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

Abstract

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.

‘Red eye’ in main pulmonary artery: new sonographic sign for diagnosing aortopulmonary window

“…During fetal development, the inability of the aortopulmonary septum to split the arterial trunk into the ascending aorta and pulmonary artery can result in APW [1][2][3] . This malformation is characterized by direct communication between the ascending aorta and pulmonary artery above the semilunar valves.…”

Modern Possibilities of Ultrasound Diagnostics of Fetal Heart Defects

“…Аортопульмональное окно -это редкий врожденный порок сердца, который вызывает затруднения у большинства специалистов по УЗИ. В недавнем исследовании были ретроспективно рассмотрены 10 случаев этой патологии у плода, включая 6 с дистальными и 4 с проксимальными дефектами соответственно [33]. Кроме того, было включено 40 нормальных беременностей с аналогичным гестационным возрастом.…”

“…Дистальное аортопульмональное окно всегда с увеличивающимся углом между аортой и легочной артерией и без наличия нормального протока. Также исследователи отметили, что техника 4D STIC может предоставить дополнительную объемную визуализацию магистральных сосудов, дополнительную визуализацию магистральных артерий и таким образом помочь в диагностике патологии [33]. В другом исследовании было ретроспективно рассмотрено 8 случаев аортопульмонального окна, подтвержденных эхокардиографией и операцией, и проанализированы эхокардиографические особенности [21].…”