EACVI AEPC Congenital Heart Disease Echocardiography
Exam Prep- Echo CHD Practice Questions & Rationales 2
versions
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 optimal for measuring the pulmonary artery
acceleration time (PAAT) in a patient with suspected pulmonary hypertension?
A) Apical four-chamber view
B) Parasternal short-axis view at the level of the pulmonary valve
C) Subcostal long-axis view
D) Suprasternal short-axis view
Rationale: The parasternal short-axis view at the pulmonary valve level aligns the Doppler
beam parallel to pulmonary artery flow, allowing accurate PAAT measurement.
2. A patient with a sinus venosus atrial septal defect may have which associated
anomaly?
A) Partial anomalous pulmonary venous return
B) Coronary sinus dilation
C) Aortic stenosis
D) Tricuspid atresia
Rationale: Sinus venosus ASDs are frequently associated with partial anomalous
pulmonary venous return, most commonly of the right upper pulmonary vein.
,3. What is the characteristic Doppler finding in a patient with a large patent ductus
arteriosus?
A) Continuous diastolic flow reversal in the descending aorta
B) Systolic flow reversal in the descending aorta
C) Diastolic flow reversal in the pulmonary artery
D) Continuous flow in the pulmonary vein
Rationale: A large PDA causes continuous left-to-right shunting throughout the cardiac
cycle, resulting in diastolic flow reversal in the descending aorta due to runoff.
4. In a patient with repaired Tetralogy of Fallot, which parameter best determines
the timing for pulmonary valve replacement?
A) RV end-diastolic volume index >150 mL/m²
B) LV ejection fraction <50%
C) TR jet velocity >3 m/s
D) Pulmonary artery acceleration time <100 ms
Rationale: RV end-diastolic volume index >150 mL/m² on cardiac MRI or CT is a key
criterion for pulmonary valve replacement in repaired TOF.
5. Which 3D echocardiographic modality is most useful for assessing the
morphology of an atrioventricular septal defect?
A) 3D transthoracic echocardiography with multiplanar reformatting
B) 3D transesophageal echocardiography
C) 3D color Doppler
D) 3D strain imaging
Rationale: 3D TEE provides high-resolution en face views of the common AV valve and
septal defects, aiding surgical planning.
,6. A patient with a bicuspid aortic valve and aortic stenosis may have which
associated finding on echocardiography?
A) Coarctation of the aorta
B) Pulmonary stenosis
C) Tricuspid atresia
D) Ebstein anomaly
Rationale: Bicuspid aortic valves are associated with coarctation of the aorta and other
left-sided obstructive lesions.
7. What is the most sensitive echocardiographic sign of cardiac tamponade in a
patient with a large pericardial effusion?
A) Right ventricular diastolic collapse
B) Left ventricular hypertrophy
C) Dilated coronary sinus
D) Apical displacement of the tricuspid valve
Rationale: Right ventricular diastolic collapse is a highly sensitive and specific sign of
cardiac tamponade.
8. In a patient with transposition of the great arteries after arterial switch
operation, which finding suggests pulmonary artery stenosis?
A) Peak velocity >3 m/s across the pulmonary artery anastomosis
B) Continuous flow in the pulmonary artery
C) Diastolic flow reversal in the pulmonary artery
D) Systolic flow reversal in the aorta
Rationale: Pulmonary artery stenosis after arterial switch presents with elevated peak
velocities at the anastomotic site.
9. Which parameter is used to estimate right ventricular systolic pressure in a
patient with a tricuspid regurgitation jet?
, A) 4 × (TR velocity)² + estimated right atrial pressure
B) 4 × (TR velocity)² − estimated right atrial pressure
C) 2 × (TR velocity)² + estimated right atrial pressure
D) 2 × (TR velocity)² − estimated right atrial pressure
Rationale: RVSP is calculated using the Bernoulli equation (ΔP = 4v²) with TR velocity, plus
estimated RAP.
10. A patient with an ostium primum atrial septal defect may have which
associated valve abnormality?
A) Cleft mitral valve
B) Tricuspid stenosis
C) Aortic stenosis
D) Pulmonary stenosis
Rationale: Ostium primum ASDs are part of the AVSD spectrum and are associated with a
cleft anterior mitral valve leaflet.
11. Which view is best for assessing the right ventricular outflow tract in a patient
with Tetralogy of Fallot?
A) Parasternal short-axis view
B) Apical four-chamber view
C) Subcostal long-axis view
D) Suprasternal short-axis view
Rationale: The parasternal short-axis view visualizes the RVOT and pulmonary valve,
which are critical in TOF assessment.
12. What is the characteristic finding of a double-chambered right ventricle on
echocardiography?
A) Obstruction within the right ventricle causing a pressure gradient
B) Right ventricular dilation
Exam Prep- Echo CHD Practice Questions & Rationales 2
versions
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 optimal for measuring the pulmonary artery
acceleration time (PAAT) in a patient with suspected pulmonary hypertension?
A) Apical four-chamber view
B) Parasternal short-axis view at the level of the pulmonary valve
C) Subcostal long-axis view
D) Suprasternal short-axis view
Rationale: The parasternal short-axis view at the pulmonary valve level aligns the Doppler
beam parallel to pulmonary artery flow, allowing accurate PAAT measurement.
2. A patient with a sinus venosus atrial septal defect may have which associated
anomaly?
A) Partial anomalous pulmonary venous return
B) Coronary sinus dilation
C) Aortic stenosis
D) Tricuspid atresia
Rationale: Sinus venosus ASDs are frequently associated with partial anomalous
pulmonary venous return, most commonly of the right upper pulmonary vein.
,3. What is the characteristic Doppler finding in a patient with a large patent ductus
arteriosus?
A) Continuous diastolic flow reversal in the descending aorta
B) Systolic flow reversal in the descending aorta
C) Diastolic flow reversal in the pulmonary artery
D) Continuous flow in the pulmonary vein
Rationale: A large PDA causes continuous left-to-right shunting throughout the cardiac
cycle, resulting in diastolic flow reversal in the descending aorta due to runoff.
4. In a patient with repaired Tetralogy of Fallot, which parameter best determines
the timing for pulmonary valve replacement?
A) RV end-diastolic volume index >150 mL/m²
B) LV ejection fraction <50%
C) TR jet velocity >3 m/s
D) Pulmonary artery acceleration time <100 ms
Rationale: RV end-diastolic volume index >150 mL/m² on cardiac MRI or CT is a key
criterion for pulmonary valve replacement in repaired TOF.
5. Which 3D echocardiographic modality is most useful for assessing the
morphology of an atrioventricular septal defect?
A) 3D transthoracic echocardiography with multiplanar reformatting
B) 3D transesophageal echocardiography
C) 3D color Doppler
D) 3D strain imaging
Rationale: 3D TEE provides high-resolution en face views of the common AV valve and
septal defects, aiding surgical planning.
,6. A patient with a bicuspid aortic valve and aortic stenosis may have which
associated finding on echocardiography?
A) Coarctation of the aorta
B) Pulmonary stenosis
C) Tricuspid atresia
D) Ebstein anomaly
Rationale: Bicuspid aortic valves are associated with coarctation of the aorta and other
left-sided obstructive lesions.
7. What is the most sensitive echocardiographic sign of cardiac tamponade in a
patient with a large pericardial effusion?
A) Right ventricular diastolic collapse
B) Left ventricular hypertrophy
C) Dilated coronary sinus
D) Apical displacement of the tricuspid valve
Rationale: Right ventricular diastolic collapse is a highly sensitive and specific sign of
cardiac tamponade.
8. In a patient with transposition of the great arteries after arterial switch
operation, which finding suggests pulmonary artery stenosis?
A) Peak velocity >3 m/s across the pulmonary artery anastomosis
B) Continuous flow in the pulmonary artery
C) Diastolic flow reversal in the pulmonary artery
D) Systolic flow reversal in the aorta
Rationale: Pulmonary artery stenosis after arterial switch presents with elevated peak
velocities at the anastomotic site.
9. Which parameter is used to estimate right ventricular systolic pressure in a
patient with a tricuspid regurgitation jet?
, A) 4 × (TR velocity)² + estimated right atrial pressure
B) 4 × (TR velocity)² − estimated right atrial pressure
C) 2 × (TR velocity)² + estimated right atrial pressure
D) 2 × (TR velocity)² − estimated right atrial pressure
Rationale: RVSP is calculated using the Bernoulli equation (ΔP = 4v²) with TR velocity, plus
estimated RAP.
10. A patient with an ostium primum atrial septal defect may have which
associated valve abnormality?
A) Cleft mitral valve
B) Tricuspid stenosis
C) Aortic stenosis
D) Pulmonary stenosis
Rationale: Ostium primum ASDs are part of the AVSD spectrum and are associated with a
cleft anterior mitral valve leaflet.
11. Which view is best for assessing the right ventricular outflow tract in a patient
with Tetralogy of Fallot?
A) Parasternal short-axis view
B) Apical four-chamber view
C) Subcostal long-axis view
D) Suprasternal short-axis view
Rationale: The parasternal short-axis view visualizes the RVOT and pulmonary valve,
which are critical in TOF assessment.
12. What is the characteristic finding of a double-chambered right ventricle on
echocardiography?
A) Obstruction within the right ventricle causing a pressure gradient
B) Right ventricular dilation
