Fetal Echocardiography

What are transducer locations for fetal echo?

1. suprasternal

2. subcostal

3. apical

4. parasternal

What are imaging planes for fetal echo?

1. long axis

2. short axis

3. 4CH

What is apical view?

transducer located over apex, giving a 4CH view

Label the fetal heart

https://www.purposegames.com/game/fetal-heart-quiz

When can fetal echo be performed transvaginally?

10-16 weeks

What is the optimum time for fetal echo?

18-22 weeks

The most sensitive period in the first trimester for cardiac development is between ___ weeks

3.5 and 6.5

The cardiovascular system is the first organ system to reach a ___ state

functional

By week __, blood circulation begins

3

By week __, heartbeat is seen

5

The primitive heart is a ___ structure that forms like a large blood vessel from the ___ cells in the cardiogenic area of the embryo

tubular; mesenchymal

Paired ___ ___ ___ develop before the end of the third week and begin to fuse, thus forming the primitive heart

endocardial heart tubes

The vascular system begins during the third week in the wall of the ___ ___, the ___ ___, and the ___

yolk sac; connecting stalk; chorion

Blood vessels begin to develop ___ after vascular system

2 days

___ ___ are then formed and cavities develop inside to form primitive blood cells and vessels

Blood islands

Primitive vessels form a vascular network in the wall of the ___ ___

yolk sac

Cardinal veins return blood from the ___

embryo

Vitelline veins return blood from the ___

yolk sac

Umbilical veins return ___ blood from the ___ (only one umbilical vein persists)

oxygenated; placenta

Two dorsal aortas fuse in the caudal half of the embryo to form a ___

single dorsal aorta

What is sinus venosus?

caudal region of the primitive heart

The sinus venosus receives all blood returning to the heart from ___, ___, and ___

common cardinal veins; vitelline veins; umbilical veins

The primitive atrium develops into the ___

right and left atria

The primitive ventricle develops into the ___

left ventricle

The bulbus cordis develops into the ___

right ventricle

The truncus arteriosus dilates to form ___ from which ___ arise

aortic sac; aortic arches

When does division of the heart into four chambers occur?

4-5 weeks

Communication is open between the right and left atrium of the fetal heart through the ___

foramen ovale

Communication is also open between the aorta and the ___ via the ___

pulmonary artery; ductus arteriosus

Before birth, oxygenated blood is given to the fetus through the ___ from the ___ to the heart

umbilical vein; placenta

Half of the oxygenated blood passes through ___, the rest bypasses the liver to go through ___ into the ___

hepatic sinusoids; ductus venosus; IVC

The ductus venosus connects the ___ and ___

umbilical vein; IVC

Blood flows from the IVC and SVC and enters into the ___

right atrium

Blood in the right atrium is ___ oxygenated than blood in the umbilical vein

less

Small amount of oxygenated blood from IVC is diverted by the ___ and remains in the ___ to mix with deoxygenated blood from the ___ and ___

crista dividens; right atrium; SVC; coronary sinus

Most of the blood from IVC is directed by lower border of ___ through the foramen ovale into ___

septum secundum; left atrium

Blood in RA flows through the ___ valve into the ___ and leaves through the ___

tricuspid; right ventricle; main pulmonary artery (MPA)

MPA bifurcates into right and left pulmonary artery branches that lead to their respective ___

lungs

Most of this blood passes through the connection of the ___ into the ___; only a very small amount goes to the lungs

ductus arteriosus; descending aorta

Blood mixes with a small amount of ___ blood as it returns from the lungs via the four ___ into the ___

deoxygenated; pulmonary veins; left atrium

Pulmonary veins enter the posterior of the ___

left atrium

The four pulmonary veins are named according to their locations:

right upper, left upper, right lower, and left lower

Blood then flows from LA into LV through ___ and leaves heart through ___

mitral valve; ascending aorta

What are branches of fetal ascending aorta?

- innominate artery

- left carotid artery

- left subclavian artery

The rest of the mixed blood in the descending aorta passes into the ___ and is returned to the placenta for ___

umbilical arteries; reoxygenation

Circulation of fetal blood through placenta ceases at birth when the ___ begin to function

neonatal lungs

What fetal cardiac structures are no longer necessary at birth?

- foramen ovale

- ductus arteriosus

- ductus venosus

- umbilical vessels

Omission of placental circulation causes an immediate fall of blood pressure in newborn's ___ and ___

IVC; RA

As lungs expand with air, there is a ___ in pulmonary vascular resistance. This causes an ___ in pulmonary blood flow and progressive ___ of walls of the pulmonary arteries

fall; increase; thinning

Pressure in the left atrium becomes ___ than that in the right atrium. This causes the ___ to close

higher; foramen ovale

With time, complete closure of foramen occurs from adhesion of the septum ___ to the left margin of the septum ___

primum; secundum

Septum primum forms the floor of the ___

fossa ovalis

Ductus arteriosus constricts ___ after birth, once ___-sided pressures exceed the ___-sided pressures

24-48 hours; left; right

There is a small shunt of blood from aorta to ___ until these pressures adjust to neonatal life

PA

Once the ductus arteriosus closes, it turns into ___ in the neonate

ligamentum arteriosum

If ductus arteriosus communication persists, it is called a ___

patent ductus arteriosus

Umbilical ___ also constrict after birth to prevent blood loss from the neonate

arteries

Umbilical ___ may remain patent for some time after birth

vein

What is normal fetal heart rate?

120-160 bpm

In first trimester, heart rate begins around ___ and increases to ___ before returning to normal rate and sinus rhythm

90 bpm; 170 bpm

Heart rate less than ___ is bradycardia

100 bpm

Heart rate greater than ___ is tachycardia

200 bpm

What are fetal risk factors indicating fetal echo?

- IUGR

- cardiac arrhythmias

- abnormal amniocentesis

- abnormal amniotic fluid collections

- hydrops fettles

Presence of extracardiac abnormalities in the fetus are associated with ___

congenital heart disease

What are maternal diseases indicating fetal echo?

- diabetes

- lupus

- infections during pregnancy

If one parent has congenital heart defect, recurrence risk ranges from ___%

2.5 to 4

What is LVOT?

connects left ventricle to aorta

What is RVOT?

connects right ventricle to pulmonary artery