Ch 35 - Fetal Echocardiography

When can fetal echo be performed transvaginally?

10-16 weeks

What is the optimum time for a complete anatomical fetal echo?

18-22 weeks

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

3.5 and 6.5 weeks

Cardiovascular system is the _____ organ system to reach functional state

first

By week ____, blood circulation begins 

3

By week ____, heartbeat is seen 

5

Primitive heart is a ______ structure that forms like a large blood vessel from _________ cells in cardiogenic area of embryo

tubular; mesenchymal

Paired _____ _____ _____ develop before the end of the _____ and begin to fuse, forming the primitive heart

endocardial heart tubes; 3rd week 

Vascular system begins during the _____ week in the wall of the ____ _____, _____ _____, and ______

3rd; yolk sac; connecting stalk; chorion 

The blood vessels begin to develop ____ after the vascular system

2 days

____ ____ are formed and cavities develop in the islands to form primitive ____ _____ and ______

Blood islands; blood cells; vessels

Primitive vessels form vascular networks 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 ______; only ____ umbilical vein persists

oxygenated; placenta; one 

Two dorsal aortas fuse in the _____ half of the embryo to form ____ ____ _____

caudal; single dorsal aorta

What is sinus venosus?

Caudal region of the primitive heart

The sinus venosus receives all blood returning to the heart from _____ _____ ____, ____ ____, ____ _____

common cardinal veins; vitelline veins; umbilical veins

The primitive atrium develops into the _______ and ______

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?

During the 4th and 5th 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 through _______ into the _____

hepatic sinusoids; ductus venosus; IVC 

Blood flows from the IVC and superior vena cava and enters into the ____ _____

right atrium 

Blood in the _____ atrium is ____ oxygenated than blood in the umbilical vein

right; 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 small amount of _____ ____ as it returns from lungs via the four _____ _____ into the ____ ____

deoxygenated blood; pulmonary veins; left atrium 

The 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

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 immediate fall in 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 the 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 

pulmonary artery (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 (<60)

Heart rate greater than ____ is tachycardia

>200 bpm

What are fetal risk factors indicating fetal echo?

IUGR

Cardia arrhythmias - MOST COMMON

Abnormal amniocentesis 

Abnormal amniotic fluid collections

Hydrops fetalis 

Presence of extracardiac abnormalities in the fetus are associated with _____ _____ ____

congenital heart disease

What are extracardiac abnormalities that can cause congenital heart disease?

renal anomalies 

gastrointestinal anomalies 

Single umbilical artery 

What are maternal diseases indicating fetal echo?

diabetes

lupus erythematosus

infections during pregnancy 

If one parent has congenital heart defect recurrence risk ranges from ____-____ 

2.5-4%

What is LVOT?

connects left ventricle to aorta

What is RVOT?

connects right ventricle to pulmonary artery

Chap 32 

What is the transducer location when it is placed in the suprasternal notch?

Suprasternal 

What is the transducer location when it is located near body midline and beneath the costal margin?

subcostal 

What is the transducer location when it is located over the apex?

Apical

What is the transducer location when it is placed over the area bounded superiorly by the left clavicle, medially by the sternum, and inferiorly by the apical region?

Parasternal

What is the imaging plane when it is perpendicular to dorsal and ventral surfaces and parallel with the long axis of the heart?

Long axis 

What is the imaging plane when it is perpendicular to dorsal and ventral surfaces and perpendicular to the long axis of the heart?

short axis

What is the imaging plane when there is a apical view and it is parallel with dorsal and ventral surfaces?

4cH heart