Fetal heart anomalies PT 2 Flashcards
What are 2 main anomalies to consider when the LV appears smaller than RV?
- Hypoplastic left heart syndrome
2. coarctation of the aorta
Hypoplastic left heart syndrome?
- Consists of a small LV with aortic atresia and MV hypoplasia or atresia
- The LA may be small or normal in size
- aortic valve is an imperforate membreane
- acsending aorta and arch are most often hypoplastic
Coarctation of the aorta?
- what is it?
- where does it occur?
- what is it due to?
- narrowing of the aortic lumen
- occurs between the insertion of the ductus arteriosus and lt subclavian artery
- due to a discrete shelf-like lesion in the aorta
what is most likely an ethology with RV smaller than LV?
PULMONARY ATRESIA
Pulmonary atresia?
- no flow from the RV through the pulmonary valve onto the main pulmonary artery
- main pulmonary artery may be normal in size or hypoplastic
Enlarged right atrium (Ebstein’s anomaly)?’
- what is it?
- what view is it visualized in?
- Inferior displacement of the septal and posterior leaflets of the tricuspid valve
- Tv usually incompetent leading to RT atria enlargement
- seen in 4CH view
ebstein’s anomaly may be associated with?
a variety of structural cardiocascular defect:
- Pulmonary atresia or stenosis
- arrhythmia
- chromosomal anomalies
Overriding aorta?
- the aorta displaced more to the right side and positioned over a VSD instead of left ventricle (causing mixing of oxygenated and deoxygenated blood)
- disrupts normal continuity of the ventricular septum and the wall of the aorta
what is a key structure to evaluate when an overriding aorta is seen?
pulmonary artery
Tetralogy of Fallot accounts for what % of CHD?
10%
What is the primary diagnosis to consider when overriding aorta is seen?
Tetralogy of Fallot
Tetralogy of Fallot consists of? (6)
- stenosis of the RVOT
2 Hyplastic or stenotic pulmonary artery - Abnormality of the pulmonary valve or annulus
- Infundibular stenosis (below the PA in the RV)
- Ventricular septal defect
- Overriding aorta
What is tetralogy of Fallot?
- hypertrophy of the right ventricle
- happens after birth
- RV works against resistance to flow due to pulmonary stenosis
What is the most important problem after birth associated with tetralogy of fallot?
systemic hypoxia
Truncus arteriosus?
- rare and a more severe form of TOF
- a single blood vessel (truncus arteriosus) comes out of the right and left ventricle, instead of two normal vessels (pulmonary artery and aorta)
normally what relationship to the aorta and pulmonary artery have?
aorta and pulmonary artery crisscross in their initial course as they exit the heart (normally Aorta arises from LV and PA from RV)
in complete transposition of the great arteries what occurs?
the atrioventricular connection is normal but the aorta arises from the RV and the PA from the LV
What can occur in transposition of the great arteries?
Usually there is no hemodynamic consequence in utero, although if pulmonary stenosis is present, congestive heart failure can occur.
What is Double outlet right ventricle?
is a type of transposition abnormality where both great arteries connect to RV
When does double outlet right ventricle occur?
- when the pulmonary artery and most of aorta arise from the RV
- VSD is usually also present, unless there are associated obstructing lesion, such as pulmonic or mitral stenosis
consequence of double outlet right ventricle?
There is usually no hemodynamic consequence to the fetus. As in complete transposition, the normal crossing of aorta and PA is lost
Echogenic intracardiac foci?
- described as “peas or golf balls”
- Appear to represent mineralization or calcification in the papillary muscle. (5% rate)
- The most frequent observation is a single focus in the LV (60% of the cases).
- The majority of fetuses with an echogenic focus in the heart will be normal.
Echogenic intracardiac foci risk?
In isolated echogenic intracardiac focus, the risk of Tri-21 is 1%.
what is frquently associated with Rhabdomyomas (intracardiac mass)?
- Tuberous sclerosis
most common type of cardiac tumor in the fetus?
Rhabdomyomas
rhabdomyoma on ultrasound?
- Cardiac tumours are generally isolated
- While most are benign, they should be followed during gestation as CHF may occur if the tumour position obstructs inflow or outflow
- Sonographically, cardiac masses are more echogenic than the ventricular myocardium.
Congestive heart failure occurs when?
heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Causes of fetal congestive heart failure? (6)
- Fetal arrhythmias
- Anaemia
- Congenital heart disease with valvular regurgitation
- Non-cardiac malformations such as diaphragmatic hernia or cystic hygroma
- Twin-twin transfusion recipient volume and pressure overload
- Atrioventricular fistula with high cardiac output
definition of congestive heart failure?
Inability of the heart to deliver adequate blood flow to organs such as the brain, liver, and kidneys, is a common final outcome of many intrauterine disease states that may lead to fetal demise
CHR- Fetal echocardiographic findings at an advances stage? (6)
cardiomegaly valve regurgitation venous congestion fetal edema and effusions oligohydramnios preferential shunting of blood flow to the brain, heart, and adrenals in the distressed fetus
congestive heart failure abnormalities? (4)
- cardiac/thoracic size
- venous doppler
- arterial doppler
- hydrops
what is venous doppler?
IVC and umbillical cord vein
arterial doppler?
- Four valve Doppler - any leak of the valve should be evaluated further.
- M-mode of the ventricular wall – Abnormal myocardial function
PERICARDIAL EFFUSION
- what is it?
- whats concidered abnormal?
- refers to an accumulation of pericardial fluid in utero
- In order to be considered abnormal, pericardial fluid thickness should be greater than 2 mm
What is pericardial effusion associated with? (5)
- Hydrops
- Fetal arrhythmia (fetal tachyarrhythmia)
- Congenital cardiac anomalies : especially if large
- Fetal cardiac tumours : e.g. fetal pericardial teratoma
- Increased incidence of chromosomal anomalies (Trisomy-21)
