Pediatric Echocardiography |Latest Update 2025
Questions with Answers
Levoposition - ✔✔most of the cardiac mass is to the left of midline
Dextroposition - ✔✔most of the cardiac mass is to the right of midline
Mesoposition - ✔✔the heart is evenly divided around the midline
Connection - ✔✔The exact anatomic attachment of the pulmonary vein to a chamber or
other vein
Drainage - ✔✔Venous flow may be directed or flow to a chamber other than, or in addition
to the one that it is connected to as a result of an ASD or malpositioned IAS
Total Anomalous Pulmonary Venous Connection (TAPVC) - ✔✔All pulmonary veins from both
lungs don't connect to the LA. May connect to the RA or other veins. Must have an ASD or PFO
to survive
Partial Anomalous Pulmonary Venous Connection (PAPVC) - ✔✔Abnormal connection of
pulmonary veins to the LA. At least one will be connected. Many variations for the other
connections. May have an ASD.
Supracardiac TAPVC - ✔✔The pulmonary veins come together in a common channel that
enters a "vertical vein" (remnant of the cardinal and splanchnic systems), usually on the left
side of the chest. This drains into the inominate vein. This is the most common type of TAPVC.
Cardiac TAPVC - ✔✔All pulmonary veins connect to a vein that directly enters the right side
of the heart--usually the coronary sinus.
,Infracardiac TAPVC - ✔✔All of the pulmonary veins connect to a vertical vein that descends
below the diaphragm.
Sinus Venosus Defect - ✔✔There is absence of the sinus venosus tissue between the right
pulmonary vein and the SVC
Syndromes associated with PAPVC - ✔✔Turner and noonan syndromes
Syndromes associated with TAPVC - ✔✔Cat-eye, Holt-Oram, and asplenia syndromes
Persistent LSVC to the CS - ✔✔Most common systemic venous anomaly. LSVC normally
passes in front of the left PA and aortic arch.
LSVC to the CS with an atretic RSVC - ✔✔Rare. The right-sided head and neck vessels drain
via the R. inominate vein into the LSVC, then into a dilated CS
LSVC to the LA - ✔✔Rare, isolated defect. CS is usually absent. Without communication
between the atria, patients present early in infancy with cyanosis. Presence of a connecting
vein between the right and left SVCs allows decompression of the LA blood into the RSVC. If no
connecting vein, saline injection into left arm will show up in LA.
Dilated CS - ✔✔a response to abnormally increased volume or pressure. Causes include
persistent LSVC, coronary sinoseptal defect, PAPVC or TAPVC into CS, coronary arteriovenous
fistula, and total or partial anomalous hepatic venous drainage into the CS.
Interrupted IVC with azygos/hemiazygos coninuation - ✔✔of clinical significance with
heterotaxy syndrome. Echo diagnosis is important in setting of cardiac catheterization and
intra-operative venous cannulation.
Bilateral IVCs - ✔✔Two IVCs. Significance depends on where the two connect.
, Secundum defects - ✔✔occur in the central portion of the IAS, result from true deficiency in
the development of the septum primum.
Primum defects - ✔✔result from abnormal formation of embryonic endocardial cushions
Foramen primum (primary foramen) - ✔✔The space between the leading edge of the
septum primum and the endocardial cushions
Patent foramen ovale (PFO) - ✔✔incomplete closure of the space between a normally
developed septum primum and a normally formed septum secundum. Normal in fetal life,
allowing flow from the ductus venosus and IVC to go to the LA, into the LV to be pumped to the
fetal tissues. After birth, LA pressure increases and the foramen ovale narrows.
Secundum ASD - ✔✔Most common ASD. A defect within the fossa ovale, usually due to a
single or multiple defects in the septum primum.
Primum ASD - ✔✔Second most common ASD. An endocardial cushion defect where there is
interatrial communication in the area between the anterior-inferior margin of the fossa ovalis
and the AV valves. It's classed as a form of partial AV canal defect.
Sinus Venosus Defect (SVD) - ✔✔This involves communication between one or more of the
right pulmonary veins and the cardiac end of the SVC and/or posterior wall of the RA.
Coronary sinus defect - ✔✔Uncommon anomaly resulting from unroofing of the tissue that
separates the CS from the LA, allowing the RA and LA to communicate through the defect.
Raghib syndrome - ✔✔A coronary sinus defect along with a persistent LSVC
Questions with Answers
Levoposition - ✔✔most of the cardiac mass is to the left of midline
Dextroposition - ✔✔most of the cardiac mass is to the right of midline
Mesoposition - ✔✔the heart is evenly divided around the midline
Connection - ✔✔The exact anatomic attachment of the pulmonary vein to a chamber or
other vein
Drainage - ✔✔Venous flow may be directed or flow to a chamber other than, or in addition
to the one that it is connected to as a result of an ASD or malpositioned IAS
Total Anomalous Pulmonary Venous Connection (TAPVC) - ✔✔All pulmonary veins from both
lungs don't connect to the LA. May connect to the RA or other veins. Must have an ASD or PFO
to survive
Partial Anomalous Pulmonary Venous Connection (PAPVC) - ✔✔Abnormal connection of
pulmonary veins to the LA. At least one will be connected. Many variations for the other
connections. May have an ASD.
Supracardiac TAPVC - ✔✔The pulmonary veins come together in a common channel that
enters a "vertical vein" (remnant of the cardinal and splanchnic systems), usually on the left
side of the chest. This drains into the inominate vein. This is the most common type of TAPVC.
Cardiac TAPVC - ✔✔All pulmonary veins connect to a vein that directly enters the right side
of the heart--usually the coronary sinus.
,Infracardiac TAPVC - ✔✔All of the pulmonary veins connect to a vertical vein that descends
below the diaphragm.
Sinus Venosus Defect - ✔✔There is absence of the sinus venosus tissue between the right
pulmonary vein and the SVC
Syndromes associated with PAPVC - ✔✔Turner and noonan syndromes
Syndromes associated with TAPVC - ✔✔Cat-eye, Holt-Oram, and asplenia syndromes
Persistent LSVC to the CS - ✔✔Most common systemic venous anomaly. LSVC normally
passes in front of the left PA and aortic arch.
LSVC to the CS with an atretic RSVC - ✔✔Rare. The right-sided head and neck vessels drain
via the R. inominate vein into the LSVC, then into a dilated CS
LSVC to the LA - ✔✔Rare, isolated defect. CS is usually absent. Without communication
between the atria, patients present early in infancy with cyanosis. Presence of a connecting
vein between the right and left SVCs allows decompression of the LA blood into the RSVC. If no
connecting vein, saline injection into left arm will show up in LA.
Dilated CS - ✔✔a response to abnormally increased volume or pressure. Causes include
persistent LSVC, coronary sinoseptal defect, PAPVC or TAPVC into CS, coronary arteriovenous
fistula, and total or partial anomalous hepatic venous drainage into the CS.
Interrupted IVC with azygos/hemiazygos coninuation - ✔✔of clinical significance with
heterotaxy syndrome. Echo diagnosis is important in setting of cardiac catheterization and
intra-operative venous cannulation.
Bilateral IVCs - ✔✔Two IVCs. Significance depends on where the two connect.
, Secundum defects - ✔✔occur in the central portion of the IAS, result from true deficiency in
the development of the septum primum.
Primum defects - ✔✔result from abnormal formation of embryonic endocardial cushions
Foramen primum (primary foramen) - ✔✔The space between the leading edge of the
septum primum and the endocardial cushions
Patent foramen ovale (PFO) - ✔✔incomplete closure of the space between a normally
developed septum primum and a normally formed septum secundum. Normal in fetal life,
allowing flow from the ductus venosus and IVC to go to the LA, into the LV to be pumped to the
fetal tissues. After birth, LA pressure increases and the foramen ovale narrows.
Secundum ASD - ✔✔Most common ASD. A defect within the fossa ovale, usually due to a
single or multiple defects in the septum primum.
Primum ASD - ✔✔Second most common ASD. An endocardial cushion defect where there is
interatrial communication in the area between the anterior-inferior margin of the fossa ovalis
and the AV valves. It's classed as a form of partial AV canal defect.
Sinus Venosus Defect (SVD) - ✔✔This involves communication between one or more of the
right pulmonary veins and the cardiac end of the SVC and/or posterior wall of the RA.
Coronary sinus defect - ✔✔Uncommon anomaly resulting from unroofing of the tissue that
separates the CS from the LA, allowing the RA and LA to communicate through the defect.
Raghib syndrome - ✔✔A coronary sinus defect along with a persistent LSVC
