heart point to the left 45 degrees

left ventricle drains into aorta

right ventricle drains into pulmonary trunk/artery

displaced heart

different echogenicity to lungs

(mass may be isoechoic to lungs)

chest masses are life threatening due to cardiac failure and pulmonary hypoplasia

Opening in the diaphragn that allows contents to pass through

*most common cause for malposition of the heart

Compression of lung by invading contents may cause pulmonary hypoplasia and secondary respiratory disease

False.

95% unilateral

True

50% of CDH has associated abnormalities.

up to 85% contain herniated liver

bochdalek hernia: defect in the posterlateral aspect of the diaphragm (most common)

morgagnic hernia: defect in the anterior diaphragm (rare)

displaced heart

stomach in thorax

bowel in chest

liver in chest

spleen in chest

decreased AC

Cardiac abnormalities

chromosomal adnormalities

pulmonary hypoplasia

What is the prognosis of CDH?

What is the measurement used to determine prognosis?

CDH only: poor

CDH w/ other abnormalities: even worse

Lung/HC Index: if less than 1, poor prognosis. 1.4 and up is good prognosis

Left Sided hernia: most common. contents in chest: stomach, bowel, lt lobe of liver (doppler shows LPV)

Right Sided hernia: liver in chest displacing heart to far left. rt lobe of liver (doppler shows RPV)

*harded to see in utero b/c lung & liver are isoechoic

rare, benign, pulmonary tumor

multicystic mass within the lung consisting of overgrowth of the bronchial tissue

I - macrocystic (cysts > 2cm)

II - multiple small cysts < 1cm

III - microcystic (appearing solid)

solid or cystic lung mass with arterial supply from pulm. artery

heart may be displaced

hydrops (10%) - most important predictor of outcome. 100% mortality if untreated hydrops.

polyhydramnios

variable size

single or multiple large cysts > 2 cm

good prognosis, may spontaneously regress.

cysts may be drained in utero

multiple cysts < 1cm

associated with congenital abnormalities

poor prognosis

multiple tiny, nonvisible cysts resulting in bulky hyperechoic appearance.

appears as solid

displacement of mediastinal structures

very poor prognosis: may develop hydrops

a separate mass of nonfunctioning lung tissue with its own blood supply; separate from normaly bronchial tree

associated with pulmonary hypoplasia and hydrops

excellent prognosis when isolated

lesion is located within normal lobe/lacks own pleura

most common form (75%)

may result in reccurrent respiratory infections

50% present over 20 years old

not well seen on US

seen in fetus

located outside the normal lung, has own pleura

 blood supply: thoracic aorta (arterial)

solid lung mass with arterial supply from aorta

generally small to moderate size

traingular shaped echogenic mass (90% lt sided, bass of lung)

spontaneous regression is common

accumulation of fluid in the pleural cavity

unilateral or bilateral

types: 

primary: cause unknown, usually rt sided

secondary: related to other abnormalities (mass, chromosomal, cardiac, infection)

75% mortality when hydrops is present

compression of lung may cause pumonary hypoplasia

worse prognosis when present before 15 weeks

usually none

can use drain or shunt, fetal thoracentesis

embolization of feeding vessel is caused by a mass

surgical ligation and resection

chest tubes

anechoic fluid displacing echogenic lung from chest wall

lung floats in fluid

variable size

severe effusions may compress lungs, displace heart, and occupy entire cavity

bilateral - bat winged sign

brings oxygentated blood from placenta to the right atrium

rt atrium blood shunted to left atrium through foramen ovale

RA to LA to LV to AO: to supply head and neck

Mesocardia - central heart with apex pointed ant.

Dextracardia - Apex to the right, heart in right chest

Dextroposition - normal axis, displaced to right

abnormal axis: associated with 50% mortality

abnormal position: associated with 81% mortality

fetal arrhythmia

extracardiac anomaly

chromosomal abnormalities

hydrops

twin gestation

previously affected child w/ heart disease

maternal heart disease

5% infants born with cardiac anomalies has family hx of heart disease

a communication between the two atria

oxygen rich and poor blood mixing

3 types

secundum - most common (true defect of atrial septum)

Primum - located low in atrial septum

Sinus Venosus - posterior to foramen ovale, inferior to IVC or SVC

prognosis: good with surgery to close defect

Isolated VSD is the most common cardiac defect

accounts for 20-30% of CHD

appears as discontinuity in interventricular septum

teratogens may be a factor

good prognosis, spontaneous closure can occur in utero and within 1st year of life

surg required for large defect

Atrioventricular Septal Defects (AVSD)

used to be endocardial cushion defect or A-V canal defect

defect in the central part of the heart

results from malformation in development of endocardial cushion

chromosomal or extracardiac anomalies associated in 78% 

• Trisomy 21 - 40%
• tetralogy of fallot
• subaortic stenosis
• ventricular hypoplasia
• pulmonary valve stenosis

worse prognosis w/abnormalities

Severly malformed tricuspid valve resulting in regurgitation or leakage from the right ventricle back to the right atrium

50% have atrial septal defects

visualized on a good 4CH

enlarged RA with inferior displacement of tricuspid valce toward RV

color/spectral doppler will reveal regurgitation across the tricuspid valce

difficult to visualize if mild

• absent or small left ventricle
• no communication between the LA and LV
• aortic atresia possible
• aortic stenosis possible

small RV, small or absent pulmonary artery

right hypoplastic ventricle occurs secondary to pulmonary atresia

*most common form of cyanotic heart

4 components:

• obstruction of RVOT (pulmonary stenosis)
• RV hypertrophy
• overriding aorta - overrides both ventricles
• ventricular septal defect (VSD)

true

poor prognosis and requires multiple operations

A single large vessel comes out of the right and left ventricles, instead of two - vessel supplies coronary arteries and pulmonary and systemic circulation

VSD almost always present

Rare type of heart disease

oxygenated and nonoxygenated blood

too much blood sent to lungs causing extra fluid build up around lungs and damage in vessels to lungs causing pulmonary HTN

surgery is necessary, death in 1st year of untreated

normal 4CH

VSD frequently seen

truncal root overrides the ventricular septum

outflow tracks will be abnormal

complete transposition of the great vessels

the two main arteries leaving the heart are reversed

leaves a shortage of O2 in blood flowing from the heart to the rest of the body.

serious complications/death w/o treatment

birth defect that causes narrowing of the aortic lumen

almost 90% associated with other abnormalitites

difficult to see on US

good prognosis when isolated .

39% mortality if other anomalies are present

echogenic foci in the heart - calcification of the muscle

often single focus in LV

associated with trisomy 21

3-4% normal fetuses have ECF

isolated finding is almost always a normal finding

most common fetal intracardiac tumor

associated with tuberous sclerosis, cardiac failure and hydrops

echogenic masses within fetal heart

most regress prenatally

sinus tachycardia = 180 - 120 bpm

supraventricular tachycardia = 220-260 bpm

atrial flutter = greater than 300 bpm

bradycardia = less than 100 bpm