Utility of a modified vascular corrosion casting technique in the diagnosis of fetal total anomalous pulmonary venous connection

Abstract

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiac malformation, and prenatal detection of TAPVC malformation remains a challenging. TAPVC can be easily missed or misdiagnosed in prenatal examinations. This study was aimed to use the modified vascular corrosion casting technique to prepare fetal cardiovascular casts with TAPVC and investigate the utility of cardiovascular casting for the demonstration of fetal TAPVC. The retrospective study enrolled twenty fetuses (22 to 29 + 4 gestational weeks) with TAPVC diagnosed by prenatal echocardiography and casting technique from May 2015 to May 2020. Pre- and postnatal medical records, including results obtained by prenatal ultrasound, postpartum computed tomography angiography, as well as anatomic and cardiovascular casting findings were carefully reviewed and analyzed. In twenty cases, 80% (16/20) had intra- or extracardiac malformations. The TAPVC types were supracardiac (n = 8), cardiac (n = 6), infracardiac (n = 4), and mixed (n = 2). The diagnosis of 1 case each of supracardiac and cardiac TAPVC was modified to partial anomalous pulmonary venous connection; additionally, 4 malformations were missed and 2 were misdiagnosed, including an anomalous left brachiocephalic vein in supracardiac TAPVC, abnormal inflow of the hepatic vein and a double inferior vena cava in infracardiac TAPVC; and bilateral ductus arteriosus in infracardiac TAPVC; a tetralogy of Fallot in cardiac TAPVC that was corrected to right ventricular double outlet; and an absence of ductus arteriosus that was misdiagnosed as slim ductus arteriosus. Comparing with ultrasound, casting technique has its own superiority in exhibiting TAPVC abnormalities, especially in certain types such as course, origin and absence abnormalities of ductus. Postpartum cardiovascular casts can accurately depict the branch structure of the heart’s larger vessels, and may be used as a clinical assessment and teaching method in complex cardiac malformations.

Characterization of ultrasound and postnatal pathology in fetuses with heterotaxy syndrome

“…As ACPV is often located in the dorsal side of the heart, it is prone to missed diagnosis or misdiagnosis as a complete anomalous pulmonary venous connection (30). However, vascular casting greatly assists ultrasonologists in examining intracardiac malformations and systemic and pulmonary venous connections, broadening their understanding of the disease (31). The postnatal mortality rate of ACPV is extremely high, and the afflicted rarely survive for more than 4 weeks (32).…”

Innovative cardiovascular casting technique features the complex malformation of berry syndrome

“…In this case report, we provide an in-depth analysis of the distinctive features of Berry syndrome and highlight the critical aspects of prenatal ultrasound diagnosis. Additionally, we employed advanced cardiovascular technology to construct a cardiovascular cast model, which enhances our understanding of this complex cardiac malformation [ 7 – 10 ].…”

Development of Digital Fetal Heart Models with Virtual Ultrasound Function Based on Cardiovascular Casting and Computed Tomography Scan

“…Since the 1990s, magnetic resonance imaging [ 10 , 11 ] and micro-computed tomography [ 12 , 13 , 14 ] have been used for postmortem cardiac imaging. Although these methods can display delicate intracardiac and extracardiac structures, the spatial configuration of the complex malformation of the cardiovascular system can be demonstrated more stereoscopically and vividly by the vascular corrosion technique [ 15 , 16 , 17 , 18 , 19 ]. Moreover, the cardiovascular systems are initially separated during the casting process, making the next step of precise segmentation easier.…”