NBE Pediatric Echocardiography 2 — Questions and Answers
Question 1: In a neonate with transposition of the great arteries (TGA), which echocardiographic finding confirms the diagnosis?
- Aorta arising from the left ventricle and pulmonary artery from the right ventricle
- Aorta arising from the right ventricle and pulmonary artery from the left ventricle (Correct answer)
- Both great arteries arising from the right ventricle
- Pulmonary artery anterior and rightward to the aorta
Correct answer: Aorta arising from the right ventricle and pulmonary artery from the left ventricle
In TGA, the aorta arises from the morphologic right ventricle and the pulmonary artery from the morphologic left ventricle, resulting in ventriculoarterial discordance.
Question 2: When assessing tricuspid annular plane systolic excursion (TAPSE) in a child with suspected right ventricular dysfunction, where is the M-mode cursor placed?
- At the level of the mitral valve leaflet tips
- At the lateral tricuspid annulus in the apical 4-chamber view (Correct answer)
- At the medial tricuspid annulus in the subcostal view
- At the right ventricular outflow tract in the parasternal short-axis view
Correct answer: At the lateral tricuspid annulus in the apical 4-chamber view
TAPSE is measured by placing the M-mode cursor at the lateral tricuspid annulus in the apical 4-chamber view and measuring the longitudinal displacement during systole.
Question 3: A 6-month-old infant has an unrestrictive ventricular septal defect (VSD). Which Doppler finding best indicates the development of elevated pulmonary vascular resistance?
- High-velocity left-to-right shunt across the VSD
- Low-velocity bidirectional or right-to-left shunting across the VSD (Correct answer)
- Increased E/A ratio across the mitral valve
- Prolonged isovolumic relaxation time
Correct answer: Low-velocity bidirectional or right-to-left shunting across the VSD
Low-velocity bidirectional or right-to-left shunting across a VSD indicates near-equal or elevated pulmonary vascular resistance relative to systemic resistance.
Question 4: In pediatric echocardiography, the Z-score is used to interpret cardiac measurements. What does a Z-score of -2.5 for the aortic root dimension indicate?
- The measurement is 2.5 standard deviations above the mean for body surface area
- The measurement is 2.5 standard deviations below the mean for body surface area (Correct answer)
- The measurement equals 2.5 times the normal value
- The measurement is at the 2.5th percentile regardless of body size
Correct answer: The measurement is 2.5 standard deviations below the mean for body surface area
A Z-score of -2.5 indicates the aortic root dimension is 2.5 standard deviations below the mean expected value for a given body surface area.
Question 5: Which echocardiographic view is most useful for visualizing the right ventricular outflow tract obstruction in tetralogy of Fallot?
- Apical 5-chamber view
- Parasternal long-axis view
- High parasternal or parasternal short-axis view at the great vessel level (Correct answer)
- Subcostal coronal view
Correct answer: High parasternal or parasternal short-axis view at the great vessel level
The high parasternal or parasternal short-axis view at the great vessel level best demonstrates the subpulmonary infundibulum, pulmonary valve, and main pulmonary artery in tetralogy of Fallot.
Question 6: In a child with Kawasaki disease, which echocardiographic finding warrants urgent cardiology consultation?
- Trivial mitral regurgitation
- Coronary artery Z-score of +1.5
- Coronary artery aneurysm with Z-score ≥ +10 (Correct answer)
- Mild pericardial effusion without tamponade
Correct answer: Coronary artery aneurysm with Z-score ≥ +10
A coronary artery Z-score ≥ +10 indicates a giant aneurysm, conferring high risk of thrombosis and myocardial infarction, requiring urgent management.
Question 7: In a fetus at 22 weeks gestation, which finding on fetal echocardiography is most consistent with hypoplastic left heart syndrome (HLHS)?
- Dilated left ventricle with poor function
- Small or absent left ventricle with mitral and aortic valve hypoplasia (Correct answer)
- Large ventricular septal defect with balanced ventricles
- Absent pulmonary valve with dilated pulmonary artery
Correct answer: Small or absent left ventricle with mitral and aortic valve hypoplasia
HLHS is characterized by a severely underdeveloped left heart including a small or absent left ventricle with mitral and/or aortic atresia or hypoplasia.
NBE Pediatric Echocardiography 2
In a neonate with transposition of the great arteries (TGA), which echocardiographic finding confirms the diagnosis?