Echo Board Pt. 1

When are all four chambers of the heart fully developed?

8 weeks GA

What is the sino-atrium?

Fetal anatomy that forms atria

What is the primitive ventricle?

Fetal anatomy that forms LV

What are bulbous cords?

Fetal anatomy that forms RV and truncus arteriosus

What is the truncus arteriosus?

Fetal anatomy that forms aorta and pulmonary artery

What is the sinus venosus?

Fetal anatomy that forms SVC, IVC, and atrial floor

(T/F) Right heart pressures are higher than left heart pressures in the fetus.

True; Right heart pressures are higher than left heart pressures in the fetus because lungs are not in use until birth

What composes the fetal circulation system?

1. Umbilical vein carries OXYGENATED blood into IVC

2. Umbilical arteries carry DEOXYGENATED blood to placenta

What is the ductus arteriosus?

Part of fetal circulation system that connects pulmonary artery to aorta and closes within 72 hours after birth to become ligamentum arteriosum

What is the ductus venosus?

Part of fetal circulation system that connects umbilical vein to IVC and closes when umbilical cord is cut to become ligamentum venosum

What is the foramen ovale?

Part of fetal circulation system that connects RA to LA and leaves small indentation after birth called fossa ovalis

Where is the heart located?

Posterior to sternum within middle mediastinum

What angle does the heart lie at?

45 degrees towards left side between third and fifth intercostal space

What is levocardia?

Normal heart axis

What is dextrocardia?

Abnormal heart axis in which heart points towards right side of chest

What is the apex of the heart?

Cone or bottom of heart that consists of tip of left ventricle and rests on diaphragm below seventh rib

What is the base of the heart?

Top of heart that consists of atria and great vessels

What is the most anterior part of the heart?

RV

What is the crux of the heart?

Posterior portion of heart that is junction of atrial and ventricular septums or all four parts of heart

What is the pericardium?

Thin sac that surrounds heart and roots of great vessels

What is located within the pericardial cavity?

10-20 mL or 50 cc of serous fluid used to lubricate for smooth contractions

What are the two layers of the pericardium?

1. Serous: Innermost layer composed of visceral and parietal layers

2. Fibrous: Outermost layer

What is the epicardium or visceral layer of the heart?

Outermost layer composed of connective tissue

What is the myocardial layer of the heart?

Middle layer composed of muscle fibers

What is the endocardial layer of the heart?

Innermost layer composed of epithelial cells

What is the right atrium?

Chamber composed of two portions separated by crista terminalis

• Anterior: Connected to right atrial appendage

• Posterior: Where IVC and SVC enter heart

What is a Eustachian valve?

Valve that protects opening of IVC into RA

Identify this image.

Eustachian valve

What is the Chiari Network?

Net-like remnant of fetal development in RA

What is the Thebesian valve?

Valve that protects coronary sinus opening into RA

Identify this image.

Crista terminalis resembling cardiac mass

What is the normal size of RA?

VOLUME USED TO ASSESS RA SIZE

1. Women: < 27ml/m²

2. Men: < 32 ml/m²

What is the right ventricle?

Chamber composed of three portions

• Posterior inflow: Trabeculated portion containing papillary muscles and TV

• Apex: Heavily trabeculated portion

• Anterior outflow: Smooth walled infundibulum

What is the moderator band?

Muscular tissue that connects IVS to anterior RV free wall to create a quick path for conduction system

What is the normal size of RV?

WIDTH USED TO ASSESS RV SIZE

1. Basal < 4.1 cm

2. Mid < 3.5 cm

3. Apex < 3.5 cm

Where is the moderator band best visualized?

A4C

What is the left atrium?

Chamber composed of two portions

1. True left atrium: Where pulmonary veins enter heart

2. Left atrial appendage (LAA): Posterior portion where blood is stored

(T/F) The left atrial appendage is typically seen transthoracically.

False; LAA is seen with TEE

Where is the left atrial appendage best visualized?

A2C

What is the normal size of the LA?

AREA AND AP USED TO ASSESS LA SIZE

1. Area < 34 ml/m²

2. PLAX AP < 4 cm

What is the left ventricle?

Largest chamber composed of three portions

1. Inflow: Contains MV

2. Apex

3. Outflow: Portion below AV

How much cardiac mass does the left ventricle compose?

75%

What is the normal size of the LV?

WALL THICKNESS AND CHAMBER SIZE USED TO ASSESS LV SIZE

1. Wall thickness in women: 0.6-0.9 cm

2. Wall thickness in men: 0.6-1.0 cm

3. End diastolic chamber size in women: 3.8-5.2 cm

4. End diastolic chamber size in men: 4.2-5.8 cm

What are the differences between the LV and RV?

LV

• No moderator band

• Smooth walled

• 2 papillary muscles

• Bi-leaflet valve

RV

• Moderator band present

• Trabeculations present

• 3 papillary muscles

• Tri-leaflet valve

What oxygen percentage does “deoxygenated” blood have?

75%

• RA

• RV

• MPA

What oxygen percentage does “oxygenated” blood have?

98%

1. Pulmonary veins

2. LA

3. LV

4. Aorta

What is the interatrial septum (IAS)?

Septum located between right and left atrium that is best evaluated SUBCOSTALLY

What is the interventricular septum (IVS)?

Septum between right ventricle and left ventricle that is best evaluated in SHORT AXIS OR SUBCOSTAL

What are papillary muscles?

Muscles attached to atrioventricular valves by chordae tendineae

Identify this image.

1. LV

2. Moderator band

3. Posterior medial papillary muscle

4. Anterior lateral papillary muscle

What are chordae tendineae?

Fibrous strands connecting papillary muscles to leaflet

What are atrioventricular (AV) valves?

Valves located between atria and ventricles

• TV

• MV

What is the tricuspid valve (TV)?

Valve located between RA and RV that contains three leaflets

• Anterior

• Posterior

• Septal or medial

What is the normal valve area for the TV?

5-8 cm²

What is the mitral or bicuspid valve (MV)?

Valve located between LA and LV that contains two leaflets

• Anterior

• Posterior

What is the normal valve area for the MV?

4-6 cm²

(T/F) TV is located higher in the heart than MV.

False; TV is located downset or further down in heart than MV

Identify this image.

PLAX MV

1. MV

2. Anterior leaflet

3. Posterior leaflet

Identify this image.

PLAX MV

1. Anterior leaflet

2. Posterior leaflet

Identify this image.

A4C MV

1. Anterior leaflet

2. Posterior leaflet

What are semilunar valves?

Valves located between ventricles and great vessels or outflow tracts

• PV

• AV

What is the aortic valve (AV)?

Valve between LV and aortic root that contains three leaflets

• Right coronary

• Left coronary

• Non-coronary cusp

What is the normal valve area for the AV?

3-4 cm²

Identify this image.

PLAX AV

1. Right coronary cusp

2. Non-coronary cusp

Identify this image.

1. Non-coronary cusp

2. Right coronary cusp

3. Left coronary cusp

What is the pulmonary valve (PV)?

Valve located between RV and MPA or outflow tract and contains three leaflets

• Right leaflet

• Left leaflet

• Anterior leaflet

Which valve is the most anterior?

PV

What is the superior vena cava (SVC)?

Vessel that drains deoxygenated blood from superior portions of body and empties into posterior RA

What is the inferior vena cava (IVC)?

Vessel that drains deoxygenated blood from inferior portions of body and empties into posterior RA

What is the coronary sinus?

Vessel that drains deoxygenated blood from myocardium and empties into RA

What is the main pulmonary artery (MPA)?

Vessel that carries deoxygenated blood from RV to lungs

What is the normal value for the main pulmonary artery (MPA)?

Mean pulmonary artery pressure (MPAP): 9-18 mmHg

What are the pulmonary veins?

Four vessels that bring oxygenated blood from lungs to heart

What is the right coronary artery (RCA)?

Vessel that arises from right coronary cusp at sinuses of Valsalva and supplies blood to

• Atria

• IAS

• RV free wall

• RV apex

• Inferoseptal LV wall

• Inferior LV wall

• Posterior medial papillary muscle

What is the distal portion of the right coronary artery (RCA)?

Continuation of RCA that gives rise to posterior descending artery (PDA) and supplies blood to

• IVC

• Inferior LV wall

What is the left coronary artery (LCA)?

Vessel that arises from left coronary cusp at sinuses of Valsalva

What is the left anterior descending artery (LAD)?

Branch of LCA that supplies blood to

• Anterior septal wall

• Anterior LV wall

• LV apex

• Anterior lateral papillary muscle

What is the left circumflex (LCX)?

Branch of LCA that supplies blood to

• Inferior lateral LV wall

• Anterior lateral LV wall

• Anterior lateral papillary muscle

Identify this image.

1. RCA

2. Right marginal artery

3. LCA

4. LCX

5. Left marginal artery

6. LAD

7. Diagonal branch

Identify this image.

1. RCA

2. LCA

Identify this image.

A4C

Identify this image.

A2C

Identify this image.

A3C or LONG AXIS

Identify this image.

Base or top

Identify this image.

Mid

Identify this image.

Apex or bottom

What is the “scout view”?

First image taken with an increased depth to visualize effusion

Identify this image.

PLAX

1. RV

2. LA

3. MV

4. LVOT

5. AV

6. Aortic root

7. Descending AO

Identify this image.

PLAX AV measurements during MID SYSTOLE

1. White: LVOT

2. Red: Aortic annulus

Identify this image.

PLAX AV measurements during END DIASTOLE

1. Sinus of Valsalva or aortic root

2. Sinotubular junction (STJ)

3. Ascending aorta

Identify this image.

PLAX LA diameter measured during END SYSTOLE

Identify this image.

PLAX RVIT

A. RV

B. TV

C. RA

Identify this image.

PLAX RVOT

1. RVOT

2. PV

3. Main pulmonary artery

Identify this image.

PSAX AV Basal

1. Descending aorta

2. LA

3. IAS

4. RA

5. TV

6. RVOT

7. PV

8. Main pulmonary artery

9. Right coronary cusp (adjacent to RVOT)

10. Noncoronary cusp

11. Left coronary cusp (adjacent to LA)

Identify this image.

1. Proximal RVOT measured at END DIASTOLE

2. Distal RVOT measured at END DIASTOLE

Identify this image.

PSAX MV level

Identify this image.

Planimetry or most accurate way to measure MVA

Identify this image.

PSAX LV

1. Papillary muscle

2. LV

Identify this image.

LV mass measured at END DIASTOLE

Identify this image.

A4C

1. LA

2. MV

3. LV

4. RA

5. TV

6. RV