Term
| State the purpose of the sequential and systematic approach to cardiac anatomy |
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Definition
| To detect cardiac malpositions and to diagnose complex congenital heart disease |
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Term
| Given a list of steps, select the sequence of steps for the echocardiographic examination of the patient with suspected congenital heart disease |
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Definition
| The first step in the sequential approach is to determine atrial situs and to assess the venous inflow patterns of the atria. Then, AV connections are defined and ventricular morphology and position are determined. Finally, ventriculoarterial relationships are evaluated |
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Term
| Given a list of views, choose the best view for examining the following cardiac structures |
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Definition
Atrial Situs - subcostal views.
Abdominal Aorta and Inferior Vena Cava - Transverse Imaging Plane of the abdomen, subcostal long axis
Pulmonary Venous Connections – Apical and Suprasternal window |
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Term
| Discuss how echocardiography is used to determine atrial location and morphology |
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Definition
By using 2-D echocardiography the morphology of the atria can be
determined. The morphologic right atrium always contains the Eustachian valve, and its appendage is shorter and broader than that of the LA. The LA lacks the Eustachian valve and has a more rounded shape than the RA. The LAA is long and thing and has a narrower atrial junction than that of the right |
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Term
| Discuss normal spatial relationship between systemic and venous return and how echocardiography is used to differentiate between the two vessels |
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Definition
| Normally the abdominal AO lies to the left of the spine and the IVC lies to the right of the spine. Compared with the vena cava, the aorta appears larger, more rounded, and more pulsatile. When in doubt, color flow imaging can be used to differentiate between the two vessels by demonstrating higher velocity and primarily systolic flow in the AO |
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Term
| State the approach/view best used for defining pulmonary venous drainage in adults |
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Definition
| With TEE, the pulmonary venous drainage pattern can be defined more precisely |
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Term
| Given a list of echocardiographic characteristics, select the ones that match the characteristics of the left and right ventricles |
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Definition
RV:
Trabeculated endocardial surface
Three papillary muscles
Chordae insert into ventricular spetum
Infundibular muscle band
Moderator band
Triangular cavity shape
Tricuspid atrioventricular valve with relatively apical insertion
LV:
Smooth endocardial surface
Two papillary muscles
Ellipsoidal geometry
Mitral atrioventricular valve with two leaflets with relatively basal insertion. |
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Term
| State the helpful echocardiographic features when examining a patient for ventricular identity |
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Definition
The presence of muscle bundles, particularly the moderator band, gives the RV a trabeculated endocardial surface. In contrast, the LV is characterized by a smooth endocardial surface. This distinction is apparent using echo and serves as one of the more reliable characteristics when determining ventricular morphology.
The relative positions of the AV valves and the presence or absence of chordal insertions into the septum are the most helpful echo features when attempting to determine ventricular identity. |
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Term
| State which views allow the echocardiographer to determine ventricular morphology and the relative positions of the atrioventricular valves |
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Definition
| The Apical 4 chamber. The short axis views permit definition of the papillary muscles and chordal insertions |
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Term
| List the last step in the segmental approach to cardiac anatomy |
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Definition
| The final step in the segmental approach to cardiac anatomy involves identification of the great arteries and their respective connections |
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Term
| State the anatomical relationship of the aorta and the pulmonary artery in a normal heart with concordant connections |
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Definition
| In the normal heart with concordant connections, the morphologic LV gives rise to the Ao and the PA serves as the outlet of the RV. In the presence of normal ventricular orientation, this arrangement results in an anterior and leftward pulmonary artery and a posterior and rightward aorta with a left-sided aortic arch and descending aorta |
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Term
| Define the following normal structures located within the right atrium |
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Definition
oEustachian Valve— is a remnant of the embryologic valve responsible for directing IVC blood across the atrial septum to the LA. Arises along the posterior margin of the IVC to the border of the fossa ovalis.
oChiari Network—a delicate-appearing membranous structure arising near the orifice of the IVC and serving as the valve of the coronary sinus. It is highly mobile and usually fenestrated, and its site of attachment usually varies within the chamber. |
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Term
| Describe Ebstein’s anomaly |
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Definition
| Ebstein’s anomaly consists of apical displacement of the septal and posterior (and sometimes the anterior) leaflets of the TV into the RV. Typically, the leaflets are elongated and redundant with abnormal chordal attachments. This results in “atrialization” of the basal portion of the RV as the functional orifice is displaced apically relative to the anatomic annulus. Ebstein’s anomaly is a spectrum of abnormalities, depending on the extent of apical displacement of the valve, the distal attachments of the leaflets, the size and function of the remaining RV, the degree of TR, and the presence of RVOT obstruction (usually from the redundant anterior TV leaflet) |
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Term
| State the best echocardiographic view for evaluation of Ebstein’s Anomaly |
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Definition
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Term
| Given a list of structures, choose the levels upon which left ventricular inflow obstruction can occur |
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Definition
Pulmonary veins:
Pulmonary vein stenosis (discrete)
Hypoplastic pulmonary veins
Extrinsic compression
Left atrium
Cor triatriatum
Supravalvular stenosing ring
Mitral valve
Hypoplastic mitral valve
Congenital mitral stenosis
Parachute mitral valve
Anomalous mitral arcade
Double-orifice mitral valve |
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Term
| Define Pulmonary Vein Stenosis |
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Definition
| may be seen as an isolated entity or in association with other congenital lesions. In one form, discrete areas of stenosis involving one or more pulmonary veins occur at or near the junction with the LA. Hypoplasia of the pulmonary veins may be present. Visualizing pulmonary vein stenosis with 2-D echo is rarely possible. Color Doppler—turbulent flow in the posterior LA may be the initial echo abnormality and should suggest the possibility of a stenotic pulmonary vein |
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Term
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Definition
| atrial membrane becomes fibrous that impedes the flow of blood through the chamber, these membranes may be located in the middle of the atrium, effectively partitioning the LA into two chambers |
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Term
| Define Supravalvular Stenosing Ring |
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Definition
| atrial membrane becomes fibrous that impedes the flow of blood through the chamber, these membranes may occur at or near the level of the mitral annulus |
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Term
| Define Congenital Mitral Stenosis |
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Definition
| less common than rheumatic mitral valve disease, several anatomic variations exist; Parachute MV, Arcade-type MV and Double-orifice MV |
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Term
| Define Parachute Mitral Valve |
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Definition
| all chordate insert into a single large papillary muscle. |
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Term
| Define Arcade-type Mitral Stenosis |
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Definition
| the chordae insert into multiple small papillary muscles |
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Term
| Define Double-orifice Valve |
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Definition
| duplication of the mitral orifice with or without fusion of subvalvular chordal structures, usually, all the chordae associated with each orifice insert into the same papillary muscle |
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Term
| Define Subvalvular Pulmonic Stenosis |
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Definition
| discrete fibromuscular narrowing or hypertrophied subvalvular muscle bundles, also called “double chambered RV” |
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Term
| Define Arrhythmogenic RV Dyplasia |
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Definition
| dysplasia of the RV myocardium, results in a form of RV cardiomyopathy with decreased contractility and a propensity for ventricular arrhythmias, thinning and hypokinesis of the free wall are characteristic, systolic dysfunction may appear regional or global |
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Term
| Define Pulmonary Valve Stenosis |
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Definition
| most frequently encountered form is characterized by fusion of the PV cusps and incompletely formed raphes resulting in a domelike structure with a narrowed orifice |
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Term
| Define Pulmonary Artery Stenosis |
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Definition
| “peripheral or supravalvular pulmonic stenosis”, several morphologic forms exist, including discrete membrane-like lesions, long tubular stenosis, and tubular hypoplasia, these anomalies frequently are associated with other congenital cardiac and extracardiac lesions |
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Term
| State the level that subvalvular pulmonic stenosis occurs |
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Definition
| Subvalvular pulmonic stenosis usually involves the infundibulum and is less common than valvular stenosis |
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Term
| State the best views for evaluating the right ventricular outflow tract |
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Definition
| Parasternal short-axis and the subcostal 4C |
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Term
| Define Discrete Membranous Stenosis (Subvalvular LV) |
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Definition
| results from a thin, fibrous membrane or ridge that forms a crescentic barrier within the outflow tract just below the AoV, the membrane usually extends from the anterior septum to the anterior mitral leaflet, 50% of patients develop AI |
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Term
| Define Fibromuscular Tunnel (Subvalvular LV) |
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Definition
| diffuse thickening and narrowing of the LVOT with associated concentric LVH, a fibromuscular ridge may also obstruct the outflow tract. Similar to discrete membranous subaortic stenosis, but the obstruction is thicker, is less discrete, and appears more muscular |
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Term
| Define Unicuspid Aortic Valve |
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Definition
| slitlike orifice, resembling an exclamation point |
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Term
| Define Bicuspid Aortic Valve |
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Definition
| two cusps of nearly equal size, two associated sinuses, and a single linear commissure. A raphe may or may not be present and, if present, creates the illusion of three separate cusps, during systole, the number of distinct cusps is apparent |
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Term
| Define Discrete (Supravalvular LV) |
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Definition
| a discrete fibrous membrane in a normal sized aorta usually located near the sinotubular junction |
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Term
| Define Aortic Hypoplasia or Atresia |
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Definition
| more diffuse and extensive narrowing with variable involvement of the branch vessels |
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Term
| Define Interrupted Aortic Arch |
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Definition
May be thought of as an extreme form of
coarctation. The length of the “missing” segment varies as does the relative insertion sites of the arch vessels |
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Term
| Define Coarctation of the Aorta |
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Definition
| localized narrowing of the descending aorta near the origin of the ductus arteriosus, consists of a ridge-like indentation of the posterolateral wall of the aorta resulting from thickening and infolding of the aortic media, typically located just distal to the origin of the left subclavian artery and the specific location may be “preductal” or “postductal” depending on the position of the ridge of tissue relative to the ductus arteriosus |
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Term
| Define Supravalvular (LV) |
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Definition
| dilation of the coronary arteries, sometimes with ostial obstruction, thickening and fibrosis of the aortic cusps, usually with an element of AI |
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