Medicolegal Lessons -
​Hypoplastic Left Heart

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Related Videos
4-Chamber View Video Series

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Judging the technical adequacy of a 4 chamber view

• The 4 Chamber view is really an axial view through the lower thorax
• You know that you are in the axial plane when the ribs are long and symmetrical 

Important findings in this case

1. Transverse diameter of the ventricles is asymmetric
2. Transverse diameter of the atria is asymmetric
3. The black blood in the left ventricle does not reach the apex of the heart
4. The black blood in the right ventricle is closer to the apex than the black blood in the left ventricle
5. The endocardium of the left ventricle is markedly echogenic

endocardial fibroelastosis

• This is the marked increased echogenicity of the endocardium of the left ventricle which can be a secondary feature of hypoplastic left heart syndrome.
• Indicates that the entity has been present for a while which can have important implications in medico-legal cases.