Fetal Echo

List 3 “maternal risk factors” that might indicate need for fetal echocardiogram

• Diabetes mellitus 

• Connective tissue disease; lupus erythematosus 

• Maternal use of drugs; lithium or alcohol

List 5 “fetal risk factors” that might indicate need for a fetal echocardiogram

• Intrauterine growth restriction

• Cardiac arrhythmia

• Abnormal amniocentesis indicating a trisomy

• Abnormal amniotic fluid collections

• Abnormal heart rate

• Hydrops fetalis

List 4 “familial risk factors” that might indicate need for a fetal echocardiogram

• Family history of congenital heart defects

• Genetic syndromes associated with heart defects

• Maternal diabetes or other metabolic disorders

• Maternal autoimmune diseases such as lupus

What is the ideal timing in menstrual weeks, to evaluate the fetal heart?  Which transducer is usually utilized?

• 4.5-5 weeks gestation (heart beats), 5.5-6 weeks gestation (seen); better at 8 weeks of gestation

• 5.0-MHz transducer

List 8 aspects evaluated and included in the “Basic Cardiac Screen”

• Cardiac position

• Cardiac axis

• Cardiac size

• Four-chamber view

• Atrioventricular (AV) valves

• Left and right ventricular outflow tracts

• Three-vessel view

• Heart rate and rhythm

List the 7 basic sonographic views for fetal echocardiography that are described in Callen

• Transverse view of the upper abdomen

• Four-chamber view

• Three-vessel view

• Left ventricular outflow tract view

• Right ventricular outflow tract view

• Basal short-axis view

• Aortic arch view

What cardiac chamber lies anterior to the descending aorta?

Left atrium

What is the normal cardiac axis within the fetal chest; pointed in what direction?  Approximately what portion of the chest does the fetal heart occupy?

• 45 degrees to the left of midline

• 1/3 of thoracic area on transverse view of chest

Which of the AV valves is positioned closer to the apex?

Tricuspid valve

What structures are visualized in the “3 vessel view”?

• Main pulmonary artery

• Ductus arteriosus

• Transverse aortic arch

What specific information can be obtained with Doppler of the fetal heart? (List 6)

• Fetal heart rate patterns

• Heart rate variability

• Presence of abnormal waveforms

• Measure blood flow in major vessels

• Evaluate heart function

• Identify fetal arrhythmias

Define visceral heterotaxy syndrome; and right and left isomerism.  What is the clinical presentation?

• Condition where internal organs are reversed or mirrored from normal positions 

• Right isomerism = bilateral right-sided structures

• Left isomerism = bilateral left-sided structures

• Both can lead to complex cardiac anomalies and other organ malformations

What abnormalities are involved with Ebsteins and what specifically would we see on fetal echo?

• Displacement of septal leaflet of tricuspid valve toward the apex of right ventricle

• Abnormal function: 

• Malformed tricuspid valve

• “Atrialized” portion of the right ventricle

• Reduced capacity of pumping portion of right ventricle

Describe 3 specific locations of “ASD”.  Which is most common?  List 4 other congenital anomalies associated with ASD

• Secundum ASD (most common), primum ASD, and sinus venosus ASD

• Other congenital anomalies: ventricular septal defect, patent ductus arteriosus, partial anomalous pulmonary venous return, and atrioventricular septal defect