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CNIH > Fetal heart anomalies PT 2 > Flashcards

Fetal heart anomalies PT 2 Flashcards

1
Q

What are 2 main anomalies to consider when the LV appears smaller than RV?

A
  1. Hypoplastic left heart syndrome

2. coarctation of the aorta

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2
Q

Hypoplastic left heart syndrome?

A
  • 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
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3
Q

Coarctation of the aorta?

  • what is it?
  • where does it occur?
  • what is it due to?
A
  • 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
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4
Q

what is most likely an ethology with RV smaller than LV?

A

PULMONARY ATRESIA

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5
Q

Pulmonary atresia?

A
  • no flow from the RV through the pulmonary valve onto the main pulmonary artery
  • main pulmonary artery may be normal in size or hypoplastic
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6
Q

Enlarged right atrium (Ebstein’s anomaly)?’

  • what is it?
  • what view is it visualized in?
A
  • Inferior displacement of the septal and posterior leaflets of the tricuspid valve
  • Tv usually incompetent leading to RT atria enlargement
  • seen in 4CH view
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7
Q

ebstein’s anomaly may be associated with?

A

a variety of structural cardiocascular defect:

  • Pulmonary atresia or stenosis
  • arrhythmia
  • chromosomal anomalies
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8
Q

Overriding aorta?

A
  • 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
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9
Q

what is a key structure to evaluate when an overriding aorta is seen?

A

pulmonary artery

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10
Q

Tetralogy of Fallot accounts for what % of CHD?

A

10%

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11
Q

What is the primary diagnosis to consider when overriding aorta is seen?

A

Tetralogy of Fallot

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12
Q

Tetralogy of Fallot consists of? (6)

A
  1. stenosis of the RVOT
    2 Hyplastic or stenotic pulmonary artery
  2. Abnormality of the pulmonary valve or annulus
  3. Infundibular stenosis (below the PA in the RV)
  4. Ventricular septal defect
  5. Overriding aorta
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13
Q

What is tetralogy of Fallot?

A
  • hypertrophy of the right ventricle
  • happens after birth
  • RV works against resistance to flow due to pulmonary stenosis
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14
Q

What is the most important problem after birth associated with tetralogy of fallot?

A

systemic hypoxia

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15
Q

Truncus arteriosus?

A
  • 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)
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16
Q

normally what relationship to the aorta and pulmonary artery have?

A

aorta and pulmonary artery crisscross in their initial course as they exit the heart (normally Aorta arises from LV and PA from RV)

17
Q

in complete transposition of the great arteries what occurs?

A

the atrioventricular connection is normal but the aorta arises from the RV and the PA from the LV

18
Q

What can occur in transposition of the great arteries?

A

Usually there is no hemodynamic consequence in utero, although if pulmonary stenosis is present, congestive heart failure can occur.

19
Q

What is Double outlet right ventricle?

A

is a type of transposition abnormality where both great arteries connect to RV

20
Q

When does double outlet right ventricle occur?

A
  • 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
21
Q

consequence of double outlet right ventricle?

A

There is usually no hemodynamic consequence to the fetus. As in complete transposition, the normal crossing of aorta and PA is lost

22
Q

Echogenic intracardiac foci?

A
  • 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.
23
Q

Echogenic intracardiac foci risk?

A

In isolated echogenic intracardiac focus, the risk of Tri-21 is 1%.

24
Q

what is frquently associated with Rhabdomyomas (intracardiac mass)?

A
  • Tuberous sclerosis
25
Q

most common type of cardiac tumor in the fetus?

A

Rhabdomyomas

26
Q

rhabdomyoma on ultrasound?

A
  • 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.
27
Q

Congestive heart failure occurs when?

A

heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body

28
Q

Causes of fetal congestive heart failure? (6)

A
  1. Fetal arrhythmias
  2. Anaemia
  3. Congenital heart disease with valvular regurgitation
  4. Non-cardiac malformations such as diaphragmatic hernia or cystic hygroma
  5. Twin-twin transfusion recipient volume and pressure overload
  6. Atrioventricular fistula with high cardiac output
29
Q

definition of congestive heart failure?

A

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

30
Q

CHR- Fetal echocardiographic findings at an advances stage? (6)

A 
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
31
Q

congestive heart failure abnormalities? (4)

A
  1. cardiac/thoracic size
  2. venous doppler
  3. arterial doppler
  4. hydrops
32
Q

what is venous doppler?

A

IVC and umbillical cord vein

33
Q

arterial doppler?

A
  • Four valve Doppler - any leak of the valve should be evaluated further.
  • M-mode of the ventricular wall – Abnormal myocardial function
34
Q

PERICARDIAL EFFUSION

  • what is it?
  • whats concidered abnormal?
A
  • refers to an accumulation of pericardial fluid in utero

- In order to be considered abnormal, pericardial fluid thickness should be greater than 2 mm

35
Q

What is pericardial effusion associated with? (5)

A
  1. Hydrops
  2. Fetal arrhythmia (fetal tachyarrhythmia)
  3. Congenital cardiac anomalies : especially if large
  4. Fetal cardiac tumours : e.g. fetal pericardial teratoma
  5. Increased incidence of chromosomal anomalies (Trisomy-21)

CNIH (69 decks)

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