Ductal Arch

Aorta

1. Pulmonary stenosis
a. Occurs due to improper development of the pulmonary valve in the first eight
weeks of fetal growth.
b. Right ventricular hypertrophy/cavity appears hypoplastic. Right dilated with thick
walls. Thick pulmonary valve leaflets with little to no movement.
2. Coarctation of the aorta
a. Narrowing of the aorta, most commonly distal to the origin of the left subclavian
b. Hypoplasia of the transverse arch. Associated with anomalies of the AV valves,
turners and other syndromes.
3. Aneurysm
a. Seen in the 3rd trimester. Abnormal shape of the vessel. Some are associated with
connective tissue disorder
b. Sigmoid shapes. Abnormal bulging of the normally smooth walled vessel.

Aortic Arch

1. Tetralogy of Fallot
a. Most common form of cyanotic heart disease. It is a rare condition caused by a
combination of four heart defects that are present at birth; subaortic VSD, aortic
valve overriding the defect, pulmonic stenosis, and right ventricular hypertrophy.
b. Sonographically will see an enlarged aortic root and an overriding aorta
2. Coarctation of the aorta
a. Narrowing of the aorta, most commonly distal to the origin of the left subclavian
b. Hypoplasia of the transverse arch. Associated with anomalies of the AV valves,
turners and other syndromes.
3. Aortic Stenosis
a. Condition that causes obstruction to blood flow between the left ventricle and
aorta. There are a variety of causes, including muscular obstruction below the
aortic valve, obstruction at the valve itself, or aortic narrowing immediately above
the valve.

b. Decreased leaflet mobility/valve thickened. Associated with hypoplasia of left

heart structures. Left ventricle dilated mitral valve regurgitation, or concentric
hypertrophy.

Apical 4Chamber

TV
MV

1. Tricuspid Atresia
a. A form of congenital heart disease whereby there is a complete absence of the
tricuspid valve. Therefore, there is an absence of right atrioventricular connection.
This leads to a hypoplastic or absent right ventricle.
b. Sonographically appears as a univentricular appearing heart. The right side will be
small. CHF develops. This usually occurs secondary to pulmonary atresia and
tricuspid valve atresia.
2. Hypoplastic Left Heart Syndrome
a. Rare congenital heart defect in which the left heart is severely underdeveloped.
b. Small or absent left ventricle, poor contractibility of left ventricle, small aorta,
aorta stenosis or atresia, and mitral valve stenosis or atresia.
3. ASD
a. Results from an error in the amount of tissue resorbed or deposited in the
interatrial septum.

b. Appears as an anechoic, larger than expected defect in the central portion of the
atrial septum near the foramen ovale.

Subcostal 4Chamber

TV
MV

1. VSD
a. Most common cardiac anomaly. A hole occurs in the wall that separates the
septum and allows blood to pass from the left to the right side of the heart
b. Appears as an area of discontinuity in the interventricular septum. Color Doppler
usually shows bidirectional interventricular shunting, with a systolic right-to-left
shunt and a late diastolic left-to-right shunt.
2. Ebsteins Anomaly
a. Inferior displacement of tricuspid valve leaflets into the right ventricle.
Associated with maternal Lithium use
b. Sonographically appears as a dilated right atrium and small right ventricle, the
tricuspid valve with appear lower than the mitral valve, and there will be
regurgitation across the tricuspid valve.
3. Rhabdomyomas (cardiac hamartomas)

a. Most common intracardiac tumor seen as early as 22 weeks. Can be one or

multiple. Benign.
b. RV, LV, or IVS echogenic masses. May cause arrhythmias or grow into
chambers. Associated with tuberous sclerosis. Spontaneously resolve postnatally.

Short Axis RVOT

1. Truncus Arteriosus
a. Single great vessel arising from the base of the heart, typically overrides
ventricular septum and supplies the systemic, pulmonary, and coronary blood
supply.
b. Arises above a VSD and straddles the septum. One main trunk coming from both
ventricles.
2. Double outlet right ventricle
a. Aorta and pulmonary artery arise from right ventricle. Associated with Trisomy
18 and maternal diabetes. Arrangement of great arteries may vary.
b. Associated with a large VSD (subaortic or subpulmonary). 4 chamber view
usually normal. Difficult to distinguish from tetralogy of Fallot, VSD, and
transposition. Will see both aorta and pulmonary artery arising from the right
ventricle.
3. Ebsteins Anomaly

a. Inferior displacement of tricuspid valve leaflets into the right ventricle.

Associated with maternal Lithium use
b. Sonographically appears as a dilated right atrium and small right ventricle, the
tricuspid valve with appear lower than the mitral valve, and there will be
regurgitation across the tricuspid valve.

Long Axis RVOT

1. Double outlet right ventricle

a. Aorta and pulmonary artery arise from right ventricle. Associated with Trisomy
18 and maternal diabetes. Arrangement of great arteries may vary.
b. Associated with a large VSD (subaortic or subpulmonary). 4 chamber view
usually normal. Difficult to distinguish from tetralogy of Fallot, VSD, and
transposition. Will see both aorta and pulmonary artery arising from the right
ventricle.
2. Total/partial anomalous pulmonary venous drainage
a. Abnormal connection between pulmonary veins and the atria. Associated with
heterotaxy syndromes (asplenia) and other cardiac anomalies. Requires surgical
repair. There is embryological failure of pulmonary venous development that
results in persistent patency of primitive systemic veins.
b. Some connect into RA. Normal pulmonary venous drainage is draining into right
side of the heart, mixture of blood flows, do not have O2 levels that are needed,

Patient will be cyanotic. Ultrasound may show blind ended left atrium with no
connecting veins.
3. Pulmonary stenosis
a. Occurs due to improper development of the pulmonary valve in the first eight
weeks of fetal growth.
b. Right ventricular hypertrophy/cavity appears hypoplastic. Right dilated with thick
walls. Thick pulmonary valve leaflets with little to no movement.

Long Axis LVOT

1. Transposition of the great arteries

a. The aorta arises from the right ventricle and the pulmonary artery arises from the
left ventricle. Associated anomalies include patent DA, PFO, and VSD.
b. Normal 4 chamber, great vessels will be seen arising parallel. Great vessels
should crisscross. Deoxygenated blood going into aorta.
2. Echogenic Foci
a. Found in about 4% of pregnancies and in 12% of fetuses with Trisomy 21.
Histological studies have shown these foci to be due to mineralization within a
papillary muscle or chordae tendinae.
b. More common on the left. Echogenic area in the ventricle. Normal heart function.
3. Mitral valve stenosis/regurgitation
a. Associated with other heart anomalies specifically left heart obstruction.
Developmental abnormality of the mitral valve leaflets, commissures, interchordal
spaces, papillary muscles, annulus, and/or immediate supravalvular area
producing obstruction to the left ventricular filling.

b. Thick and dysplastic mitral valve. Dilated LA, hypoplastic LV. Reduction in the
size of the mitral valve orifice in diastole.

SVC/IVC

1. Sinus venosus defect ASD

a. Located near the entrance of SVC or IVC. Usually associated with anomalous
pulmonary venous drainage from the right upper lobe into the RA. Failure of the
sinus venosus to fuse to the superior and posterior portions of the right atrium
properly.
b. Anechoic area seen in the upper atrial septum and is contiguous with the superior
vena cava. The lesion is rostral and posterior to the fossa ovalis and is separate
from it. Less commonly the defect may occur at the junction of the right atrium
and inferior vena cava.
2. Persistent left SVC
a. Most common form of anomalous venous drainage involving the superior vena
cava. It results from failure of the left horn of the embryonic sinus venosus, left
anterior and common cardinal veins to involute. A persistent left superior vena
cava starts at the junction of the left jugular and subclavian veins, runs anterior to
the aortic arch and left pulmonary artery and on the lateral border of the left
atrium. It joins the coronary sinus in the posterior left atrioventricular groove

b. The left superior vena cava was located to the left of the pulmonary artery at the
3-vessel view. The persistent LSVC drains into the right atrium via the coronary
sinus and is of no hemodynamic consequence. Dilated coronary sinus.
3. Interrupted IVC
a. Associated with Polysplenia. Absence of the hepatic segment of the IVC. The
hepatic veins join and drain directly into the right atrium.
b. Liver located more centrally. Small splenic masses along stomach. Bilateral left
lungs. Absence of the hepatic portion of the IVC with an azygous vein connected
to the SVC. Enlarged azygos vein at the confluence with the SVC and in the
retrocrural space.

3VV

1. Truncus Arteriosus
a. Single great vessel arising from the base of the heart, typically overrides
ventricular septum and supplies the systemic, pulmonary, and coronary blood
supply.
b. Arises above a VSD and straddles the septum. One main trunk coming from both
ventricles.
2. Transposition of the great arteries
a. The aorta arises from the right ventricle and the pulmonary artery arises from the
left ventricle. Associated anomalies include patent DA, PFO, and VSD.
b. Normal 4 chamber, great vessels will be seen arising parallel. Great vessels
should crisscross. Deoxygenated blood going into aorta.
3. Persistent left SVC

a. Most common form of anomalous venous drainage involving the superior vena
cava. It results from failure of the left horn of the embryonic sinus venosus, left
anterior and common cardinal veins to involute. A persistent left superior vena
cava starts at the junction of the left jugular and subclavian veins, runs anterior to
the aortic arch and left pulmonary artery and on the lateral border of the left
atrium. It joins the coronary sinus in the posterior left atrioventricular groove
b. The left superior vena cava was located to the left of the pulmonary artery at the
3-vessel view. The persistent LSVC drains into the right atrium via the coronary
sinus and is of no hemodynamic consequence. Dilated coronary sinus.