Prenatal diagnosis of anomalous origin of one pulmonary artery branch by two-dimensional echocardiography: summary of 12 cases

Abstract

Objectives:To improve the prenatal diagnosis for anomalous origin of pulmonary artery branches by comparing and analyzing different types of fetal echocardiography features.Methods:Between June 2012 and December 2018, fetal echocardiographic features were analyzed retrospectively from fetuses with a prenatal diagnosis of anomalous origin of pulmonary artery branch. The main points of identification were summarized.Results:A total of 12 fetuses were diagnosed, including anomalous origin of a pulmonary artery branch from the innominate artery and six cases with unilateral absence of pulmonary artery. The shared characteristic sonographic finding was the lack of confluence at the bifurcation of the main pulmonary artery. The differences between the two conditions are highlighted by the origin of the anomalous vessel. In fetuses with anomalous origin of one pulmonary artery branch, the affected pulmonary artery arose from the posterior wall of the ascending aorta as noted on three vessels and trachea view as well as the long axis of the left ventricular outflow tract. This is in contrast to fetuses with unilateral absence of pulmonary artery, where the origin of affected pulmonary artery arises from the base of the innominate artery via the ipsilateral patent arterial duct as evident on the three vessels and trachea view and the coronal view of innominate (brachiocephalic) artery.Conclusion:(1) The main similarity is an absence of a confluence at the bifurcation of the main pulmonary artery. (2) The main distinguishing feature is the origin of the anomalous vessel from either the subclavian or directly from the aorta.

Anomalous origin of the right pulmonary artery from the descending aorta in a fetus

“…In the cases of UAPA, the color blood flow signal of the pulmonary artery branch could be seen in the parenchyma of the affected side; A three‐vessel trachea view and a coronary view of the initial part of the innominate artery showed that the affected pulmonary artery was connected to the innominate artery by the ipsilateral arterial duct; The distal LPA connected with the ventral arch of the aorta (combining TOF); The absence of the left proximal pulmonary artery combined with the right arch and the absence of the right proximal pulmonary artery combined with the left arch. In the cases of AOPA, three‐vessel and trachea view (3VT view) and long axial views of the left ventricular outflow tract showed the affected pulmonary artery emanating from the left or right posterior wall of the ascending aorta (near aortic valve level) 2 …”

“…1 AOPA can be divided into proximal and distal types according to the distance between the origin of the pulmonary artery and the aortic valve. 2 The most common pulmonary origin abnormality is one of the pulmonary arteries (right or left) arising from the ascending aorta. 3 Here we presented an extremely rare case of anomalous origin of the right pulmonary artery from the descending aorta (DAo) in a fetus at 24 weeks of gestation.…”

“…Anomalous origin of the branches of the pulmonary artery to the aorta (AOPA) is a rare anomaly that accounts for .12% of all congenital heart defects 1 . AOPA can be divided into proximal and distal types according to the distance between the origin of the pulmonary artery and the aortic valve 2 . The most common pulmonary origin abnormality is one of the pulmonary arteries (right or left) arising from the ascending aorta 3 .…”

Type II Left Pulmonary Artery Sling Associated with Double-Outlet Right Ventricle Diagnosed by Fetal Echocardiography and Postnatal Computer Tomography

“…LPAS is a type of anomalous origin of the pulmonary artery, which should be distinguished from the absence of LPA, and LPA anomaly originates from the aorta. The absence of the LPA refers to the proximal interruption of LPA, with the distal pulmonary artery being usually intact in the lungs [7]. LPA anomaly originating from the aorta is also an extremely rare malformation, with a normal origin of the RPA from the main pulmonary artery [6].…”

Prenatal diagnosis of the ductal origin of the distal right pulmonary artery with bilateral ductus arteriosus using STIC‐HD live flow rendering mode

“…It refers to the proximal interruption of right pulmonary artery , with the distal section arising from the base of the brachiocephalic artery (BA) via the ipsilateral ductus arteriosus (DA). There have been sporadic reports of antenatal diagnoses using two‐dimensional (2D) ultrasound 1,2 . However, to the best of our knowledge, this is the first case applying spatiotemporal image correlation, combined with high definition (STIC‐HD) live flow rendering mode for prenatal diagnosis of DODRPA with BDA.…”