e describe the prenatal diagnosis of an obstructed pulmonary venous connection to the common atrium in a fetus with right isomerism at 35 weeks' gestation. There was levocardia with situs inversus of the viscera, a complete balanced atrioventricular septal defect, a double-outlet right ventricle, and dextro-malposition of the great arteries with pulmonary and subpulmonary stenosis. The liver was midline with an intermittent hiatal hernia and left juxtaposition of the inferior vena cava and descending aorta with absence of the spleen, suggestive of right isomerism. There was abnormal incorporation of the common pulmonary chamber by a single orifice into the roof of the common atrium on the left side. Obstruction was documented at the site of insertion into the roof of the common atrium by color and pulsed Doppler imaging. To the best of our knowledge, this type of pulmonary venous obstruction has not been reported prenatally.
Case ReportA 32-year-old woman, gravida 2, para 1, was referred at 35 weeks' gestation because of a suspected abnormality on the 4-chamber view. She was evaluated at our institution for further management. The fetal echocardiogram revealed levocardia, a common atrium with a primitive strand of atrial tissue in the center, a common atrioventricular valve with a complete balanced atrioventricular septal defect, and situs inversus of the viscera with the stomach situated between the heart and spine in the chest, suggestive of a hiatal hernia (Figure 1, A and B). The finding of the hiatal hernia was intermittent. There was normal biventricular function and normal pulsed Doppler flow across the common atrioventricular valve without any atrioventricular valve regurgitation. There was a double-outlet right ventricle with dextro-malposition of the great arteries and mild hypoplasia of the pulmonary trunk with valvar and subvalvar pulmonary