Chapter 27--the fetal heart and chest

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Atrioventricular septal defects result from what?

Abnormal development of the central portion of the heart

What are the sonography findings of atrial septal defect?

Absence of part of the atrial septum, color Doppler is helpful at detecting small defects

What are the sonography findings of ventricular septal defects?

Absence of part of the ventricular septum, color Doppler is helpful at detecting small defects

What are the sonography findings of atrioventricular septal defects?

Absence of the atrial and ventricular septum, color Doppler findings are helpful it showing mixture of flow patterns

What are the sonography findings of hypoplastic left heart syndrome?

Absent or small left ventricle, no communication between the left atrium and left ventricle, aortic atresia, aortic stenosis, coarctation of the aorta

What are the sonography findings of hypoplastic right heart syndrome?

Absent or small right ventricle, enlarged left ventricle, fetal hydrops secondary to cardiac failure, narrowing of the pulmonary valve

What are the sonography findings of rhabdomyoma?

Academic tumors within The myocardium of the heart, isolated or multiple

What are the sonography findings of a pleural effusion?

Anechoic fluid surrounding the fetal lungs, other signs of hydrops may be present, unilateral or bilateral, batwing sign if unilateral

What is the sonography finding of pericardial effusion?

Anechoic fluid surrounding the heart

A condition of having an abnormal number of chromosomes

Aneuploidy

Atrioventricular septal defects are commonly associated with what?

Aneuploidy, trisomy 21, 18

The normal pulmonary artery should be positioned where to the aorta?

Anterior

Abnormality in which there is a small or absent opening between the left ventricle and the aorta

Aortic atresia

The ventricular septum should be on interrupted and of equal thickness to what? Vs atrial septum is open only at the what?

Equal thickness to the left ventricular wall,, only Foreman ovale

Lack of muscle in the Dome of the diaphragm

Eventration of the diaphragm

An abnormal accumulation of fluid in at least two fetal body cavities

Fetal hydrops

An opening located in the left posteriorolateral portion of the diaphragm

Foramen of Bochdalek

Incomplete development of the right ventricle resulting in a small or absent right ventricle

Hypoplastic right heart syndrome

A test of the amniotic fluid that predicts fetal lung maturity

Lecithin to sphingomyelin ratio

Academic intracardiac focus is most often seen within which ventricle of the heart?

Left

Which ventricle has smoother walls?

Left

The Chamber of the heart closest to the fetal spine is what?

Left atrium

The apex of the heart will be angled where?

Left of midline with the base closest to the

Rhabdomyoma is a tumor located where and has an association with what?

Located within The myocardium of the heart, association with tuberous sclerosis, eventual cardiac failure, subsequent development of fetal hydrops

Pulmonary hypoplasia is a common finding with what? It can also be associated with what?

Oligohydramnios, bilateral renal agenesis and the abnormal facial features in the conditions known as Potter syndrome

Oligohydramnios an anterior abdominal wall defect where there is herniation of the fetal bowel and other abdominal organ into the base of the umbilical cord

Omphalocele

What are the sonography findings of tetralogy of fallot?

Overriding aortic root, ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy

In the normal umbilical cord the vein entering the umbilicus brings what rich blood from the placenta to the fetus?

Oxygen

Paired muscles in both sides of the heart that hold in place either the mitral or tricuspid valves

Papillary muscle

A group of anomalies that include and omphalocele along with ectopic Cordis, cleft sternum, anterior diaphragmatic defect, pericardial defects

Pentalogy of Cantrell

The abnormal accumulation of fluid in the pleural space

Pleural effusion

What the most common form of cardiac defect?

Ventricular septal defect

The normal fetal heart will fill approximately what fraction of the fetal chest?

1/3

The heart is fully formed by how many weeks?

10

After the first trimester what is the range of the heartbeat?

110 to 180 beats per minute

An average fetal heart rate is what?

140 beats per minute

Functional fetal lung tissue does not typically exist until after how many weeks?

25

The heart begins to contract at how many days of gestation?

36 to 37 days

The fetal heart Apex will form what degree angle with the fetal spine?

45 degree angle

To distinguish hypoplastic left heart syndrome from complete absence of the left side of the heart what must be visualized?

A small or normal left atrium

A diaphragmatic hernia results in what?

Abnormal opening in the fetal diaphragm that allows the herniation of the abdominal contents into the chest cavity

The left ventricular outflow tract leads to where?

Aorta

Abnormal development of the central portion of the heart AKA endocardial cushion defect

Atrioventricular defect

The sonography appearance of a fetal unilateral pleural effusion

Batwing sign

What is the most common location for coarctation of the aorta?

Between the left subclavian artery and the ductus arteriosus

A method of fetal monitoring with sonography to produce a numeric scoring system that predicts fetal well-being

Biophysical profile

The herniation of abdominal contents into the chest cavity because of an opening in the left posteriorolateral portion of the diaphragm

Bochdalek hernia

Echogenic intracardiac focus is thought to represent what?

Calcification of the papillary muscle or chordae tendineae

Tendons within the heart that attach to the tricuspid valve in the right ventricle and the mutual valve in the left ventricle to their respective papillary muscle

Chordae tendineae

The narrowing of the aortic Arch

Coarctation of the aorta

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

Cystic adenomatoid malformation

Pulmonary hypoplasia or under development of the lungs is caused by what?

Decreased number of lung cells, Airways, alveoli

The herniation of the abdominal contents into the chest cavity through a defect in the diaphragm

Diaphragmatic hernia

The most common lesion that occupies the chest resulting in pulmonary hypoplasia is what?

Diaphragmatic hernia

A fetal shunt that connects the pulmonary artery to the aortic Arch

Ductus arteriosus

A fetal shunt that connects the umbilical vein to the IVC

Ductus venosus

The malformation or mal positioning of the tricuspid valve that causes multiple heart defects

Ebstein anomaly

What are the sonography findings of an echogenic intracardiac Focus?

Echogenic structure most commonly located within the left ventricle

What are the sonography findings of sequestration?

Echogenic, triangular shaped Mass within the chest, pleural effusion may be present, typically left side of fetal chest

A condition in which the heart is located either partially or completely outside the fetal chest

Ectopic Cordis

The most common reason for fetal cardiac malposition is what?

Existence of a diaphragmatic hernia

An opening located right into anteromedially within the diaphragm

Foramen of morgagni

An opening with a fetal heart within the atrial septum that allows blood to flow from the right atrium to the left atrium

Foramen ovale

How much of the blood goes to the liver through the left portal vein? Where does the other half go and by how?

Half, other half is shunted directly into the IVC via a small branch of the umbilical vein called ductus venosus

What are the sonography findings of ectopic Cordis?

Heart located either partially or completely on the outside of the chest

Incomplete development of the left ventricle resulting in a small or absent left ventricle

Hypoplastic left heart syndrome

What syndrome is the leading cause of cardiac death in the neonatal period with 95% dying within the first month of life if surgery is not performed?

Hypoplastic left heart syndrome

Normally as the loan matures the level of lecithin will what where is the level of sphingomyelin what?

Increases, decreases

Pericardial effusion can be what? You should evaluate for what?

Isolated or associated with fetal hydrops, evaluate fetus closely for other signs of fetal hydrops such as ascites and pleural effusion

The most common location of a diaphragmatic hernia is where?

Left

What side is the mitral valve on?What side is the mitral valve on?

Left

What are the sonography findings of cystic adenomatoid malformation?

Lung Mass with cystic and solid components type 1, pleural effusion may be present, completely academic similar to pulmonary circulation, unilateral, resolve spontaneously, large masses can lead to fetal hydrops with 4 prognosis

Pulmonary hypoplasia is often associated with what?

Major structural and chromosomal abnormalities

What are the sonography findings of a diaphragmatic hernia?

Malposition of the heart, anechoic stomach bubble noted adjacent to the fetal heart in the four chamber heart for you, other abdominal organs including the liver, pancreas, spleen may be located along the chest

What are the sonography findings of ebstein anomaly?

Malpositioned tricuspid valve, right and left atrial shunting, tricuspid regurgitation, and large right atrium, deviation of the atrial septum to the left, fetal hydrops secondary to cardiac failure

What are the sonography findings of coarctation of the aorta?

Narrowing of the aortic Arch, right ventricular enlargement, pulmonary artery enlargement

Echogenic intracardiac Focus can be seen in What patients?

Normal fetus, trisomy 21 if there is especially more than one detected

Lower than normal amount of amniotic fluid for the gestational age

Oligohydramnios

Fluid accumulation around the heart in the pericardial cavity

Pericardial effusion

What is the prognosis of ebstein anomaly?

Poor, 80% of infants dying in perinatal period

Syndrome characterized by bilateral renal agenesis, abnormal facies, pulmonary hypo plasia, limb abnormalities

Potter syndrome

Right ventricular outflow tract leads to where?

Pulmonary artery and branches

The absence of the pulmonary valve which in turn prohibits blood flow from the right ventricle into the pulmonary artery and essentially to the lungs

Pulmonary atresia

Under development of the lungs

Pulmonary hypoplasia

A separate mass of non-functioning lung tissue with its own blood supply

Pulmonary sequestration

The narrowing of the pulmonary valve

Pulmonary stenosis

Hypoplastic heart syndrome most often results from what?

Pulmonary stenosis or pulmonary atresia but it may result from stenosis or atresia of the tricuspid valve

A fetal heart tumor found within The myocardium

Rhabdomyoma

The most common fetal cardiac tumor is what?

Rhabdomyoma

What side is the tricuspid valve on?

Right

Within what ventricle can the moderator band be seen as an echogenic Focus?

Right ventricle

With coarctation of the aorta what are associated findings?

Right ventricle and pulmonary artery enlargement, patent ductus arteriosus and vsd

What goes on with ebstein's anomaly?

Right ventricle is continuous with the right atrium referred to as atrialized right ventricle

Oxygen the umbilical vein travels where where it connects to the left portal vein?

Superiorly

A group of abnormalities consisting of an overriding aortic root, ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy

Tetralogy of fallot

Abnormality in which the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle

Transposition of the great vessels

The leakage of blood back through the tricuspid valve

Tricuspid regurgitation

Ebstein anomaly is associated with what?

Tricuspid regurgitation, ASD, tetralogy of fallot, transposition of the great vessels, coarctation of the aorta

Which valve is positioned closer to the cardiac Apex?

Tricuspid valve

A systemic disorder that leads to the development of tumors within various organs

Tuberous sclerosis

When hypoplastic left heart syndrome is found in girls what syndrome should be suspected?

Turner syndrome also connection with Trisomy 18

The normal umbilical cord contains how many arteries and veins?

Two arteries and one vein

The embryonic heart begins as what?

Two tubes

An opening within the septum that separates the right and left ventricle

Ventricular septal defect


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