ septum. The ventricular septum should be uninterrupted and of equal ________ to the left ventricular wall, whereas the atrial septum is open only at the __________
septums; atrial; ventricular; thickness; foramen ovale
Within the _______can be seen the moderator band, a normal structure that appears as an echogenic focus. The _______ ventricle has much smoother walls compared to the right.
right ventricle; left
Between the right ventricle and the right atrium, one should visualize the ______ valve, and between the left ventricle and the left atrium, the ______ valve should be noted. Normally, the ________valve is positioned closer to the cardiac apex than the mitral valve
tricuspid; mitral; tricuspid
The right ventricular outflow tract leads to the ________ artery and branches, whereas the left ventricular outflow tract leads to the ______. One important anatomic finding is that the normal pulmonary artery should be positioned _______ to the aorta and should be visualized crossing over it. That means, the aorta and pulmonary artery normally ________each other.
pulmonary; aorta; anterior; crisscross
The ________ places the main pulmonary artery, ascending aorta, and superior vena cava in the image. The ____ is used to detect abnormal vessel _____, abnormal vessel ______, abnormal ___________, and abnormal ________.
three-vessel view (3VV), 3VV, number, caliber, course or alignment of the vessels, flow
The three-vessel trachea view (3VT) is used to evaluate the major vessels in the fetal mediastinum as well. In the 3VT, a āVā is formed by the merging of the transverse _____ arch and ______ and the ________trunk and _______ arteriosus. The 3VT is also used to assess the number, size, and alignment of the main pulmonary artery, aorta, and superior vena cava.
aortic, isthmus, pulmonary, ductus
a fetal shunt that connects the umbilical vein to the inferior vena cava
ductus venosus
an opening within the fetal heart within the atrial septum that allows blood to flow from the right atrium to the left atrium
foramen ovale (this closes to become the fossa ovalis
a fetal shunt that connects the pulmonary artery to the aortic arch
ductus arteriosus
The normal umbilical cord contains ____arteries and ____ vein.
2; 1
The umbilical ______ brings oxygen-rich blood from the placenta to the fetus. It travels superiorly and connects to the _______portal vein. Half of the blood goes to the ____ through the left portal vein, whereas the other half is shunted directly into the inferior vena cava (IVC) via a small branch of the umbilical vein called the _______.
vein; left; liver; ductus venosus
The blood that was taken to the liver is used to oxygenate the liver and is then returned back to the IVC by the ________
hepatic veins
The existing oxygen-rich blood in the IVC travels up to the heart and enters the_______. Blood can then travel across the _______, an opening in the lower middle third of the atrial septum and into the left atrium, or it can enter the right ventricle through the _______ valve. The blood then leaves the right ventricle through the main ________. The main pulmonary artery bifurcates into right and left, thus allowing a small amount of blood to travel to the _________.
right atrium; foramen ovale; tricuspid; pulmonary artery; respective lung
Blood from the right ventricle can flow through the _______and into the _______ aorta.
ductus arteriosus; descending
The blood returning from the lungs through the pulmonary veins enters into the ____atrium. Blood then travels from the left atrium into the left ventricle via the ______ valve. From the left ventricle, it travels to the ________ aorta and into the aortic arch, where it exits into the _______ artery, ______ common carotid artery, and ______ subclavian artery on its way to the thorax, upper extremities, and head. The blood will return from the head and upper torso via the ________ to the ______ atrium.
left; mitral; ascending; brachiocephalic; left; left; superior vena cava; right
The blood that flows through the ductus arteriosus and into the descending aorta travels inferiorly to either exit the abdomen via the ________ or travel to the abdomen and lower extremities to replenish those regions. Therefore, the ________ return the ________blood from the fetus back to the placenta.
umbilical arteries; umbilical arteries; deoxygenated
Basic assessment of the fetal outflow tracts
- The aortic outflow tract originates from the ______ ventricle.
2.The pulmonary outflow tract originates from the ______ ventricle.
3.The outflow tracts should be comparable in size.
4.The ______ and the main pulmonary artery are perpendicular to each other because they exit their respective ventricles. They should be seen ______ and not lying in the same plane.
left; right; ascending aorta; crossing
incomplete development of the left ventricle, resulting in a small or absent left ventricle
Hypoplastic left heart syndrome
a chromosomal aberration where one sex chromosome is absent; may also be referred to as monosomy X
Turner syndrome
abnormality in which there is a small or absent opening between the left ventricle and the aorta
Aortic atresia
abnormal narrowing of the aortic valve
Aortic stenosis
the narrowing of the aortic arch
Coarctation of the aorta
_______ is the leading cause of cardiac death in the neonatal period, with 95% dying within the first month of life if surgery is not performed. This anomaly can be recognized on a ______-chamber heart view.
Hypoplastic left heart syndrome; four
To distinguish this anomaly (Hypoplastic left heart syndrome) from complete absence of the left side of the heart, a small or normal ____ atrium must be visualized.
left
When hypoplastic left heart syndrome(HLHS) found in girls, ______ syndrome should be suspected. There is also a connection with trisomy ______.
Turner; 18
Sonographic Findings of _________
1.Absent or small left ventricle
2.No communication between the left atrium and the left ventricle
2.Aortic atresia (possibly)
3.Aortic stenosis (possibly)
4.Coarctation of the aorta (possibly)
Hypoplastic Left Heart Syndrome
incomplete development of the right ventricle, resulting in a small or absent right ventricle
Hypoplastic right heart syndrome
Hypoplastic right heart syndrome is also best visualized with the _____-chamber heart view. Hypoplastic heart syndrome most often results from pulmonary ______ or pulmonary ______, but it may result from stenosis or atresia of the _____ valve.
four; stenosis; atresia; tricuspid
Sonographic Findings of _____
1.Absent or small right ventricle
2.Enlarged left ventricle
3.Fetal hydrops (secondary to cardiac failure)
3.Narrowing of the pulmonary valve
Hypoplastic Right Heart Syndrome
the narrowing of the pulmonary valve
pulmonary stenosis
the absence of the pulmonary valve, which, in turn, prohibits blood flow from the right ventricle into the pulmonary artery and essentially to the lungs
pulmonary atresia
an abnormal accumulation of fluid in at least two fetal body cavities
fetal hydrops
A ________ is an abnormal opening in the septum between the two ventricles of the heart. The _____ is the most common form of cardiac defect.
ventricular septal defect (VSD)
This defect (VSD) can be ____, seen in the presence of ______abnormalities, or associated with other ______anomalies, including tetralogy of Fallot, which is mentioned later in this chapter. _____can be used to identify the flow within and through the defect.
isolated; chromosomal; cardiac; Color Doppler
a group of abnormalities consisting of an overriding aortic root, ventricular septal defect, pulmonary stenosis, and right ventricular hypertrophy
tetralogy of Fallot
Sonographic Findings of _______
1.Absence of part of the ventricular septum
2.Color Doppler is helpful at detecting small defects
Ventricular Septal Defects
Sonographic Findings of ______
1.Absence of part of the atrial septum
2.Color Doppler is helpful at detecting small defects
Atrial Septal Defects
An ______ is an abnormal opening in the septum between the two atria of the heart . There are several different types (numbered 1-5) and an ASD can be isolated but may be found in the presence of various syndromes.
atrial septal defect (ASD)
abnormal development of the central portion of the heart; also referred to as endocardial cushion defect (another AKA AV Canal defect)
atrioventricular septal defect (AVSD)
The combination of both ASD and VSD is termed _______or atrioventricular canal. An AVSD results from the abnormal development of the central portion of the heart.
atrioventricular septal defect (AVSD)
The central portion of the heart is referred to as the ā__________ā; this is the reason why the AVSD may be referred to as an _________.
āendocardial cushionā; endocardial cushion defect
AVSDs are commonly associated with aneuploidy, trisomy ___, and trisomy ___.
21; 18
the malformation or malpositioning of the tricuspid valve that causes multiple heart defects
Ebstein anomaly
the leakage of blood back through the tricuspid valve
tricuspid regurgitation
abnormality in which the pulmonary artery arises from the left ventricle and the aorta arises from the right ventricle
transposition of the great vessels
Malformation or malpositioning of the tricuspid valve results in _______.
Ebstein anomaly
With this abnormality(Ebstein anomaly), the right ventricle is contiguous with the right atrium, a finding referred to as an ā_______ā right ventricle. This anomaly is associated with ______regurgitation, ASDs, tetralogy of Fallot, transposition of the great vessels, and coarctation of the aorta. The prognosis is poor, with 80% of infants dying in the perinatal period.
atrialized; tricuspid
________ is the narrowing of the aortic arch. The most common location is between the ______ and the _______.
Coarctation of the aorta; left subclavian artery; ductus arteriosus
Sonographic Findings of _______
1.Malpositioned tricuspid valve
2.Right and left atrial shunting
3.Tricuspid regurgitation
3.Enlarged right atrium
4.Deviation of the atrial septum to the left
5.Fetal hydrops (secondary to cardiac failure)
Ebstein Anomaly
Sonographic Findings of _______
1.Narrowing of the aortic arch
2.Right ventricular enlargement
3.Pulmonary artery enlargement
4.disproportion in the size of the ventricles in the four-chamber view
Other common findings include patent ductus arteriosus and VSDs.
Coarctation of the Aorta
*Clue that differentiates coarctation of the aorta from hypoplastic left heart syndrome, is that the LV is apex forming in coarctation (look at image pg 671)
________is defined as an overriding aortic root, subaortic VSD, pulmonary stenosis, and right ventricular hypertrophy. The right ventricular hypertrophy is not always noted in utero but rather manifests after birth.
Tetralogy of Fallot
Sonographic Findings of ________
1.Overriding aortic root (defect where the aorta is positioned directly over a ventricular septal defect, instead of over the left ventricle.)
2.VSD
3.Pulmonary stenosis
4.Right ventricular hypertrophy
Tetralogy of Fallot
With transposition of the great vessels, the outflow tracts are reversed. That means, the pulmonary artery abnormally arises from the ______, and the aorta abnormally arises from the ______.
left ventricle; right ventricle
Often, the four-chamber view of the heart is ______ in the presence of transposition of the great vessels.
normal
However, when the outflow tract images are obtained in a fetus with transposition, instead of the normal crisscross orientation of the outflow tracts, they will be positioned ____to each other, with the aorta noted ______ and to the right of the pulmonary artery
parallel; anterior
Transposition of the great vessels, which may also be referred to as ________, has a good prognosis if it is discovered in utero, because corrective surgery can be performed shortly after birth.
transposition of the great arteries
Sonographic Findings of _______
1.The pulmonary artery abnormally arises from the left ventricle, and the aorta abnormally arises from the right ventricle
2.The outflow tracts will be positioned parallel to each other rather than crisscrossing
3.VSD may be present
Transposition of the Great Vessels
An echogenic intracardiac focus (EIF) is most often seen within the ______ ventricle of the heart. This is thought to represent the calcification of the _______ or chordae tendineae
left ventricle; papillary muscle
paired muscles in both sides of the heart that hold in place either the mitral or tricuspid valves
papillary muscle
tendons within the heart that attach the tricuspid valve in the right ventricle and the mitral valve in the left ventricle to their respective papillary muscle
chordae tendineae
An EIF may be seen in the normal fetus. However, there have been studies that have linked the incidence of an EIF with trisomy ____, particularly if there is more than one EIF detected.
21
Sonographic Findings of an _______
1.Echogenic structure most commonly located within the left ventricle (echogenicity comparable to that of fetal bone)
Echogenic Intracardiac Focus
The most common fetal cardiac tumor is the _________.It is associated with ________.
rhabdomyoma; tuberous sclerosis
*they are also associated with eventual cardiac failure, and subsequent development of fetal hydrops
a fetal heart tumor found within the myocardium
rhabdomyoma
a systemic disorder that leads to the development of tumors within various organs
tuberous sclerosis
Sonographic Findings of a _______
Echogenic tumor(s) within the myocardium of the heart (can be isolated or multiple)
Rhabdomyoma
__________ is fluid located around the heart. This condition can be isolated or associated with fetal hydrops
Pericardial effusion
when pericardial fluid is suspected the sonographer should evaluate the fetus closely for other signs of ________, such as ascites and pleural effusion
fetal hydrops
a condition in which the heart is located either partially or completely outside the fetal chest
ectopic cordis
a group of anomalies that include an omphalocele, along with ectopic cordis, cleft sternum, anterior diaphragmatic defect, and pericardial defects
Pentalogy of Cantrell
an anterior abdominal wall defect where there is herniation of the fetal bowel and other abdominal organs into the base of the umbilical cord
omphalocele
a test of the amniotic fluid that predicts fetal lung maturity
lecithin-to-sphingomyelin ratio (L/S ratio)
With ________, the heart is located either partially or completely outside the chest. _________is a group of anomalies that combine ectopic cordis and an existing omphalocele. The prognosis is poor.
ectopic cordis; Pentalogy of Cantrell
The lungs develop in early embryogenesis. However, functional fetal lung tissue does not typically exist until after _____weeks.
25
Fetal lung maturity can be assessed using the _______. An amniocentesis is performed for this test, and the laboratory findings indicate the levels of lecithin and sphingomyelin within the amniotic fluid. Normally, as the lungs mature, the level of lecithin ______, whereas the level of sphingomyelin _______
lecithin-to-sphingomyelin ratio (L/S ratio); increases; decreases
_________, or underdevelopment of the lungs, is caused by a decreased number of lung cells, airways, and alveoli. ___________ is often associated with major structural and chromosomal abnormalities.
Pulmonary hypoplasia
The most common lesion that occupies the chest, resulting in pulmonary hypoplasia, is the ___________.
diaphragmatic hernia
Amniotic fluid plays an important role in the development of the fetal lungs; therefore, the fetus, surrounded by ____or ___ amniotic fluid, is at increased risk of pulmonary hypoplasia. Consequently, pulmonary hypoplasia is a common finding with ________
little or no,oligohydramnios
the herniation of the abdominal contents into the chest cavity through a defect in the diaphragm
diaphragmatic hernia
the sonographic appearance of a fetal unilateral pleural effusion
ābat-wingā sign
a procedure that uses a needle to drain fluid from the pleural cavity for either diagnostic or therapeutic reasons
thoracentesis
Sonographic Findings of a ________
1.Anechoic fluid surrounding the fetal lung(s)āābat-wingā sign
2.Other signs of hydrops may be present
Pleural Effusion
Fluid surrounding the lungs is referred to as a ______ or _______. __________that occur in utero may spontaneously resolve or may be found in the presence of fetal hydrops, other chest abnormalities, and Turner syndrome. They can be unilateral or bilateral
pleural effusion or hydrothorax; pleural effusions
Fetal pleural effusions can be treated with an ultrasound-guided __________
thoracentesis
a mass consisting of abnormal bronchial and lung tissue that develops within the fetal chest
Cystic adenomatoid malformation (CAM)
a separate mass of nonfunctioning lung tissue with its own blood supply
pulmonary sequestration
_____________, also referred to as congenital cystic adenomatoid malformation (CCAM), is actually a mass consisting of abnormal bronchial and lung tissue. Although there are three types (types 1 to 3), a common sonographic appearance of CAM is that of a mass that has both ______ and ______ components. However, it can also appear completely echogenic (type 3) and, therefore, sonographically similar to __________
Cystic adenomatoid malformation (CAM); cystic and solid; pulmonary sequestration
Most CAMs are _______ and may resolve spontaneously, although large masses can lead to fetal hydrops and carry a poor prognosis.
unilateral
Sonographic Appearance of ______________
1.Lung mass with varying degrees of cystic and solid components
2.Completely echogenic mass within the lungs
2,Pleural effusion may be present
Cystic Adenomatoid Malformations
______________ ,or bronchopulmonary sequestration, is a separate mass of nonfunctioning lung tissue with its own blood supply. The fetal form of this disease is specifically referred to as extrapulmonary sequestration, which denotes its location.
Pulmonary sequestration
The most common sonographic appearance of pulmonary sequestration is an _____, triangular-shaped mass, typically located within the _______ side of the fetal chest. Pulmonary sequestration may resolve spontaneously or lead to the development of fetal hydrops.
echogenic; left
Sonographic Findings of ________
1.Echogenic, triangular-shaped mass within the fetal chest
2.Pleural effusion may be present
Pulmonary Sequestration
The most common reason for fetal cardiac malposition is the existence of a _________.
diaphragmatic hernia.
A diaphragmatic hernia results in an abnormal opening in the fetal ________ that allows the herniation of abdominal contents into the chest cavity. The most common location of a diaphragmatic hernia is on the _______side. This type may also be referred to as a Bochdalek hernia.
diaphragm; left
the herniation of abdominal contents into the chest cavity because of an opening in the left posterolateral portion of the diaphragm
Bochdalek hernia
an opening located in the left posterolateral portion of the diaphragm
foramen of Bochdalek
The _________ is located in the left posterolateral portion of the diaphragm.
foramen of Bochdalek
The __________, which is located right anteromedially within the diaphragm, may lead to a ______-sided diaphragmatic hernia, thus allowing the entire liver to herniate into the chest
foramen of Morgagni; right
an opening located right anteromedially within the diaphragm
foramen of Morgagni
Diaphragmatic hernias that are located on the _______ side may be more difficult to diagnose, given the similar echogenicity of the fetal lungs and fetal liver.
right
One differential diagnosis of a diaphragmatic hernia is ________, which is a lack of muscle in the dome of the diaphragm. This will have a similar sonographic appearance to a diaphragmatic hernia and can, therefore, be difficult to distinguish sonographically.
eventration of the diaphragm
lack of muscle in the dome of the diaphragm
eventration of the diaphragm (*Diaphragm located to high)
Sonographic Findings of a ________
1.Malposition of the heart
2.Anechoic stomach bubble noted adjacent to the fetal heart in the four-chamber heart view
3.Other abdominal organs, including the liver, pancreas, and spleen, may be located within the chest
*Often, sagittal and coronal imaging at the level of the diaphragm can be helpful to confirm this abnormality.
Diaphragmatic Hernia
The ________ gland is located anterior to the mediastinum. It is part of the ________ system because it provides a place for the maturation of ___ cells, which are specialized white blood cells.
thymus; immune; T
The thymus sonographically, it appears as a _______structure located in the _______ chest at the level of the sternum between the lungs.
hypoechoic; anterior
a genetic disorder characterized by an absent or hypoplastic thymus, which ultimately leads to impairment of the immune system and susceptibility to infection, as well as cognitive disorders, congenital heart defects, palate defects, and hormonal abnormalities
DiGeorge syndrome
The fetal heart is fully formed by _____
10wks
The blood returning from the lungs through the pulmonary veins enters into the:
a. right atrium
b. left atrium
c. right ventricle
d. left ventricle
left atrium
