Ch 8 Normal Heart

Question 1

Blood starts to circulate within the embryo by how many weeks gest age?

Answer 1

5 weeks

Question 2

The heart begins as a set of paired tubular structures known as what?

Answer 2

Cardiogenic cords

Question 3

The cardiogenic cords begin to fuse on what day?

Answer 3

22nd day

Question 4

What do the cardiogenic cords form after they fuse?

Answer 4

Forms the single heart tube

Question 5

At approx what day does the endocardial cushions begin to develop + separate the atria from ventricles?

Answer 5

Day 27

Question 6

What does the endocardial cushions separate?

Answer 6

Atria + ventricles

Question 7

By what day post-conception are the mitral + tricuspid valves formed?

Answer 7

Day 33

Question 8

B/w what days does the septum primum form?

Answer 8

25th-28th day post conception

Question 9

What does the septum primum create an initial division b/w?

Answer 9

The right + left portions of the atrium

Question 10

Once the septum secundum is formed, why does the foramen ovale remain?

Answer 10

Remains to allow the right to left shunting until birth

Question 11

Where do the great vessels (AO/PAs) arise from?

Answer 11

The common vessel of the truncus arteriosis

Question 12

Swellings in the truncus arteriosus form + twist around each other during what week? What does this form?

Answer 12

-7th week
-Forms the aorticopulmonary septum

Question 13

The pulmonary channel is contiguous/touching the RV or LV?

Answer 13

RV

Question 14

The systemic (aortic) channel is contiguous/touching the RV or LV?

Answer 14

LV

Question 15

The AO + pulmonary arches arise from what? When does this occur?

Answer 15

-Series of primitive aortic arches
-B/w 19-30 days post conception

Question 16

By the beginning of what week has the heart fully formed + placental circulation has begun?

Answer 16

Start of 8th week gestation

Question 17

The majority of the blood from the umbilical vein is shunted into what?

Answer 17

The ductus venosus

Question 18

What does the majority of the blood from the umbilical vein bypass + enter?

Answer 18

Bypasses the hepatic circulation + enters the IVC

Question 19

Where does the remainder of blood flow through?

Answer 19

The hepatic circulation prior to entering into the IVC via hepatic veins

Question 20

Blood enters the RA from what vessels?

Answer 20

IVC + SVC

Question 21

How does oxygenated blood get into the LA from the RA?

Answer 21

Oxygenated blood is directed by the eustachian valve through the foramen ovale into the LA

Question 22

The remained of blood in the RA (plus returning blood from SVC) pass through which valve to enter the RV?

Answer 22

TV

Question 23

From the RV, blood passes through which valve into the PA?

Answer 23

PV

Question 24

The majority of blood that enters the PA is diverted through what?

Answer 24

The ductus arteriosus into the AO + systemic circulation

Question 25

Blood in the LA comes from 2 places, what are they?

Answer 25

-From pulmonary circulation -Gets shunted through foramen ovale (from RA)

Question 26

Blood in LA passes through what valve to get into LV?

Answer 26

MV

Question 27

The highly oxygenated portion of blood is shunted mainly to what portion of the fetus?

Answer 27

The cranial portion

Question 28

Highly oxygenated blood gets shunted mainly to the cranial portion of the fetus via what arteries?

Answer 28

Brachiocephalic arteries (which arise from the prox portion of the AO arch)

Question 29

What are the brachiocephalic arteries?

Answer 29

Right subclavian artery + right carotid artery

Question 30

The remainder of blood goes where after it reaches the cranial portion of the fetus?

Answer 30

Spreads to distal portion of fetus through abdominal AO

Question 31

The remainder of blood goes where after it reaches the distal portion of the fetus?

Answer 31

Returns to the placental circulation through the umbilical arteries

Question 32

Does the MCA + umbilical artery have opposite or the same dopplers in regards to diastolic flow?

Answer 32

Opposite (MCA wants low, UA wants high)

Question 33

Difference b/w MCA + umbilical artery dopplers?

Answer 33

MCA: higher peaks, lower diastolic flow UA: lower peaks, higher diastolic flow

Question 34

The location + orientation of the heart can be evaluated once what is determined?

Answer 34

Fetal position

Question 35

The heart should occupy how much of the left side of the fetal chest?

Answer 35

The majority of it

Question 36

Should the apex normally point to the left or right?

Answer 36

Left

Question 37

What is the normal angle of the heart in degrees?

Answer 37

45 degrees to left of midline (plus/minus 20 degrees)

Question 38

What is the term that represents a normal sided heart?

Answer 38

Levocardia (levo = left side)

Question 39

What is dextrocardia?

Answer 39

When the heart is on the right side of chest, with apex also pointing to right (fully flipped)

Question 40

What is dextroposition?

Answer 40

When the heart is on right side of chest, with apex pointing to left (apex still in right position, but wrong side chest)

Question 41

What is mesocardia?

Answer 41

When heart is in middle portion of chest, with apex pointing along midline (meso = middle)

Question 42

Dextroposition + mesocardia occur m/c due to what?

Answer 42

There being a mass lesion in the left chest (ex. mass causes heart to shift over onto wrong side of chest)

Question 43

Is dextrocardia usually a congenital condition?

Answer 43

Yes

Question 44

List the heart protocol?

Answer 44

-4 ch view -LVOT + RVOT -SAX -AO + ductal arch -Bicaval -3 vessel view -Cine sweep from stomach to 3VV (with + w/o CD) -Split screen/cine showing axis of heart relative to stomach

Question 45

Is the heart often a reason why moms comes back for a repeat u/s?

Answer 45

Yes!

Question 46

How is the apical 4 ch view obtained?

Answer 46

-From TRV image of fetal chest -Apex points either directly towards or away from probe -Ventricular + apical/atrial septa is parallel to probe -Ensure valves are on the same level

Question 47

Should the RA + LA be approx equal size?

Answer 47

Yes!

Question 48

Does the RV or LV appear slightly larger?

Answer 48

RV (remember is opposite of adults)

Question 49

The MV + TV valves (AV valves) are located where?

Answer 49

B/w atria + ventricles

Question 50

What do we have to watch out for when imaging the 4 ch view in regards to the ventricular septum?

Answer 50

-Watch out for drop out (as the septum is parallel to the beam) -Ensure septum is continuous w/o any disruption

Question 51

What should the atrial septum contain in fetuses?

Answer 51

The normal opening of the foramen ovale

Question 52

What is the foramen ovale?

Answer 52

-Hole in b/w RA + LA -Foraminal flap should be seen opening into the LA

Question 53

Are the 2 superior pulmonary arteries or veins seen entering into the LA in the 4 ch view?

Answer 53

Veins

Question 54

How do we angle the probe to get LVOT?

Answer 54

Angle towards the fetal right shoulder from the 4 ch view

Question 55

If a VSD is present, how would it appear in LVOT?

Answer 55

As a break in the continuity of the IVS

Question 56

Is PLAX in adults the same view as LVOT in fetuses?

Answer 56

Yes!

Question 57

How do we angle the probe to get RVOT?

Answer 57

Angle further toward the fetal right shoulder while in LVOT

Question 58

Should RVOT + LVOT cross when switching/angling back and forth b/w them?

Answer 58

Yes!! Should show AO crossing anteriorly to the PA

Question 59

How do we angle the probe to get SAX?

Answer 59

Angle slightly towards fetal left shoulder

Question 60

Is PSAX - AoV level in adults the same as SAX in fetuses?

Answer 60

Yes!

Question 61

What structures are seen in SAX?

Answer 61

-AO appears as central circular structure (encircled by surrounding PA) -RA, RV + PA seen -AoV, PV + TV seen -Size of AO + PA can be directly compared here

Question 62

How do we angle the probe to get the AO arch?

Answer 62

Angle from left shoulder to right hemithorax while in a longitudinal/SAG view of fetus

Question 63

How can we distinguish the AO arch from the ductal arch?

Answer 63

-By identifying the head + neck vessels -Ductal arch is more caudal

Question 64

AO arch has what appearance?

Answer 64

Candy cane

Question 65

Ductal arch has what appearance?

Answer 65

Hockey stick (think dudes = play hockey = ductal)

Question 66

How do we angle the probe to get the ductal arch?

Answer 66

Remaining in longitudinal/SAG view from the AO arch, but rotating back to a straighter anterior-posterior view

Question 67

What structures are seen in the ductal arch?

Answer 67

PA (top) , ductus arteriosus (middle) + descending AO (bottom)

Question 68

What 3 vessels come off the Ao arch?

Answer 68

-Left subclavian artery -Left common carotid artery -Brachiocephalic trunk

Question 69

How do we angle the probe to get the 3 vessel view?

Answer 69

Apical 4 ch view obtained, then probe is moved cephalad

Question 70

List the structures in the 3VV?

Answer 70

From midline to lateral: acronym PASS -PA -AO -SVC (can compare size of AO to PA here)

Question 71

Why does the PA appear more elongated in the 3VV compared to the AO + SVC?

Answer 71

B/c the PA is being imaged at the level of the ductus arteriosus

Question 72

What is the ductus arteriosus?

Answer 72

-A blood vessel that connects the fetal PA to the AO, it closes after birth -It allows oxygenated blood to bypass pulmonary circulation + go right into AO, since the lungs aren't being used yet

Question 73

How can we obtain the bicaval view?

Answer 73

Go oblique, SAG view through heart

Question 74

What structures are seen in the bicaval view?

Answer 74

-SVC entering RA superiorly -IVC entering RA inferiorly (make sure we image IVC and not accidentally AO)

Question 75

What is SAX short for?

Answer 75

Short Axis

Question 76

The smallest vessel on the 3V view is the?

Answer 76

SVC

Question 77

The heart should point 45 degrees to the left, +/- this many degrees?

Answer 77

20 degrees

Question 78

Levocardia is defined as?

Answer 78

A normal heart