Fetal left-atrial posterior-space-to-diagonal ratio at 17-37 weeks' gestation for prediction of total anomalous pulmonary venous connection

Prenatal MR Diagnosis of Total Anomalous Pulmonary Venous Connection and Related Brain Growth Changes

BACKGROUND

Prenatal diagnosis of total anomalous pulmonary venous connection (TAPVC) is challenging, and little is known about how it affects brain development.

PURPOSE

To evaluate the utility of fetal MRI to diagnose TAPVC and related brain growth changes.

STUDY TYPE

Retrospective case-control study.

POPULATION

Twenty-one fetuses (23.0 to 30.8 weeks, mean 26.4 weeks) with pre-natal MRI diagnosis of TAPVC. Post-natal images and surgery were available in 18 fetuses. Brain volumes in TAPVC fetuses were compared with age and sex matched 100 cases of normal controls and 38 fetuses with tetralogy of Fallot (TOF).

SEQUENCE

Single shot turbo spin echo sequence for evaluating fetal brain, and steady-state free precession (SSFP) sequence for evaluating fetal cardiovascular structures at 1.5 T.

ASSESSMENT

TAPVC type was determined by visualizing the drainage of the common pulmonary vein and dilated coronary sinus: supracardiac, intracardiac and infracardiac. The fetal pulmonary edema was evaluated, and fetal brain volumes were measured using automatic segmentation.

STATISTICAL TESTS

One-way analysis of variance and post hoc least square difference tests to evaluate differences in variables between TAPVC, TOF and control groups. A P value <0.05 was considered significant.

RESULTS

Of the 21 cases of TAPVC, 10 (47.6%) were identified as supracardiac, 8 (38.1%) as intracardiac, and 3 (14.3%) as infracardiac. Eighteen cases were confirmed by postnatal imaging and surgery; the remaining three cases had no confirmation. Six cases were associated with other cardiovascular abnormalities. Key MRI features of fetal TAPVC included a dilated coronary sinus and vertical vein. Fetal pulmonary edema was seen in six cases. Compared to controls, TAPVC fetuses had lower cerebellum and brainstem volumes and higher e-CSF, while had larger subcortical brain tissue, cerebellum, brainstem, e-CSF, and intracranial cavity volumes than those of TOF cases.

DATA CONCLUSION

Fetal MRI may be a useful modality for evaluating fetal TAPVC and altered brain development.

EVIDENCE LEVEL

3 TECHNICAL EFFICACY: Stage 3.

The Holy Grail of obstetric ultrasound: can artificial intelligence detect hard-to-identify fetal cardiac anomalies?

Linked article: This Editorial comments on articles by Day et al. and Taksøe‐Vester et al.

Prenatal Ultrasound Markers of Isolated Total Anomalous Pulmonary Venous Return and a Sequential Approach to Reach Diagnosis

This article comprehensively reviews the literature concerning prenatal ultrasound findings of isolated total anomalous pulmonary venous return (TAPVR) and the application of specific sonographic markers to differentiate among the TAPVR types. These markers can be categorized as direct and indirect, based on either morphological features or hemodynamic changes in TAPVR. Indirect markers include the ventricular disproportion, an increased distance between the left atrium (LA) and the descending aorta, as well as the dilatation of superior vena cava or coronary sinus for supracardiac or cardiac TAPVR, along with abnormal pulmonary venous spectral Doppler patterns. Direct markers predominantly focus on the absence of a connection between the pulmonary veins and the LA. Some direct markers are specific to certain TAPVR types, such as the vertical vein. Diagnosing isolated TAPVR can pose challenges, but following a sequential approach can improve detection rates and outcomes. In cases with equivocal findings, additional follow-ups are recommended. The sequential approach described in the current article provides a step-wise methodology and sonographic markers for prenatal diagnosis of TAPVR, which can be utilized by fetal-maternal medicine specialists, obstetricians, and radiological technicians to ensure timely interventions.

From Other Journals: A Review of Recent Articles by Our Editorial Team

In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our hope is to provide a summary of the latest articles published recently in other journals in our field. The articles address (1) A new index for prenatal diagnosis of total anomalous pulmonary venous return, (2) Outcomes of patients with Tetralogy of Fallot after pulmonary valve replacement (PVR), and (3) Short-term outcomes of the self expanding Harmony valve for transcatheter PVR.