Great Vessels Anomalies – Prenatal Echocardiography and Neonatal Angio-CT – A Pictorial Essay

Abstract

Introduction: Fetal echocardiography is a method of choice for diagnosing cardiovascular anomalies prenatally. However, in the majority of cases, the complexity of a defect creates a diagnostic challenge. Moreover, postnatal validation of sonographic findings rarely can be obtained. Nevertheless, the feedback is vital for improving diagnostic capabilities. Thus, the aim of this research was to compare results of prenatal echocardiography with postnatal angio-CT in patients with anomalies of great vessels. Material and methods:We retrospectively compared results of prenatal echocardiography and postnatal angio-CT in 10 patients with selected anomalies of the aortic arch. This was a qualitative analysis, thus discrepancies in recognized anomalies were compared between these two modalities.Results: In 8/10 patient diagnoses were fully consistent. Nevertheless, the tiny caliber of vessels created a diagnostic challenge (e.x. to differentiate the hypoplastic aortic arch from the aortic arch interruption). In the remaining case, the discrepancy was due to a problem with complete visualization of all branches of the aortic arch in prenatal ultrasound.Conclusions: Fetal echocardiography in tertiary center was a reliable method for assessment of great vessels anomalies. However, critically narrow vessels remain a diagnostic challenge and neonatal angio-CT seems to be the method of choice in cases of diagnostic doubts.Key words: prenatal cardiology, congenital heart defects, angio-CT, aortic arch, echocardiography.Corresponding author: majkares@uni.lodz.pl Submitted: 2017Submitted: -09-26, accepted: 2017 INTRODUCTIONIn fetal echocardiography, the 4 chamber view and outflow tracts are usually well seen. It allows recognize most common cardiac pathologies such as hypoplastic left ventricle or complete atrioventricular canal, just to mention the most common prenatal heart defects 1 . However, there are anomalies that become diagnostic challenges for fetal echocardiography. Thus, answering for quarries whether there is an aortic hypoplasia with coarctation of the aorta or an aortic arch interruption might be problematic.Therefore the aim of our work was to determine the accuracy of a fetal echocardiography in a tertiary center for fetal cardiology in diagnosing selected / anomalies of the aortic arch. This issue will be addressed by comparing diagnoses made with prenatal echocardiography and postnatal angio-CT as a gold standard method. Based on this comparison we will indicate causes of discrepancies, what may improve diagnostic efficiency of prenatal echocardiography. MATERIAL AND METHODS:It was a retrospective analysis of selected cases who had prenatal echocardiography at no more than 14 days before delivery followed by a neonatal angio-CT prior to any cardiovascular intervention. All examinations were performed in years 2014-2016.Fetal echocardiography was performed in our referral center for fetal cardiology due to abnormalities picked up in obstetrical screening ultrasound.