Prenatal diagnosis of ventriculocoronary fistula

Background Cardiac anomalies may be associated with abnormal coronary vascular connections. We report the prenatal diagnosis of ventriculocoronary fistula in three fetuses with associated cardiac anomalies. Materials and Methods Fetal echocardiography was performed in three patients referred for sus...

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Bibliographic Details
Published in:Ultrasound in obstetrics & gynecology 2001-07, Vol.18 (1), p.39-43
Main Authors: Baschat, A. A., Love, J. C., Stewart, P. A., Gembruch, U., Harman, C. R.
Format: Article
Language:English
Subjects:
Adult
Aorta - abnormalities
Biological and medical sciences
Cardiac anomaly
Cardiology. Vascular system
Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava
Diseases of mother, fetus and pregnancy
Fatal Outcome
Female
Fetal Diseases - diagnostic imaging
Gynecology. Andrology. Obstetrics
Heart
Heart Bypass, Right
Heart Defects, Congenital - diagnostic imaging
Heart Defects, Congenital - surgery
Heart Ventricles - abnormalities
Humans
Medical sciences
Pregnancy. Fetus. Placenta
Prenatal ultrasound
Ultrasonography, Doppler, Color
Ultrasonography, Prenatal
Vascular Fistula - diagnostic imaging
Ventriculocoronary fistula
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Summary:Background Cardiac anomalies may be associated with abnormal coronary vascular connections. We report the prenatal diagnosis of ventriculocoronary fistula in three fetuses with associated cardiac anomalies. Materials and Methods Fetal echocardiography was performed in three patients referred for suspected cardiac anomaly. Two‐dimensional fetal echocardiography was complemented by color Doppler flow imaging and spectral Doppler in all cases. Results A ventriculocoronary fistula was diagnosed in three patients referred at 22, 23 and 32 weeks. The first patient had hypoplastic left heart associated with transposition of the great arteries and pulmonary atresia with an intact interventricular septum. The coronary fistula arose from the transposed aorta to the left ventricle. In two patients ventriculocoronary fistula was found in association with pulmonary atresia and an intact interventricular septum. In all cases there was bidirectional flow within the fistula (diastolic blood flow towards the ventricle with reversal during ventricular systole). The pregnancy with hypoplastic left heart with transposition, and one of those with pulmonary atresia resulted in neonatal death and stillbirth, respectively. In the third instance the ventriculocoronary fistula was verified by postpartum cardiac angiography. The infant initially received a Blalock–Taussig shunt, subsequently replaced by a bidirectional Glenn shunt, and was doing well at the time of writing. Conclusion A ventriculocoronary fistula can be identified prenatally by color and spectral Doppler. This anomaly should be sought in fetuses with outflow tract obstructive cardiac lesions and an intact interventricular septum. Prenatal diagnosis allows early angiography postnatally. Delineation of coronary vascular regions may therefore facilitate preoperative planning. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
ISSN:0960-7692
1469-0705
DOI:10.1046/j.1469-0705.2001.00438.x