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Four-dimensional evaluation of anomalies of the fetal venous connections
INTRODUCTION
Abnormalities of systemic and pulmonary venous connections are among the most frequently missed congenital heart disease (CHD) in prenatal ultrasound studies. Their prenatal detection is difficult and requires adequate image resolution and attention to detail [1]. Abnormal systemic venous connections (ASVC) include anomalies of the left and right superior vena cava and coronary sinus, and anomalies of the inferior vena cava.
Anomalous pulmonary venous connections can be partial (PAPVC) or total (TAPVC). TAPVC is characterized by the anomalous drainage of all the pulmonary veins, whereas PAPVC is characterized by the anomalous drainage of one, two, or three of the four pulmonary veins. Three-four D US has been suggested to provide a signifi cant contribution to our understanding of the developing heart in both normal and anomalous cases [2 - 8]. In particular “B-flow-STIC imaging” and “inversion mode” have been demonstrated to supply additional information over that provided by 2D US in the prenatal diagnosis of some congenital heart defects (CHD) due to the ability to trace the spatial course of the vessels involved in the anomaly [3, 5, 8,-10], and to facilitate the identifi cation of small vessels [8 - 10].In-fact B-flow – STIC imaging seems to improve the accuracy of prenatal diagnosis either of TAPVC [8 - 10] and of ASVC whereas inversion mode has been used only in the cases of ASVC [5].
In this review, we report the 2D prenatal characterization of the most common anomalies of the venous connections, namely total anomalous pulmonary veins connection, persistent left superior vena cava (LSVC) with dilation of the coronary sinus (CS), interrupted inferior vena cava (IVC) with azygos continuation and describe the application and added value of 4D echocardiography with B-flow-STIC imaging or with inversion mode in the prenatal diagnosis of TAPVC and ASVC respectively.
Author:
Paolo VOLPE, MD
Head of the Fetal Medicine Unit,
Di Venere and Sarcone Hospitals,
Bari, Italy.
E-mail: paolo-volpe@libero.it