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fetal heart (midterm) Flashcards

1
Q

how much blood does the umbilical vein return saturated blood form the placenta to the fetus?

A

80%

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2
Q

what do the umbilical arteries do?

A

carry mainly deoxygenated blood back to the placenta for oxygenation

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3
Q

when does erythopoeisis begin?

A

week 3

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4
Q

Dextrocardia

A

Heart is located in the right side of the chest with apex pointing to the right

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5
Q

Dextroposition

A

heart is located in the right side of chest but the apex pointing to the left

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6
Q

Mesocardia

A

heart is located in the middle portion of the chest with the apex pointing along the midline

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7
Q

what is located in the 3VV?

A
  • pulmonary artery
  • aorta
  • SVC
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8
Q

what is M mode used for evaluaton for?

A
  • fetal heart motion
  • heart rate
  • wall thickness
  • chamber size
  • motion of the valves or myocardium
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9
Q

what is normal fetal HB at 8 weeks?

A

175 beats/min

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10
Q

what is normal fetal HB at 20 weeks?

A

140 beats/min

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11
Q

what is the normal fetal HB at term?

A

130 beats/min

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12
Q

what is assessed with doppler?

A
  • regurgitation at valves
  • assess septal defects
  • determine pressure gradients
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13
Q

what is normal HB?

A

120-160 bpm

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14
Q

what is atrial flutter?

A

atrial rate of 400 beats per minute and a completely irregular ventricular rhythm

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15
Q

what does PAC stand for?

A

premature atrial contractions

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16
Q

what is PAC?

A

conducted to the ventricles or be blocked within the AV node and thus manifest either as extra beat or as missed beat

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17
Q

what are the most common form of birth defects?

A

congenital heart diseases (CHD)

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18
Q

what is the most common congenital heart disease?

A

ventricular septal defect

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19
Q

what is ventricular septal defect?

A

area of discontinuity in the interventricular septum

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20
Q

what is seen with doppler for ventricular septal defect and direction?

A

bidirectional shunting (right to left shunt during systole and left to right shunting in diastole)

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21
Q

what view do we use for ventricular septal defect?

A
  • four chamber view (using a lateral view to detect bidirectional shunt)
  • LVOT (five chamber view)
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22
Q

what is an atrial septal defect?

A

defect in a portion of the atrial septum

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23
Q

what are the types of atrial septal defect?

A
  • ostium secundum (midatrial septum)
  • ostium primum (lower atrial septum)
  • sinus venosus (outside the atrial septum in the wall separating the SVC or IVC from the LA)
  • coronary sinus defect - partial or complete
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24
Q

what view do we detect atrial septal defect?

A

four chamber view

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25
Q

secundumDSA

A

foramen ovale is larger than the aortic diameter

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26
Q

how do we prove AV septal defect?

A

complete AVSD showing a single 5 leaflet atrioventricular valve with an inlet VSD and an atrial septum primum defect

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27
Q

what is another term for AVSD?

A

endocardial cushion defect

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28
Q

what is the defect of the atrioventricular septum?

A

defects of the interatrial septum (ostium primumASD) of the interventricular septum (inlet VSD), and the division of the atrioventricular valves

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29
Q

how fo we visualize the AVSD on the four chamber view?

A

the absence of crux of the heart, the

presence of theprimumASD and the absence of the usual offset of the AV valves

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30
Q

what are the 4 characteristics of Tetralogy of Fallot?

A
  • ventricular septal defect (VSD)
  • right ventricular outflow tract obstruction (RVOTO)
  • overriding aorta
  • late right ventricular hypertrophy
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31
Q

what is tetralogy of fallot associated with?

A

chromosomal and extracardiac abnormalities

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32
Q

what view do we detect tetralogy of fallot?

A

five chamber view and the basal short axis view

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33
Q

why must we look at the 5 chmaber view for tetralogy of fallot?

A

four chamber cardiac view is normal

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34
Q

what happens with truncus arteriosus with the arteries

A

single arterial trunk that feeds the systemic pulmonary circulation and coronary arteries with a single semilunar valve

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35
Q

what happens with the blood in truncus arteriosus?

A

mixture of oxygenated and deoxygenated blood in the common trunk results in subnormal systemic oxygenation

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36
Q

what view do we detect truncus arteriosus?

A

five chamber view

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37
Q

how do we detect the truncus arteriosus?

A

presence of a thickened truncal valve that overrides a large VSD

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38
Q

why must we look at the 5 chamber view for truncus arteriosus?

A

four chamber view is normal

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39
Q

what is ebstein anomaly?

A

displacement and attachment of one or more tricuspid leaflets (usually septal or posterior leaflets) toward the apex of the RV

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40
Q

what is ebstein anomaly associated with?

A
  • maternal lithium use
  • chromosomal abnormalities
  • ASD
  • patent foramen ovale
  • pulmonary stenosis or atresia
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41
Q

what do we see with ebstein anomaly in the 4 chmaber view?

A

RA is enlarged and the thickened cusps of the TV are displaced down and tethered on the septal surface

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42
Q

what happens with transposition of the great arteries?

A

abnormal origin of the great arteries from the ventricles

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43
Q

D-transposition

A

(80%) aorta originating from morphologic RV and PA originating from the morphologic LV

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44
Q

L-transposition

A

in addition to the ventriculoarterial concordance, also AV discordance with the morphologic LA connected to the morphologic RV and the morphologic RA connected to the morphologic LV

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45
Q

what view do we detect the D-TGA?

A

five chamber view

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46
Q

do the arteries cross eachother in the D-TGA view?

A

arteries do not cross eachother

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47
Q

what view do we detect the L-TGA?

A

four chamber view

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48
Q

how do we detect L-TGA in the four chamber view?

A

abnormal with a left-sided ventricle containing the moderator band which characterizes the morphologically RV

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49
Q

what is Hypoplastic Left Heart Syndrome (HLHS)?

A

underdevelopment of left heart structures

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50
Q

what is Hypoplastic Left Heart Syndrome (HLHS) inclusive of?

A
  • left ventricle
  • mitral valve: stenosis/atresia
  • aortic valve: atresia/hypoplasia
  • ascendingaortic root/arch
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51
Q

what view do we detect Hypoplastic Left Heart Syndrome (HLHS)?

A

four chamber view

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52
Q

what do we see in the 4 chamber view for Hypoplastic Left Heart Syndrome (HLHS)?

A

no inflow into the left ventricle (mitral atrasia) and a severly hypoplastic LV

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53
Q

what is another term for pulmonary atresia?

A

Right Ventricular Hypoplasia

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54
Q

how do we visualize the pulmoary atresia?

A

five chamber view

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55
Q

how do we see pumonary atresia in the 5 chmaber view?

A

immobile and thickenedpulmonary valve and presence of a reversed flow in the pulmonary artery from theductus arteriosusto the pulmonary valve bycolor Doppler

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56
Q

what is tricuspid atresia?

A

agenesis of the tricupsid valve with no direct communication between the RA and RV

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57
Q

how do we visualize tricuspid atresia?

A

four chamber view

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58
Q

what is seen when we look at tricuspid atresia?

A

an echogenic and immobile tricupsid valve, absence of flow across the TV on doppler during diastole, and hypoplastic RV with oe without VSD

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59
Q

how do we visualize coarctation of the aorta?

A

four chamber view

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60
Q

what does coarctation of aorta ook like?

A
  • ventricular size discrepancy with right dominance

- long axis of aortic arch, trancsverse aortic arch hypoplasia and isthmus hypoplasia

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61
Q

what does DORV stand for?

A

double-outlet right ventricular outflow tract

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62
Q

what is DORV?

A

both great arteries arise predominantly from the morphologically right ventricle

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63
Q

how dows DORV look in the 4 chamber view?

A

normal

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64
Q

what does DORV look in the 5 chamber view?

A

malaligned VSD and aortic-mitral discontinuity

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65
Q

are tumors in the heart common or rare/

A

extremely rare

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66
Q

how do tumors occur?

A

abnormal growth in the heart muscle or in one of the cardiac chambers

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67
Q

what may tumors cause?

A 
intracardiac flow obstruction
heart valve insufficiency
arrythmia
heart failure
hydrops fetalis
fetal death
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68
Q

what is the most common type of nonmalignant tumors?

A

rhabdomyomas

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69
Q

where are Rhabdomyomas most often found?

A

on the ventricles and more than one tumor will be present

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70
Q

what are Rhabdomyomas associated with?

A

cerebral tuberous sclerosis

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71
Q

what is an echogenic intracardiac focus?

A

small bright echoic focus within the fetal heart on a four chmaber view

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72
Q

where is a echogenic intracardiac focus seen?

A

unilateral usually on left ventricle

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73
Q

what should be turned off when imaging echogenic intracardiac focus?

A

tissue harmonic

-bright as bone

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74
Q

what is echogenic intracardiac focus a soft marker for?

A

aneuploidic anomalies

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75
Q

which atria usually appears larger?

A

right usually appearing larger than left

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76
Q

where is the foramen ovale flap located?

A

in left atrium

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77
Q

where is the atrial septum primum?

78
Q

which ventricle usually appears larger?

79
Q

where is the moderator band located?

A

right ventricular aoex

80
Q

whic valve is located closer to the apex?

A

tricupsid valve

81
Q

where is the mitral valve?

82
Q

where is the tricuspid valve?

83
Q

what can the 3VV diagnose?

A

-coarctation of the aorta
right aortic arch
-double aortic arch (seen in tetralogy of fallot)
-Absence of a great artery
-Truncus arteriosus
-Transposisition of the great arteries (TGA)

84
Q

what are the anomalies for the tetralogy of fallot?

A
  • VSD
  • Thickened muscle wall
  • pulmonary valve stenosis
  • misplaced aorta
85
Q

what are the anomalies with TGA?

A
  • aorta arises from right ventricle

- PA rises from the left ventricle

86
Q

what is truncus arteriosis almost always associated with?

87
Q

what is truncus arteriosis?

A

single trunk supplies both the pulmonary and systemic circulation

88
Q

what problems may truncus arteriosis cause?

A
  • in utero=nothin

- postnatally=major problem and 80% of infants will die if left untreated

89
Q

what does 4 chamber view allow us to assess in the heart?

A

morphology and symmetry

90
Q

what is seen in the LVOT?

A

aorta arises first, sweeping to the fetal right

91
Q

what is seen in the RVOT?

A

the pulmonary artery (PA) crosses over

92
Q

what is the leading cause of infant mortality?

A

congenital heart disease

93
Q

what is the normal rythem of the heart set by?

A

the natural pacemaker of the heart called the sinoatrial (or sinus) node. It is located on the wall of the right atrium

94
Q

what are most irregular rythems due to?

A

premature atrial contractions (PAC’s)

95
Q

what is a complete heart block?

A

There is complete dissociation between the atria and ventricles.

96
Q

heart rates below _____________ in early gestation have an increased risk of fetal demise?

97
Q

what is the most commonly seen bradycardia?

A

atrioventricular (AV) block

98
Q

of all arrythmias, which has the most liklihood to be associated with a structural heart abnormality?

A

bradycardia

99
Q

what is the most frequent structural defect associated with bradycardia?

A

antrioventricular canal defect

100
Q

what heart rate is considered tachycardia?

A

over 180 bpm

101
Q

what is tachycardia associated with?

A

a risk of congestive heart failure and hydrops

102
Q

levovardia?

A

normal cardiac position and axis

103
Q

dextrocardia

A

bulk of heart is in the anterior right chest and cardiac axis is reversed

104
Q

dextroposition

A

refers to fetal heart which is displaced to the right side of the chest, but maintains normal apical axis

105
Q

ectopia cordis

A

heart is located outside the thoracic cavity

106
Q

how does ectopia cordis happen?

A

results from failure of fusion of the lateral body fold in the thoracic region

107
Q

what are the 4 types of ectopia cordis?

A
  • thoracic
  • abdominal
  • thoracic abdominal
  • cervical
108
Q

thoracic ectopia cordis

A

heart displaces from thoracic cavity through a sternal defect

109
Q

abdominal ectopia cordis

A

heart is displaced into the abdomen through a diaphragmatic defect

110
Q

thoracic abdominal ectopia cordis

A

The heart is displaced from the chest through a defect in the lower sternum, with an associated diaphragmatic or ventral abdominal wall defect

111
Q

what is Pentalogy of Cantrell?

A

syndrome that causes defects involving the diaphragm, abdominal wall, pericardium, heart and lower sternum

112
Q

cervical ectopia cordis

A

the heart is displaced in the neck area

113
Q

atrial septal defects (ASD)

A

results from error in the amount of tissue reabsorbed or deposited in the interatrial septum

114
Q

what is ventricualar septal defect (VSD) seen as?

A

holes in the ventricular septum

115
Q

what is the most common cardiac anomaly associated with chromosomal abnormality and diabetis?

116
Q

what is another name for Atrioventricular Septal Defect (AVSD)?

A

endocardial cushion defect

117
Q

what is Atrioventricular Septal Defect (AVSD)?

A

a defect in the lower position of the atrial septum and upper portion of the ventricular septum

118
Q

what is AVSD most commonly associated with?

119
Q

complete AVSD

A

defects in all structures fromed by endocardial cushions. defects in thr atrial and ventricular septa

120
Q

partial or incomplete AVSD

A

part of the ventricular septum formed by the endocardial cushions has filled in

121
Q

transitional type AVSD

A

leaflets of the common AV valve are stuck to the ventricular septum

122
Q

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

A
  • hypoplastic left heart syndrome

- coarctation of the aorta

123
Q

what is hypoplastic left heart?

A
  • LV is severly underdeveloped.
  • the MV is typically hypoplastic while the aortic valve is an imperforate membrane. -Ascending aorta and arch are most often hypoplastic
124
Q

where does coarctation of the aorta occur?

A

between the insertion of ductus arteriosus and left subclavian artery

125
Q

what patients usually have coarctation seen?

A

turner’s syndrome

126
Q

what can happen when right ventricle is smaller than the left?

A

pulmonary atresia however not all have small RV

127
Q

what happens in pulmonary atresia?

A

there is no flow from the RV through the pulmonary vlave into the main pulmonary artery

128
Q

what is an enlarged right atrium usually associated with?

A

Ebsteins anomaly

129
Q

what is Ebsteins anomaly?

A

Inferior displacement of the septal and posterior leaflets of the Tricuspid Valve (TV is made of 3 parts called leaflets or flaps).

130
Q

how do you detect ebsteins anomaly?

A

the 4CH view shows an enlarged RA with apical displacement of the TV and the RV

131
Q

what may ebsteins anomaly be associated with?

A
  • pulmonary atresia or stenosis
  • arrythmia
  • chromosomal anomlies
132
Q

where is a overriding aorta placed usually?

A

the aorta is displaced more to the right side and positioned over a VSD instead of left ventricle

133
Q

what is a key feature to evaluate overridding aorta?

A

pulmonary aorta

134
Q

what does tetralogy of fallot prevent for flow?

A

prevents the venous flow of the right heart from moving freely towards the pulmonary circulaton

135
Q

what is double outlet right ventricle?

A

both great arteries connect to the RV

136
Q

what are echogenic intracardiac foci describes as?

A

peas or golf balls

137
Q

where are echogenic intracardiac foci mostly seen?

138
Q

In isolated echogenic intracardiac focus, the risk of _________

A

Tri-21 is 1%

139
Q

what is the most common cardiac tumor in the fetus?

A

Rhabdomyomas

140
Q

what is associated with Rhabdomyomas?

A

tuberous sclerosis

141
Q

are Rhabdomyomas benign or malignant?

A

usually benign but can obstruct flow

142
Q

what does Rhabdomyomas look like sonographically?

A

more echogenic than the ventricular myocardium

143
Q

causes of congestive heart failure?

A
  • fetal arrythmias
  • anaemia
  • congenital heart disease with valvular regurgitation
  • non-cardiac malformations such as diaphramatic hernia or cystic hygroma
  • twin-twin transfusion
  • atrioventricular fistula with high cardiac output
144
Q

what are abnormalities for congestive heart failure?

A
  • cardiac size/thoracic size
  • venous doppler (IVC and ummbilical vein pulsations)
  • arterial doppler (M-mode)
  • hydrops
145
Q

what is pericardial effusion?

A

accumulation of pericardial fluid in utero

146
Q

what measurment says pericardial fluid thickness is abnormal?

147
Q

what is pericardial effusion associated with?

A
  • 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)
148
Q

how much does the heart take up in the chest?

149
Q

what may cardiomediastinal shift be the first clue to?

A

the presence of a unilateral chest mass or diaphragmatic hernia.

150
Q

echogenicity of normal lungs

A

homogenous and slightly more echogenic than the liver

151
Q

what is pulmoary hypoplasia (PH) defined by?

A

reduction in the number of cells, airways, and alveoli and results in decrease in size and weight of the fetal lungs

152
Q

PH can be _______________

A
  • primary or secondary

- unilateral or bilateral

153
Q

what is primary PH caused by?

A
  • unilateral pulmonary agenesis

- bilateral pulmonary agenesis

154
Q

secondary PH caused by?

A
  • masses compressing lungs
  • skeletal malformations
  • severe prolonged olgiohydramnois
  • others
155
Q

what are majority of PH cases are associated with?

A

major structural or chromosomal abnormalities

156
Q

what is CDH?

A

presence of abdominal viscera in the thoracic cavity due to a congenital defect in diaphragm

157
Q

what are typical sonographic features of left sided CDH?

A
  • DEXTROPOSITION OF THE HEART
  • visualization of fluid filled stomach and/or obstructed fluid filled-distended loops of bowel
  • small abdo circumferance
  • polyhydramnois
158
Q

what are the typical sonographic features of the right sided CDH?

A
  • liver herniates to the chest and mediastinal shift is to the left
  • livers echogenicity can appear simialr to lung
  • presence of GB and hepatic vessel in thorax can help confirm
  • ascites and hydrops
159
Q

what can be associated with CDH?

A
  • congenital heart disease (most common)
  • anecephaly ventromegaly, and nueral tube
  • Tri 18
160
Q

what has been an effective tool to predict the severity of pulmoary hypoplasia associated with CDH?

A

measurment of lung diameter/thoracic circumference

161
Q

where do most CDH occur?

162
Q

what is pleaural effusion also known as?

A

hydrothorax

163
Q

what is plerual effusion?

A

pathological accumalaton of fluid in the pleural space

164
Q

how does pleural effusion appear?

A

anechoic space outlining the lungs

165
Q

what is pleural effusion a manifestation of?

A

fetal hydrops
ascities
edema (skin thickening)

166
Q

what may a large pleural effusion cause?

A

displace or compress the heart and great vessels and is associated with a high potential morbidity and mortality rate

167
Q

what is the managment of pleural effusion?

A

aggressively by ultrasound thoraco-amniotic shunt (a drainage tube with one end in the pleural space and the other in the amniotic fluid)

168
Q

what is Congenital Cystic Adenomoid Malformation (CCAM)?

A

It is a rare lesion in which normal lung tissue is replaced by cysts of varying sizes.

169
Q

what is CCAM describes as?

A

a focal dysplasia of the lungs

170
Q

what are the most common congenital lung lesions?

171
Q

what does CCAM result from?

A

pulmonary insult during embryonic development of the bronchial tree before the 7th week of gestation

172
Q

CCAM type 1

A
  • mainly cystic
  • single or multiple cysts (2-10 cm)
  • cystic mass appearance
173
Q

CCAM type 2

A
  • mainly solid lesion with multiple solid cysts <2 cm

- hyperechoic mass with detectable cysts appearance

174
Q

CCAM type 3

A
  • mainly solid lesion with tiny cysts <0.5cm

- hyperechoic mass without detectable cysts appearance

175
Q

pathological features of CCAM?

A
  • unilateral

- mostly involves only part of a lung with lower lobe being most common

176
Q

what are some complications with CCAM?

A
  • pulmonary hypoplasia
  • heart compression
  • fetal hydrops
  • polyhydramnios
177
Q

what is Bronchopulmonary Sequestration?

A

the presence of non-functioning pulmonary tissue that usually does not have communication with the bronchial tree

178
Q

where does Bronchopulmonary Sequestration recieve its blood supply?

A

blood supply from an anomalous artery from the aorta rather than a pulmonary artery branch

179
Q

what are the 2 main types of Bronchopulmonary Sequestration?

A

intralobular sequestration

extralobar sequestration

180
Q

Intralobar sequestration

A

the abnormal tissue lies within the normal lung, usually in a posterior segment of a lower lobe

181
Q

Extralobar sequestration

A

The abnormal tissue is anatomically separated from the normal lung. The most common location is the left chest, in particular the basal region (near the diaphragm)

182
Q

sonographic findings of extralobar pulmonary sequestraton?

A

appears as a homogenous echogenic chest mass with or without a cardiac shift
-intra prenatal diagnosis is rare

183
Q

what is the differential diagnosis of Bronchopulmonary Sequestration?

A

Type 3 CCAM and CDH

184
Q

how to exclude CDH when it may be Bronchopulmonary Sequestration?

A

If the abdominal viscera appear normal (stomach, liver, and bowel identified in their normal locations), then CDH can be excluded.

185
Q

what are bronchogenic cysts?

A

rare anomalies that result from abnormal buddding of branching of the tracheobronchial tree

186
Q

what does bronchogenic cysts look like on ultrasound?

A
  • anechoic

- unilocular intrathoracic cyst with layering echogenic material

187
Q

what are the main differential diagnosis for bronchogenic cyst?

A

CCAM

distal lung accumulating fluid

188
Q

what is the managment of bronchogenic cyst?

A
  • surgical resection for bronchogenic cysts

- risk of hemorrhage, infection, or malignancy

189
Q

what is a Tracheosophageal Fistula?

A

abnormal connection between the esophagus and trachea

190
Q

is Tracheosophageal Fistula common?

A

It is a common congenital abnormality.

191
Q

how does Tracheosophageal Fistula occur?

A

It is due to failed fusion of the tracheosophageal ridges during the third week of embryological development.

Abnormal OB (7 decks)

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