Fetal Vascular Rings and Pulmonary Slings: Strategies for Two- and Three-Dimensional Echocardiographic Diagnosis

Abstract

Fetal aortic arch anomalies and pulmonary slings can be difficult to accurately diagnose but have important clinical implications related to vascular rings, congenital heart disease, and chromosomal anomalies. In this article, the authors briefly review the embryology and development of the fetal arch to facilitate understanding of its diverse variants. Two-dimensional echocardiographic characteristics are summarized for each type of these malformations to propose a strategy for fetal diagnosis. The added benefits of three-dimensional echocardiography with spatiotemporal image correlation are also shown. Finally, the authors propose a strategy for volume acquisition and postanalysis to spur postanalysis clinical use of this technology.

Update on Color Flow Imaging in Obstetrics

“…Radiant flow (GE Healthcare) or LumiFlow (Samsung Medison) is a new technology which converts the index of erythrocyte density in a certain area into a height index and can be applied to CDFI, PDI, HDFI, or MVFI [21] (Figure 2A-C). This new two-dimensional (2D) technology shows the blood flow with a sense of depth or a "three-dimensional (3D)-like" appearance, reduces blood overflow, and enhances the spatial comprehension of blood vessels and their boundaries [21].…”

“…Radiant flow (GE Healthcare) or LumiFlow (Samsung Medison) is a new technology which converts the index of erythrocyte density in a certain area into a height index and can be applied to CDFI, PDI, HDFI, or MVFI [21] (Figure 2A-C). This new two-dimensional (2D) technology shows the blood flow with a sense of depth or a "three-dimensional (3D)-like" appearance, reduces blood overflow, and enhances the spatial comprehension of blood vessels and their boundaries [21]. The newly developed glass-body mode, after a 3D or 4D spatio-temporal image correlation (STIC) volume acquisition, demonstrates the heart cycle-related flow events and vessel spatial relationship by displaying both gray-scale and color information [4,22] (Figure 3A).…”

Applications of Advanced Ultrasound Technology in Obstetrics

“…Radiant flow shows the blood flow with a sense of depth by using a specific algorithm to convert the index of erythrocyte density in a certain area into a height index which is then superimposed on the initial coding of color, power Doppler, or high-definition flow [ 42 ]. Other advantages include reducing blood overflow and indicating the vessel with sharp edges.…”

“…Radiant flow is used to show fast blood flow in the fetal heart and brachycephalic arteries [ 42 ] ( Videos S5d and S6a,b ), as well as slow-blood flow in the neurovascular circulation [ 43 ] ( Video S7 ).…”

“…The 3D rendered images are useful for counseling to parents. In addition, STIC volume can facilitate interdisciplinary consultation and teleconsultation [ 42 ].…”