Prenatal Diagnosis of Distal Aortopulmonary Window With Type A Aortic Arch Interruption With 4-Dimensional Spatiotemporal Image Correlation Rendering

Vaidyanathan, Balu; Vijayaraghavan, Aparna; Karmagaraj, Balaganesh; Kottayil, Brijesh P

doi:10.1161/circimaging.118.007721

Cited by 6 publications

(5 citation statements)

References 3 publications

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“…4D echocardiography can be a good supplement. Previous reports have proposed that STIC technique can provide important insights into the configuration of the great arteries 8,9 . We confirmed its value in the diagnosis of fetal APW.…”

Section: Discussionsupporting

confidence: 82%

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Prenatal diagnosis of fetal aortopulmonary window by two‐ and four‐dimensional echocardiography with spatiotemporal image correlation

et al. 2020

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Background: Aortopulmonary window (APW) is a rare congenital heart disease which challenges most screening sonographers. The current study aims to summarize the two-dimensional (2D) and four-dimensional (4D) sonographic features in the fetal diagnosis.Methods: Ten cases of fetal APW were retrospectively reviewed, including 6 and 4 fetuses with distal and proximal defects, respectively. In addition, 40 normal fetuses with similar gestational age were also enrolled. The angle (α) between the pulmonary artery and aorta, and the length (D) of the ductus/pulmonary artery before its convergence with aorta were measured and compared between the normal and APW fetuses, respectively. Cardiac volumes of APW fetuses were acquired with spatial temporal image correlation (STIC) technique and post-analyzed to obtain 4D rendered images. Results:The D and the α were smaller and greater in distal APW fetuses than those in the normal fetuses, respectively (both P < .01), while no difference presented between the proximal APW fetuses and the normal fetuses. The ductus was absent for all distal APW fetuses, while it was normal for proximal APW fetuses. In 9 of 10 fetuses (90%), the 4D rendered image could be successfully obtained, which clearly showed the abnormal blood communication between the two great arteries in space. Conclusion:It is essential to scan around the three-vessel view and three-vessel trachea view to identify fetal APW using grayscale and color Doppler echocardiography.Distal APW is always with an increasing angulation between aorta and the pulmonary artery, and without the presence of normal ductus. 4D STIC technique may provide additional spatial relationships of the great arteries and thus help the diagnosis and consultation. K E Y W O R D S aortopulmonary window, echocardiography, fetus, prenatal diagnosis, spatial temporal image correlation technique, STIC | 733 TANG eT Al. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. Movie S1. Detection of fetal proximal APW at the three-vessel trachea view by conventional echocardiogram. Movie S2. Detection of fetal distal APW at the three-vessel trachea view by conventional echocardiogram. Movie S3. 4D cineloops showing the abnormal communication in a case of fetal proximal APW. Movie S4. 4D cineloops showing the abnormal communication in a case of fetal distal APW. How to cite this article: Tang H, Wang Y, Sun X, Zhang Y. Prenatal diagnosis of fetal aortopulmonary window by two-and four-dimensional echocardiography with spatiotemporal image correlation. Echocardiography.

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Section: Discussionsupporting

confidence: 82%

“…By a single automatic sweep, the examiner may acquire cardiac volumes which could be further analyzed offline to get interested 4D rendered images. These reconstructed 4D images have proved their values in the diagnosis of fetal CHDs in previous reports 8,9 …”

Section: Introductionsupporting

confidence: 56%

Prenatal diagnosis of fetal aortopulmonary window by two‐ and four‐dimensional echocardiography with spatiotemporal image correlation

et al. 2020

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“…Only isolated cases of APW in association with TOF have been described in the literature [8][9][10][11][12][13][14]. Just 40 cases of APW have been detected prenatally, and among them, the combination with TOF was described in only 2 articles (Table 1) [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

“…This is why early detection of APW, preferably in the prenatal period, remains the key issue in terms of this condition [33,38]. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Author (year), country…”

Section: Discussionmentioning

confidence: 99%

A case of aortopulmonary window mimicking common arterial trunk on fetal echocardiography

Wiecheć,

Nocuń,

Merta

et al. 2023

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Aortopulmonary window (APW) is a rare congenital cardiac anomaly characterised by abnormal communication between the aorta and the pulmonary trunk in the presence of separately formed semilunar valves. We present a case that was initially diagnosed in prenatal life at 21 weeks as common arterial trunk. Follow-up scans starting from 31 weeks revealed APW type I in the setting of tetralogy of Fallot (S, D, S) with a right-sided aortic arch with wide interatrial communication. The neonate was born at 38 weeks of gestation by caesarean section; its birth weight was 2825 g. The postnatal echocardiogram confirmed the prenatal diagnosis provided later in gestation. Three weeks after birth, the child was scheduled for surgery: complete repair and APW closure using an autologous pericardial patch, excision of trabeculae in the right ventricular outflow tract (RVOT), transannular reconstruction below the RVOT, reconstruction of the RVOT, and partial ASD closure. The child was discharged from the hospital, weighing 3300 g, with 97% saturation. APW may remain undiagnosed until adulthood. A late diagnosis may result in congestive heart failure and irreversible damage to the pulmonary vessels. Early detection of APW, preferably in the prenatal period, remains the key issue in terms of this condition.

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“…Yagel et al 17 reported a 6% incremental benefit of 3D/4D STIC over conventional 2D echocardiography. Other reports have highlighted the potential benefits of 3D/4D STIC fetal echocardiography for evaluation of the vascular structures, including the arches and systemic and pulmonary vein 26,27 .…”

Section: Discussionmentioning

confidence: 99%

3D/4D spatiotemporal image correlation (STIC) fetal echocardiography provides incremental benefit over 2D fetal echocardiography in predicting postnatal surgical approach in double‐outlet right ventricle

Karmegaraj

Kumar

Srimurugan

et al. 2021

Ultrasound in Obstet & Gyne

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Objective To analyze the incremental benefit of 3D/4D spatiotemporal image correlation (STIC) fetal echocardiography over 2D fetal echocardiography with respect to the accuracy of identification of anatomic details crucial for surgical decision‐making and in predicting surgical approach in fetuses with double‐outlet right ventricle (DORV). Methods This was a retrospective study of fetuses with DORV which had undergone both 2D echocardiography and 3D/4D STIC echocardiography and which underwent surgery postnatally in a tertiary pediatric cardiac center in Kerala between October 2015 and March 2019. All such cases with normal atrial arrangement, concordant atrioventricular connections and balanced ventricles were included. 2D and 3D/4D STIC fetal echocardiographic data were analyzed by two experienced observers blinded to the other dataset. Anatomic variables crucial for surgical decision‐making, i.e. location and routability of the ventricular septal defect, relationship of the great arteries and presence of outflow obstruction, were compared between the two modalities with respect to agreement with postnatal echocardiography. The accuracy of prenatal prediction of the surgical pathway was compared between 2D and 3D/4D modalities with respect to the procedure undertaken. Results Included in the study were 22 fetuses with DORV which had undergone both 2D and 3D/4D imaging as well as postnatal surgery. Accuracy of prenatal interpretation of all four anatomic variables was significantly higher using 3D/4D STIC than using 2D fetal echocardiography (19/22 (86.4%) vs 8/22 (36.4%), P < 0.001). Surgical procedures included single‐stage repair in 14 (63.5%) patients and a multistage approach in eight (36.4%). Prenatal prediction of the surgical pathway was significantly more accurate on 3D/4D STIC than on 2D echocardiography (20/22 (90.9%) vs 12/22 (54.5%), P = 0.021). Prenatal predictive accuracy of single‐stage biventricular repair was significantly better for 3D/4D STIC than for 2D echocardiography (14/14 (100%) vs 8/14 (57.1%), P = 0.04). Conclusion Addition of 3D/4D STIC to conventional 2D fetal echocardiography confers incremental benefit on the accuracy of identification of anatomic details crucial for surgical decision‐making and the prediction of postnatal surgical approach in fetuses with DORV, thereby potentially aiding prenatal counseling. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

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Prenatal Diagnosis of Distal Aortopulmonary Window With Type A Aortic Arch Interruption With 4-Dimensional Spatiotemporal Image Correlation Rendering

Cited by 6 publications

References 3 publications

Prenatal diagnosis of fetal aortopulmonary window by two‐ and four‐dimensional echocardiography with spatiotemporal image correlation

Prenatal diagnosis of fetal aortopulmonary window by two‐ and four‐dimensional echocardiography with spatiotemporal image correlation

A case of aortopulmonary window mimicking common arterial trunk on fetal echocardiography

3D/4D spatiotemporal image correlation (STIC) fetal echocardiography provides incremental benefit over 2D fetal echocardiography in predicting postnatal surgical approach in double‐outlet right ventricle

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