FE FE Reporting & Counseling 2 — Questions and Answers
Question 1: Fetal hydrops on echocardiography is defined by fluid accumulation in at least how many body compartments?
- One compartment
- Two or more compartments (Correct answer)
- Three or more compartments
- All four compartments must be involved
Correct answer: Two or more compartments
Fetal hydrops is defined by abnormal fluid accumulation in at least two body compartments (ascites, pleural effusion, pericardial effusion, skin edema).
Question 2: Which cardiac lesion is most likely to require fetal intervention (in-utero balloon valvuloplasty)?
- Small membranous VSD
- Critical aortic stenosis with evolving HLHS (Correct answer)
- Mild pulmonary stenosis
- Isolated tricuspid regurgitation
Correct answer: Critical aortic stenosis with evolving HLHS
Critical aortic stenosis with evidence of evolving hypoplastic left heart syndrome may be treated with fetal aortic balloon valvuloplasty to promote biventricular heart development.
Question 3: When a fetal cardiac abnormality is detected, chromosomal microarray analysis is recommended because:
- It replaces the need for fetal echocardiography
- It detects submicroscopic copy number variants that karyotype misses (Correct answer)
- It is required by law for all cardiac anomalies
- It determines cardiac surgical outcomes
Correct answer: It detects submicroscopic copy number variants that karyotype misses
Chromosomal microarray detects submicroscopic copy number variants (CNVs), including 22q11.2 deletion, that standard karyotype will miss but are clinically relevant.
Question 4: Which cardiac defect is most strongly associated with 22q11.2 deletion (DiGeorge syndrome)?
- Complete AVSD
- Truncus arteriosus and interrupted aortic arch type B (Correct answer)
- Hypoplastic left heart syndrome
- Ebstein anomaly
Correct answer: Truncus arteriosus and interrupted aortic arch type B
22q11.2 deletion (DiGeorge/velocardiofacial syndrome) is strongly associated with conotruncal defects, especially truncus arteriosus and interrupted aortic arch type B.
Question 5: Which medication used for fetal arrhythmia therapy requires maternal EKG monitoring for maternal cardiac toxicity?
- Digoxin
- Flecainide
- Sotalol
- Both sotalol and flecainide (Correct answer)
Correct answer: Both sotalol and flecainide
Both sotalol (QTc prolongation risk) and flecainide (proarrhythmic risk) require maternal ECG monitoring when used transplacentally for fetal arrhythmia.
Question 6: The Ebstein anomaly severity in the fetus is best predicted by which index?
- Cardiothoracic ratio alone
- Celermajer index (right heart to left heart ratio) (Correct answer)
- Tricuspid regurgitation velocity
- Doppler ductus venosus PI
Correct answer: Celermajer index (right heart to left heart ratio)
The Celermajer index (ratio of right atrium + atrialized right ventricle area to functional right ventricle + left ventricle + left atrium area) predicts prognosis in fetal Ebstein anomaly.
FE FE Reporting & Counseling 2
Fetal hydrops on echocardiography is defined by fluid accumulation in at least how many body compartments?