Prenatal diagnosis of total and partial anomalous pulmonary venous connection: multicenter cohort study and meta‐analysis

Paladini, D.; Pistorio, Angela; Lh, Wu; Meccariello, Gabriella; Lei, Ting; Tuo, Giulia; Donarini, G.; Marasini, Maurizio; Xie, Hong‐Ning

doi:10.1002/uog.18907

Cited by 61 publications

(58 citation statements)

References 35 publications

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“…3 However, several echocardiographic signs are useful for the prenatal diagnosis of TAPVC, including ventricular disproportion, a smooth left atrium (LA) posterior wall, an increased post-LA area, a vertical vein, and abnormal spectral Doppler waveforms in the pulmonary veins. 6,12,13 Additionally, color Doppler ultrasound plays an important role in diagnosing this condition, and 3-dimensional spatiotemporal image correlation has incremental value in the evaluation of TAPVC types and drainage pathways. 14 Normally, the LA is a midline posterosuperior chamber, which receives pulmonary venous blood return.…”

Section: Discussionmentioning

confidence: 99%

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

Han

et al. 2020

J of Ultrasound Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

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

Han

et al. 2020

J of Ultrasound Medicine

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“…Prenatal diagnosis of isolated TAPVC is still thought to be very difficult . In fact, only one fetus was diagnosed prenatally out of eight with TAPVC in the previous study period (2005‐2013) .…”

Section: Discussionmentioning

confidence: 99%

“…Prenatal diagnosis of isolated TAPVC is still thought to be very difficult. [5][6][7] In fact, only one fetus was diagnosed prenatally out of eight with TAPVC in the previous study period (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) We think that this simple index is useful for raising the suspicion of anomalous pulmonary venous return, allowing referral of these fetuses to centers where specialists can perform fetal echocardiography.…”

Section: Mao Et Al Measured the Distance Between The La And Descendingmentioning

confidence: 99%

“…We previously reported that this space is wider in fetuses with total anomalous pulmonary venous connection (TAPVC), a rare form of severe congenital heart disease that requires emergency neonatal surgery associated with a high mortality . It is still difficult to detect TAPVC prenatally because the four‐chamber view looks normal . We reported that the post‐LA space index (PLAS index) is significantly higher in fetuses with TAPVC than in normal fetuses, suggesting this index may be useful for detecting TAPVC .…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the post‐LA space index in the normal fetus

et al. 2019

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Objective We previously reported the post‐LA space index (PLAS index), which is calculated as left atrial‐descending aorta distance (LD) divided by the diameter of descending aorta (DA), could be useful for prenatal diagnosis of total anomalous pulmonary venous connection (TAPVC). In this study, we evaluated PLAS index in normal fetuses to assess its usefulness. Methods In 304 normal fetuses, LD and DA were retrospectively measured, and the PLAS index was calculated. In 206 fetuses with data on the biparietal diameter (BPD) and femoral length (FL), the relationship between the PLAS index and them was investigated. We also calculated the PLAS index in 13 TAPVC fetuses. Results Mean LD was 3.0+/−0.94 mm, mean DA was 4.8+/−0.87 mm, and the mean PLAS index was 0.62+/−0.19. DA and LD were correlated with gestational age (R = 0.52, 0.25), while the PLAS index showed little variation with gestational age (R < 0.2). BPD and FL were correlated with DA (R = 0.4, 0.42) but not with LD or the PLAS index (both R < 0.2). In the TAPVC fetuses, both LD and the PLAS index were significantly higher than in normal fetuses. Conclusion In normal fetuses, the PLAS index was independent of gestational age and fetal physique and may be useful for raising the suspicion of congenital heart disease, including TAPVC.

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“…Volume Overload. Prenatal volume overload occurs in fetal anemia [17], vascularized tumors [17], severe intrauterine growth restriction [6,15,18,19], abnormal venous drainage [20], or twin-to-twin transfusion syndrome [12,14]. The natural response is to enlarge heart dimensions (cardiac dilation), thus increasing the stroke volume with every beat, in order to better manage the increased blood volume.…”

Section: Main Determinants Of Fetal Cardiac Remodelingmentioning

confidence: 99%

Main Patterns of Fetal Cardiac Remodeling

et al. 2020

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The heart is a central organ in the fetal adaptation to an adverse environment. Fetal cardiac changes may persist postnatally and increase the risk of cardiovascular disease in adulthood. Knowledge about fetal cardiac structural as well as functional remodeling has radically improved over the last few years. As it occurs in postnatal life, the fetal heart remodels -changing its structure and shape -to adapt to an insult. Several conditions have been reported to be associated with fetal cardiac remodeling including intrauterine growth restriction, diabetes, exposure to antiretroviral drugs, conception by assisted reproductive technologies, pulmonary stenosis, and other congenital heart diseases. Here we summarized the main observable patterns of cardiac remodeling, i.e., globular shape, hypertrophy without dilation, and hypertrophy with cardiomegaly. We discuss the potential pathophysiology behind different types of remodeling. Defining precisely the distinct patterns of fetal cardiac remodeling is critical for advancing in the understanding of fetal cardiovascular programming and its consequences on adult health, and potentially for the design of preventive strategies that might have an impact on long-term cardiovascular health.

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Prenatal diagnosis of total and partial anomalous pulmonary venous connection: multicenter cohort study and meta‐analysis

Cited by 61 publications

References 35 publications

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

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

Evaluation of the post‐LA space index in the normal fetus

Main Patterns of Fetal Cardiac Remodeling

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