Fetal Heart Project

Helen McKinney
DMS 463
Obstetrics and Gynecology II

Short Axis RVOT

Pulmonary Valve

Tricuspid Valve

Left Pulmonary Artery

Left Atrium
Aortic Valve
Right Pulmonary Artery

RVOT Short
1. Double Outlet Right Ventricle

Double outlet right ventricle affects the aorta and main pulmonary artery in the
RVOT short view.

Defined as a spectrum of cardiac lesions unified by an abnormal

ventriculoarterial connection. Further defined as a condition in which more than
fifty percent of the aortic root and pulmonary artery arise from the ventricle with
right morphological features.

Identified sonographically in the RVOT short view as the aorta and pulmonary
artery arising from the right ventricle with a parallel orientation to one another.

2. Congenital pulmonic stenosis

Congenital pulmonic stenosis affects the pulmonary artery and the right ventricle
in the RVOT short view.

Defined as obstruction of the right ventricular outflow tract by either an abnormal

pulmonary valve or narrowing of the infundibulum.

Identified sonographically in the RVOT short view as pulmonary artery dilatation

and a small right ventricular chamber.

3. Bicuspid Aortic Valve

Bicuspid aortic valve affects the aortic valve in the RVOT short view.

Defined as the most common cardiac valvular anomaly in which the aortic valve
consists of two leaflets instead of three leaflets.

Identified sonographically in the RVOT short view as two leaflets of the aortic
valve coapting and forming a straight line.

Aortic Arch
Ascending Aorta
Brachiocephalic Artery

Left Common Carotid Artery

Left Subclavian Artery

Descending Aorta

Aortic Arch
1. Coarctation of the aorta

Coarctation of the aorta will affect the aortic arch in an aortic arch view.

It is defined as a narrowing of a segment of the aortic lumen along the aortic arch,
which results in an obstruction to blood flow.

It can be identified in the aortic arch view as a narrowing of the aorta just distal to
the left subclavian artery. Color Doppler will reveal an area of increased velocity
distal to the left subclavian artery.

2. Persistent truncus arteriosus

Persistent truncus arteriosus will affect the aortic arch and the descending aorta in
an aortic arch view.

It is defined as a rare cardiac anomaly in which the truncoconal ridges fail to fuse
resulting in a single great vessel arising from the heart that over rides the
interventricular septum.

Identified sonographically in the aortic arch view as an interruption of the aortic

arch as well as an anomalous pulmonary artery seen originating from the
descending aorta.

3. Cardiosplenic syndromes (Asplenia/Polysplenia)

Cardiosplenic syndromes will affect the normal appearance of the aortic arch in
an aortic arch view.

Defined as disorders of lateralization characterized by the symmetrical

development of normally asymmetrical organs or organ systems.

Identified sonographically in the aortic arch view as a dilated azygous vein

running parallel to the aorta and extending above the heart to join the superior
vena cava.

SVC/IVC

SVC/IVC
1. Hypoplasia of the Right Ventricle

Hypoplasia of the right ventricle will affect right atrium, SVC, and IVC in the
SVC/IVC view.

Defined as hypoplasia of the right ventricle resulting from pulmonary atresia with
an intact ventricular septum which severely reduces blood flow to the right
ventricular chamber impeding its ability to develop properly.

Visualized sonographically in this view with enlargement of the right atrium,

SVC, and IVC.

2. Persistent left SVC

Persistent left SVC can affect the right SVC in a SVC/IVC view.

Defined as the most common congenital venous anomaly in the chest resulting
from failure of degeneration of the left cardinal vein.

Visualized sonographically in this view as the absence of a normal right sided

SVC connecting to the right atrium.

3. Tricuspid Valve Atresia

Tricuspid valve atresia affects the right atrium, SVC, and IVC in a SVC/IVC
view.

Defined as a congenital heart malformation in which the tricuspid heart valve is

missing or abnormally developed.

Visualized sonographically in this view with enlargement of the right atrium,

SVC, and IVC.

Ductal Arch
Pulmonary Valve

Ductal Arch
1. Tetrology of Fallot

Tetrology of Fallot will affect the pulmonary artery in the ductal arch view.

Defined as a common malformation in children born with congenital heart disease

consisting of four classic features including VSD, aortic over ride of the defect,
pulmonary stenosis or atresia, and right ventricular hypertrophy.

Identified sonographically in the ductal arch view as a dilated pulmonary artery.

Color Doppler will reveal retrograde flow from the descending aorta through the
ductus arteriosus into the main pulmonary artery with no detectable antegrade
right ventricular flow.

2. Persistent truncus arteriosus

Persistent truncus arteriosus will affect the descending aorta in a ductal arch view.

It is defined as a rare cardiac anomaly in which the truncoconal ridges fail to fuse
resulting in a single great vessel arising from the heart that over rides the
interventricular septum.

Identified sonographically in the ductal arch view with an absent ductus arteriosus
and aberrant pulmonary arteries arising from the descending aorta.

3. Complete Transposition of the Great Arteries

Complete transposition of the great arteries affects the pulmonary artery and the
aorta in the ductal arch view.

Defined as the aorta arising from the right ventricle and the pulmonary artery
arising from the left ventricle.

Visualized sonographically in the ductal arch view as the pulmonary artery arising
from the left ventricle.

Apical 4-Chamber
Moderator Band

Interventricular Septum

Tricuspid Valve

Atrial Septum
Mitral Valve

Foramen Ovale

Pulmonary Veins

Apical 4 Chamber
1. Ebsteins anomaly

Ebsteins anomaly will affect the tricuspid valve and the right atrium in the apical
4-chamber view.

Ebsteins anomaly is defined as the displacement of the tricuspid valve leaflets

from their normal location at the atrioventricular junction to the right ventricle.

It is identified sonographically in the apical 4-chamber view by inferior

displacement of the echogenic tricuspid valve resulting in atrialization of the right
ventricle. An enlarged right atrium and apical displacement of the echogenic
tricuspid septal leaflet are the most reliable signs.

2. Hypoplastic left heart syndrome

Hypoplastic left heart syndrome will affect the left ventricle and left atrium in an
apical 4-chamber view.

Hypoplastic left heart syndrome is defined as a spectrum of cardiac abnormalities

that includes underdevelopment of the left ventricle, mitral valve, aorta, and aortic
valve.

Identified in the apical 4-chamber view as decreased size of both the left ventricle
and the left atrium. The right atrium and right ventricle will be enlarged due to
alterations in hemodynamics.

3. Univentricular heart

Univentricular heart will affect the right and left ventricles in the apical 4chamber view.

Univentricular heart is defined as a three chambered organ composed of two atria

and one ventricle connected by one or two atrioventricular valves.

Identified in the apical 4-chamber view as three apparent chambers including two
atria and one large ventricle.

Subcostal 4-Chamber
Tricuspid Valve
Atrial Septum
Moderator Band

Foramen Ovale

Pulmonary Veins

Interventricular Septum

Mitral Valve

Subcostal 4-chamber
1. Ebsteins anomaly

Ebsteins anomaly will affect the tricuspid valve and the right atrium in a
subcostal 4-chamber view.

Ebsteins anomaly is defined as the displacement of the tricuspid valve leaflets

from their normal location at the atrioventricular junction to the right ventricle.

Identified sonographically in the subcostal 4-chamber view as a thickened,

displaced, echogenic, septal leaflet of the tricuspid valve. The right atrium will be
visualized as enlarged and compressing the left atrium.

2. Membranous ventricular septal defect

Membranous ventricular septal defect will affect the ventricular septum in a

subcostal 4-chamber view.

A ventricular septal defect is defined as a malformation that results in a

hemodynamic communication between the right and left ventricles.

Identified sonographically in the subcostal 4-chamber view as an anechoic defect

in the membranous septum between the right and left ventricle.

3. Hypoplastic left heart syndrome

Hypoplastic left heart syndrome will affect the left atrium and left ventricle in a
subcostal 4-chamber view.

Hypoplastic left heart syndrome is defined as a spectrum of cardiac abnormalities

that includes underdevelopment of the left ventricle, mitral valve, aorta, and aortic
valve.

Identified in the subcostal 4-chamber view with the right ventricle seen as the
apex forming ventricle as a result of the decreased size of the left ventricle. The
right atrium and right ventricle will be enlarged due to alterations in
hemodynamics.

Long Axis- RVOT

Pulmonary Valve

Left Pulmonary Artery

Right Pulmonary Artery

RVOT Long
1. Tetrology of Fallot

Tetrology of Fallot will affect the pulmonary artery and the right ventricle in the
RVOT long view.

Defined as a common malformation in children born with congenital heart disease

consisting of four classic features including VSD, aortic over ride of the defect,
pulmonary stenosis or atresia, and right ventricular hypertrophy.

Identified sonographically in the RVOT long view as pulmonary artery dilatation

and a small right ventricular chamber with hyperplastic right ventricular walls.

2. Hypoplasia of the Right Ventricle

Hypoplasia of the right ventricle will affect right ventricle and pulmonary artery
in the RVOT long view.

Defined as hypoplasia of the right ventricle resulting from pulmonary atresia with
an intact ventricular septum which severely reduces blood flow to the right
ventricular chamber impeding its ability to develop properly.

Identified sonographically in the RVOT long view as a small hyperechoic

pulmonary artery with an intact ventricular septum arising from the right
ventricle.

3. Double Outlet Right Ventricle

Double outlet right ventricle affects the aorta and main pulmonary artery in the
RVOT long view.

Defined as a spectrum of cardiac lesions unified by an abnormal ventriculoarterial

connection. Further defined as a condition in which more than fifty percent of the
aortic root and pulmonary artery arise from the ventricle with right morphological
features.

Identified sonographically in the RVOT long view as the aorta and pulmonary
artery arising from the right ventricle with a parallel orientation to one another.

3 Vessel View

Ductal Arch

Descending Aorta

Three Vessel View

1. Complete Transposition of the Great Arteries

Complete transposition of the great arteries affects the pulmonary artery and the
aorta in the 3 vessel view.

Defined as the aorta arising from the right ventricle and the pulmonary artery
arising from the left ventricle.

Visualized sonographically in the 3 vessel view as the pulmonary artery and aorta
arising in a parallel orientation. In the 3 vessel tracheal view, only the aorta and
SVC may be visualized displaying a 2 vessel view with no visualization of the
pulmonary artery.

2. Vascular Ring

Vascular ring affects the pulmonary artery, aorta, and ductus arteriosus in the 3
vessel view.

Defined as rare anatomical anomaly of the great vessels which encircle the
trachea and esophagus.

Visualized sonographically in the 3 vessel view as a left sided duct connecting to

the descending aorta in a U configuration. The trachea will be visualized as an
echogenic structure between the right transverse aortic arch and the left ductus
arteriosus.

3. Persistent Left SVC

Persistent left SVC can affect the right SVC in a 3vessel view.

Defined as the most common congenital venous anomaly in the chest resulting
from failure of degeneration of the left cardinal vein.

Identified sonographically in the three vessel view to the left of the pulmonary
artery with or without the presence of the right SVC.

Long Axis- LVOT

Interventricular Septum
Aortic Valve

Mitral Valve

Pulmonary Veins

LVOT
1. Perimembranous ventricular septal defect

Perimembranous VSD will affect the interventricular septum in a LVOT view.

Defined as a malformation resulting in the hemodynamic communication between

the right and left ventricles.

Identified sonographically in the LVOT view as an anechoic defect in the septum

between the right and left ventricles.

2. Endocardial cushion defect

Endocardial cushion defect will affect the LVOT by affecting the aortic root and
the anterior septal bridging leaflet in a LVOT view.

Defined as a spectrum of cardiac malformations that include abnormalities of the

interatrial septum, interventricular septum, and atrioventricular valves resulting
from endocardial cushions of the heart failing to properly fuse.

Identified sonographically in the LVOT view as an anteriorly and superiorly

displaced aortic root and anterior septal bridging leaflet causing a goose neck
deformity or narrowing of the LVOT.

3. Valvular Congenital Aortic Stenosis

Valvular congenital aortic stenosis will affect the aortic valve, aorta, and left
ventricle in a LVOT view.

Defined as obstruction of outflow from the left ventricle, resulting from abnormal
formation of the aortic valve.

Identified sonographically in the LVOT view as a thickened, echogenic aortic

valve that may appear immobile, fused, or dysplastic along with aorta dilatation
and left ventricular enlargement.