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CASE REPORTA 19-year-old primigravida was referred with suspected fetal cardiac abnormality observed on a routine ultrasound examination at 24 weeks' gestation. The pregnancy until this point had been unremarkable. Fetal growth and the amniotic fluid volume were normal, and no signs of fetal cardiac failure were noted. However, all cardiac chambers were enlarged. The posterior aspect of the left atrium (LA) was aneurysmally dilated and extended to the right paravertebral region (Figure 1). The main pulmonary artery and its right branch were grossly dilated. The dilated right pulmonary artery (RPA) just distal to the division of the main pulmonary artery was seen to abut Figure 1 Ultrasound images showing (a) the four-chamber view of the fetal heart with the left atrial aneurysmal pouch extending to the right paravertebral region (arrow) and (b) the short-axis view with the right pulmonary artery projecting into the left atrium (arrow). The communication is at the tip of this projection. AAo, ascending aorta; DA, ductus arteriosus; DAo, descending aorta; LA, left atrium; MPA, main pulmonary artery; RA, right atrium; RPA, right pulmonary artery; RV, right ventricle.

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