Ch. 35, 36 & 61 Flashcards
With transvaginal scanning, the fetal heartbeat can be detected at _______ weeks
4-5
With transvaginal scanning, detailed anatomy and screening for defects is done in the ________
2nd-3rd trimesters
About _______ infants are born each year with congenital heart defects
30,000
Fetal echocardiography may be done after _____ with the optimum time of _______
14-16 weeks, 18-22 weeks
What is a fetal echocardiogram
focused ultrasound on the fetal heart, targeted sonogram done by trained personnel for specific indications
Details of fetal heart anatomy are better seen as gestation progresses
true
Doppler imaging of the fetal heart may be done without any concern about risk of bioeffects at all
false
There is no special training needed for a sonographer to do fetal echocardiograms
false
If a fetus has severe genetic abnormalities what is the usual outcome of the pregnancy
spontaneous abortion
The ______ system is the first fetal organ system to function
cardiovascular
By the end of the _____ week circulation of blood has begun
3rd
Blood formation in the embryo begins in the ______ week
5th
The space between the primitive atria and primitive ventricles is called the
AV canal
Endocardial cushions grow to divide the AV canal into _______ and ________
right, left halves
Truncal cushions are formed by _______ cells that migrate from the _______
neurocrest, hind brain
Why is it possible for most of the fetal blood to bypass the fetal lungs
foramen ovale, oxygenation occurs in the placenta and lungs aren’t used yet
List the 3 fetal circulatory structures that are no longer needed after birth and what they become
foramen ovale, ductus venosus, ductus arteriosus/arch
Define brachycardia
heart rate <100 bpm
Define tachycardia
heart rate >200 bpm
List the fetal risk factors that are associated with an increased likelihood for congenital heart defects
IUGR, cardiac arrhythmias, abnormal amniocentesis indicating a trisomy, abnormal amniotic fluid collections, abnormal heart rate, thickened nuchal translucency, hydrops fetalis, renal and GI anomalies, single umbilical artery
List the maternal risk factors that are associated with an increased likelihood for congenital heart defects
previous occurrence of CHD in siblings or parents, untreated diabetes, lupus, drug use, alcohol use, smoking, hypertension
List the Familial risk factors that are associated with an increased likelihood for congenital heart defects
genetic syndromes, presence of CHD in previous sibling
Why would a fetus whose mother has lupus be more likely to have bradycardia
due to heart block and pericardial effusion caused by the connective tissue disorder
Why is a broad band transducer preferred for fetal echocardiography
creates more detailed images
How can a transvaginal probe be used for fetal echocardiography
used when fetus is in transverse lie, easily angled toward heart, higher frequency means more detailed images
Why would cineloop be useful for fetal echocardiography
frame-by-frame analysis
______ is used to create a tracing of heart motion over time. This is used to evaluate ____ and _____ motion, opening and closing of ______ and ______ size
M-mode, wall, septal, valves, chamber
If the fetal heart beats 3 times/second what is the heart rate
180 bpm
Color doppler is useful for detecting ______ and ______ in blood flow
direction, turbulence
Why is 3D fetal echocardiography not better than 2D
decrease image clarity
What should the fetal echocardiographer document before targeting the fetal heart
position of fetus, stomach, aorta, IVC, location of apex, position of placenta, BPD, FL
List the anatomy that can be seen and evaluated from the four chamber view of the heart
RA, RV, tricuspid valve, LA, LV, mitral valve, interventricular septum, interatrial septum, foramen ovale, pulmonary veins as they enter LA, pulmonic valve
In the fetus, the foramen ovale opens into the _____ atrium
left
The ______ is a faint echogenic structure that can be seen in the right ventricle
moderator band
The tricuspid valve is located just ________ to the mitral valve
inferior
Which pulmonary vein is NOT seen in the four chamber view
right lower vein
What measurements of the fetal heart are done in the 4 chamber view
right/left ventricular width measurements, IVS thickness, atrium width valves
Why is it important to only use one focal zone when doing fetal echocardiography
increases frame rate
How does the sonographer differentiate the aortic arch from the ductus arteriosus
aortic arch has 3 vessels/branches looks like candy cane, ductus arteriosus has no branches and looks like a hockey stick
To reach the five chamber view, the transducer is angled ______ from the four chamber view
anterior (up)
The pulmonary artery is normally _____ and _______ to the aorta
anterior, left
What cardiac structures are imaged in the five chamber view
LA, LV, mitral valve, LVOT, aortic root
What cardiac structures are imaged in the LVOT view
rt & lt ventricles, LA, aortic valve, ascending aorta, IVS
What does the sonographer assess to the long axis view to evaluate for membranous VSD
continuing of right IVS with anterior wall of the aortic root
If there is no VSD seen on fetal echo, does that guarantee that there isn’t one? Why or why not
No, VSD must be 5-10mm, half of aortic diameter
The pulmonary artery is a little _____ at its origin than the aorta
wider
What is a tricuspid aortic valve
3 cusps with or without eccentric closure
How does tricuspid valve dhow up on fetal echo
fish mouth appearance
What vessel is evaluated in the hockey stick view? Will this view be possible in the normal child or adult
ductus arteriosus, no
What are the 3 most common types of congenital heart defects
ASD, VSD, pulmonary stenosis
Why are ASDs difficult to recognize in fetal life
foramen ovale remains open until after birth, when pressure change between right and left atrium forcing foramen to close completely
If the flap of the foramen ovale is too long, what can happen to the fetal heart rhythm. Why?
can cause fetal arrhythmias, flap is touching lateral wall of atrium agitating the SA node in the right atrium
Atrioventricular septal defect is a defect of the
endocardial cushions
Atrioventricular septal defects affect the valves as well as the septum
true
_________ is a defect with a single, free-floating valve leaflet that stretches across both ventricles across a VSD
complete atrioventricular septal defect
What is a common atria
complete absence of the interartial septum, atria completely fill through systole and diastole
In the 4 chamber view of the fetal heart, the left ventricle is enlarged/dilated. The right ventricle is very hypoplastic. There is no movement seen at the tricuspid valve annulus and a VSD is present. What is the probable diagnosis
tricuspid atresia
_______ is the abnormal displacement of the septal leaflet of the tricuspid valve into the right ventricle
ebsteins anomaly
________ is the most common form of cyanotic heart disease
tetralogy of fallot
What is the cyanotic heart disease
pulmonary stenosis causes baby to turn blue, prevents oxygenation of blood
List the 4 characteristic findings of tetralogy of fallot
rt ventricular hypertrophy, large VSD, overriding aorta, pulmonary stenosis
Define double outlet right ventricle
both great vessels arising from right side of the heart, aorta is directed more to the right ventricle than to the left
In a fetal echo, the mitral valve orifice is echogenic and thick and the valve doesn’t move. The left ventricle is hypoplastic and the ventricular wall is thick. What is the likely diagnosis
mitral valve atresia, hypoplastic left heart, mitral stenosis
Mitral regurgitation is a normal finding in the fetus
false
In cases of congenital aortic stenosis, what happens to the left ventricle? Why?
LVOT dilates (blocked), fluid overload occurs and ventricle can’t empty
Define coarctation of the aorta
narrowing of the arch
Coarctation of the aorta is almost always an isolated defect
false
Hypoplastic Left Heart syndrome may be caused by premature closing of the foramen ovale
true
Define transposition of the great arteries (vessels). What causes it?
abnormal condition when aorta is connected to RV and pulmonary artery is connected to the LV, abnormal completion of the loop in emnryology
________ is a condition in which the right atrium is connected to the morphologic left ventricle and the left atrium is connected to the morphologic right ventricle. List two conditions that this anomaly is associated with
corrected transposition of the great vessel, malposition of the heart and situs inversus
_______ occurs when the contotruncus fails to separate into the aorta and pulmonary trunk. Is this anomaly easily seen on fetal echo
persistent truncus arteriosus, yes
_______ is an anomaly where the two atria connect to only one ventricle
single ventricle, 3 chamber heart
Define cardiomyopathy
disease of the myocardium
List two causes of cardiomyopathy
bacterial infection, hereditary and metabolic syndrome
_________ occurs when the pulmonary veins do not drain into the left atrium. The prognosis is ______
total anomalous, poor
Cardiac tumors are common
false
The majority of cardiac tumors are malignant
false
All cardiac tumors are benign
false
List two cardiac findings associated with asplenia syndrome
transposition of great vessels, single ventricle, ASD, AVSD, pulmonary atresia, dextrocardia, double outlet right ventricle
Asplenia is more common in males than in females
true
List two cardiac findings with polysplenia syndrome
ASD, AVSD, transposition of the great vessels, dextrocardia, double outlet right ventricle
_______ is an anomaly where the heart is located outside the chest wall
ectopic cordis
Premature atrial or ventricular contractions occur when the electrical impulse is generated _______ the SA node
outside
What mode is helpful in documenting fetal arrhythmias
M mode
A benign tumor of the heart associated with tuberous sclerosis is
rhabdomyomas
Which abnormality is a fetal cardiac arrhythmia caused by extra systoles and ectopic beats
ectopic premature atrial and ventricular contractions
Failure of the leaflets to close completely, allowing blood to leak backward into the left atrium is called ______ regurgitation
mitral
A discrete or long-segment narrowing in the aortic arch, usually at the level of the left subclavian artery near the insertion of the ductus arteriosus, is called
coarctation of the aorta
A disease of the myocardial muscle layer of the heart that causes the heart to dilate secondary to regurgitation and also affects cardiac function is
cardiomyopathy
In which of the following congenital heart lesions does only one great artery arise from the base of the heart
truncus arteriosus
What cardiac structures are imaged in the short axis view (RVOT)
RA, RV, tricuspid valve, pulmonic valve, MPA anterior to aorta and bifurcation of right and left pulmonary artery, aortic valve, aortic root
With the addition of cardiac outflow tract views ______ of CHD can be detected
85-90%
What are the 4 characteristics of tetralogy of fallot
rt ventricular hypertrophy, VSD-large, overiding aorta, pulmonary stenosis
_______ is typically a unilateral condition characterized by replacement of normal lung parenchyma by abnormal tissue which includes cysts
congenital cystic adenomatoid malformation CCAM
Which CCAM type is one or more large cysts >2cm
type 1
Which CCAM type is multiple small cysts <1-2cm
type 2
Which CCAM type is multiple small cysts-too small to be seen by ultrasound beam so lung appears hyperechoic
type 3
