American Registry for Diagnostic Medical Sonography — Fetal Echocardiography specialty exam. 150 questions / 3 hours. Normal fetal cardiac anatomy, CHD recognition, imaging protocols.

ARDMS Fetal Echocardiography (FE)

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Official 2024 syllabus extracted from https://www.ardms.org/wp-content/uploads/pdf/FE-Examination-Content-Outline-V24.1-2.pdf

Domain 1: Gather pertinent medical history prior to exam (7%)

Review referral information and clarify pertinent data and indications for exam

Correlate known genetic syndromes and chromosomal anomalies with expected exam findings

Correlate history of maternal disease and drug exposure (e.g., maternal congenital heart disease, lupus, diabetes, indomethacin use)

Correlate extracardiac anomalies with expected exam findings (e.g., CHARGE, VACTERL syndromes)

History & Risk Factors

Domain 2: Anatomy and Physiology (25%)

Normal embryologic development (early chamber development, normal septal formation)

Fetal anatomic structures of abdomen/pelvis (IVC, ductus venosus, hepatic veins, stomach, bladder, spleen)

Fetal anatomic structures of chest/thorax (lungs, esophagus, trachea, thymus, diaphragm)

Anatomy of tissues composing the heart (pericardium, myocardium)

Normal cardiac chamber morphology and position

Septa (atrial, ventricular, arterial)

Normal atrioventricular and semilunar valve morphology

Systemic veins and arteries

Outflows

Pulmonary veins and arteries

Aortic arch

Ductus arteriosus

Ductus venosus

Umbilical vein and arteries

Fetal cardiac electrical conduction system (SA node, AV node)

Cardiac Anatomy

Domain 3: Perform the exam (34%)

Recognize and inform supervising physician of fetal critical findings (sustained bradycardia/tachycardia, fetal demise, hydrops, anhydramnios)

Monitor and adjust exam based on maternal clinical symptoms (supine hypotensive disorder, severe headache, unrelenting vomiting)

Clinical Care and Safety

Select transducer and console settings appropriate for the exam

Evaluate multiple gestations and associated cardiac complications (fetal position, number, TTTS)

Determine visceral-atrial situs (Cordes and other methods)

Evaluate and obtain standard cardiac views

Evaluate and obtain standard views of great vessels (branch pulmonary arteries, systemic veins, pulmonary veins, aortic and ductal arches)

Determine orientation and relationship of great vessels using standard cardiac views

Measurements of chamber size using 2D and M-mode

Measurements of cardiac valves and great vessels

Measurement of cardiothoracic (CT) ratio

Fetal biometric measurements (BPD, HC, AC, FL)

Exam Techniques & Measurements

Assess ventricular function

Assess AV and semilunar valve function using color and spectral Doppler (regurgitation, stenosis)

Assess fetal heart rate and rhythm using Doppler and M-mode

Spectral and color Doppler of MCA, umbilical arteries, umbilical vein, ductus venosus

Spectral and color Doppler of pulmonary and systemic veins

Spectral and color Doppler of pulmonary and systemic arteries

Assess mechanical PR intervals

Cardiac Function & Hemodynamics

Domain 4: Evaluate pathology and pathophysiology (34%)

Recognize signs of fetal distress (abnormal fluid collections, cardiomegaly, hemodynamics)

Evaluate for fetal cardiomyopathies

Evaluate for fetal dysrhythmias

Abnormal Physiology and Perfusion

Genetic syndromes (trisomy 21, Noonan, monosomy X, 22q11 deletion)

Cardiac malpositioning

Heterotaxy syndromes

Cardiac septal defects

Left-sided cardiac anomalies

Right-sided cardiac anomalies

Conotruncal anomalies

Systemic venous anomalies

Pulmonary venous anomalies

Aortic arch anomalies

Ductus arteriosus abnormalities

Ductus venosus anomalies

Congenital cardiac masses

Cardiac changes with thoracic anomalies

Abnormal blood flow across cardiac valves and vessels

Congenital Anomalies

ARDMS Fetal Echocardiography (FE) Syllabus

Students preparing for ARDMS Fetal Echocardiography (FE)