Fetal Heart 2 Flashcards
If the LV is smaller than RV, what two main anomalies could be considered?
hypoplastic lt. heart syndrome
coarctation of the aorta
Hypoplastic left heart:
LV is usually severely underdeveloped
typically, MV is hypoplastic and aortic valve is an imperforate membrane
asc aorta and arch and often hypoplastic
Coarctation of the aorta:
narrowing of aortic lumen occuring between the insertion of the ductus arteriosus and lt. SCA
lesser degree in LV size than HLHS
shelf like lesion in aorta
Coarctation is mostly seen in what syndrome?
Turner’s
If the RV is smaller than LV, what is likely the cause?
pulmonary atresia (but not always the case)
Pulmonary atresia:
no flow through from the RV through the pulmonary valve into main pulmonary artery
RV can also appear small in what anomaly?
Ebstein’s anomaly
Enlarged RA (Ebstein’s anomaly):
inferior displacement of the septal and posterior leaflets of the TV
TV is incompetent which leads to enlarged RA
4CH view shows this
What can Ebstein’s anomaly be associated with?
pulmonary atresia (valve does not form correctly)
arrhythmia
chromosomal anomalies
Overriding aorta:
aorta is displaced more to the right and positioned over a VSD instead of LV causing a mixing of oxygenated and deoxygenated blood
disrupts the normal continuity of the ventricular septum and the wall of aorta seen in the view
VSD
What is a key structure to visualize when scanning an overriding aorta?
PA
What is the primary diagnosis when an overriding aorta is seen?
tetralogy of fallot
Tetralogy of Fallot consists of what?
stenosis of RVOT hypoplastic or stenotic PA abnormality of the pulmonary valve or annulus infundibular stenosis (below PA in RV) VSD overriding aorta
*hypertrophy of RV
Tetralogy of Fallot becomes a problem when?
after birth. Systemic hypoxia occurs
Truncus arteriosus:
rare more severe form of TOF in which a single blood vessel comes out of the right and left ventricle
What are the anomalies of the outflow tract?
transposition of the great arteries
double outlet right ventricle
Transposition of the Great Arteries:
atrioventricular connection is normal, but the aorta arises from the RV and PA from LV
no hemodynamic consequence in utero unless pulmonary stenosis is present
Double outlet right ventricle:
both great arteries connect to the RV
PA and most of aorta arise from the RV
VSD– unless there are obstructing lesions such as a pulmonic or mitral stenosis
Where are echogenic intracardiac foci typically observed?
LV - 60%
Intracardiac foci have an association with what?
risk of Tri21- 1%
With an echogenic intracardiac foci, is the heart typically normal or abnormal?
normal
Rhabdomyomas:
tuberous sclerosis is frequently associated with this
most are benign and isolated
can cause CHF if it obstructs inflow or outflow
typically more echogenic than ventricular myocardium
What’s the most common type of cardiac tumor in the fetus (90%)
rhabdomyomas:
Congestive heart failure:
occurs when the heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Causes of CHF:
arrhythmias
anemia
congenital heart disease w/ valvular regurgitation
non-cardiac malformations such as diaphragmatic hernia or cystic hygroma
TTTS volume and pressure overload
arterioventricular fistula w/ high cardiac output
What are the advanced findings of CHF?
cardiomegaly valve regurgitation venous congestion fetal edema and effusions oligohydramnios preferential shunting of blood flow to the brain, heart, and adrenals in distressed fetus
What is an abnormal pericardial fluid collection?
> 2mm
What can pericardial effusion be associated with?
hydrops fetal arrhythmia (tachyarrhythmia) congenital cardiac anomalies fetal cardiac tumors increased incidence of chromosomal anomalies
