Eacvi Aepc Congenital Heart Disease Echocardiography (Echo Chd) Practice Exam 2026 | Verified Answers, Rationales & Exam Prep | Just Released Pdf

EACVI AEPC CONGENITAL HEART DISEASE
ECHOCARDIOGRAPHY (ECHO CHD)
PRACTICE EXAM 2026 | VERIFIED ANSWERS,
RATIONALES & EXAM PREP | JUST
RELEASED PDF

EACVI AEPC CONGENITAL HEART DISEASE ECHOCARDIOGRAPHY (ECHO CHD)
PRACTICE EXAM 2026 VERIFIED ANSWERS, RATIONALES & EXAM PREP | JUST
RELEASED



DOCUMENT OVERVIEW:

• Comprehensive question study resource covering all major congenital heart
disease pathologies, echocardiographic assessment techniques, and clinical
applications for EACVI-AEPC certification preparation

• Study strategically by working through questions systematically, reviewing
detailed rationales to reinforce understanding of physiology, imaging protocols,
Doppler interpretation, and diagnostic criteria essential for expert-level CHD
echocardiography practice




SECTION 1: ATRIAL SEPTAL DEFECTS (ASD)



1. A secundum atrial septal defect is located in which anatomical region?

A) Posteroinferior portion of the atrial septum near the inferior vena cava

B) Superior portion of the atrial septum

C) Central portion of the fossa ovalis

D) Anterior region near the aorta

E) Around the coronary sinus

,✓ CORRECT ANSWER: C) Central portion of the fossa ovalis

Secundum ASD represents approximately 70% of all ASDs and occurs due to
inadequate development of the septum secundum or excessive resorption of the
septum primum. The defect is located centrally within the fossa ovalis region.
Echocardiographically, secundum ASDs are best visualized in the subcostal coronal
view or bicaval view. The defect allows left-to-right shunting at the atrial level due to
lower right ventricular compliance compared to the left ventricle.



2. What is the primary color flow finding in an ostium secundum ASD on
echocardiography?

A) Blue color mosaic pattern throughout the defect

B) Red color flow from right atrium to left atrium during systole

C) Bidirectional flow with left-to-right predominance during systole and diastole

D) Continuous spectral Doppler pattern

E) Absence of any color flow signal

✓ CORRECT ANSWER: C) Bidirectional flow with left-to-right predominance
during systole and diastole

The characteristic color flow pattern in secundum ASD demonstrates
predominantly left-to-right shunting, visible as red color flow crossing the defect
from the left atrium to the right atrium. The bidirectional nature reflects the
pressure gradients between the atria throughout the cardiac cycle. The magnitude
of the shunt depends on the ASD size, compliance of both ventricles, and the
relative pulmonary and systemic vascular resistance. In secundum ASDs, the shunt
is typically large due to the larger defect size compared to other ASD types.



3. Which chamber measurement abnormality is most commonly associated
with significant secundum ASD shunting?

A) Left atrial enlargement

,B) Left ventricular dilation

C) Right atrial and right ventricular enlargement

D) Left ventricular hypertrophy

E) Aortic root dilation

✓ CORRECT ANSWER: C) Right atrial and right ventricular enlargement

Significant left-to-right shunting through a secundum ASD results in increased
pulmonary blood flow (Qp:Qs ratio > 1.5:1) leading to volume overload of the right
heart. The right atrium dilates due to increased systemic venous return, and the
right ventricle dilates due to increased pulmonary venous return. Chronic volume
overload can eventually lead to right ventricular dysfunction and, if untreated,
pulmonary hypertension and reversal of the shunt (Eisenmenger physiology). Left
heart chambers typically remain normal or even slightly small due to reduced left
ventricular preload.



4. What is the Qp:Qs ratio threshold typically used to recommend ASD
closure?

A) Greater than 1.0:1

B) Greater than 1.2:1

C) Greater than 1.5:1

D) Greater than 2.0:1

E) Greater than 2.5:1

✓ CORRECT ANSWER: C) Greater than 1.5:1

A pulmonary-to-systemic flow ratio (Qp:Qs) greater than 1.5:1 indicates
hemodynamically significant left-to-right shunting and is a standard criterion for
recommending ASD closure. This threshold reflects the point at which the volume
overload becomes physiologically significant, with increased risk of atrial
arrhythmias, right ventricular dysfunction, and progressive pulmonary
hypertension. The Qp:Qs ratio is calculated from Doppler measurements of flow

, across the mitral and aortic valves or across the pulmonary and aortic valves using
the formula: Qp/Qs = (mitral valve area × mitral VTI) / (aortic valve area × aortic VTI).



5. Primum atrial septal defects are more accurately classified as which of the
following?

A) Type I ASD

B) Atrioventricular septal defects (AVSD)

C) Sinus venosus ASD

D) Unroofed coronary sinus

E) High ostium secundum ASD

✓ CORRECT ANSWER: B) Atrioventricular septal defects (AVSD)

Primum ASDs represent part of the spectrum of atrioventricular septal defects and
should be classified as such rather than as true ASDs. Primum ASDs involve a
deficiency of the septum primum in the area of the fossa ovalis, with the defect
extending inferiorly toward the mitral valve. Associated findings typically include
left cleft mitral valve leaflet, creating the potential for mitral regurgitation. Sinus
venosus and secundum ASDs are true secundum-type defects, while primum
defects are fundamentally different in embryology and anatomy, making the AVSD
classification more appropriate.



6. Which imaging plane is optimal for measuring the size of a secundum ASD
for transcatheter device planning?

A) Parasternal long axis

B) Parasternal short axis at the aortic valve level

C) Apical four-chamber view

D) Bicaval view combined with subcostal coronal view

E) Suprasternal notch view