EACVI AEPC Congenital Heart Disease Echocardiography (Echo
Chd) Practice Exam Questions And Answers | Exam Prep | All
Questions And Answers | Verified Answers Plus Rationales |
Graded Q&A Comprehensive Study Guide | Verified Latest
1. A newborn presents with mild cyanosis and a continuous murmur. Echocardiography
shows a patent ductus arteriosus (PDA) with a left-to-right shunt. Which view provides the
best anatomic visualization of the ductal arch and the PDA insertion site into the
descending aorta?
A. Parasternal long-axis view
B. High left parasternal ductal view
C. Apical four-chamber view
D. Subcostal short-axis view
Rationale: The high left parasternal view (often called the ductal view) is specifically oriented
to visualize the pulmonary artery bifurcation, the patent ductus arteriosus, and its connection
to the descending aorta. It provides superior spatial resolution for measuring ductal
dimensions and determining flow dynamics.
2. In transthoracic echocardiography, which frequency transducer selection is optimal for
achieving high-resolution imaging of intracardiac structures in a 3 kg neonate with
suspected transposition of the great arteries?
A. 2.0 – 3.5 MHz
B. 3.5 – 5.0 MHz
C. 8.0 – 12.0 MHz
D. 1.5 – 2.5 MHz
Rationale: High-frequency transducers (8.0 to 12.0 MHz) offer excellent near-field spatial
resolution, which is essential for detailed anatomical evaluation in small neonates with
shallow imaging depths. Lower frequencies are reserved for older children and adults needing
deeper penetration.
3. An infant with a large ventricular septal defect (VSD) undergoes Doppler evaluation.
Peak systolic velocity across the VSD is measured at 2.0 m/s, with a systolic blood pressure
of 80 mmHg. What is the estimated peak right ventricular systolic pressure (RVSP)?
A. 16 mmHg
B. 32 mmHg
C. 64 mmHg
D. 76 mmHg
,Rationale: Using the simplified Bernoulli equation ($\Delta P = 4v^2$), the pressure gradient
across the VSD is $4 \times (2.0)^2 = 16\text{ mmHg}$. Peak RVSP is calculated as Systemic
Systolic Pressure minus the VSD gradient: $80 - 16 = 64\text{ mmHg}$, indicating significant
right ventricular hypertension.
4. When assessing atrial septal defect (ASD) morphology for potential transcatheter
closure, which rim is characteristically absent in a secunda-type ASD located anteriorly
near the aortic root?
A. Superior vena cava rim
B. Inferior vena cava rim
C. Aortic (anterosuperior) rim
D. Atrioventricular valve rim
Rationale: Secundum ASDs located adjacent to the ascending aorta lack an aortic
(anterosuperior) rim. While deficient aortic rims are common and often still amenable to
device closure, deficiency of other rims (especially the IVC rim) poses higher risks for device
instability.
5. In a patient with tetralogy of Fallot, pulsed-wave Doppler signal placed in the right
ventricular outflow tract demonstrates dynamic subpulmonary obstruction. What Doppler
signal characteristics support dynamic rather than fixed obstruction?
A. Symmetrical parabolic curve peaking early in systole
B. Late-peaking dagger-shaped velocity profile with concave envelope
C. Continuous flow throughout both systole and diastole
D. Flat square-wave profile with low peak velocity
Rationale: Dynamic muscular obstruction in the right or left ventricular outflow tract
produces a characteristic late-peaking, dagger-shaped Doppler spectral envelope due to
progressive mechanical narrowing during ventricular contraction.
6. Which subcostal view is most reliable for confirming the systemic venous anatomy and
ruling out interrupted inferior vena cava with azygos continuation?
A. Subcostal short-axis view at the aortic valve level
B. Subcostal bicaval sagittal view
C. Subcostal coronal short-axis view of the ventricular apex
D. Subcostal four-chamber view with posterior tilt
Rationale: The subcostal bicaval sagittal view aligns the imaging plane with the long axis of
both the superior and inferior vena cava entering the right atrium, directly demonstrating IVC
continuity into the atrium.
,7. When applying Color Doppler to evaluate left-to-right shunting across a patent foramen
ovale in a neonate, which setting adjustment optimizes detection of low-velocity shunts?
A. Increasing the color scale (Nyquist limit)
B. Decreasing the color scale (Nyquist limit)
C. Decreasing the color Doppler gain
D. Setting wall filter to maximum threshold
Rationale: Decreasing the Nyquist limit increases sensitivity to low-velocity blood flow,
making low-pressure, low-velocity interatrial shunts more conspicuous on color Doppler
imaging.
8. An pediatric patient with corrected coarctation of the aorta undergoes routine follow-up.
Continuous-wave Doppler across the coarctation repair site displays continuous forward
flow during diastole ("diastolic tailing"). What does this finding indicate?
A. Completely normal postoperative flow profile
B. Severe recurrent or residual aortic coarctation
C. Presence of a large concomitant atrial septal defect
D. Systemic hypertension secondary to renal artery stenosis
Rationale: Persistent continuous forward flow in diastole (diastolic tailing or diastolic run-off)
across a coarctation site indicates a significant pressure gradient maintained throughout the
cardiac cycle, characteristic of severe aortic obstruction.
9. In complete atrioventricular canal defect (Rastelli Type A), what structural relationship
defines the anterior bridging leaflet morphology?
A. The leaflet bridges the septal crest and attaches to the right ventricular papillary muscle
B. The leaflet is attached predominantly to the left ventricular side of the anterior ventricular
septum
C. The leaflet floats freely without chordal attachments to the ventricular septum
D. The leaflet attaches directly to the anterior free wall of the left ventricle
Rationale: In Rastelli Type A complete AV canal defect, the anterior bridging leaflet is divided
and attached by chordae to the crest of the ventricular septum on the left ventricular side.
Type C features a unattached, free-floating bridging leaflet.
10. What echocardiographic landmark is essential for differentiating a anatomic right
ventricle from a anatomic left ventricle in complex congenital heart disease?
A. Triphasic inflow profile
B. Smooth septal surface
C. Apical displacement of the tricuspid valve hinge point and presence of moderator band
D. Dual papillary muscle architecture attached to the free wall
, Rationale: The morphologic right ventricle is unequivocally identified by apical displacement
of its AV valve insertion (tricuspid valve) relative to the mitral valve, coarse trabeculations,
and the presence of the moderator band near the apex.
11. During an echocardiogram on a child with suspected vascular ring, what sonographic
finding on the suprasternal notch short-axis view strongly suggests a double aortic arch?
A. Single large vessel arching leftward giving off four isolated head vessels
B. Bifurcation of the ascending aorta into left and right arches encircling the trachea and
esophagus
C. Prominent left superior vena cava draining to the coronary sinus
D. Retroesophageal left subclavian artery arising from a normal left arch
Rationale: A double aortic arch is characterized on suprasternal cross-sectional views by
division of the ascending aorta into two distinct arches (right and left) that surround the
trachea and esophagus before coalescing into the descending aorta.
12. A 4-year-old child presents with fever, coronary artery dilation on echocardiography,
and systemic inflammation. Which acoustic window is primary for measuring the main left
coronary artery diameter and obtaining Z-scores?
A. Subcostal four-chamber view
B. Parasternal short-axis view at the aortic valve level
C. Apical two-chamber view
D. Suprasternal long-axis view
Rationale: The high parasternal short-axis view at the aortic valve level brings the origin of
the left main coronary artery and right coronary artery perpendicular to the ultrasound beam,
allowing accurate 2D wall-to-wall inner-edge diameter measurements.
13. What is the classic echocardiographic presentation of Ebstein anomaly of the tricuspid
valve?
A. Normal insertion of septal leaflet with severe anterior leaflet prolapse
B. Apical displacement of the septal and posterior leaflets > 8 mm/m² body surface area
C. Complete absence of the tricuspid valve tissue with imperforate membrane
D. Systolic anterior motion of the tricuspid valve causing obstruction
Rationale: Ebstein anomaly is characterized by down-to-apex displacement of the septal and
posterior tricuspid valve leaflets from the true AV junction (exceeding 8 mm/m² BSA),
resulting in atrialization of the right ventricle.
14. In patients with d-transposition of the great arteries (d-TGA) prior to surgery, what is
the spatial relationship of the great arteries observed in parasternal short-axis views?
Chd) Practice Exam Questions And Answers | Exam Prep | All
Questions And Answers | Verified Answers Plus Rationales |
Graded Q&A Comprehensive Study Guide | Verified Latest
1. A newborn presents with mild cyanosis and a continuous murmur. Echocardiography
shows a patent ductus arteriosus (PDA) with a left-to-right shunt. Which view provides the
best anatomic visualization of the ductal arch and the PDA insertion site into the
descending aorta?
A. Parasternal long-axis view
B. High left parasternal ductal view
C. Apical four-chamber view
D. Subcostal short-axis view
Rationale: The high left parasternal view (often called the ductal view) is specifically oriented
to visualize the pulmonary artery bifurcation, the patent ductus arteriosus, and its connection
to the descending aorta. It provides superior spatial resolution for measuring ductal
dimensions and determining flow dynamics.
2. In transthoracic echocardiography, which frequency transducer selection is optimal for
achieving high-resolution imaging of intracardiac structures in a 3 kg neonate with
suspected transposition of the great arteries?
A. 2.0 – 3.5 MHz
B. 3.5 – 5.0 MHz
C. 8.0 – 12.0 MHz
D. 1.5 – 2.5 MHz
Rationale: High-frequency transducers (8.0 to 12.0 MHz) offer excellent near-field spatial
resolution, which is essential for detailed anatomical evaluation in small neonates with
shallow imaging depths. Lower frequencies are reserved for older children and adults needing
deeper penetration.
3. An infant with a large ventricular septal defect (VSD) undergoes Doppler evaluation.
Peak systolic velocity across the VSD is measured at 2.0 m/s, with a systolic blood pressure
of 80 mmHg. What is the estimated peak right ventricular systolic pressure (RVSP)?
A. 16 mmHg
B. 32 mmHg
C. 64 mmHg
D. 76 mmHg
,Rationale: Using the simplified Bernoulli equation ($\Delta P = 4v^2$), the pressure gradient
across the VSD is $4 \times (2.0)^2 = 16\text{ mmHg}$. Peak RVSP is calculated as Systemic
Systolic Pressure minus the VSD gradient: $80 - 16 = 64\text{ mmHg}$, indicating significant
right ventricular hypertension.
4. When assessing atrial septal defect (ASD) morphology for potential transcatheter
closure, which rim is characteristically absent in a secunda-type ASD located anteriorly
near the aortic root?
A. Superior vena cava rim
B. Inferior vena cava rim
C. Aortic (anterosuperior) rim
D. Atrioventricular valve rim
Rationale: Secundum ASDs located adjacent to the ascending aorta lack an aortic
(anterosuperior) rim. While deficient aortic rims are common and often still amenable to
device closure, deficiency of other rims (especially the IVC rim) poses higher risks for device
instability.
5. In a patient with tetralogy of Fallot, pulsed-wave Doppler signal placed in the right
ventricular outflow tract demonstrates dynamic subpulmonary obstruction. What Doppler
signal characteristics support dynamic rather than fixed obstruction?
A. Symmetrical parabolic curve peaking early in systole
B. Late-peaking dagger-shaped velocity profile with concave envelope
C. Continuous flow throughout both systole and diastole
D. Flat square-wave profile with low peak velocity
Rationale: Dynamic muscular obstruction in the right or left ventricular outflow tract
produces a characteristic late-peaking, dagger-shaped Doppler spectral envelope due to
progressive mechanical narrowing during ventricular contraction.
6. Which subcostal view is most reliable for confirming the systemic venous anatomy and
ruling out interrupted inferior vena cava with azygos continuation?
A. Subcostal short-axis view at the aortic valve level
B. Subcostal bicaval sagittal view
C. Subcostal coronal short-axis view of the ventricular apex
D. Subcostal four-chamber view with posterior tilt
Rationale: The subcostal bicaval sagittal view aligns the imaging plane with the long axis of
both the superior and inferior vena cava entering the right atrium, directly demonstrating IVC
continuity into the atrium.
,7. When applying Color Doppler to evaluate left-to-right shunting across a patent foramen
ovale in a neonate, which setting adjustment optimizes detection of low-velocity shunts?
A. Increasing the color scale (Nyquist limit)
B. Decreasing the color scale (Nyquist limit)
C. Decreasing the color Doppler gain
D. Setting wall filter to maximum threshold
Rationale: Decreasing the Nyquist limit increases sensitivity to low-velocity blood flow,
making low-pressure, low-velocity interatrial shunts more conspicuous on color Doppler
imaging.
8. An pediatric patient with corrected coarctation of the aorta undergoes routine follow-up.
Continuous-wave Doppler across the coarctation repair site displays continuous forward
flow during diastole ("diastolic tailing"). What does this finding indicate?
A. Completely normal postoperative flow profile
B. Severe recurrent or residual aortic coarctation
C. Presence of a large concomitant atrial septal defect
D. Systemic hypertension secondary to renal artery stenosis
Rationale: Persistent continuous forward flow in diastole (diastolic tailing or diastolic run-off)
across a coarctation site indicates a significant pressure gradient maintained throughout the
cardiac cycle, characteristic of severe aortic obstruction.
9. In complete atrioventricular canal defect (Rastelli Type A), what structural relationship
defines the anterior bridging leaflet morphology?
A. The leaflet bridges the septal crest and attaches to the right ventricular papillary muscle
B. The leaflet is attached predominantly to the left ventricular side of the anterior ventricular
septum
C. The leaflet floats freely without chordal attachments to the ventricular septum
D. The leaflet attaches directly to the anterior free wall of the left ventricle
Rationale: In Rastelli Type A complete AV canal defect, the anterior bridging leaflet is divided
and attached by chordae to the crest of the ventricular septum on the left ventricular side.
Type C features a unattached, free-floating bridging leaflet.
10. What echocardiographic landmark is essential for differentiating a anatomic right
ventricle from a anatomic left ventricle in complex congenital heart disease?
A. Triphasic inflow profile
B. Smooth septal surface
C. Apical displacement of the tricuspid valve hinge point and presence of moderator band
D. Dual papillary muscle architecture attached to the free wall
, Rationale: The morphologic right ventricle is unequivocally identified by apical displacement
of its AV valve insertion (tricuspid valve) relative to the mitral valve, coarse trabeculations,
and the presence of the moderator band near the apex.
11. During an echocardiogram on a child with suspected vascular ring, what sonographic
finding on the suprasternal notch short-axis view strongly suggests a double aortic arch?
A. Single large vessel arching leftward giving off four isolated head vessels
B. Bifurcation of the ascending aorta into left and right arches encircling the trachea and
esophagus
C. Prominent left superior vena cava draining to the coronary sinus
D. Retroesophageal left subclavian artery arising from a normal left arch
Rationale: A double aortic arch is characterized on suprasternal cross-sectional views by
division of the ascending aorta into two distinct arches (right and left) that surround the
trachea and esophagus before coalescing into the descending aorta.
12. A 4-year-old child presents with fever, coronary artery dilation on echocardiography,
and systemic inflammation. Which acoustic window is primary for measuring the main left
coronary artery diameter and obtaining Z-scores?
A. Subcostal four-chamber view
B. Parasternal short-axis view at the aortic valve level
C. Apical two-chamber view
D. Suprasternal long-axis view
Rationale: The high parasternal short-axis view at the aortic valve level brings the origin of
the left main coronary artery and right coronary artery perpendicular to the ultrasound beam,
allowing accurate 2D wall-to-wall inner-edge diameter measurements.
13. What is the classic echocardiographic presentation of Ebstein anomaly of the tricuspid
valve?
A. Normal insertion of septal leaflet with severe anterior leaflet prolapse
B. Apical displacement of the septal and posterior leaflets > 8 mm/m² body surface area
C. Complete absence of the tricuspid valve tissue with imperforate membrane
D. Systolic anterior motion of the tricuspid valve causing obstruction
Rationale: Ebstein anomaly is characterized by down-to-apex displacement of the septal and
posterior tricuspid valve leaflets from the true AV junction (exceeding 8 mm/m² BSA),
resulting in atrialization of the right ventricle.
14. In patients with d-transposition of the great arteries (d-TGA) prior to surgery, what is
the spatial relationship of the great arteries observed in parasternal short-axis views?
