EACVI AEPC Congenital Heart Disease Echocardiography
Exam Prep- Echo CHD Practice Questions & Rationales 2
versions [2026]
This specialized clinical preparation resource provides high-yield practice questions,
verified answers, and comprehensive structural rationales designed for the European
Association of Cardiovascular Imaging (EACVI) and Association for European
Paediatric and Congenital Cardiology (AEPC) joint certification track. It thoroughly
details advanced pediatric and adult congenital heart disease (ACHD) imaging
competencies, including complex segment-by-segment sequential analyses, multi-
planar Doppler flow physics, intraoperative transesophageal screening (TEE), and fetal
echocardiographic assessment parameters. Cardiac sonographers, pediatric
cardiologists, and fellowship candidates will master European imaging codes and
diagnostic decision-making to confidently pass their proctored registry certification.
1. Which echocardiographic view is most useful for detecting an anomalous origin
of the left coronary artery from the pulmonary artery (ALCAPA)?
A) Apical four-chamber view
B) Parasternal short-axis view
C) Subcostal long-axis view
D) Suprasternal short-axis view
Rationale: The parasternal short-axis view visualizes the coronary artery origins and is
optimal for detecting ALCAPA, which shows a dilated right coronary artery and retrograde
flow into the pulmonary artery.
2. A patient with tricuspid atresia will typically have which associated finding?
A) Hypoplastic right ventricle
B) Normal right ventricle
C) Dilated right ventricle
D) Right ventricular hypertrophy
Rationale: Tricuspid atresia is characterized by absent tricuspid valve, leading to a
hypoplastic right ventricle and obligate right-to-left atrial shunt.
,3. What is the characteristic Doppler finding in a patient with a Blalock-Taussig
shunt?
A) Continuous flow in the shunt
B) Systolic flow only
C) Diastolic flow only
D) Absent flow
Rationale: A Blalock-Taussig shunt (systemic-to-pulmonary artery shunt) produces
continuous flow throughout the cardiac cycle due to the pressure gradient between the
systemic and pulmonary circulations.
4. In a patient with hypoplastic left heart syndrome, which structure is typically
atretic or severely hypoplastic?
A) Mitral and aortic valves
B) Tricuspid and pulmonary valves
C) Mitral and pulmonary valves
D) Aortic and tricuspid valves
Rationale: HLHS involves severe hypoplasia of the left ventricle, mitral valve, and aortic
valve, along with aortic arch hypoplasia.
5. Which view is best for assessing the Glenn anastomosis (superior vena cava to
pulmonary artery) in a patient with a Fontan circulation?
A) Suprasternal long-axis view
B) Apical four-chamber view
C) Parasternal long-axis view
D) Subcostal short-axis view
Rationale: The suprasternal long-axis view visualizes the superior vena cava and its
connection to the right pulmonary artery, which is the Glenn anastomosis.
,6. A patient with an interrupted aortic arch will have which echocardiographic
finding?
A) Complete discontinuity between the ascending and descending aorta
B) Narrowing of the aortic arch
C) Dilated aortic arch
D) Normal aortic arch
Rationale: Interrupted aortic arch is a complete discontinuity of the aortic arch, often
associated with a ventricular septal defect and patent ductus arteriosus.
7. What is the characteristic finding of a vascular ring on echocardiography?
A) Double aortic arch or right aortic arch with left ligamentum
B) Single left aortic arch
C) Coarctation of the aorta
D) Aortic stenosis
Rationale: Vascular rings, such as double aortic arch or right aortic arch with left
ligamentum, can compress the trachea and esophagus. Echocardiography can identify the
arch anomaly.
8. In a patient with pulmonary atresia with intact ventricular septum, which
finding is expected?
A) Hypoplastic right ventricle with atretic pulmonary valve
B) Dilated right ventricle
C) Normal right ventricle
D) Left ventricular hypoplasia
Rationale: Pulmonary atresia with intact ventricular septum causes right ventricular
hypoplasia and an atretic pulmonary valve, with an obligate right-to-left shunt at the
atrial level.
, 9. Which parameter is used to assess the severity of aortic coarctation by
echocardiography?
A) Peak systolic gradient across the coarctation
B) Mean diastolic gradient
C) Aortic valve area
D) Left ventricular ejection fraction
Rationale: The peak systolic gradient across the coarctation, measured by continuous-
wave Doppler, is used to assess severity. A gradient >20 mm Hg is significant.
10. A patient with a double outlet right ventricle may have which associated
finding?
A) Ventricular septal defect
B) Atrial septal defect
C) Patent ductus arteriosus
D) All of the above
Rationale: Double outlet right ventricle is defined by both great arteries arising
predominantly from the right ventricle, and it is almost always associated with a VSD.
Other defects may coexist.
11. What is the characteristic finding of a coronary cameral fistula on
echocardiography?
A) Continuous flow from a coronary artery into a cardiac chamber
B) Systolic flow reversal in the coronary artery
C) Diastolic flow reversal in the coronary artery
D) Absent flow in the coronary artery
Rationale: Coronary cameral fistula produces continuous flow from a coronary artery into
a cardiac chamber, often causing chamber enlargement.
Exam Prep- Echo CHD Practice Questions & Rationales 2
versions [2026]
This specialized clinical preparation resource provides high-yield practice questions,
verified answers, and comprehensive structural rationales designed for the European
Association of Cardiovascular Imaging (EACVI) and Association for European
Paediatric and Congenital Cardiology (AEPC) joint certification track. It thoroughly
details advanced pediatric and adult congenital heart disease (ACHD) imaging
competencies, including complex segment-by-segment sequential analyses, multi-
planar Doppler flow physics, intraoperative transesophageal screening (TEE), and fetal
echocardiographic assessment parameters. Cardiac sonographers, pediatric
cardiologists, and fellowship candidates will master European imaging codes and
diagnostic decision-making to confidently pass their proctored registry certification.
1. Which echocardiographic view is most useful for detecting an anomalous origin
of the left coronary artery from the pulmonary artery (ALCAPA)?
A) Apical four-chamber view
B) Parasternal short-axis view
C) Subcostal long-axis view
D) Suprasternal short-axis view
Rationale: The parasternal short-axis view visualizes the coronary artery origins and is
optimal for detecting ALCAPA, which shows a dilated right coronary artery and retrograde
flow into the pulmonary artery.
2. A patient with tricuspid atresia will typically have which associated finding?
A) Hypoplastic right ventricle
B) Normal right ventricle
C) Dilated right ventricle
D) Right ventricular hypertrophy
Rationale: Tricuspid atresia is characterized by absent tricuspid valve, leading to a
hypoplastic right ventricle and obligate right-to-left atrial shunt.
,3. What is the characteristic Doppler finding in a patient with a Blalock-Taussig
shunt?
A) Continuous flow in the shunt
B) Systolic flow only
C) Diastolic flow only
D) Absent flow
Rationale: A Blalock-Taussig shunt (systemic-to-pulmonary artery shunt) produces
continuous flow throughout the cardiac cycle due to the pressure gradient between the
systemic and pulmonary circulations.
4. In a patient with hypoplastic left heart syndrome, which structure is typically
atretic or severely hypoplastic?
A) Mitral and aortic valves
B) Tricuspid and pulmonary valves
C) Mitral and pulmonary valves
D) Aortic and tricuspid valves
Rationale: HLHS involves severe hypoplasia of the left ventricle, mitral valve, and aortic
valve, along with aortic arch hypoplasia.
5. Which view is best for assessing the Glenn anastomosis (superior vena cava to
pulmonary artery) in a patient with a Fontan circulation?
A) Suprasternal long-axis view
B) Apical four-chamber view
C) Parasternal long-axis view
D) Subcostal short-axis view
Rationale: The suprasternal long-axis view visualizes the superior vena cava and its
connection to the right pulmonary artery, which is the Glenn anastomosis.
,6. A patient with an interrupted aortic arch will have which echocardiographic
finding?
A) Complete discontinuity between the ascending and descending aorta
B) Narrowing of the aortic arch
C) Dilated aortic arch
D) Normal aortic arch
Rationale: Interrupted aortic arch is a complete discontinuity of the aortic arch, often
associated with a ventricular septal defect and patent ductus arteriosus.
7. What is the characteristic finding of a vascular ring on echocardiography?
A) Double aortic arch or right aortic arch with left ligamentum
B) Single left aortic arch
C) Coarctation of the aorta
D) Aortic stenosis
Rationale: Vascular rings, such as double aortic arch or right aortic arch with left
ligamentum, can compress the trachea and esophagus. Echocardiography can identify the
arch anomaly.
8. In a patient with pulmonary atresia with intact ventricular septum, which
finding is expected?
A) Hypoplastic right ventricle with atretic pulmonary valve
B) Dilated right ventricle
C) Normal right ventricle
D) Left ventricular hypoplasia
Rationale: Pulmonary atresia with intact ventricular septum causes right ventricular
hypoplasia and an atretic pulmonary valve, with an obligate right-to-left shunt at the
atrial level.
, 9. Which parameter is used to assess the severity of aortic coarctation by
echocardiography?
A) Peak systolic gradient across the coarctation
B) Mean diastolic gradient
C) Aortic valve area
D) Left ventricular ejection fraction
Rationale: The peak systolic gradient across the coarctation, measured by continuous-
wave Doppler, is used to assess severity. A gradient >20 mm Hg is significant.
10. A patient with a double outlet right ventricle may have which associated
finding?
A) Ventricular septal defect
B) Atrial septal defect
C) Patent ductus arteriosus
D) All of the above
Rationale: Double outlet right ventricle is defined by both great arteries arising
predominantly from the right ventricle, and it is almost always associated with a VSD.
Other defects may coexist.
11. What is the characteristic finding of a coronary cameral fistula on
echocardiography?
A) Continuous flow from a coronary artery into a cardiac chamber
B) Systolic flow reversal in the coronary artery
C) Diastolic flow reversal in the coronary artery
D) Absent flow in the coronary artery
Rationale: Coronary cameral fistula produces continuous flow from a coronary artery into
a cardiac chamber, often causing chamber enlargement.
