Post–Left Atrium Space Index in Fetuses With Total Anomalous Pulmonary Venous Connection and Other Congenital Heart Diseases

Abstract

Objectives-We aimed to explore the value of the post-left atrium space (PLAS) index in the diagnosis of total anomalous pulmonary venous connection (TAPVC) and the effect of other congenital heart diseases on the PLAS index in the fetus. Methods-The PLAS index of 69 fetuses with TAPVC was analyzed retrospectively. Approximately 252 healthy fetuses were randomly selected as controls, and 110 cases of intracardiac malformations were randomly selected for comparison. The PLAS index was defined as the ratio of the left atrium-descending aorta distance divided by the descending aorta diameter from the 4-chamber view in the end-systolic phase. Results-There were no significant differences in the PLAS index among the 3 groups of isolated TAPVC subtypes (P > .05), or among the isolated TAPVC group and the simple and complex cardiac anomaly groups (P > .05). Compared with the control group, the PLAS index of the TAPVC group was significantly increased (P < .001). The PLAS index was significantly higher in the TAPVC group than in hypoplastic left heart syndrome, endocardial cushion defect, conotruncal defect, and ventricular septal defect groups (P < .05). The PLAS indices of the hypoplastic left heart syndrome, endocardial cushion defect, and conotruncal defect groups were all higher than that of the control group (P < .05). There was no significant difference in the PLAS index between the ventricular septal defect and control groups (P > .05). Conclusions-The PLAS index is a sensitive parameter for the diagnosis of fetal TAPVC. There were no significant differences in the PLAS index among different TAPVC types. Complex intracardiac anomalies have an influence on the PLAS index.

Fetal left‐atrial posterior‐space‐to‐diagonal ratio at 17–37 weeks' gestation for prediction of total anomalous pulmonary venous connection

“…The optimal cut‐off for the PLAS index in most previous studies was approximately 1 9,13,16 , consistent with that in our study. Kawazu et al 9 .…”

“…It is easy to use and can be remembered easily when calculating the ratio of the LDD to the DA. It also has a high detection rate and a low false-positive rate 9,13,16 .…”

“…This may be due to comparing the measurements of novice and expert examiners in the first 21 cases only; the learning curve may have influenced reproducibility of these measurements. All ICCs are comparable to those reported previously 3,9,13,16 . However, Mao et al 10 .…”

“…However, they calculated that there would be a mildly decreased specificity of 89% in the first study and 93% in their subsequent study. In a study by Han et al 16 ,. the best cut‐off for the PLAS index was found to be 0.99, with a sensitivity of 100% and specificity of 99.6%.…”

“…Some congenital heart diseases involving a small left atrium, such as hypoplastic left heart syndrome (HLHS), may be associated with an increase in the LAPSD ratio. HLHS was also associated with an increased PLAS index due to a decreased left atrial volume 16 . These factors may contribute to a false‐positive diagnosis of TAPVC.…”