ARDMS Echo Congenital Heart Disease 2 — Questions and Answers
Question 1: In coarctation of the aorta, which echocardiographic Doppler finding is characteristic?
- Diastolic flow reversal in the abdominal aorta with a 'sawtooth' pattern
- High-velocity turbulent systolic jet with persistent diastolic antegrade flow ('diastolic tail') (Correct answer)
- Holodiastolic flow reversal in the descending aorta
- Normal laminar flow with elevated RVSP
Correct answer: High-velocity turbulent systolic jet with persistent diastolic antegrade flow ('diastolic tail')
Coarctation produces a high-velocity systolic jet with a persistent diastolic tail (diastolic runoff) in the descending aorta due to the pressure gradient.
Question 2: What is the echocardiographic hallmark of D-transposition of the great arteries (D-TGA)?
- The aorta arises from the left ventricle and the pulmonary artery from the right ventricle
- The aorta arises from the right ventricle and the pulmonary artery from the left ventricle (Correct answer)
- Both great arteries arise side by side from the right ventricle
- The pulmonary artery is posterior and rightward to the aorta
Correct answer: The aorta arises from the right ventricle and the pulmonary artery from the left ventricle
In D-TGA, ventriculoarterial discordance exists: the aorta arises from the morphologic RV and the pulmonary artery from the morphologic LV.
Question 3: Which congenital lesion is associated with a 'double-bubble' appearance on subcostal echo due to bilateral ventricular inflow obstruction?
- Cor triatriatum
- Parachute mitral valve
- Hypoplastic left heart syndrome
- Atrioventricular septal defect (AVSD) (Correct answer)
Correct answer: Atrioventricular septal defect (AVSD)
Complete AVSD features a common AV valve and both atrial and ventricular septal defects, often creating a characteristic 'gooseneck' deformity of the LVOT.
Question 4: A bicuspid aortic valve (BAV) is associated with which aortic complication requiring surveillance?
- Mitral valve prolapse
- Ascending aortic dilation and risk of dissection (Correct answer)
- Pulmonary hypertension
- Left ventricular non-compaction
Correct answer: Ascending aortic dilation and risk of dissection
BAV is associated with aortopathy — medial degeneration predisposing to ascending aortic dilation, aneurysm, and dissection independent of valve function.
Question 5: In Eisenmenger syndrome, the shunt direction in an ASD or VSD reverses because:
- Left ventricular pressure exceeds right ventricular pressure
- Pulmonary hypertension raises RV pressure to exceed LV pressure, reversing the gradient (Correct answer)
- Increased pulmonary venous return elevates LA pressure
- Aortic stenosis reduces systemic pressure below pulmonary pressure
Correct answer: Pulmonary hypertension raises RV pressure to exceed LV pressure, reversing the gradient
Eisenmenger syndrome occurs when pulmonary vascular resistance rises enough to reverse the shunt from right-to-left, causing cyanosis.
Question 6: What is the echocardiographic finding that distinguishes a primum ASD from a secundum ASD?
- Primum ASD is located in the superior interatrial septum
- Primum ASD is located in the inferior septum adjacent to the AV valves and is associated with a cleft mitral valve (Correct answer)
- Secundum ASD involves the AV valves
- Primum ASD is smaller than secundum ASD
Correct answer: Primum ASD is located in the inferior septum adjacent to the AV valves and is associated with a cleft mitral valve
Primum ASDs are located low in the interatrial septum near the AV valves and are frequently associated with a cleft anterior mitral leaflet causing MR.
ARDMS Echo Congenital Heart Disease 2
In coarctation of the aorta, which echocardiographic Doppler finding is characteristic?