Aberrant drainage of the umbilical vein into the coronary sinus without ductus venosus agenesis

Anomalous drainage of the ductus venosus into the coronary sinus: prenatal ultrasound diagnosis utilizing two-dimensional and three-dimensional imaging techniques and differential diagnosis

BACKGROUND

Anomalous drainage of the ductus venosus (DV) into the coronary sinus (CS) is a rare fetal vascular anomaly that poses challenges for prenatal diagnosis. This study aimed to investigate the role of two-dimensional (2D) and three-dimensional (3D) ultrasound imaging, specifically spatiotemporal image correlation (STIC) technology, in improving the prenatal diagnosis of this anomaly.

METHODS

We retrospectively reviewed eight cases of fetuses diagnosed with anomalous DV drainage into the CS at Gansu Provincial Maternal and Child Health Hospital between September 2019 and September 2024. The gestational age of the fetuses ranged from 24 to 30 weeks. Ultrasound examinations, including 2D and Doppler imaging, along with HDlive Flow combined with STIC technology, were used for diagnosis. Differential diagnoses were made based on imaging findings. Descriptive statistics were employed to summarize the results.

RESULTS

Eight fetuses with anomalous DV drainage into the CS were identified. Of these, five cases were isolated anomalies, while three had associated malformations, such as aberrant right subclavian artery and right aortic arch. Dilated CS was observed in all cases, with an average inner diameter of 5.7 mm. STIC imaging successfully visualized the abnormal course of the DV, enhancing diagnostic confidence. Postnatal follow-up indicated favorable outcomes for most neonates (except for Case NO.3 and Case NO.7), although persistent CS dilation was observed in these cases, without significant hemodynamic compromise or clinical symptoms.

CONCLUSIONS

Prenatal diagnosis of anomalous DV drainage into the CS can be effectively achieved using 2D and 3D ultrasound, with STIC technology providing added diagnostic clarity. Early and accurate detection is crucial for ensuring appropriate clinical management and favorable outcomes. Ongoing surveillance of CS dilation in the postnatal period is recommended.

Prenatal diagnosis of an aberrant ductus venosus draining into the coronary sinus using two- and three-dimensional echocardiography: a case report

Background

Ductus venosus (DV) abnormalities may be associated with intracardiac or extracardiac deformities, chromosomal anomalies, and/or congestive heart failure. Aberrant DV connecting with the coronary sinus (CS) is rare and the prenatal diagnosis presents challenges for most examiners.

Case presentation

A 35-year-old pregnant woman, gravida 2, para 1, was referred to our center at 27 gestational weeks for a full evaluation of fetal cardiac anomalies. Transverse scans indicated normal cardiac anatomy except for a dilated CS; we then scanned sagittal planes to clarify the reasons for the CS dilatation. High-definition flow imaging (HDFI) together with radiant flow (R-flow) imaging was used to delineate the aberrant DV returning to the CS, enabling the diagnosis. Three-dimensional (3D) technology was also used to obtain color-rendered images showing the spatial relationships of the vessels involved, thus confirming the two-dimensional (2D) diagnosis. Chromosomal analysis revealed a normal karyotype. The neonate appeared healthy and the echocardiogram showed a normal cardiac anatomy except for a dilated CS with the DV closed and imperceptible.

Conclusions

The aberrant course of the DV returning to the CS was clearly demonstrable by traditional 2D echocardiography using HDFI and the R-flow technique. We deem it helpful to trace the inflow of the dilated CS to make the differential diagnosis. The 3D modality might also provide additional spatial information on the associated vessels and thereby assist in prenatal diagnosis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03870-x.

Abnormal Connection of the Ductus Venosus to a Dilated Coronary Sinus Imaged by Prenatal Echocardiography: Case Report

We describe a case of a fetus with an ectopic connection of the ductus venosus to a dilated coronary sinus that was diagnosed at ShengJing Hospital of China Medical University. A dilated coronary sinus was initially detected with prenatal echocardiography. Neither a persistent left superior vena cava nor an anomalous pulmonary venous connection was present. After comprehensive examination, we discovered that the ductus venosus had an abnormal course draining into the coronary sinus. The postnatal outcome of this fetus was good. Once a dilated coronary sinus is confirmed, further ultrasound evaluation should be performed to search for a potential cause.