CHAPTER 27 - THE FETAL HEART AND CHEST

Narrowing of the aortic arch Right ventricular enlargement Pulmonary artery enlargement

Sonographic Findings of Coarctation of the Aorta;

Anechoic fluid surrounding the heart

Sonographic Findings of Pericardial Effusion

Echogenic, triangular-shaped mass within the fetal chest. Pleural effusion may be present.

Sonographic Findings of Pulmonary Sequestration;

The pulmonary artery abnormally arises from the left ventricle and the aorta abnormally arises from the right ventricle. The outflow tracts will be positioned parallel to each other rather than crisscrossing. VSD maybe present.

Sonographic Findings of Transposition of the great vessels;

Echogenic tumor(s) within the myocardium of the heart.

Sonographic Findings of a Rhamdomyoma

A group of anomalies that includes an omphalocele, along with ectopic cordis, cleft sternum, anterior diaphragmatic defect, and pericardial defects.

Sonographic features of pentalogy of Cantrell;

Absence of the atrial and ventricular septum

Sonographic findings of Atrioventricular Septal Defects;

Absence of part of the ventricular septum. Color Doppler is helpful at detecting small defects.

Sonographic findings of ventricular septal defects;

Enlarged right atrium Fetal hydrops Malpositioned tricuspid valve

Sonographic signs of Ebstein anomaly;

Pleural effusion

The accumulation of fluid around the lungs is termed;

Left atrium

The blood returning from the lungs through the pulmonary veins enters into the;

The normal pulmonary artery should be positioned anterior to the aorta and should be visualized crossing over it.

True concerning fetal outflow tracts;

Fetal hydrops

A coexisting pericardial effusion and a pleural effusion is consistent with the diagnosis of;

Hypoplastic Left Heart Syndrome

A group of anomalies characterized by a small or an absent left ventricle is;

Pulmonary sequestration

A separate mass of non functioning fetal lung tissue is referred to as;

Left ventricle

An EIF is most often seen within the;

Trisomy 21

An EIF would most likely be associated with;

Endocardial cushion defect

Atrioventricular Septal Defects can be referred to as;

Abnormal development of the central portion of the heart. The central portion of the heart referred to as the ''endocardial cushion''

Atrioventricular Septal Defects results from the;

The aorta arises from the right ventricle, and the pulmonary artery arises from the left ventricle.

Best describes transposition of the great vessels;

Potter Syndrome it's associated with pulmonary hypoplasia.

Bilateral renal agenesis and the abnormal facial features in the condition known as;

VSD (ventricular septal defect)

Considered to be the most common cardiac defect;

Tetralogy of Fallot

Defined as an overriding aortic root, subaortic VSD, pulmonary stenosis, and right ventricular hypertrophy is;

The left ventricle of the heart. May represent the calcification of the papillary muscle or chordae tendineae.

Echogenic Intracardiac Focus is most often seen within;

L/S ratio (lecithin/sphingomyelin)

Fetal lung maturity can be assessed using the;

Pericardial Effusion

Fluid located around the heart is referred as;

Pleural effusion or hydrothorax

Fluid surrounding the lungs is referred to as;

Absent or small left ventricle No communication between the left atrium and the left ventricle Aortic atresia Aortic stenosis Coarctation of the aorta When found in girls, turner syndrome should be suspected. Connection with trisomy 18

Hypoplastic Left Heart Syndrome is a group of anomalies characterized sonographically as a small or absent left ventricle. Sonographic Findings;

Results from pulmonary stenosis or pulmonary atresia. Absent or small right ventricle Enlarged left ventricle Fetal hydrops(secondary to cardiac failure) Narrowing of the pulmonary valve

Hypoplastic Right Heart Syndrome is a sonographically identified as a small or an absent right ventricle. Sonographic Findings;

Atrial Septal Defects

Is an abnormal opening in the septum between the two atria of the heart.

Ventricular Septal Defects

Is an abnormal opening in the septum between the two ventricles of the heart. Most common form of cardiac defect. Tetralogy of Fallot

Eventration of the diaphragm

Lack of muscle in dome of diaphragm

Sonographic findings of a diaphragmatic hernia

Malposition of the heart Anechoic stomach bubble noted adjacent to fetal heart in four chamber view Other abd organs may be located along chest

Pulmonary sequestration

Separate mass of non functioning lung tissue with its own blood supply is;

Lung mass with varying degrees of cystic and solid components. Completely echogenic mass within the lungs. Pleural effusion may be present. Most of them are unilateral, may resolve spontaneously.

Sonographic Appearance of Cystic Adenomatoid Malformations;

Overriding aortic root VSD Pulmonary stenosis

Tetralogy of Fallot consist of all the following;

In the left posterolateral portion of the diaphragm. The stomach, bowel and the left love of the liver are found within the chest.

The foramen of Bochdalek is located;

Right anteromedially within the diaphragm. Right sided diaphragmatic hernia - allowing liver to herniate in chest.

The foramen of Morgagni is located;

anterior to the aorta and should be visualized crossing over it.

The normal pulmonary artery should be positioned

Transposition of the great vessels

The pulmonary artery abnormally arises from the ventricle, and the aorta abnormally arises from the right ventricle. they will be parallel to each other, with aorta noted anterior and to the right of the pulmonary artery.

Pleural effusion

The sonographic ''bat-wing'' sign is indicative of;

between right ventricle and right atrium

The tricuspid valve is located;

Sound OFF

The ventricular septal defects (VSD) is the most common form of cardiac defect.

Pulmonary hypoplasia is caused by a decreased number of lung cells, airways and alveoli.

Underdevelopment of the lungs;

VSD (ventricular septal defect)

What is an opening within the septum that separates the right and the left ventricles?

mitral valve

between the left ventricle and left atrium

tricuspid valve

between the right ventricle and right atrium;

Sound OFF

blood from the right ventricle can flow through the ductus arteriosus and into the descending aorta.

Sound OFF

blood is shunted directly into the IVC via small branch of the umbilical vein called ductus venosus.

aorta

left ventricular outflow tract leads to the;

pulmonary artery and branches

right ventricular outflow tract leads to the;

left atrium

the blood returning from the lungs through the pulmonary veins enters into the;

two arteries and one vein.

the normal umbilical cord contains;

it travels superiorly and connects to the left portal vein.

the umbilical vein - brings oxygenated rich blood from the placenta to the fetus.

A lack of muscle in the dome of the diaphragm

Eventration of the diaphragm is best described as;

Ectopic cordis

The condition in which the heart is located outside the chest wall is termed;

Sound OFF

Malformation or malpositioning of the tricuspid valves results in Epstein anomaly. Ventricle is contiguous with the right atrium, a finding referred to as an atrialized right ventricle.

Oligohydraminos

Pulmonary hypoplasia is a common finding with;

Absence of part of the atrial septum

Sonographic Findings of Atrial Septal Defects;

Between the left subclavian artery and the ductus arteriosis.

The most common location for coarctation of the aorta is;

Sound OFF

The most common location of a diaphragmatic hernia is on the left side. This type may also be referred to as a Bochdalek hernia.

Sound OFF

The most common reason for fetal cardiac malposition is the existence of a diaphragmatic hernia.

Triangular echogenic mass within the chest

The most common sonographic appearance of pulmonary sequestration is;

Coarctation of the aorta

The narrowing of the aortic arch is indicative of;

Coarctation of the Aorta

The narrowing of the aortic arch;

one-third

The normal heart will fill approximately - of the fetal chest;

Pulmonary atresia

What is described as the absencence of the pulmonary valve which in turn prohibits blood flow from the right ventricle into the pulmonary artery and essentially to the lungs?

Pulmonary hypoplasia

What is the term for underdevelopment of the lungs?

Atrioventricular Septal Defects or Atrioventricular Canal

The combination of both atrial and ventricular septal defects is termed;

Two tubes

The embryonic heart begins as;

Foramen ovale

What is the normal opening in the lower middle third of the atrial septum?

Foramen of Morgagni

What is the opening located right anteromedially within the diaphragm?

Ductus venosus

What structure shunts blood into the IVC from the umbilical vein;

Hypoplastic right heart syndrome

A group of anomalies characterized by a small or an absent right ventricle is;

Cystic Adenomatoid Malformation

A mass consisting of abnormal bronchial and lung tissue that develops within the fetal chest;

Sound OFF

An Echogenic Intracardiac Focus (EIF) may be seen in the normal fetus. However, there have been studies that have linked the EIF with trisomy 21.

Diaphragmatic Hernia

An abnormal opening in the fetal diaphragm that allows the herniation of abdominal contents into the chest cavity is;

1- The aortic outflow tract originates from the left ventricle. 2-The pulmonary outflow tract originates from the right ventricle. 3-The outflow tracts should be comparable in size. 4-The ascending aorta and the main pulmonary artery are perpendicular to each other because they exit their respective ventricles. They should be seen crossing and not lying in the same place.

Basic assessment of the fetal outflow tracts

The fetal form of pulmonary sequestration

Extrapulmonary sequestration is;

Sound OFF

Functional fetal lung tissue does not typically exists until after 25 weeks., Fetal lung maturity can be assessed using the lecithin to sphingomyelin ratio. (L/S ratio) Normally as the lungs mature,the level of lecithin increases, whereas the level of sphingomyelin decreases.

DiGeorge Syndrome

Genetic disorder characterized by an absent or hypoplastic thymus;

Malpositioned tricuspid valve Right and left atrial shunting Tricuspid regurgitation Enlarged right atrium Deviation of the atrial septum to the left Fetal hydrops (secondary to cardiac failure)

Sonographic findings of Ebstein Anomaly;

Overriding aortic root VSD Pulmonary stenosis Right ventricle hypertrophy

Sonographic findings of Tetralogy of Fallot;

Anechoic fluid surrounding the fetal lung(s) ''bat-wing'' sign Other signs of hydrops may be present. can be treated with thoracentesis

Sonographic findings of a pleural effusion;

Heart located either partially or completely outside the chest.

Sonographic findings of ectopic cordis

Atrioventricular defect can be referred to as endocardial cushion defect. associated with aneuploidy, trisomy 21, 18

The central portion of the heart is referred to as the endocardial cushion.

Pentalogy of Cantrell

The group of anomalies that combines the ectopic cordis and existing omphalocele;

Ectopic Cordis

The heart is located either partially or completely outside of the chest describes as;

Between the left ventricle and the left atrium

The mitral valve is located;

Right ventricle

The moderator band is located within the;

Diaphragmatic hernia

The most common cause of cardiac malposition is;

Rhabdomyoma

The most common fetal cardiac tumor is the;

Rhabdomyoma. It is associated with tuberous sclerosis and located within the myocardium of the heart.

The most common fetal cardiac tumor is the;

Foramen of Borchdalek

The most common form of diaphragmatic hernia is the;

Diaphragmatic hernia

The most common lesion that occupies the chest, resulting in pulmonary hypoplasia is the;

Diaphragmatic hernia

The visualization of the fetal stomach within the fetal chest is most indicative of ;

The chamber closest to the fetal spine is the left atrium

True statement about fetal heart;

The mitral valve is positioned closer to the cardiac apex than the tricuspid valve.

True statement about the normal fetal heart;

Tuberous sclerosis

What is fetal rhabdomyomas associated with?

Ductus arteriosis

What is the fetal shunt that connect the pulmonary artery to the aortic arch?