PMC9283767_01
Echocardiograms showing fetal atrial situs and the four-chamber view (4CV). (A) The pulmonary veins drain into the left atrium (indicated by arrows) on the left of the fetus by high-definition flow imaging (HDFI). (B) The superior vena cava and the inferior vena cava are connected to the right atrium on the right of the fetus. (C) The 4CV shows a heart of normal size with balanced chambers, situs solitus of the atria, atrioventricular discordance, a VSD (indicated by arrows), and an enlarged coronary sinus. CS, coronary sinus; DAO, descending aorta; IVC, inferior vena cava; L, left; LA, left atrium; LPV, left pulmonary vein; LV, left ventricle; R, right; RA, right atrium; RPV, right pulmonary vein; RV, right ventricle; SVC, superior vena cava.
fmed-09-904662-g0001.jpg
PMC9283767_01_fmed-09-904662-g0001.jpg
F1
At first, a long-axis plane of the fetus together with the transverse planes at both the fetal abdominal level and thoracic level was scanned to determine the visceral and cardiac position (Figures 1A,B). In addition, a 6.4 mm wide VSD and an enlarged coronary sinus connecting with the left superior vena cava were also in visualization (Figure 1C).
Echocardiograms showing the main pulmonary artery (MPA) with its branching and the aberrant ductus arteriosus (DA). (A) The Color flow mapping shows the antegrade flow in both the LPA and RPA together with the retrograde flow in the distal MPA (indicated by arrows). (B) The course and the direction of the blood flow (indicated by arrows) in the DA are clearly shown when using HDFI in a parasagittal view. AO, aorta; DA, ductus arteriosus; DAO, descending aorta; LPA, left pulmonary artery; MPA, main pulmonary artery; RPA, right pulmonary artery.
fmed-09-904662-g0002.jpg
PMC9283767_01_fmed-09-904662-g0002.jpg
F2
Color Doppler provided useful information as it showed the antegrade flow in both the left and right pulmonary arteries together with the retrograde flow in the distal pulmonary trunk (Figure 2A). In fact, it represented a special ductal arch that connected the pulmonary artery with the innominate artery, instead of the descending aorta (Figure 2B).
The 3D reconstructed image and gross findings. (A) The 3D reconstructed image showing the spatial relationship of the related great vessels. The aberrant DA connects the base of the innominate artery with the pulmonary artery. The course of the DA, the LPA, and the RPA is indicated by arrows. (B) The heart is in the right hemithorax with the apex pointing to the right. The aortic arch is on the left of the trachea. The DA is visualized connecting the base of innominate artery with the PA. The origination of RPA from PA is also visualized. (C) When pulling up the heart and the great arteries to the right side, the connection of DA with PA, together with the origination of LPA is determined. ARCH, aortic arch; DA, ductus arteriosus; DAO, descending aorta; INA, innominate artery; LCCA, left common carotid artery; LPA, left pulmonary artery; LSA, left subclavian artery; PA, pulmonary artery; RCCA, right common carotid artery; RPA, right pulmonary artery; RSA, right subclavian artery.
fmed-09-904662-g0003.jpg
PMC9283767_01_fmed-09-904662-g0003.jpg
F3
The 3D color-rendered image can demonstrate the spatial relationship of the related great arteries, including the course and connection of the aberrant DA (Figure 3A).