Fetal Heart Project

Shelley Kraft (DMS 463 OB/GYN II 2014)

Apical 4 chamber

T
V
MV

1.

FO

SPINE

Ebstein anomaly
a. Definition inferior displacement of the tricuspid valve, tethered leaflets from
their normal location at the atrioventricular junction into the right ventricle with
tricuspid dysplasia, and right ventricle dysplasia.
b. Sonographic features reduction in the size of the functional right ventricle
caused by atrilization of the right ventricular inlet; there will be apical, and
usually posterior, displacement of the septal leaflet of the tricuspid valve into the
right ventricle; dilated right atrium; color and spectral Doppler will reveal
tricuspid regurge along with diminished flow due to potential pulmonary atresia
or stenosis.
2. Hypoplastic right ventricle
a. Definition small right ventricle; usually occurs secondary to pulmonary atresia
and tricuspid valve atresia due to the limited flow volume of blood flowing
through the ventricle.
b. Sonographic features small, hypertrophic right ventricle; small or absent
pulmonary artery which causes obstruction due to lack of blood pumping through
it and possibly the absence of a tricuspid valve. All of these result in an

unvientricular appearance. Doppler ultrasound will demonstrate decreased flow

through the tricuspid valve or pulmonary artery.
3. Univentricular heart
a. Definition a rare condition in which two atria empty into a single ventricle by
two atrioventricular valves or a common A-V valve resulting from a failure of the
interventricular septum to develop.
b. Sonographic features single ventricle with absence of the interventricular
septum is seen. Doppler will determine if the normal outflow tract is present with
normal velocities acquired with a forward color scale of blood being pumped out
of the heart; potentially outflow tract obstruction may be visualized. With
obstruction spectral Doppler will indicate little to no forward moving flow
through the pulmonary artery with a possible jet with increased velocities and
aliasing through the stenosis. Color Doppler will also demonstrate minimal
forward moving flow, based upon color scale and aliasing at the stenosis. In some
cases a hypoechoic, rudimentary accessory ventricle may be present.

Subcostal 4 chamber
M
V

FO
TV
1.

Muscular ventricular septal defect

a. Definition a ventricular septal defect as referred to as a perimembranous defect
that also involves not only the membranous portion of the septum, but a portion of
the muscular septum as well. Can be considered inlet, trabecular, or outlet
depending on which area of the septum it occurs.
b. Sonographic features it appears as an anechoic area of discontinuity in the
interventricular septum. Color Doppler will demonstrate blood flow passing
through this defect from a ventricle of higher pressure to lower pressure.
2. Ostium primum atrial septal defect
a. Definition the second most common type of ASD which is located low in the
atrial septum, near the atrioventricular valves. May occur alone, but generally
accompanies a more complex congenital anomaly.
b. Sonographic features an anechoic area within the atrial septum visualized in the
primum portion of the atrial septum. Color Doppler will demonstrate blood flow
flowing across the septum from low pressure to high pressure. Spectral Doppler
will also document this shunt of blood flow as well.
3. Ostium secundum atrial septal defect

a. Definition most common form of ASD and occurs at the secundum portion of
the atrial septum. It is caused by excessive resorption of the septum primum or by
inadequate growth of the septum secundum.
b. Sonographic features an anechoic area within the atrial septum that
demonstrates a void in the atrial septum. Color Doppler will demonstrate blood
flow through this anechoic space from the atrium with higher pressure to lower
pressure. Spectral Doppler will also indicate forward flow depending on the scale
from one atria to the other.

Long axis RVOT

PV

1.

Hypoplastic right ventricle

a. Definition small right ventricle; usually occurs secondary to pulmonary atresia
and tricuspid valve atresia due to the limited flow volume of blood flowing
through the ventricle.
b. Sonographic features small, hypertrophic right ventricle; small or absent
pulmonary artery which causes obstruction due to lack of blood pumping through
it and possibly because of the absence of a tricuspid valve. Doppler ultrasound
will demonstrate decreased flow through pulmonary artery.
2. Double outlet right ventricle
a. Definition a malformation in which the both the aorta and the pulmonary artery
arise from the right ventricle. It can occur in three different forms: aorta
posterior and to the right of the pulmonary artery; aorta and pulmonary artery
parallel, with the aorta anterior and to the right; and aorta and pulmonary artery
parallel, with the aorta and anterior and to the left. A ventricular septal defect
(VSD) is usually, but not always present.
b. Sonographic features Arising from the right ventricle the aorta will arise and run
parallel along the right or left side of the pulmonary artery.
3. Pulmonary stenosis
a. Definition restriction of the motion of the pulmonary leaflets and is commonly
associated with pulmonary annular hypoplasia

b. Sonographic features right ventricle hypoplasia and possibly hypertrophy of the

right ventricle in which thickened hypoechoic walls will be seen. With
hypoplasia of the right ventricle, pulmonary atresia may also be seen due to the
lack of blood flow. Pulse wave and continuous wave along with color Doppler
will demonstrate elevated speed in flow of blood at the pulmonary valve.

Long axis LVOT

AV
AO
RTI
C
RO
OT
1.

SPINE

Persistent truncus arteriosus (type I)

a. Definition a single great vessel arising from the base of the heart and supplies
the systemic, pulmonary, and coronary blood flow
b. Sonographic features a pulmonary artery bifurcates into right and left branches
after it arises from the ascending portion of the truncal vessel. Therefore, one
large vessel will be seen from the right and left ventricle giving the appearance of
a univentricular heart. A VSD will be present, and anechoic opening in the
ventricular septum. The aorta will be seen located off of the side of the truncus
arteriosus.
2. Hypoplastic left heart syndrome
a. Definition the left ventricular cavity is pathologically reduced in size.
b. Sonographic features a reduced hypoechoic left ventricle, smaller than normal;
aortic atresia (small), aortic stenosis (thick/hyperechoic), mitral valve atresia
(small), and possible coarctation of the aorta (narrowing of the anechoic vessel.
Color and spectral (PW/CW) will demonstrate low flow of blood throughout the
left ventricle resulting in aortic atresia/stenosis, mitral valve atresia, or coarctation
of the aorta.
3. Dextrotransposition of the great vessels
a. Definition Atrial ventricle concordance (atria and ventricles are correctly paired)
and ventriculoarterial discordance (aorta arises from right ventricle and the
pulmonary artery arises from the left ventricle)
b. Sonographic features the hypoechoic aortic valve may be seen parallel with the
hypoechoic pulmonary valve that may be stenotic (thickened and echogenic

leaflets), or can be straight and anterior to the pulmonary valve. The aortic valve
is seen to the right or anterior to the pulmonary vein. A VSD may or may not be
seen, an anechoic void within the ventricular septum.

Short axis RVOT

AV

PV

RPA

1.

LPA

Double outlet right ventricle

a. Definition the aorta and the pulmonary artery arise predominately from the right
ventricle
b. Sonographic features the pulmonary artery and aorta are seen parallel to each
other. Stenosis of the aortic or pulmonary valve is commonly seen by thickened
hyperechoic leaflets in gray scale. Color and spectral Doppler may also indicate
stenosis with aliasing visualized with color or increased velocities noted with
spectral Doppler within either valve. Due to stenosis the right ventricle may be
enlarged.
2. Persistent truncus arteriosus (type I)
a. Definition a single great vessel arising from the base of the heart and supplies
the systemic, pulmonary, and coronary blood flow
b. Sonographic features a pulmonary artery bifurcates into right and left branches
after it arises from the ascending portion of the truncal vessel. Therefore, one
large vessel will be seen from the right and left ventricle giving the appearance of
a univentricular heart. A VSD will be present, and anechoic opening in the
ventricular septum. The aorta will be seen located off of the side of the truncus
arteriosus.
3. Tetrology of Fallot
a. Definition the conus septum is located too far anteriorly and divides the conus
into a smaller, anterior right ventricular portion and a larger posterior part;
consists of VSD, overriding aorta, hypertrophy of the right ventricle, and stenosis
of the right ventricular outflow tract.

b. Sonographic features an anechoic aorta will be visualized overriding both

ventricles with an anechoic void within the ventricular septum. Color Doppler
will demonstrate blood jetting across the anechoic void (VSD) in the
interventricular septum.

DA (ductus arteriosus)

PULMONARY
TRUNK

1. Pulmonary stenosis
a. Definition restriction of the motion of the pulmonary leaflets and is commonly
associated with pulmonary annular hypoplasia
b. Sonographic features right ventricle hypoplasia and possibly hypertrophy of the
right ventricle in which thickened hypoechoic walls will be seen. With
hypoplasia of the right ventricle, pulmonary atresia may also be seen due to the
lack of blood flow. Pulse wave and continuous wave along with color Doppler
will demonstrate elevated speed in flow of blood at the pulmonary valve.
2. Coarctation of the aorta
a. Definition narrowing of the aortic lumen, usually occurring between the
insertion of the ductus arteriosus and the left subclavian artery. Another location
is just distal to the left subclavian artery.
b. Sonographic features- a narrowing anechoic descending aorta just past the
anechoic subclavian artery may be seen. Color Doppler will demonstrate aliasing
flow through the narrowing portion of the aorta indicating elevated velocities.
Pulse Doppler will also demonstrate elevated flows leading to an increase in the
scale.
3. Aneurysm of the aorta
a. Definition a dilated portion of the aorta, greater than 1.5 the normal size.
b. Sonographic features abnormal sigmoid shape of the anechoic aorta may be
seen. Color and spectral Doppler will demonstrate aliasing and eddy currents in
the widened area of the anechoic vessel.

AA (aortic arch)

Left
innominate
artery
Left common
carotid artery
Left
subclavian
artery

1.

Coarctation of the aorta

a. Definition narrowing of the aortic lumen, usually occurring between the
insertion of the ductus arteriosus and the left subclavian artery. Another location
is just distal to the left subclavian artery.
b. Sonographic features- a narrowing anechoic descending aorta just past the
anechoic subclavian artery may be seen. Color Doppler will demonstrate aliasing
flow through the narrowing portion of the aorta indicating elevated velocities.
Pulse Doppler will also demonstrate elevated flows leading to an increase in the
scale.
2. Aortic stenosis (valvular)
a. Definition a stricture or obstruction of the ventricular outflow tract.
b. Sonographic features valvular stenosis will present with an aortic valve will
appear thickened with dilation of the anechoic aorta just distal to the valve.
Doppler will demonstrate increased velocities and turbulent flow with color
aliasing.
3. Tetrology of Fallot
a. Definition the conus septum is located too far anteriorly and divides the conus
into a smaller, anterior right ventricular portion and a larger posterior part;
consists of VSD, overriding aorta, hypertrophy of the right ventricle, and stenosis
of the right ventricular outflow tract.
b. Sonographic features an anechoic aorta will be visualized overriding both
ventricles with an anechoic void within the ventricular septum. Color Doppler
will demonstrate blood jetting across the anechoic void (VSD) in the
interventricular septum.

SVC/IVC

1.

Bilateral SVC
a. Definition congenital anomaly in which there are two superior vena cavas
draining into the right atrium
b. Sonographic features an additional anechoic SVC is seen draining into the right
atrium
2. Absent SVC
a. Definition a congenital abnormality in which there is an absence of the superior
vena cava entering the right atrium.
b. Sonographic features an anechoic SVC will be absent arising from the right
atrium.
3. Sinus venosus atrial septal defect
a. Definition a rare defect that can be of the superior vena cava with the defect
adjacent to the SVC, or of the inferior vena cava with the defect adjacent to the
IVC.
b. Sonographic features an anechoic void in the atrial septum shunting blood from
the right atrium to the left atrium either adjacent to the SVC or IVC. Color
Doppler will demonstrate blood flow jetting across the atrial septum through the
anechoic void.

3 Vessel view

DA

1. Aortic stenosis (valvular)

a. Definition a stricture or obstruction of the ventricular outflow tract.
b. Sonographic features valvular stenosis will present with an aortic valve will
appear thickened with dilation of the anechoic aorta just distal to the valve.
Doppler will demonstrate increased velocities and turbulent flow with color
aliasing.
2. Pulmonary atresia
a. Definition small or absent pulmonary valve leading to a small or absent
pulmonary artery.
b. Sonographic features small or absent pulmonary artery with decreased anechoic
pulmonary artery. Doppler will demonstrate minimal flow with spectral and
color. The right ventricle may be hypoechoic and dilated due to minimal or
absent flow through the pulmonary valve.
3. Bilateral SVC
a. Definition congenital anomaly in which there is an additional SVC draining into
the right atrium.
b. Sonographic features an additional anechoic vessel, SVC, will be seen next to
the pulmonary artery