EACVI AEPC Congenital Heart Disease
Echocardiography (Echo CHD) 2026 | Exam
Questions and Correct Answers with
Detailed Rationales | Congenital Cardiac
Imaging Certification
EACVI AEPC CONGENITAL HEART DISEASE ECHOCARDIOGRAPHY EXAM
QUESTIONS AND CORRECT ANSWERS
DOCUMENT OVERVIEW
• Contains 200 comprehensive multiple-choice questions designed to test
knowledge across all major domains of congenital cardiac echocardiography for
certification preparation
• Study this material systematically by covering one topic area at a time, using the
detailed rationales to deepen understanding of imaging principles, hemodynamic
assessment, and diagnostic criteria for each lesion
QUESTION 1: Which echocardiographic view best demonstrates the secundum
atrial septal defect in its entirety?
A) Apical four-chamber view
B) Subcostal bicaval view
C) Parasternal short-axis view at the level of the aorta
D) Suprasternal notch view
E) Parasternal long-axis view
✓ CORRECT ANSWER: B) Subcostal bicaval view
Rationale: The subcostal bicaval view is the gold standard for assessing secundum
ASDs as it demonstrates both atrial chambers, the interatrial septum, and the
relationship to the superior and inferior vena cava. The apical four-chamber view
may underestimate the defect due to ultrasound beam orientation. The parasternal
,views are suboptimal for septal assessment in this region. The suprasternal notch
provides limited assessment of the atrial septum.
QUESTION 2: In a neonate with a restrictive ventricular septal defect, what is
the primary hemodynamic consequence?
A) Left-to-right shunt with increased pulmonary blood flow
B) Right-to-left shunt causing cyanosis
C) Minimal shunt with pressure gradient across the defect
D) Balanced bidirectional shunt
E) Increased systemic venous return
✓ CORRECT ANSWER: C) Minimal shunt with pressure gradient across the
defect
Rationale: A restrictive VSD is defined by a small defect with a large pressure
gradient between the ventricles, resulting in minimal flow across the defect. The
continuous wave Doppler demonstrates a high-velocity jet due to the pressure
differential. Unlike large VSDs, there is no significant left-to-right shunt or
pulmonary overcirculation in the restrictive type.
QUESTION 3: Which structure serves as the echo marker for the ductus
venosus in a fetal echocardiogram?
A) Eustachian valve
B) Inferior vena cava
C) First hepatic vein
D) Umbilical vein
E) Foramen ovale
✓ CORRECT ANSWER: D) Umbilical vein
,Rationale: The ductus venosus is the fetal shunt that allows umbilical venous blood
to bypass the liver. It appears as a narrow conduit connecting the umbilical vein to
the inferior vena cava. In fetal echocardiography, identification of the ductus
venosus and its flow pattern is important for assessing appropriate cardiac
connection and blood distribution in the fetus.
QUESTION 4: What is the characteristic Doppler finding in patent ductus
arteriosus?
A) Diastolic flow reversal in the descending aorta
B) Continuous flow from systole through diastole
C) Purely systolic flow
D) Bidirectional flow pattern
E) No flow during diastole
✓ CORRECT ANSWER: B) Continuous flow from systole through diastole
Rationale: The patent ductus arteriosus permits continuous left-to-right shunting
due to the persistent aortic-pulmonary connection. On color Doppler and
continuous wave interrogation, the characteristic "continuous" or "machinery"
murmur appearance shows flow throughout the cardiac cycle. This differentiates it
from other lesions that may show only systolic or diastolic flows.
QUESTION 5: In tetralogy of Fallot, the four anatomic components include:
A) VSD, mitral stenosis, tricuspid regurgitation, right ventricular hypertrophy
B) VSD, pulmonary stenosis, right ventricular hypertrophy, overriding aorta
C) ASD, pulmonary stenosis, tricuspid stenosis, left ventricular hypertrophy
D) VSD, aortic stenosis, left ventricular hypertrophy, mitral stenosis
E) PDA, pulmonary stenosis, right atrial enlargement, tricuspid stenosis
, ✓ CORRECT ANSWER: B) VSD, pulmonary stenosis, right ventricular
hypertrophy, overriding aorta
Rationale: Tetralogy of Fallot comprises four classic anatomic abnormalities: a
ventricular septal defect, obstruction of pulmonary outflow (pulmonary stenosis),
right ventricular hypertrophy secondary to the obstruction, and an aorta that
overrides the VSD rather than arising entirely from the left ventricle. These four
components form the basis of the diagnosis.
QUESTION 6: Which view optimally shows the aortic arch in the suprasternal
approach?
A) Suprasternal notch short-axis view
B) Suprasternal notch long-axis view
C) High parasternal right-sided view
D) Apical long-axis view
E) Subcostal coronal view
✓ CORRECT ANSWER: B) Suprasternal notch long-axis view
Rationale: The suprasternal notch long-axis view, obtained by angling the
transducer superiorly and anteriorly, visualizes the aortic arch in profile. This view
demonstrates the ascending aorta, arch, and descending aorta, making it ideal for
assessing arch anatomy, coarctation, and other arch abnormalities. The short-axis
view from the suprasternal notch is better for demonstrating the branch
pulmonary arteries.
QUESTION 7: What is the primary echocardiographic finding in d-transposition
of the great arteries?
A) Aorta arises from the left ventricle parallel to the pulmonary artery
B) Aorta arises anteriorly and to the right from the right ventricle, parallel to the
pulmonary artery arising from the left ventricle
Echocardiography (Echo CHD) 2026 | Exam
Questions and Correct Answers with
Detailed Rationales | Congenital Cardiac
Imaging Certification
EACVI AEPC CONGENITAL HEART DISEASE ECHOCARDIOGRAPHY EXAM
QUESTIONS AND CORRECT ANSWERS
DOCUMENT OVERVIEW
• Contains 200 comprehensive multiple-choice questions designed to test
knowledge across all major domains of congenital cardiac echocardiography for
certification preparation
• Study this material systematically by covering one topic area at a time, using the
detailed rationales to deepen understanding of imaging principles, hemodynamic
assessment, and diagnostic criteria for each lesion
QUESTION 1: Which echocardiographic view best demonstrates the secundum
atrial septal defect in its entirety?
A) Apical four-chamber view
B) Subcostal bicaval view
C) Parasternal short-axis view at the level of the aorta
D) Suprasternal notch view
E) Parasternal long-axis view
✓ CORRECT ANSWER: B) Subcostal bicaval view
Rationale: The subcostal bicaval view is the gold standard for assessing secundum
ASDs as it demonstrates both atrial chambers, the interatrial septum, and the
relationship to the superior and inferior vena cava. The apical four-chamber view
may underestimate the defect due to ultrasound beam orientation. The parasternal
,views are suboptimal for septal assessment in this region. The suprasternal notch
provides limited assessment of the atrial septum.
QUESTION 2: In a neonate with a restrictive ventricular septal defect, what is
the primary hemodynamic consequence?
A) Left-to-right shunt with increased pulmonary blood flow
B) Right-to-left shunt causing cyanosis
C) Minimal shunt with pressure gradient across the defect
D) Balanced bidirectional shunt
E) Increased systemic venous return
✓ CORRECT ANSWER: C) Minimal shunt with pressure gradient across the
defect
Rationale: A restrictive VSD is defined by a small defect with a large pressure
gradient between the ventricles, resulting in minimal flow across the defect. The
continuous wave Doppler demonstrates a high-velocity jet due to the pressure
differential. Unlike large VSDs, there is no significant left-to-right shunt or
pulmonary overcirculation in the restrictive type.
QUESTION 3: Which structure serves as the echo marker for the ductus
venosus in a fetal echocardiogram?
A) Eustachian valve
B) Inferior vena cava
C) First hepatic vein
D) Umbilical vein
E) Foramen ovale
✓ CORRECT ANSWER: D) Umbilical vein
,Rationale: The ductus venosus is the fetal shunt that allows umbilical venous blood
to bypass the liver. It appears as a narrow conduit connecting the umbilical vein to
the inferior vena cava. In fetal echocardiography, identification of the ductus
venosus and its flow pattern is important for assessing appropriate cardiac
connection and blood distribution in the fetus.
QUESTION 4: What is the characteristic Doppler finding in patent ductus
arteriosus?
A) Diastolic flow reversal in the descending aorta
B) Continuous flow from systole through diastole
C) Purely systolic flow
D) Bidirectional flow pattern
E) No flow during diastole
✓ CORRECT ANSWER: B) Continuous flow from systole through diastole
Rationale: The patent ductus arteriosus permits continuous left-to-right shunting
due to the persistent aortic-pulmonary connection. On color Doppler and
continuous wave interrogation, the characteristic "continuous" or "machinery"
murmur appearance shows flow throughout the cardiac cycle. This differentiates it
from other lesions that may show only systolic or diastolic flows.
QUESTION 5: In tetralogy of Fallot, the four anatomic components include:
A) VSD, mitral stenosis, tricuspid regurgitation, right ventricular hypertrophy
B) VSD, pulmonary stenosis, right ventricular hypertrophy, overriding aorta
C) ASD, pulmonary stenosis, tricuspid stenosis, left ventricular hypertrophy
D) VSD, aortic stenosis, left ventricular hypertrophy, mitral stenosis
E) PDA, pulmonary stenosis, right atrial enlargement, tricuspid stenosis
, ✓ CORRECT ANSWER: B) VSD, pulmonary stenosis, right ventricular
hypertrophy, overriding aorta
Rationale: Tetralogy of Fallot comprises four classic anatomic abnormalities: a
ventricular septal defect, obstruction of pulmonary outflow (pulmonary stenosis),
right ventricular hypertrophy secondary to the obstruction, and an aorta that
overrides the VSD rather than arising entirely from the left ventricle. These four
components form the basis of the diagnosis.
QUESTION 6: Which view optimally shows the aortic arch in the suprasternal
approach?
A) Suprasternal notch short-axis view
B) Suprasternal notch long-axis view
C) High parasternal right-sided view
D) Apical long-axis view
E) Subcostal coronal view
✓ CORRECT ANSWER: B) Suprasternal notch long-axis view
Rationale: The suprasternal notch long-axis view, obtained by angling the
transducer superiorly and anteriorly, visualizes the aortic arch in profile. This view
demonstrates the ascending aorta, arch, and descending aorta, making it ideal for
assessing arch anatomy, coarctation, and other arch abnormalities. The short-axis
view from the suprasternal notch is better for demonstrating the branch
pulmonary arteries.
QUESTION 7: What is the primary echocardiographic finding in d-transposition
of the great arteries?
A) Aorta arises from the left ventricle parallel to the pulmonary artery
B) Aorta arises anteriorly and to the right from the right ventricle, parallel to the
pulmonary artery arising from the left ventricle
