Fetal Heart Sonographic Evaluation:
Anatomy, Abnormalities, and
Screening
What is the purpose of a normal fetal cardiac screening examination? - CORRECT ANSWERS
To identify two atrial chambers of approximately the same size with a normal-appearing foramen ovale
flap in the left atrium.
What is heterotaxy in the context of fetal heart morphology? - CORRECT ANSWERS A
condition where the heart has inappropriate symmetry, often requiring investigation of atrial
morphologic appearance.
What are the two types of atrial morphologic features associated with heterotaxy? - CORRECT
ANSWERS (1) Sickle shape with tip pointing laterally and apically, (2) Blunt shape
resembling the usual atrial appearance.
What is the significance of differentiating between bilateral left and bilateral right isomerism? -
CORRECT ANSWERS It is important because left atrial isomerism has greater attrition
during fetal life, while right atrial isomerism is associated with postnatal problems.
What is an atrial septal aneurysm? - CORRECT ANSWERS A condition defined as redundant
tissue extending at least halfway across the left atrium, found in 7.6% of fetal echocardiograms.
What is the typical outcome for atrial septal aneurysms after birth? - CORRECT ANSWERS
They almost always resolve after birth and are not typically associated with major cardiac dysrhythmias.
What should be assessed during routine screening of the fetal heart? - CORRECT ANSWERS
The pulmonary veins, ensuring at least two of the four pulmonary veins enter the left atrium.
What condition should be suspected if the connection between the pulmonary veins and the left atrium
is not evident? - CORRECT ANSWERS Total anomalous pulmonary venous return (TAPVC).
, What is the role of pulsed-Doppler studies in diagnosing TAPVC? - CORRECT ANSWERS They
can confirm the diagnosis based on standard axial views during the cardiac screening examination.
What is the normal size ratio of the right ventricle to the left ventricle during late gestation? - CORRECT
ANSWERS The normal RV/LV size ratio increases with gestational age, with 90% confidence
intervals ranging from 0.79 to 1.24.
What is the typical shape and position of the left ventricle in relation to the right ventricle? - CORRECT
ANSWERS The left ventricle is cone-shaped and lies posterior to and leftward of the right
ventricle.
What are the two distinct papillary muscles found in the left ventricle? - CORRECT ANSWERS
The anterolateral and posteromedial papillary muscles.
What connects the papillary muscles to the mitral valve? - CORRECT ANSWERS Chordae
tendineae.
What is the significance of visualizing the coronary sinus during fetal echocardiography? - CORRECT
ANSWERS It can be visualized in the left atrioventricular groove and is important for
assessing atrial anatomy.
What is the primary reason for investigating atrial morphologic appearance in fetuses? - CORRECT
ANSWERS To rule out heterotaxy (isomerism) and assess for potential cardiac anomalies.
What is the incidence of atrial septal aneurysm found in a retrospective study of fetal echocardiograms?
- CORRECT ANSWERS 7.6%.
What are the implications of severe atrial septal aneurysms that extend over the mitral valve apparatus?
- CORRECT ANSWERS They may be associated with left-right asymmetry and occasionally
with coarctation of the aorta.
Anatomy, Abnormalities, and
Screening
What is the purpose of a normal fetal cardiac screening examination? - CORRECT ANSWERS
To identify two atrial chambers of approximately the same size with a normal-appearing foramen ovale
flap in the left atrium.
What is heterotaxy in the context of fetal heart morphology? - CORRECT ANSWERS A
condition where the heart has inappropriate symmetry, often requiring investigation of atrial
morphologic appearance.
What are the two types of atrial morphologic features associated with heterotaxy? - CORRECT
ANSWERS (1) Sickle shape with tip pointing laterally and apically, (2) Blunt shape
resembling the usual atrial appearance.
What is the significance of differentiating between bilateral left and bilateral right isomerism? -
CORRECT ANSWERS It is important because left atrial isomerism has greater attrition
during fetal life, while right atrial isomerism is associated with postnatal problems.
What is an atrial septal aneurysm? - CORRECT ANSWERS A condition defined as redundant
tissue extending at least halfway across the left atrium, found in 7.6% of fetal echocardiograms.
What is the typical outcome for atrial septal aneurysms after birth? - CORRECT ANSWERS
They almost always resolve after birth and are not typically associated with major cardiac dysrhythmias.
What should be assessed during routine screening of the fetal heart? - CORRECT ANSWERS
The pulmonary veins, ensuring at least two of the four pulmonary veins enter the left atrium.
What condition should be suspected if the connection between the pulmonary veins and the left atrium
is not evident? - CORRECT ANSWERS Total anomalous pulmonary venous return (TAPVC).
, What is the role of pulsed-Doppler studies in diagnosing TAPVC? - CORRECT ANSWERS They
can confirm the diagnosis based on standard axial views during the cardiac screening examination.
What is the normal size ratio of the right ventricle to the left ventricle during late gestation? - CORRECT
ANSWERS The normal RV/LV size ratio increases with gestational age, with 90% confidence
intervals ranging from 0.79 to 1.24.
What is the typical shape and position of the left ventricle in relation to the right ventricle? - CORRECT
ANSWERS The left ventricle is cone-shaped and lies posterior to and leftward of the right
ventricle.
What are the two distinct papillary muscles found in the left ventricle? - CORRECT ANSWERS
The anterolateral and posteromedial papillary muscles.
What connects the papillary muscles to the mitral valve? - CORRECT ANSWERS Chordae
tendineae.
What is the significance of visualizing the coronary sinus during fetal echocardiography? - CORRECT
ANSWERS It can be visualized in the left atrioventricular groove and is important for
assessing atrial anatomy.
What is the primary reason for investigating atrial morphologic appearance in fetuses? - CORRECT
ANSWERS To rule out heterotaxy (isomerism) and assess for potential cardiac anomalies.
What is the incidence of atrial septal aneurysm found in a retrospective study of fetal echocardiograms?
- CORRECT ANSWERS 7.6%.
What are the implications of severe atrial septal aneurysms that extend over the mitral valve apparatus?
- CORRECT ANSWERS They may be associated with left-right asymmetry and occasionally
with coarctation of the aorta.
