ARDMS Echo Congenital Heart Disease 1 — Questions and Answers
Question 1: Which echocardiographic view best visualizes a secundum atrial septal defect (ASD)?
- Parasternal long axis
- Subcostal four-chamber and off-axis views (Correct answer)
- Apical two-chamber view
- Parasternal short axis at the base
Correct answer: Subcostal four-chamber and off-axis views
Subcostal views orient the ultrasound beam perpendicular to the interatrial septum, providing the most reliable detection of secundum ASDs.
Question 2: A ventricular septal defect (VSD) with left-to-right shunt produces which hemodynamic finding on echo?
- RV dilation with pressure overload
- LV and LA volume overload (Correct answer)
- LV pressure overload with concentric hypertrophy
- RA and RV volume overload only
Correct answer: LV and LA volume overload
Left-to-right VSD shunting causes increased pulmonary flow returning to the left heart, resulting in LV and LA volume overload.
Question 3: Patent ductus arteriosus (PDA) is best assessed using which Doppler approach?
- Apical five-chamber view with CW Doppler
- High parasternal or suprasternal notch view with color and CW Doppler (Correct answer)
- Subcostal view with pulsed Doppler
- Parasternal long axis view
Correct answer: High parasternal or suprasternal notch view with color and CW Doppler
PDA is best imaged from the high parasternal or suprasternal notch, where color Doppler shows continuous flow from aorta to pulmonary artery.
Question 4: In tetralogy of Fallot, which four cardiac defects are present?
- VSD, ASD, PDA, pulmonary stenosis
- VSD, RVOT obstruction, aortic override, RV hypertrophy (Correct answer)
- TGA, VSD, ASD, pulmonary atresia
- Coarctation, VSD, ASD, aortic stenosis
Correct answer: VSD, RVOT obstruction, aortic override, RV hypertrophy
Tetralogy of Fallot consists of a large VSD, right ventricular outflow tract obstruction, overriding aorta, and RV hypertrophy.
Question 5: What does the Qp:Qs ratio represent in the assessment of intracardiac shunts?
- Pressure gradient across a shunt
- Ratio of pulmonary to systemic blood flow (shunt fraction) (Correct answer)
- Ratio of mitral to aortic valve area
- Cardiac index in pulmonary circulation
Correct answer: Ratio of pulmonary to systemic blood flow (shunt fraction)
Qp:Qs compares pulmonary to systemic flow; a ratio >1.5:1 typically indicates a hemodynamically significant left-to-right shunt.
Question 6: Ebstein's anomaly is characterized by which echocardiographic finding?
- Apical displacement of the tricuspid valve septal leaflet by ≥8 mm/m² (Correct answer)
- Bicuspid aortic valve with apical leaflet displacement
- Sub-pulmonic VSD with tricuspid override
- Apical displacement of the mitral valve
Correct answer: Apical displacement of the tricuspid valve septal leaflet by ≥8 mm/m²
Ebstein's anomaly is defined by apical displacement of the tricuspid septal and posterior leaflets ≥8 mm/m² BSA, 'atrialization' the RV.
ARDMS Echo Congenital Heart Disease 1
Which echocardiographic view best visualizes a secundum atrial septal defect (ASD)?