Linhua Yang1, Liuying Zhou, Lin Chen. 1. Department of Ultrasound, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, China.
Abstract
RATIONALE: Right atrial isomerism (RAI) is one of the most severe forms of congenital heart disease. This case of RAI was so complex that it incorporated 7 heart defects. It can be challenging to display the spatial relationship between different anatomical structures using conventional two-dimensional and color ultrasound (2D-Doppler imaging); therefore, we used spatio-temporal image correlation (STIC) and high definition live flow imaging technology to vividly display this case of RAI in a stereoscopic mode. PATIENT CONCERNS: A 24-year-old woman was referred to our tertiary center at 24 weeks of gestation. The woman had difficult conceiving. Once pregnant, she was opposed to abortion, even if there was a possibility of deformity. DIAGNOSIS: The fetus presented with an atrioventricular septal defect, persistent left superior vena cava, supra-cardiac total anomalous pulmonary venous connection (TAPVC), double outlet right ventricle, right ductus arteriosus, right aortic arch (RAA) with mirror image branching, and aortic arch dysplasia. INTERVENTIONS: After consulting a pediatric cardiologist, the woman requested an abortion and consented to an autopsy. OUTCOMES: Autopsy supported the echocardiographic findings. LESSONS: Accurate diagnosis of RAI is essential for clinical and parent decision making. 2D-Doppler imaging combined with STIC-HD live flow can be used to visualize the spatial morphology of blood vessels, including the cardiac chambers and great vessels of the fetal heart, and smaller peripheral vessels.
RATIONALE: Right atrial isomerism (RAI) is one of the most severe forms of congenital heart disease. This case of RAI was so complex that it incorporated 7 heart defects. It can be challenging to display the spatial relationship between different anatomical structures using conventional two-dimensional and color ultrasound (2D-Doppler imaging); therefore, we used spatio-temporal image correlation (STIC) and high definition live flow imaging technology to vividly display this case of RAI in a stereoscopic mode. PATIENT CONCERNS: A 24-year-old woman was referred to our tertiary center at 24 weeks of gestation. The woman had difficult conceiving. Once pregnant, she was opposed to abortion, even if there was a possibility of deformity. DIAGNOSIS: The fetus presented with an atrioventricular septal defect, persistent left superior vena cava, supra-cardiac total anomalous pulmonary venous connection (TAPVC), double outlet right ventricle, right ductus arteriosus, right aortic arch (RAA) with mirror image branching, and aortic arch dysplasia. INTERVENTIONS: After consulting a pediatric cardiologist, the woman requested an abortion and consented to an autopsy. OUTCOMES: Autopsy supported the echocardiographic findings. LESSONS: Accurate diagnosis of RAI is essential for clinical and parent decision making. 2D-Doppler imaging combined with STIC-HD live flow can be used to visualize the spatial morphology of blood vessels, including the cardiac chambers and great vessels of the fetal heart, and smaller peripheral vessels.
Authors: Christopher R Broda; Katherine B Salciccioli; Keila N Lopez; Peter R Ermis; Douglas S Moodie; Heather A Dickerson Journal: Congenit Heart Dis Date: 2019-10-16 Impact factor: 2.007
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Authors: C Berg; A Geipel; J Smrcek; M Krapp; U Germer; T Kohl; U Gembruch; A A Baschat Journal: Ultrasound Obstet Gynecol Date: 2003-11 Impact factor: 7.299