Chapter 27--the fetal heart and chest
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