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OB/GYN 303 > Module 12: Fetal Cardiac Abnormalities > Flashcards

Module 12: Fetal Cardiac Abnormalities Flashcards

1
Q

When does the heart begin to develop and how?

A

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

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2
Q

When do the heart chambers develop?

A

6-8 weeks LMP

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3
Q

When is the heart fully formed?

A

10 weeks LMP

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4
Q

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

A
  • 2 vessel cord
  • Congenital diaphragmatic hernia
  • Omphalocele
  • Thick nuchal fold or NT
  • Hydrops
  • Chromosomal abnormalities
  • Bradycardia
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5
Q

What does the three vessel view include?

A
  • Pulmonary artery
  • Aorta
  • Superior vena cava
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6
Q

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

A

4 ch = 1/3 ruled out

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

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7
Q

When is a fetal echo best performed?

A

20-22 weeks to term

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8
Q

What is a normal heart rate in a fetus?

A

120-160 bpm

But up to 180 in 1st trimester can be normal

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9
Q

Why is an ASD difficult to DX?

A

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

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10
Q

The foramen ovale should be no larger than what?

A

The aortic root

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11
Q

What is the most common cardiac anomaly?

A

Ventricular septal defect

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12
Q

What is an atrioventricular septal defect?

A

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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13
Q

What is an AVSD also called?

A

AV canal or endocardial cushion defect

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14
Q

About 50% of fetuses with AVSD have what?

A

T21

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15
Q

What is Ebstein’s anomaly?

A

Apical displacement of the tricuspid valve into the right ventricle

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16
Q

Ebstein’s anomaly is associated with what?

A

Pulmonary stenosis and lithium ingestion (Bipolar medication)

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17
Q

What is a hypoplastic right ventricle?

A

Sonographically small right ventricule

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18
Q

What is a hypoplastic left ventricle?

A

Sonographically small left ventricle

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19
Q

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

A

Decreased flow into or out of the left ventricle

Associated to coarctation of the AO

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20
Q

Endocardial fibroelastosis (EFE) is what?

A

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

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21
Q

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

A
  • VSD
  • Aorta overriding the ventricular septum
  • Hypertrophy of RV
  • Pulmonary stenosis
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22
Q

What is truncus arteriosis?

A

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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23
Q

What is a double outlet right ventricle?

A

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

24
Q

What will be seen with transposition of the great vessels?

A

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

25
Q

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

A

Complete (D loop) or corrected (L loop)

26
Q

What is a D loop transposition?

A

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.

27
Q

What is an L loop transposition?

A

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

28
Q

What will you see with corrected transposition? (3)

A
  • PA off the morphological lt ventricle (in RV spot)
  • Ao off the morphological rt ventricle (in LV spot)
  • Outflow tracts are parallel
29
Q

Where is coarctation of the aorta normally seen?

A

Usually at ductus ateriosus (distal AO arch after branches)

30
Q

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

A

Rhabdomyoma (cardia hamartoma)

Solid, echogenic obstructions usually off ventricular septum

31
Q

What is cardiomyopathy and what is it caused by?

A

Muscle damage resulting in altered cardiac function.

Due to:

  • Viral
  • Bacterial
  • Metabolic
  • Maternal type 1 diabetes
32
Q

What is ectopia cordis and what is it associated to?

A

Heart outside the chest

Associated to Pentalogy of Cantrell

33
Q

What are cardiosplenic syndromes also known as? (3)

A
  • Isomerism
  • Situ ambigous
  • Hetertaxia
34
Q

Affected organs of cardiosplenic syndromes involve what?

A

Liver, lungs, stomach, and heart

35
Q

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

A
  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
36
Q

What is the fetal echo routine? (10)

A
  • 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
37
Q

What is the “candy cane”?

A

Aortic arch with branches

38
Q

What is the “hockey stick”?

A

Ductal arch

39
Q

What is the “longhorn” view?

A

IVC/SVC

40
Q

What is the ductal arch a view of?

A

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

41
Q

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

A

Rule out arrhythmias such as heart block

42
Q

What is considered bradycardia?

A

<110 bpm

Usually due to heart block

43
Q

What is considered tachycardia and why is it dangerous?

A

> 200 bpm

SV is decreased

44
Q

How is tachycardia treated?

A

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

45
Q

What is an AV canal?

A

Other name for AVSD

46
Q

What is endocardial cushion defect?

A

Another name for AVSD

47
Q

What is EFE (endocardial fibroelastosis) associated to?

A

Hypoplastic heart syndromes

48
Q

What is situs inversus totalis?

A

Complete reversal of singular organs (heart, liver, stomach, spleen)

Lungs and kidneys no because there are 2

49
Q

What is left isomerism/bilateral left sidedness?

A
  • Singular organs are stacked midline
  • Multiple small spleens (polysplenia)
  • 2 Left atria
  • 2 left lungs
50
Q

What is right isomerism/bilateral right sidedness?

A
  • Singular organs are stacked midline
  • No spleen (asplenia)
  • 2 right atria
  • 2 right lungs
51
Q

What is situs inversus thoracalis and situs inversus abdominalis?

A

Thoracalis = thorax organs reversed

Abdominalis = Abdo organs reversed

52
Q

What is EIF?

A

Echogenic intracardiac focus

53
Q

How does asplenia affect cardiac defects?

A
  • Defects much worse

- AVSD common

54
Q

What is heterotaxia?

A

Situs inversus of any type

55
Q

What is TGA?

A

Transposition of the great arteries

56
Q

What is heterotaxia associated with? (5)

A
  • TGA
  • Pulm stenosis/atresia
  • Common atrium
  • Complete heart block
  • Anomalous pulm venous return
57
Q

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

A

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

OB/GYN 303 (21 decks)

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