Pediatric Echocardiography Flashcards

When performing echocardiography on a premature neonate with a hemodynamically significant patent ductus arteriosus (PDA), which finding best indicates left heart volume overload?

Answer: Elevated LA:Ao ratio greater than 1.4:1

An LA:Ao ratio >1.4:1 indicates left atrial enlargement from increased pulmonary venous return, reflecting significant left heart volume overload from a large left-to-right PDA shunt.

A 5-year-old child with a history of repaired tetralogy of Fallot now has significant pulmonary regurgitation. Which echocardiographic parameter is most important to monitor for timing of pulmonary valve replacement?

Answer: Right ventricular size and systolic function (including RV volumes by 3D echo or MRI correlation)

After TOF repair, progressive right ventricular dilation and dysfunction from pulmonary regurgitation are the primary indications for pulmonary valve replacement; RV size and function are monitored closely.

In the subcostal view during pediatric echocardiography, which structure is best visualized to assess situs and atrial morphology?

Answer: Relationship of the inferior vena cava and aorta to the spine, and drainage into the right atrium

The subcostal view allows visualization of the IVC and aorta relative to the spine (IVC right, aorta left = situs solitus) and confirms IVC drainage into the morphologic right atrium.

A pediatric patient with Marfan syndrome requires echocardiographic surveillance. Which measurement is the primary focus of aortic root monitoring?

Answer: Aortic root diameter at the sinuses of Valsalva with Z-score calculation

In Marfan syndrome, aortic root dilation at the sinuses of Valsalva is the most common and dangerous manifestation; serial measurement with Z-score normalization guides prophylactic surgery timing.

Which echocardiographic finding is most consistent with cardiac tamponade in a child with pericardial effusion?

Answer: Right atrial systolic collapse and right ventricular diastolic collapse with respiratory variation in mitral inflow

Tamponade physiology is confirmed by right atrial systolic collapse, right ventricular diastolic collapse, and exaggerated respiratory variation (>25%) in mitral inflow velocity.

In a child with heterotaxy syndrome and left isomerism, which cardiac anomaly is most commonly associated?

Answer: Interruption of the inferior vena cava with azygous continuation

Left isomerism (bilateral left-sidedness) is strongly associated with interruption of the IVC with azygous or hemiazygous continuation to the superior vena cava.

In a 3-year-old with a muscular ventricular septal defect, which echocardiographic view is most useful for complete visualization of the muscular septum?

Answer: Multiple views including apical 4-chamber, parasternal short-axis, and subcostal views

The muscular septum must be interrogated from multiple windows (apical 4-chamber, parasternal short-axis, subcostal) because defects can be missed if only one view is used.