Fetal Echocardiography Outline
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Fetal Echocardiography Content Outline

I. Embryology (1%-5%)

A. Timing of heart formation

B. Teratogenic insults

C. Atrial septal components

D. Endocardial cushion

E. d- and l-looping

II. Indications (1%-5%)

A. Maternal

B. Fetal

C. Environmental

III. Incidence of congenital heart disease (5-10%)

A. General population

B. Heredity

C. Chromosomal

D. Syndromes

E. Extracardiac anomalies

IV. Timing of the fetal echocardiographic exam (1%-5%)

A. American Institute of Ultrasound in Medicine Standards

V. Standard sonographic views (10%-20%)

A. Position/Situs

1. Cardiac Axis

2. Cardiac Position

B. Two-dimensional heart views

1. Four-chamber

a. Apical

b. Subcostal

2. Long axis of the aorta (Left ventricular outflow tract)

3. Long axis of the pulmonary artery (Right ventricular outflow tract)

4. Short axis of the ventricles

5. Short axis of the great arteries

6. Aortic arch

7. Ductal arch

8. Five-chamber view

9. Three-vessel view

10. Inferior vena cava/Superior vena cava

C. Doppler Hemodynamics (Pulsed / Color)

1. Regurgitation

2. Stenosis

3. Intracardiac shunts

4. Dysrhythmias

D. M-mode

1. Dysrhythmias

2. Ventricular function

3. Color

VI. Normal fetal heart anatomy (8%-12%)

A. Size

B. Venous connections

1. Superior vena cava

2. Inferior vena cava

3. Pulmonary veins

C. Atria and septum

D. Atrioventricular valves

E. Ventricles and septum

F. Outflow tracts

G. Semilunar valves

H. Great arteries

1. Pulmonary artery

2. Aorta

3. Ductal arch

I. Pericardium

J. Other

VII. Normal fetal heart physiology (4%-8%)

A. Heart rate

B. Blood flow and cardiac output

C. In-utero shunts

1. Ductus venosus

2. Foramen ovale

3. Ductus arteriosus

D. Series circulation

VIII. Structural heart anomalies (35%-55%)

A. Cardiac malposition

1. Levocardia

2. Dextrocardia

3. Mesocardia

4. Levoposition

5. Dextroposition

B. Enlarged heart

1. Dilated cardiomyopathy

2. Hypertrophic cardiomyopathy

a. Type I diabetes mellitus

b. Syndromes

C. Venous abnormalities

1. Bilateral superior vena cava

2. Interrupted inferior vena cava with azygous continuation

3. Pulmonary venous abnormalities

a. Total anomalous pulmonary venous connection

b. Partial anomalous pulmonary venous connection

c. Pulmonary vein stenosis

D. Atria and septum

1. Atrial septal defect

a. Primum

b. Secundum

c. Sinus venosus

d. Unrooted coronary sinus

2. Dilated coronary sinus

a. Left superior vena cava to coronary sinus

b. Anomalous veins to coronary sinus

c. Right atrial obstruction

3. Cor triatriatum

4. Eustachian valve

5. Restrictive foramen ovale

E. Atrioventricular valves

1. Tricuspid valve

a. Atresia

b. Stenosis

c. Regurgitation

(1). Ebstein anomaly

d. Dysplasia

2. Mitral valve

a. Atresia

b. Stenosis

(1). Parachute

(2). Supravalvular mitral ring

c. Regurgitation

(1). Cleft

F. Ventricles and septum

1. Ventricular septal defect

a. Membranous

b. Muscular

c. Inlet

d. Outlet

e. Atrioventricular septal defect

2. Endocardial fibroelastosis

3. Tumors

a. Rhabdomyoma

b. Other

G. Semilunar valves

1. Pulmonary valve

a. Atresia

b. Stenosis

c. Insufficiency

d. Absence

2. Aortic valve

a. Atresia

b. Stenosis

c. Regurgitation

d. Absence

H. Great arteries

1. Transposition of the great arteries

a. d-Transposition of the great arteries

b. l-Transposition of the great arteries

2. Truncus arteriosus

3. Coarctation of the aorta

4. Interrupted aortic arch

5. Ductal constriction

a. Premature

b. Pharmacologic

c. Tetralogy of Fallot

d. Subaortic stenosis

e. Double outlet right ventricle

I. Pericardium

1. Pericardial effusion

2. Pericardial tumor

J. Complex cardiac anomalies

1. Single ventricle

2. Hypoplastic left heart syndrome

3. Hypoplasia of the right ventricle

4. Double inlet left ventricle

5. Heterotaxy

K. Miscellaneous

1. Echogenic intracardiac focus

IX. Dysrhythmias (5%-10%)

A. Bradyarrhythmias

1. Congenital heart block

2. Blocked ectopic beats

B. Tachyarrhythmias

1. Supraventricular tachycardia

2. Atrial flutter

3. Ventricular tachycardia

C. Ectopy

1. Premature atrial contractions

2. Premature ventricular contractions

X. Acquired pathology (1%-5%)

A. Metabolic/Endocrine

1. Type I diabetes mellitus

2. Phenylketonuria

3. Collagen vascular disease

4. Hyperthyroidism

B. Infection

1. TORCH

2. Parvovirus

C. Twin-to-twin transfusion

D. Intrauterine growth restriction

E. Drugs

XI. Miscellaneous (1%-5%)

A. Hydrops fetalis

B. Extracardiac anomalies

C. Syndromes

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