Fetal Echo Chapter 8 questions and
answers with solutions
Timing of the Exam
Commonly performed between 18-22 weeks.
Some forms of CHD may be recognized during earlier stages of pregnancy
Cardiac Axis
Describes the rotational orientation of the the heart in the thorax
cardiac axis : normal
Apex of heart points to left (45 +/- 20 degrees.
cardiac axis : levocardia
Apex points too far to left (> 65 degrees)
cardiac axis : dextrocardia
Apex points to right
cardiac axis : mesocardia
Apex points midline
severe levocardia
- Apex of the heart pointing greater than 65 degrees leftward
- associated with a significant increase risk of congenital heart disease
- often occurs due to an abnormality that results in an increased right atrium:
Epstein anomaly
Severe tricuspid regurgitation
Coarctation of the aorta
,Dextrocardia
- Apex of the heart points to the right of the fetal chest
- can occur in isolation, or associated with heterotaxy
- isolated dextrocardia is associated with congenital heart disease and 95% of cases:
Abnormal pulmonary arteries/valve
DORV (DOLV)
VSD
ASD
Single ventricle
note: abdominal organs in correct position example stomach on the left
- dextrocardia with heterotaxy is associated with congenital heart disease in up to 25% of cases:
Atrial isomerism
Abnormal pulmonary artery / valves
AVSD
Anomalous pulmonary venous return
Conotruncal abnormalities
note: abdominal organs also switched. example situs inversus totalis
isolated dextrocardia
abdominal organs in the correct position
dextrocardia with heterotaxy
abdominal organs also switched example situs inversus totalis
, mesocardia
- apex of the heart points midline
- associated with congenital heart disease and 25% of cases:
Congenitally corrected TGA
Conotruncal anomalies
- associated with heterotaxy
- associated with increased risk of chromosome abnormality or syndrome:
22q11 deletion
Turner syndrome
Trisomy 18
cardiac position
describes the overall location of the heart in the chest.
- levoposition
- dextroposition
- ectopia cordis
Ectopia Cordis
Heart located outside the thoracic cavity
type : description : percent
- thoracic : heart displaced from thoracic cavity through a sternal defect : 60%
- abdominal : heart displaced into the abdomen through a diaphragmatic defect : 30%
- thoracoabdominal : heart displaced from the chest through a defect in a lower sternum, with
an associated diaphragmatic or ventral abdominal wall defect (Pentalogy of Cantrell) : 7%
- cervical : heart displaced into the neck area : 3%
Dextroposition
- bulk of the heart within the right thorax
- Apex points to the left
answers with solutions
Timing of the Exam
Commonly performed between 18-22 weeks.
Some forms of CHD may be recognized during earlier stages of pregnancy
Cardiac Axis
Describes the rotational orientation of the the heart in the thorax
cardiac axis : normal
Apex of heart points to left (45 +/- 20 degrees.
cardiac axis : levocardia
Apex points too far to left (> 65 degrees)
cardiac axis : dextrocardia
Apex points to right
cardiac axis : mesocardia
Apex points midline
severe levocardia
- Apex of the heart pointing greater than 65 degrees leftward
- associated with a significant increase risk of congenital heart disease
- often occurs due to an abnormality that results in an increased right atrium:
Epstein anomaly
Severe tricuspid regurgitation
Coarctation of the aorta
,Dextrocardia
- Apex of the heart points to the right of the fetal chest
- can occur in isolation, or associated with heterotaxy
- isolated dextrocardia is associated with congenital heart disease and 95% of cases:
Abnormal pulmonary arteries/valve
DORV (DOLV)
VSD
ASD
Single ventricle
note: abdominal organs in correct position example stomach on the left
- dextrocardia with heterotaxy is associated with congenital heart disease in up to 25% of cases:
Atrial isomerism
Abnormal pulmonary artery / valves
AVSD
Anomalous pulmonary venous return
Conotruncal abnormalities
note: abdominal organs also switched. example situs inversus totalis
isolated dextrocardia
abdominal organs in the correct position
dextrocardia with heterotaxy
abdominal organs also switched example situs inversus totalis
, mesocardia
- apex of the heart points midline
- associated with congenital heart disease and 25% of cases:
Congenitally corrected TGA
Conotruncal anomalies
- associated with heterotaxy
- associated with increased risk of chromosome abnormality or syndrome:
22q11 deletion
Turner syndrome
Trisomy 18
cardiac position
describes the overall location of the heart in the chest.
- levoposition
- dextroposition
- ectopia cordis
Ectopia Cordis
Heart located outside the thoracic cavity
type : description : percent
- thoracic : heart displaced from thoracic cavity through a sternal defect : 60%
- abdominal : heart displaced into the abdomen through a diaphragmatic defect : 30%
- thoracoabdominal : heart displaced from the chest through a defect in a lower sternum, with
an associated diaphragmatic or ventral abdominal wall defect (Pentalogy of Cantrell) : 7%
- cervical : heart displaced into the neck area : 3%
Dextroposition
- bulk of the heart within the right thorax
- Apex points to the left
