Prenatal Diagnosis of Bilateral Ventriculocoronary Fistulas With Hypoplasia of the Left Ventricle

Abstract

Fetal echocardiography and color Doppler sonography have shown that most heart defects can be reliably diagnosed in utero by associated hemodynamic changes. Congenital ventriculocoronary fistulas associated with hypoplastic right heart syndrome (HRHS) and hypoplastic left heart syndrome (HLHS) have been described in the prenatal and neonatal periods, but little attention has been paid to their incidence and hemodynamic changes. There have been only a few reports of prenatal diagnosis of ventriculocoronary communications in HRHS and HLHS. Here we report prenatal diagnosis of HLHS and fistulas between the left ventricle and both the right and left coronary arteries to the pulmonary artery with a muscular ventricular septal defect (VSD) in a fetus at 23 weeks' gestation.

Transient abnormal fetal cardiac flow patterns at 13 to 17 gestational weeks

“…Therefore, the presence of these fistulae in the neonatal period is clinically relevant. There are a number of reports describing coronary arterial fistulae in the prenatal period, all associated with other cardiac or noncardiac anomalies in the fetus . We did not find any description of transient abnormal flow in the coronary region.…”

“…High flow in the coronary in the neonate suggests the presence of coronary fistula. Their impact can range from mild changes to severe cardiac insufficiency and from asymptomatic to life‐threatening with catastrophic events, such as syncope, shock, or even sudden death . Therefore, the presence of these fistulae in the neonatal period is clinically relevant.…”

“…When performing fetal cardiac echography, the transient nature of pericardial effusion, cardiomegaly, abnormal rhythm, echogenic foci, asymmetrical ventricles, dilated aortic arch, tricuspid regurgitation, and others has been observed . Fetal coronary fistulae, aortic and pulmonary stenosis, and mitral regurgitation are occasionally reported usually associated in the presence of additional fetal malformations . Herein, we report our experience with the observation of four types of transient abnormal cardiac flow patterns (ABCFP), which may erroneously suggest the existence of valvular or fistulous anomalies early in pregnancy.…”

Prenatal diagnosis of a right coronary artery to right atrial fistula with a giant coronary artery aneurysm: A case report

“…Pulsed Doppler can show continuous flows throughout the cardiac cycle when CAFs drain into right atrium, and typical bidirectional flow when CAFs drain into right ventricle. Here the CAF featured continuous flow throughout the cardiac cycle, which strongly suggested a coronary artery to right atrium CAF 1‐4,9 …”

“…Coronary artery fistula (CAF) is a rare cardiac anomaly. Since the development of fetal echocardiography, reports of prenatally diagnosed CAFs have been published 1‐4 . No report of prenatal diagnosis of right coronary artery to right atrial fistula with giant coronary artery aneurysm (CAA) exists.…”