Module 12: Fetal Cardiac Abnormalities Flashcards by Julianna Small

When does the heart begin to develop and how?

Approx 5 weeks LMP (paired heart tubes form and fuse into a single heart).

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When do the heart chambers develop?

6-8 weeks LMP

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When is the heart fully formed?

10 weeks LMP

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What are the fetal findings associated with heart defects? (7)

2 vessel cord
Congenital diaphragmatic hernia
Omphalocele
Thick nuchal fold or NT
Hydrops
Chromosomal abnormalities
Bradycardia

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What does the three vessel view include?

Pulmonary artery
Aorta
Superior vena cava

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The 4 chamber view can rule out what amount of cardiac defects?

4 ch = 1/3 ruled out

4 ch + LVOT/RVOT = 2/3 ruled out

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When is a fetal echo best performed?

20-22 weeks to term

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What is a normal heart rate in a fetus?

120-160 bpm

But up to 180 in 1st trimester can be normal

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Why is an ASD difficult to DX?

Due to the normal presence of a patent foramen ovale in a fetus

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The foramen ovale should be no larger than what?

The aortic root

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What is the most common cardiac anomaly?

Ventricular septal defect

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What is an atrioventricular septal defect?

Instead of having separate ventricles/atria the heart is just 1 common valve with 5 leaflets (no mitral or tricuspid valves)

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What is an AVSD also called?

AV canal or endocardial cushion defect

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About 50% of fetuses with AVSD have what?

T21

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What is Ebstein’s anomaly?

Apical displacement of the tricuspid valve into the right ventricle

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Ebstein’s anomaly is associated with what?

Pulmonary stenosis and lithium ingestion (Bipolar medication)

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What is a hypoplastic right ventricle?

Sonographically small right ventricule

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What is a hypoplastic left ventricle?

Sonographically small left ventricle

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What is a hypoplastic left ventricle due to and what is it associated to?

Decreased flow into or out of the left ventricle

Associated to coarctation of the AO

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Endocardial fibroelastosis (EFE) is what?

Stiff and thick myocardium due to hypertrophy from hypoplastic syndromes causing CHF

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What will you see in a tetralogy of Fallot? (4)

VSD
Aorta overriding the ventricular septum
Hypertrophy of RV
Pulmonary stenosis

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What is truncus arteriosis?

Single large vessel arising from the base of the heart (AO and PA combined into one) that will be seen as:

VSD
Large overriding aorta
PA origin off the aorta

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What is a double outlet right ventricle?

When the aorta and pulmonary arise from the right ventricle associated with maternal diabetes and alcohol abuse

What will be seen with transposition of the great vessels?

Aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle

What are the two types of transposition of the great vessels?

Complete (D loop) or corrected (L loop)

What is a D loop transposition?

More common (80%) it is a closed circuit where the RA is attached to the RV and the vessels are parallel rather than the normal crossing.

What is an L loop transposition?

Less common (20%) the RV is attached to the LA with normal circulation but becomes problematic due to the RV not having the same pumping ability as the LV

What will you see with corrected transposition? (3)

- PA off the morphological lt ventricle (in RV spot) - Ao off the morphological rt ventricle (in LV spot) - Outflow tracts are parallel

Where is coarctation of the aorta normally seen?

Usually at ductus ateriosus (distal AO arch after branches)

Cardiac tumors are rare, but which is the most common and how do they appear?

Rhabdomyoma (cardia hamartoma) Solid, echogenic obstructions usually off ventricular septum

What is cardiomyopathy and what is it caused by?

Muscle damage resulting in altered cardiac function. Due to: - Viral - Bacterial - Metabolic - Maternal type 1 diabetes

What is ectopia cordis and what is it associated to?

Heart outside the chest Associated to Pentalogy of Cantrell

What are cardiosplenic syndromes also known as? (3)

- Isomerism - Situ ambigous - Hetertaxia

Affected organs of cardiosplenic syndromes involve what?

Liver, lungs, stomach, and heart

Describe the two paths that blood can take from the placenta in fetal circulation.

1. Placenta -> Umb vein -> ductus venosum -> IVC -> Rt atrium -> Rt ventricle -> pulm artery -> ductus arteriosis -> descending aorta -> hypogastric arteries ->umbilical arteries -> Placenta 2. Placenta -> Umb v -> ductus venosum -> IVC -> Rt atrium -> Foramen ovale -> Lt atrium -> Lt ventricle -> aortia-iliac -> hypogastric arteries -> placenta

What is the fetal echo routine? (10)

- Situs of stomach/heart - 4 chamber view - LVOT/RVOT - 3 vessel view (SVC/AO/PA) - Aortic arch and ductal arch - SAX of ventricles and atria - SVC and IVC - Pulm veins - Cine through heart - M-mode thru an atrium and ventricle

What is the "candy cane"?

Aortic arch with branches

What is the "hockey stick"?

Ductal arch

What is the "longhorn" view?

IVC/SVC

What is the ductal arch a view of?

The RV/PA joining to the ductus arteriosis that attaches to the descending AO

Why is m-mode performed on the atria/ventricle?

Rule out arrhythmias such as heart block

What is considered bradycardia?

<110 bpm | Usually due to heart block

What is considered tachycardia and why is it dangerous?

> 200 bpm SV is decreased

How is tachycardia treated?

Digoxin is given to slow HR (mothers will as well)

What is an AV canal?

Other name for AVSD

What is endocardial cushion defect?

Another name for AVSD

What is EFE (endocardial fibroelastosis) associated to?

Hypoplastic heart syndromes

What is situs inversus totalis?

Complete reversal of singular organs (heart, liver, stomach, spleen) Lungs and kidneys no because there are 2

What is left isomerism/bilateral left sidedness?

- Singular organs are stacked midline - Multiple small spleens (polysplenia) - 2 Left atria - 2 left lungs

What is right isomerism/bilateral right sidedness?

- Singular organs are stacked midline - No spleen (asplenia) - 2 right atria - 2 right lungs

What is situs inversus thoracalis and situs inversus abdominalis?

Thoracalis = thorax organs reversed Abdominalis = Abdo organs reversed

What is EIF?

Echogenic intracardiac focus

How does asplenia affect cardiac defects?

- Defects much worse | - AVSD common

What is heterotaxia?

Situs inversus of any type

What is TGA?

Transposition of the great arteries

What is heterotaxia associated with? (5)

- TGA - Pulm stenosis/atresia - Common atrium - Complete heart block - Anomalous pulm venous return

How can you determine between normal circulation and L-loop transposition since they look the same?

Look for the moderator band in the "LV spot" to prove that it is actually the RV attached to the LA and AO