Anomalous Pulmonary Venous Return Insights Into Prenatal Detection

作者：Olsen Richelle; Doyle Zoe; Levy Denis; Anton Tracy; Molkara Delaram; Tarsa Maryam; Sklansky Mark; Pretorius Dolores H^*

来源：Journal of Ultrasound in Medicine, 2016, 35(6): 1193-1206.

DOI：10.7863/ultra.15.04041

• anomalous pulmonary venous return
• fetal echocardiography
• partial anomalous pulmonary venous return
• total anomalous pulmonary venous return

Objectives-To review all cases of total anomalous pulmonary venous return (TAPVR) or partial anomalous pulmonary venous return (PAPVR) identified prenatally or postnatally at a single institution and to identify factors that may lead to a correct or missed diagnosis in both high-and low-risk fetuses on screening examinations.
Methods-Fetal images from 16 cases of prenatally or postnatally diagnosed T/PAPVR were retrospectively reviewed to analyze factors that influenced interpretations and diagnoses.
Results-Sixteen diagnoses of T/PAPVR were made, with a final number of 10 confirmed cases, 1 of which was PAPVR. Ten fetuses with a presumptive diagnosis of T/PAPVR before delivery were at an average gestational age of 24.7 weeks, with 5 cases diagnosed postnatally. None of the diagnoses of isolated TAPVR were made during a screening examination. Twelve of the pregnancies were complicated by complex cardiac defects, including 6 with heterotaxy syndromes. Of the 5 abnormal cases identified in the postpartum period, 3 had isolated TAPVR. In the 3 patients with isolated defects, prenatal echocardiography was not performed; the anatomy scan interpretations were confounded by multiple factors. In retrospect, there was no obvious sonographic evidence of TAPVR in these patients; however, color flow Doppler imaging of the pulmonary veins was not performed on any of them.
Conclusions-Although fetal echocardiography has improved the overall detection of TAPVR or PAPVR, this abnormality continues to elude prenatal diagnosis during screening in both low-and high-risk patients. We hypothesize that the use of color flow Doppler imaging in the 4-chamber view may assist in diagnosing TAPVR in screening low-risk patients, especially in those with difficult scans.

• 出版日期2016-6-1