Septal Defects - Left side of Heart

What is Mitral Stenosis/Atresia?

• Thickened mitral orifice & immobile

• Small left ventricle (hypoplastic left heart) due to decreased inflow

Left ventricular inflow disturbance type is considered…

Mitral Stenosis or Atresia

What is seen with Mitral Stenosis if aortic atresia is present?

Myocardial thickness is increased

• Secondary to increased left ventricular pressure overload

____ chamber view compares placement of mitral valve with slightly apical position of tricuspid valve.

4 [LVOT view may be used too]

• Check for mobility of leaflets

Mitral Stenosis

Left ventricular outflow disturbance type is considered…

• Abnormal Aortic Valve

• Critical Aortic Stenosis

Aortic valve between LV & Aorta normally has _____ semilunar cusps

3

Semilunar cusps can be seen best in _____ and ______ axis planes.

• Long

• Short

If development of aortic valve is interrupted: Bicuspids =

2 leaflets with asymmetric cusps

If development of aortic valve is interrupted: Unicuspid =

1 leaflet with central opening & aortic stenosis

What causes a Critical Aortic Stenosis?

Infection or virus

• Causing Aortic leaflets to thicken & close prematurely

Critical Aortic Stenosis results in…

• Enlarged, dysfunctional LV because LVOT is obstructed

• Thin LV walls & bulge into RV

What is an aortic stenosis?

Abnormal development of these cusps, aortic valve results in the thickened domed appearance

Critical Aortic Stenosis

When a small left ventricle is seen, what should the sonographer suspect?

Hypoplastic Left Heart Syndrome 

• Underdevelopment characteristics 

What syndromes are associated with Hypoplastic left heart syndrome?

• Coarctation of aorta

• Hypoplasia of aortic arch

  • Autosomal Recessive Traits

What causes Hypoplastic left heart syndrome?

Unknown cause, may be due to decrease perfusion and filling of the left ventricle

What is the prognosis of Hypoplastic left heart syndrome?

Multiple surgeries need to be done and eventually a transplant may be needed to improve the prognosis

Blockage in Aortic Arch

Hypoplastic Left Heart Syndrome

When something is found in the wrong place, what should the sonographer suspect?

Transposition of the Great Vessels

With Transposition of Great Vessels: where does the Aorta arise from?

Right ventricle & supplies systemic circulation with deoxygenated blood

With Transposition of Great Vessels: where does the PA arise from?

Left ventricle & supplies the lungs with oxygenated blood

With Transposition of Great Vessels, vessels do NOT ________, they run ______ to each other.

• Crisscross

• Parallel

What is the best way to view Transposition of Great Vessels?

Parasternal short-axis

• 4 chamber view

What abnormalities are associated with Transposition of Great Vessels?

• Pulmonary stenosis

• Underdevelopment of RT and LT ventricle

• Valve anomalies

Label this image.

• Blue - Aorta

• Green - Pulmonary Artery

• Orange - Left atrium 

With Transposition of Great Vessels, the ____ ____ ____ may appear normal.

4-chamber view

• Will see the vessels run parallel when we are attempting to obtain our 3-vessel view

What is Truncus Arteriosus?

Single great artery where the pulmonary trunk, aorta, coronary arteries arises from the same spot

• Single large truncal artery arising from the base of the heart

How does Truncus Arteriosus develop?

Early in development, failure of the bulbus to divide into the great arteries causing that single vessel

What anomalies are associated with Truncus Arteriosus?

• Mitral atresia

• ASD

• VSD

• Univentricular heart

• Aortic arch anomaly

What is the US findings of Truncus Arteriosus?

Abnormal large single vessel

• Multiple cusps within great artery

• May see hydrops, CHF, and effusions

What is the prognosis for Truncus Arteriosus?

Poor. Hydrops or pericardial fluid —> CHF

Truncus Arteriosus

Single ventricle

What view is a single ventricle best evaluated in?

4-chamber

What is present and absent in a heart that only has one ventricle?

• One ventricle

• Two atrium

• Mitral and Tricuspid valves

What causes a single ventricle to form?

A VSD

What is Coarctation of the Aorta?

Discrete shelf like lesion present in aortic arch, at isthmus or more commonly ductal insertion near left subclavian artery

____% of cases are associated with other intracardiac malformations

90 [Type 1]

Characteristics describing Type 1 of Coarctation of the Aorta.

Most common

• Focal narrowing at or just distal to ductus arteriosus

• Post ductal coarctation

Characteristics describing Type 2 of Coarctation of the Aorta.

• Narrowing is proximal to ductus arteriosus

• Preductal coarctation

  • Ductal insertion near left subclavian

What are the US findings seen with Coarctation of the Aorta?

• Left ventricle smaller than right ventricle

• Bicuspid aortic valve, narrow area of the aorta

What anomalies are associated with Coarctation of the Aorta?

• Aortic stenosis

• Aortic insufficiency

• VSDs

• TPOGA

• Truncus arteriosus

• Double outlet right ventricle

• Turners Syndrome

With Coarctation of the Aorta, a long segment of narrowing is associated with a ______.

VSD

Coarctation of the Aorta

When an enlarged heart is seen, what should the sonographer suspect?

Cardiomegaly

What may cause the fetal heart to enlarge?

• Hydrops

• Increased flow

• Intrinsic cardiac anomaly

• Cardiomyopathy

• Cardiac tumor

Cardiomegaly

Fetal Hydrops

What is a Rhabdomyoma?

Most common [58%], benign & isolated cardiac mass

• Very unusual

What is the best plane to evaluate a Rhabdomyoma?

4-chamber

• There may be multiple 

• May involve the septum

A Rhabdomyoma mass is associated with…

• Tuberous sclerosis

• Regurgitation or obstruction due to placement of mass

  • Large = symptomatic & causes obstruction of outflow tract

What is the prognosis of a Rhabdomyoma tumor?

Depends on: size, location, and type

• Leads to CHF, Pericardial fluid, Hydrops & possible Death

Rhabdomyoma

What is Ectopic Cordis?

Abnormal development of primitive heart OUTSIDE the embryonic disk

• Stemming from a ventricle wall defect

What anomalies are associated with Ectopic Cordis?

• Facial defects

• Skeletal defects

• Ventral wall defects

• Cardiac anomalies

• CNS malformations

What specific cardiac anomalies are associated with Ectopic Cordis?

• Tetralogy of Fallot

• Transposition of great vessels

What specific CNS malformations are associated with Ectopic Cordis?

• Meningocele

• Cephalocele

What is the prognosis for Ectopic Cordis?

Poor

Ectopic Cordis

What are Dysrhythmias?

Fetal heart undergoes multiple changes

Progression of cardiac electrical system _________ to cause normal sinus rhythm

Matures

It is not uncommon to see decelerations in HR or even a pause, but what other factors may be causing this?

• Fetus may be lying on umbilical cord

• Transducer pressure is too great

What may be done to help the fetal heart resume normal rhythm?

• Give time to recover

• Change position of mother

• Release transducer pressure