Fetal Echocardiogram Flashcards
1
Q
Autoimmune diseases like Lupus and Sjogrens cause what kind of CHD
A
Heart block, Constricted DA
2
Q
In Vitro can cause what kind of CHD
A
VSD, ASD, TGA
3
Q
Diabetes and Phenylketonuria cause what of CHD
A
TGA, TOF, Hypertrophic Cardiomyopathy and Heterotaxy
4
Q
Fetal abnormal heart rhythm common CHD
A
AVSD, cc-TGA, Atrial Isomerism and Ebstein Anomaly
5
Q
Hydrops common CHD
A
Cardiomyopathy, Arrhythmia
6
Q
Increased NT common CHD
A
VSD, HLHS
7
Q
Monochorionic Twins TTTS common CHD
A
VSD, ASD, Hypertrophic Cardiomyopathy
8
Q
Mother of fetus can affect fetus risk of CHD by
A
10 - 12%
9
Q
What type of CHD does DiGeorge cause
A
Conotruncal and VSD
10
Q
What type of CHD does Noonan cause
A
Pulmonary Stenosis, Hypertrophic Cardiomyopathy
11
Q
What type of CHD does William cause
A
VSD, Ao stenosis, Pulmonary stenosis
12
Q
What type of CHD does T13 cause {PATAU}
A
VSD, ASD, HLHS, Coarctation
13
Q
What type of CHD does T18 cause {EDWARD}
A
VSD, ASD, TOF, DORV, Coarctation
14
Q
What type of CHD does T21 cause
A
AVSD, VSD, ASD, TOF
15
Q
What type of CHD does Turner cause {45X}
A
Coarctation, Bicuspid AV, Aortic Stenosis, HLHS
16
Q
What type of CHD does Holt - Oram cause
A
ASD, VSD
17
Q
Lithium can cause
A
Ebstein, Tricuspid Atresia, ASD, Mitral Atresia
18
Q
There are 6 Ao arches. Which three disappear
A
3, 4 and 6
19
Q
What is the 3rd pair of Ao arches
A
Carotid
20
Q
What is the 4th Pair
A
4th left - Ao Arch right - Prox Rt Subclavian Artery
21
Q
What is the 6th Pair
A
6th left - Lt Pulmon Artery and the DA right - Rt Pulmon Artery
22
Q
What weeks do the 6 pairs of Ao Arches development
A
4th and 5th week
23
Q
What are some of the Tissue Migration Defects
A
Persistent Truncus Arteriosus, TOF, TGA, DORV, Sub-arterial VSD
24
Q
Tissue Migration Abnormalities refers to the ectomesenchymal responsible for forming what?
A
Septum within the truncus arteriosus
25
Abnormal Intracardiac Blood Flow Defects - Left Heart
Bicuspid AV, Ao stenosis, Ao atresia, Coarctation, Interrupted Ao Arch, Mitral Atresia, HLHS
26
Abnormal Intracardiac Blood Flow Defects - Right Heart
Bicuspid Pulmonic Valve, Pulmonary Stenosis, Hypoplastic Right Heart, Pulmonary Atresia with Intact Ventricular Septum, Tricuspid Atresia
27
Cell Death Abnormalities Defects
Muscular Ventricular Septal Defects, Ebstein Anomaly
28
Extracellular Matrix Abnormalities Defects
Atrioventricular Septal Defect, Ostium Primum Atrial Septal Defect, Inflow Ventricular Septal Defect, Dysplastic Aortic or Pulmonic Valve
29
Abnormal Targeted Growth Defects (affects PV)
Total Anomalous Pulmonary Venous Connection
Partial Anomalous Pulmonary Venous Connection
30
Abnormal Situs and Looping Defects
Dextrocardia, Mesocardia, Bilat Atrial Isomerism, TGA, I-transposition
31
The Left Atrium is
Most posterior, closest to spine, smooth, Coumadin Ridge, Coronary Sinus, Finger-like, PV
32
The Right Atrium is
Course, irregular, triangular, pyramidal, IVC - RA via Eustachian valve, Coronary Sinus - RA - Thebesian valve, SVC - RA - no valve
33
The Right Ventricle
Closest to anterior chest wall, rt atrium via Tricuspid valve, Course apical trabeculations "moderator band", crescent, 3 papillary muscles anchor the TV via chordae to heart wall abd IVS
34
The Left Ventricle
Lt Atrium via MV, Bullet, smooth endocardial, 2 pap muscles anchor MV via chordae to heart wall not the IVS, apex of the heart
35
AV valves (atrioventricular)
MV and TV
36
Semilunar valves
AV and PV
37
The AV valves open and close when
Open in diastole and closed in systole.
38
The Semilunar valves open and close when
Open in systole and closed in diastole.
39
MV has
2 leaflets (ant/post)
40
TV has
3 leaflets (ant, post, septal) septal lies inferiorly than the anterior
41
AV is located where?
between the lt vent and ascending AO
42
How many leaflets does the AV have.
3 - Left coronary cusp, right coronary cusp and non-coronary cusp
43
PV is located where?
between the RV and main Pulmonary artery
44
How many leaflets does the PV have.
3 - rt and lt leaflets correspond to the left and right AV, then the anterior leaflet
45
Great Vessels
The AO and the Pulmonary Artery
46
Aorta
Arises from the LV and courses behind the PA towards the fetal right shoulder
47
Pulmonary Artery
Arises from the RV and crosses over the AO toward the fetal left shoulder
48
The PA triferactes into the
Rt and Lt Pulm artery and the DA
49
The FO opens in the
septum secundum
50
Ventricular Septum
membranous and muscular
51
The Muscular Septum has 5 parts:
Inlet, outlet, trabecular, mid - muscular and apical
52
Conduction System
SA (SinoAtrial) node - Bachman's - Wenckebach - Thorel - AV (AtrioVentricular) node - Bundle of HIS - Rt/Lt Bundle Brances - Purkingie fibers
53
P wave
Atrial depolarization (contraction)
54
QRS complex
Ventricular depolarization (contraction)
55
T wave
Ventricular repolarization
56
PR Interval
Time it takes from atrial contraction to ventricular contraction.
57
RP Interval
Time it takes from ventricular contraction to atrial contraction.
58
ST Segment
Time during which the ventricles are contracting and emptying
59
TP Interval
Time during which the ventricles are relaxing and filling.
60
How many shunts in the fetal circulation
3
61
The 3 shunts
DV, FO, DA
62
The DV
carries blood from umb v to the IVC
63
The FO
carries blood from RA to LA
64
The DA
carries blood from PA to descending AO.
65
Cardiac Axis
Normal, severe levocardia, dextrocardia, mesocardia
66
Severe levocardia
apex to the left > 65, Increased Rt atrium ie. Ebstein, severe tricuspid regurg, HLHS
67
Dextrocardia
Apex to the right, isolated or heterotaxy
68
Mesocardia
Apex midline ie. Cong Corrected TGA, heterotaxy, DiGeorge, Turner, T18
69
Isolated Dextrocardia
95% Abn PA/Valve, DORV, VSD, ASD< Single Ventricle
70
Dextrocardia with Heterotaxy
25% Atrial Isomerism, Abn Pulm Art/Valve, AVSD, Anomalous Pulm Ven Return, Conotruncal Abn
71
Cardiac Position
Levoposition, Dextroposition, Ectopia Cordis
72
Levoposition
normal
73
Dextroposition
Bulk of heart in right thorax, apex points left
74
What can cause Dextroposition?
Diaphragmatic Hernia, CPAM, lung hypoplasia, agenesis
75
Ectopia Cordis
Outside the thoracic cavity; thoracic, abd, thoracoabdominal, cervical
76
Pentalogy of Cantrell
Ectopia Cordis, Sternal cleft, Ventral diaphragmatic defect, Omphalocele, Intracardiac Anomalies
77
Cervical ectopia cordis
Heart is displaced into the neck area
78
Apical 4ch Heart
Angle of insonation parallel to the interventricular septum
79
Apical 4ch evaluation
Left Atrium closest to Spine, Rt Vent closest to ant chest wall, Septal leaflet of TV more apical than ant leaflet
80
SubCoastal 4ch
Angle of insonation perpendicular to interventricular septum
81
Subcoastal evaluation
Left atrium closest to the spine, Rt Vent closest to ant chest wall, measure at end diastole just prior onset of systole.
82
When do you measure Ventricular length?
End of diastole right when the atrioventricular valves close
83
When do you measure Atrial diameter?
During systole when the atrioventricular valves are closed
84
MV and TV valve measured when?
Mid diastole when atrioventricular valves are open
85
AV/PV
Systole
86
MV/TV
Diastole
87
RV/LV
Diastole
88
RA/LA
Systole
89
Sweep from apical 4ch view to
Cephalad
90
IVS is measured when
Diastole
91
Sweep views
Trans fetal abd, apical 4ch, apical 5ch, Pulm artery, 3VTV, LBCV
92
If the Brachiocephalic Vein is dilated
Supracardiac Total Anomalous Pulm Venous, Vein of Galen Aneurysm
93
LBCV
Absent w/ PLSVC, size increases w/gest age, horz across svc in front of AO 3 branches
94
Aortic Arch
Innominate (Brachiocephalic) Artery, Lt Carotid Artery, Left Subclav Artery
95
Valves should be dopp
Distally determines velocity of flow, proximally determines presence or absences of valvular insuff
96
To assess flow through the Aortic valve
open in systole, sample gate distal to AV in ascending AO, flow from left vent to ascending aorta, Measure peak systolic vel less than 120, best angle in 5ch view.
97
Most common stenosis seen prenatally
Aortic Valvular Stenosis
98
To assess for valvular insuff in the aortic valve
gate prox to Ao V in left vent in diastole, it's not seen in a normal heart heart, best dopp 5ch view
99
DA constriction due to
Indomethacin (drug therapy)
100
101
To assess flow through the pulmonary valve
Valve must be open in systole. Sample gate distal to Pulm C in Pulm artery. Normal direction of flow is from the right ventricle to the pulmonary artery. Best Doppler angle is short access view of the great vessels.
102
To assess flow through the MV
Valve open in diastole, gate distal to MV in Lt Vent, Apical view
103
MV stenosis is
Rare
104
E point
Early diastolic filling in ventricle
105
A point
Atrial contraction "kick"
106
E and A points
equalize in late gestation
107
E:A ratio
<1%
108
Early reversal of E to A points suggests
IUGR, CHD affecting myocardium, doppler angle
109
To assess for MV and TV insuff
Sample gate in Lt, RT Atrium in systole, regurg normally in interatrtial septum, CHD has pan systolic or holosystolic flow.
110
To assess flow in TV
Valve open in diastole, gate distal to TV in Rt Vent, Apical view
111
Tricuspid regurgitation is assoc with
T21
112
If sign regurg flow is visualized think
downstream obstruction
113
Pulmonary veins flow into the
LA
114
The PV waveform
antegrade S, D and A points with slightly dampened a point
115
PV reversal of A point shows
downstream obstruction
116
You only need to dopp one PV to r/o
TAPVR
117
IVC flows toward the
RA
118
Normal IVC waveform triphasic flow where
S>D, reversal of A point
119
Loss of triphasicity or reversal marked of A point of the IVC is consistent with
Rt heart obs and IUGR
120
Marked reversal of the DV is consistent with the
IUGR, Rt Heart obstruction
121
FHR > 190 will cause reversal of A wave in the
DV
122
After what gestational age should there be no pulsatile flow in the umb v
12 weeks
123
Umbilical arteries flow is towards the
Placenta
124
Normal resistive index of umb v
PSV-EDV/PSV <70%
125
Normal pulsatility index of umb v
PSV-EDV/TAV
126
Normal S/D ratio
<3.5 before 30 wks
< 3 after 30 wks
127
MCA normal flow toward
lateral aspect of the brain
128
MCA normal resistive index
PSV-EDV/PSV >80%
129
MCA normal pulsatility index
varies
130
MCA normal S/D ratio
>6
131
Increased PSV of MCA associated with
fetal anemia
132
Coronary arteries that are prom means
heart sparing
133
Dilated coronary arteries are due to
IUGR (hypoxia) or anemia
134
CPS (cardiovascular profile) assigns
2pts for each 5 cat
135
A cardio score of 5 or less is assoc with
Sign mortality
136
List the cardio score categories.
Hydrops, Ven Dopp (umb/dv), Heart size, Cardiac function, Arterial dopp (umb artery)
137
Cardiovascular profile Score - Hydrops
Ascites, PE -1 and Skin edema -2
138
Cardiovascular profile Score - Venous Dopp (umb and DV)
Reversal flow -1 and UV pulsations -2
139
Cardiovascular profile Score - Heart Size
.35-.50 -1, >.50 or > .20 -2
140
Cardiovascular profile Score - cardiac function
Holosystolic TR or RV/LV SF <.28 - 1 and Holosystolic MR or TR dP/dt 400 or monophasic filling
141
Cardiovascular profile Score - arterial dopppler
UA AEDV - 1 and UA RREDV - 2
142
Cardiovascular profile Score is only used when
Cardiac abnormality is present. A score of 5 or less is assoc with sign mortality.
143
Fetal arrhythmias occur in
1 to 3%
144
Which fetal arrhythmias is most common
PACs (premature contraction) 90%
145
What causes PACs
Nic, Caff, alcohol, redundant foramenal flap, late gestation, idiopathic
146
Tachycardia two types
SVT and Atrial Flutter
147
SVT
>180-299 1:1 conduction
148
Atrial Flutter
300-500 180-260 variable conduction
149
Supraventricular Tachycardia Causes
Wolff-Parkinson-White Syndrome, Ebstein
150
What is PR Interval
time from atrial to ventricular contraction
151
What is RP Interval
time from ventricular contraction to atrial contraction
151
If the RP interval is shorter than PR interval
Considered a re-entrant tachy and Wolff-parkinson-white syndrome
152
152
If the RP is longer than PR interval
Permanent junctional reciprocating tachy (PJRT), more diff to treat, higher mortality
152
