ObjectiveTo compare prenatal echocardiography with postnatal cardiovascular casting for detection of fetal cardiovascular malformations, and to discuss the causes of prenatal misdiagnosis and missed diagnosis.MethodsWe retrospectively identified patients from 2013 to 2018 at our Maternal‐Fetal Medicine Center who were reported to have a fetal diagnosis of severe congenital heart malformations (CHMs). Subjects had postnatal confirmation of CHMs. Prenatal and postnatal medical records, including ultrasound results and casting findings, were reviewed and analyzed.ResultsPostnatal casting showed that all 35 fetuses had complex CHMs. In these 35 cases, 90 cardiovascular malformations were found by postnatal casting, and 69 were detected by prenatal echocardiography. Among the other 21 cardiovascular malformations, 7 were misdiagnosed and 14 diagnoses were missed by prenatal ultrasound.ConclusionPrenatal echocardiography may lead to misdiagnosis and missed diagnoses, especially in cases with great arterial branching anomalies. Postnatal casting can demonstrate the configuration of the great vessels and smaller branches directly. Thus, understanding of such malformations via postnatal casting may help to improve prenatal diagnostic accuracy.

Noncompaction of the ventricular myocardium (NVM) is a cardiomyopathy characterized by abnormally enlarged intraventricular trabeculae and intersecting deep recesses. It is believed that the failure of reticular trabeculae compaction during early embryonic development plays an important role in the disease. Cavernous cardiomyopathy often involves the left ventricle, while right ventricle and bilateral ventricles are rare. Although there have been several studies on NVM in children and adults, there are few studies on fe-tuses. NVM can occur independently or in combination with other complex cardiac malformations. 1,2 In our case, a rare pulmonary artery sling was also found. The clinical course and prognosis of PAS mainly depend on the degree of airway stenosis. It is generally believed that the high mortality rate of PAS is due to the compression of the tracheobronchial tree rather than PAS itself. Two-thirds of the patients develop symptoms associated with airway diseases in the first month of life. PAS easily escapes detection in its early stages. If untreated, the first-year mortality rate could be approximately 90%.Therefore, precise prenatal diagnosis could be beneficial to its clinical treatment and prognosis. 3,4 Fetal echocardiography is the preferred method for diagnosing fetal cardiomyopathy and other cardiac malformations due to its noninvasive, safe, and inexpensive characteristics. It can provide reliable imaging diagnosis for prenatal consultation of pregnant women. 5 Our report demonstrated that IRVNC associated with PAS can be diagnosed in fetal life by prenatal ultrasound. | C A S E REP ORTA 31-year-old pregnant woman (gravida 2, para 1) was referred to our maternal-fetal medical center at 30 + 5 weeks for suspected heart defects. Her nuchal translucency test and prenatal cell-free fetal DNA testing were both felt to be low-risk. She reported no family history. Fetal echocardiography showed the right atrium and ventricle were markedly dilated, a maximum right ventricular wall thickness of 7.5 mm, and multiple prominent trabeculations and deep intertrabecular recesses communicating with the right ventricular cavity (Figure 1). Both the LV and RV function were normal.The left pulmonary artery anomalously originates from a normally positioned right pulmonary artery and running posterior to the trachea, forming a PAS. Color Doppler Flow Imaging (CDFI) revealed that there was a right-to-left blood flow signal in the foramen ovale, AbstractNoncompaction of the ventricular myocardium (NVM), also known as spongy myocardium, is a rare type of cardiomyopathy that has a serious impact on fetuses, children, and adults. NVM mainly affects the left ventricle, as isolated right ventricular noncompaction (IRVNC) is rare. Pulmonary artery sling (PAS) is a rare condition in which the left pulmonary artery anomalously originates from a normal positioned right pulmonary artery, and only a few studies have reported PAS in fetuses. Fetal IRVNC complicated with PAS has not been reported yet. Here, we report a case of ...

The back cover image is based on the Original Article Description of misdiagnosis and missed diagnosis of fetal complex heart malformations by prenatal echocardiography combined with postnatal cardiovascular casting by Yu Wang et al., https://doi.org/10.1002/pd.5689.image

Dextrocardia with a ductus arteriosus (DA) malformation is extremely rare. Here, we present a case of dextrocardia complicated with a right DA that is circuitously connecting the pulmonary artery and the right brachiocephalic artery. Coincidentally, the deformities of this fetus are almost symmetrical with those in another fetus (also presented here), which is astonishing and meaningful. Dextrocardia is rare, complicated, and not well understood. In this report, we carefully compared prenatal echocardiographic images and cardiovascular casts from two fetuses. Our report of these cases may provide new insights for cardiologists to better understand dextrocardia and its associated malformations.

Unilateral absence of the pulmonary artery (UAPA) is a rare congenital cardiovascular malformation that can present as an isolated lesion or may be associated with other congenital heart malformations. Several studies have reported UAPA after birth. To our knowledge, the absence of the right pulmonary artery in the fetus has not been reported. Here, we report a rare case of fetal right pulmonary artery absence with aortic coarctation, which was confirmed by postpartum ultrasound and computed tomography angiography (CTA). Our case demonstrates that fetal echocardiography, especially the three‐vessel view, is beneficial for the prenatal diagnosis of pulmonary artery malformations.