fetal heart (midterm) Flashcards
(191 cards)
1
Q
how much blood does the umbilical vein return saturated blood form the placenta to the fetus?
A
80%
2
Q
what do the umbilical arteries do?
A
carry mainly deoxygenated blood back to the placenta for oxygenation
3
Q
when does erythopoeisis begin?
A
week 3
4
Q
Dextrocardia
A
Heart is located in the right side of the chest with apex pointing to the right
5
Q
Dextroposition
A
heart is located in the right side of chest but the apex pointing to the left
6
Q
Mesocardia
A
heart is located in the middle portion of the chest with the apex pointing along the midline
7
Q
what is located in the 3VV?
A
- pulmonary artery
- aorta
- SVC
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
9
Q
what is normal fetal HB at 8 weeks?
A
175 beats/min
10
Q
what is normal fetal HB at 20 weeks?
A
140 beats/min
11
Q
what is the normal fetal HB at term?
A
130 beats/min
12
Q
what is assessed with doppler?
A
- regurgitation at valves
- assess septal defects
- determine pressure gradients
13
Q
what is normal HB?
A
120-160 bpm
14
Q
what is atrial flutter?
A
atrial rate of 400 beats per minute and a completely irregular ventricular rhythm
15
Q
what does PAC stand for?
A
premature atrial contractions
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
17
Q
what are the most common form of birth defects?
A
congenital heart diseases (CHD)
18
Q
what is the most common congenital heart disease?
A
ventricular septal defect
19
Q
what is ventricular septal defect?
A
area of discontinuity in the interventricular septum
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)
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)
22
Q
what is an atrial septal defect?
A
defect in a portion of the atrial septum
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
24
Q
what view do we detect atrial septal defect?
A
four chamber view
25
secundum DSA
foramen ovale is larger than the aortic diameter
26
how do we prove AV septal defect?
complete AVSD showing a single 5 leaflet atrioventricular valve with an inlet VSD and an atrial septum primum defect
27
what is another term for AVSD?
endocardial cushion defect
28
what is the defect of the atrioventricular septum?
defects of the interatrial septum (ostium primum ASD) of the interventricular septum (inlet VSD), and the division of the atrioventricular valves
29
how fo we visualize the AVSD on the four chamber view?
the absence of crux of the heart, the
| presence of the primum ASD and the absence of the usual offset of the AV valves
30
what are the 4 characteristics of Tetralogy of Fallot?
- ventricular septal defect (VSD)
- right ventricular outflow tract obstruction (RVOTO)
- overriding aorta
- late right ventricular hypertrophy
31
what is tetralogy of fallot associated with?
chromosomal and extracardiac abnormalities
32
what view do we detect tetralogy of fallot?
five chamber view and the basal short axis view
33
why must we look at the 5 chmaber view for tetralogy of fallot?
four chamber cardiac view is normal
34
what happens with truncus arteriosus with the arteries
single arterial trunk that feeds the systemic pulmonary circulation and coronary arteries with a single semilunar valve
35
what happens with the blood in truncus arteriosus?
mixture of oxygenated and deoxygenated blood in the common trunk results in subnormal systemic oxygenation
36
what view do we detect truncus arteriosus?
five chamber view
37
how do we detect the truncus arteriosus?
presence of a thickened truncal valve that overrides a large VSD
38
why must we look at the 5 chamber view for truncus arteriosus?
four chamber view is normal
39
what is ebstein anomaly?
displacement and attachment of one or more tricuspid leaflets (usually septal or posterior leaflets) toward the apex of the RV
40
what is ebstein anomaly associated with?
- maternal lithium use
- chromosomal abnormalities
- ASD
- patent foramen ovale
- pulmonary stenosis or atresia
41
what do we see with ebstein anomaly in the 4 chmaber view?
RA is enlarged and the thickened cusps of the TV are displaced down and tethered on the septal surface
42
what happens with transposition of the great arteries?
abnormal origin of the great arteries from the ventricles
43
D-transposition
(80%) aorta originating from morphologic RV and PA originating from the morphologic LV
44
L-transposition
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
45
what view do we detect the D-TGA?
five chamber view
46
do the arteries cross eachother in the D-TGA view?
arteries do not cross eachother
47
what view do we detect the L-TGA?
four chamber view
48
how do we detect L-TGA in the four chamber view?
abnormal with a left-sided ventricle containing the moderator band which characterizes the morphologically RV
49
what is Hypoplastic Left Heart Syndrome (HLHS)?
underdevelopment of left heart structures
50
what is Hypoplastic Left Heart Syndrome (HLHS) inclusive of?
- left ventricle
- mitral valve: stenosis/atresia
- aortic valve: atresia/hypoplasia
- ascending aortic root/arch
51
what view do we detect Hypoplastic Left Heart Syndrome (HLHS)?
four chamber view
52
what do we see in the 4 chamber view for Hypoplastic Left Heart Syndrome (HLHS)?
no inflow into the left ventricle (mitral atrasia) and a severly hypoplastic LV
53
what is another term for pulmonary atresia?
Right Ventricular Hypoplasia
54
how do we visualize the pulmoary atresia?
five chamber view
55
how do we see pumonary atresia in the 5 chmaber view?
immobile and thickened pulmonary valve and presence of a reversed flow in the pulmonary artery from the ductus arteriosus to the pulmonary valve by color Doppler
56
what is tricuspid atresia?
agenesis of the tricupsid valve with no direct communication between the RA and RV
57
how do we visualize tricuspid atresia?
four chamber view
58
what is seen when we look at tricuspid atresia?
an echogenic and immobile tricupsid valve, absence of flow across the TV on doppler during diastole, and hypoplastic RV with oe without VSD
59
how do we visualize coarctation of the aorta?
four chamber view
60
what does coarctation of aorta ook like?
- ventricular size discrepancy with right dominance
| - long axis of aortic arch, trancsverse aortic arch hypoplasia and isthmus hypoplasia
61
what does DORV stand for?
double-outlet right ventricular outflow tract
62
what is DORV?
both great arteries arise predominantly from the morphologically right ventricle
63
how dows DORV look in the 4 chamber view?
normal
64
what does DORV look in the 5 chamber view?
malaligned VSD and aortic-mitral discontinuity
65
are tumors in the heart common or rare/
extremely rare
66
how do tumors occur?
abnormal growth in the heart muscle or in one of the cardiac chambers
67
what may tumors cause?
```
intracardiac flow obstruction
heart valve insufficiency
arrythmia
heart failure
hydrops fetalis
fetal death
```
68
what is the most common type of nonmalignant tumors?
rhabdomyomas
69
where are Rhabdomyomas most often found?
on the ventricles and more than one tumor will be present
70
what are Rhabdomyomas associated with?
cerebral tuberous sclerosis
71
what is an echogenic intracardiac focus?
small bright echoic focus within the fetal heart on a four chmaber view
72
where is a echogenic intracardiac focus seen?
unilateral usually on left ventricle
73
what should be turned off when imaging echogenic intracardiac focus?
tissue harmonic
| -bright as bone
74
what is echogenic intracardiac focus a soft marker for?
aneuploidic anomalies
75
which atria usually appears larger?
right usually appearing larger than left
76
where is the foramen ovale flap located?
in left atrium
77
where is the atrial septum primum?
near crux
78
which ventricle usually appears larger?
right
79
where is the moderator band located?
right ventricular aoex
80
whic valve is located closer to the apex?
tricupsid valve
81
where is the mitral valve?
left
82
where is the tricuspid valve?
right
83
what can the 3VV diagnose?
-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
what are the anomalies for the tetralogy of fallot?
- VSD
- Thickened muscle wall
- pulmonary valve stenosis
- misplaced aorta
85
what are the anomalies with TGA?
- aorta arises from right ventricle
| - PA rises from the left ventricle
86
what is truncus arteriosis almost always associated with?
VSD
87
what is truncus arteriosis?
single trunk supplies both the pulmonary and systemic circulation
88
what problems may truncus arteriosis cause?
- in utero=nothin
| - postnatally=major problem and 80% of infants will die if left untreated
89
what does 4 chamber view allow us to assess in the heart?
morphology and symmetry
90
what is seen in the LVOT?
aorta arises first, sweeping to the fetal right
91
what is seen in the RVOT?
the pulmonary artery (PA) crosses over
92
what is the leading cause of infant mortality?
congenital heart disease
93
what is the normal rythem of the heart set by?
the natural pacemaker of the heart called the sinoatrial (or sinus) node. It is located on the wall of the right atrium
94
what are most irregular rythems due to?
premature atrial contractions (PAC's)
95
what is a complete heart block?
There is complete dissociation between the atria and ventricles.
96
heart rates below _____________ in early gestation have an increased risk of fetal demise?
100 bpm
97
what is the most commonly seen bradycardia?
atrioventricular (AV) block
98
of all arrythmias, which has the most liklihood to be associated with a structural heart abnormality?
bradycardia
99
what is the most frequent structural defect associated with bradycardia?
antrioventricular canal defect
100
what heart rate is considered tachycardia?
over 180 bpm
101
what is tachycardia associated with?
a risk of congestive heart failure and hydrops
102
levovardia?
normal cardiac position and axis
103
dextrocardia
bulk of heart is in the anterior right chest and cardiac axis is reversed
104
dextroposition
refers to fetal heart which is displaced to the right side of the chest, but maintains normal apical axis
105
ectopia cordis
heart is located outside the thoracic cavity
106
how does ectopia cordis happen?
results from failure of fusion of the lateral body fold in the thoracic region
107
what are the 4 types of ectopia cordis?
- thoracic
- abdominal
- thoracic abdominal
- cervical
108
thoracic ectopia cordis
heart displaces from thoracic cavity through a sternal defect
109
abdominal ectopia cordis
heart is displaced into the abdomen through a diaphragmatic defect
110
thoracic abdominal ectopia cordis
The heart is displaced from the chest through a defect in the lower sternum, with an associated diaphragmatic or ventral abdominal wall defect
111
what is Pentalogy of Cantrell?
syndrome that causes defects involving the diaphragm, abdominal wall, pericardium, heart and lower sternum
112
cervical ectopia cordis
the heart is displaced in the neck area
113
atrial septal defects (ASD)
results from error in the amount of tissue reabsorbed or deposited in the interatrial septum
114
what is ventricualar septal defect (VSD) seen as?
holes in the ventricular septum
115
what is the most common cardiac anomaly associated with chromosomal abnormality and diabetis?
VSD
116
what is another name for Atrioventricular Septal Defect (AVSD)?
endocardial cushion defect
117
what is Atrioventricular Septal Defect (AVSD)?
a defect in the lower position of the atrial septum and upper portion of the ventricular septum
118
what is AVSD most commonly associated with?
Tri-21
119
complete AVSD
defects in all structures fromed by endocardial cushions. defects in thr atrial and ventricular septa
120
partial or incomplete AVSD
part of the ventricular septum formed by the endocardial cushions has filled in
121
transitional type AVSD
leaflets of the common AV valve are stuck to the ventricular septum
122
what are 2 main anomalies to consider when the LV appears smaller than RV?
- hypoplastic left heart syndrome
| - coarctation of the aorta
123
what is hypoplastic left heart?
- 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
where does coarctation of the aorta occur?
between the insertion of ductus arteriosus and left subclavian artery
125
what patients usually have coarctation seen?
turner's syndrome
126
what can happen when right ventricle is smaller than the left?
pulmonary atresia however not all have small RV
127
what happens in pulmonary atresia?
there is no flow from the RV through the pulmonary vlave into the main pulmonary artery
128
what is an enlarged right atrium usually associated with?
Ebsteins anomaly
129
what is Ebsteins anomaly?
Inferior displacement of the septal and posterior leaflets of the Tricuspid Valve (TV is made of 3 parts called leaflets or flaps).
130
how do you detect ebsteins anomaly?
the 4CH view shows an enlarged RA with apical displacement of the TV and the RV
131
what may ebsteins anomaly be associated with?
- pulmonary atresia or stenosis
- arrythmia
- chromosomal anomlies
132
where is a overriding aorta placed usually?
the aorta is displaced more to the right side and positioned over a VSD instead of left ventricle
133
what is a key feature to evaluate overridding aorta?
pulmonary aorta
134
what does tetralogy of fallot prevent for flow?
prevents the venous flow of the right heart from moving freely towards the pulmonary circulaton
135
what is double outlet right ventricle?
both great arteries connect to the RV
136
what are echogenic intracardiac foci describes as?
peas or golf balls
137
where are echogenic intracardiac foci mostly seen?
LV
138
In isolated echogenic intracardiac focus, the risk of _________
Tri-21 is 1%
139
what is the most common cardiac tumor in the fetus?
Rhabdomyomas
140
what is associated with Rhabdomyomas?
tuberous sclerosis
141
are Rhabdomyomas benign or malignant?
usually benign but can obstruct flow
142
what does Rhabdomyomas look like sonographically?
more echogenic than the ventricular myocardium
143
causes of congestive heart failure?
- 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
what are abnormalities for congestive heart failure?
- cardiac size/thoracic size
- venous doppler (IVC and ummbilical vein pulsations)
- arterial doppler (M-mode)
- hydrops
145
what is pericardial effusion?
accumulation of pericardial fluid in utero
146
what measurment says pericardial fluid thickness is abnormal?
2mm
147
what is pericardial effusion associated with?
- 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
how much does the heart take up in the chest?
25-30%
149
what may cardiomediastinal shift be the first clue to?
the presence of a unilateral chest mass or diaphragmatic hernia.
150
echogenicity of normal lungs
homogenous and slightly more echogenic than the liver
151
what is pulmoary hypoplasia (PH) defined by?
reduction in the number of cells, airways, and alveoli and results in decrease in size and weight of the fetal lungs
152
PH can be _______________
- primary or secondary
| - unilateral or bilateral
153
what is primary PH caused by?
- unilateral pulmonary agenesis
| - bilateral pulmonary agenesis
154
secondary PH caused by?
- masses compressing lungs
- skeletal malformations
- severe prolonged olgiohydramnois
- others
155
what are majority of PH cases are associated with?
major structural or chromosomal abnormalities
156
what is CDH?
presence of abdominal viscera in the thoracic cavity due to a congenital defect in diaphragm
157
what are typical sonographic features of left sided CDH?
- DEXTROPOSITION OF THE HEART
- visualization of fluid filled stomach and/or obstructed fluid filled-distended loops of bowel
- small abdo circumferance
- polyhydramnois
158
what are the typical sonographic features of the right sided CDH?
- 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
what can be associated with CDH?
- congenital heart disease (most common)
- anecephaly ventromegaly, and nueral tube
- Tri 18
160
what has been an effective tool to predict the severity of pulmoary hypoplasia associated with CDH?
measurment of lung diameter/thoracic circumference
161
where do most CDH occur?
left side
162
what is pleaural effusion also known as?
hydrothorax
163
what is plerual effusion?
pathological accumalaton of fluid in the pleural space
164
how does pleural effusion appear?
anechoic space outlining the lungs
165
what is pleural effusion a manifestation of?
fetal hydrops
ascities
edema (skin thickening)
166
what may a large pleural effusion cause?
displace or compress the heart and great vessels and is associated with a high potential morbidity and mortality rate
167
what is the managment of pleural effusion?
aggressively by ultrasound thoraco-amniotic shunt (a drainage tube with one end in the pleural space and the other in the amniotic fluid)
168
what is Congenital Cystic Adenomoid Malformation (CCAM)?
It is a rare lesion in which normal lung tissue is replaced by cysts of varying sizes.
169
what is CCAM describes as?
a focal dysplasia of the lungs
170
what are the most common congenital lung lesions?
CCAM
171
what does CCAM result from?
pulmonary insult during embryonic development of the bronchial tree before the 7th week of gestation
172
CCAM type 1
- mainly cystic
- single or multiple cysts (2-10 cm)
- cystic mass appearance
173
CCAM type 2
- mainly solid lesion with multiple solid cysts <2 cm
| - hyperechoic mass with detectable cysts appearance
174
CCAM type 3
- mainly solid lesion with tiny cysts <0.5cm
| - hyperechoic mass without detectable cysts appearance
175
pathological features of CCAM?
- unilateral
| - mostly involves only part of a lung with lower lobe being most common
176
what are some complications with CCAM?
- pulmonary hypoplasia
- heart compression
- fetal hydrops
- polyhydramnios
177
what is Bronchopulmonary Sequestration?
the presence of non-functioning pulmonary tissue that usually does not have communication with the bronchial tree
178
where does Bronchopulmonary Sequestration recieve its blood supply?
blood supply from an anomalous artery from the aorta rather than a pulmonary artery branch
179
what are the 2 main types of Bronchopulmonary Sequestration?
intralobular sequestration
| extralobar sequestration
180
Intralobar sequestration
the abnormal tissue lies within the normal lung, usually in a posterior segment of a lower lobe
181
Extralobar sequestration
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
sonographic findings of extralobar pulmonary sequestraton?
appears as a homogenous echogenic chest mass with or without a cardiac shift
-intra prenatal diagnosis is rare
183
what is the differential diagnosis of Bronchopulmonary Sequestration?
Type 3 CCAM and CDH
184
how to exclude CDH when it may be Bronchopulmonary Sequestration?
If the abdominal viscera appear normal (stomach, liver, and bowel identified in their normal locations), then CDH can be excluded.
185
what are bronchogenic cysts?
rare anomalies that result from abnormal buddding of branching of the tracheobronchial tree
186
what does bronchogenic cysts look like on ultrasound?
- anechoic
| - unilocular intrathoracic cyst with layering echogenic material
187
what are the main differential diagnosis for bronchogenic cyst?
CCAM
| distal lung accumulating fluid
188
what is the managment of bronchogenic cyst?
- surgical resection for bronchogenic cysts
| - risk of hemorrhage, infection, or malignancy
189
what is a Tracheosophageal Fistula?
abnormal connection between the esophagus and trachea
190
is Tracheosophageal Fistula common?
It is a common congenital abnormality.
191
how does Tracheosophageal Fistula occur?
It is due to failed fusion of the tracheosophageal ridges during the third week of embryological development.
