Prenatal dilatation of the pulmonary artery in the third trimester – important information for paediatric cardiologist or for neonatologist? Case report

Abstract

We present a case of dilated main pulmonary artery diameter with accompanying cardiac anomalies and postnatal follow-up. The abnormalities in the left side of the heart concerned the left superior vena cava (LSVC), decreased left ventricular contractility SF LV (shortening fraction), and narrowing/accelerating flows through the aortic valve and aortic arch isthmus. In our case, coarctation of the aorta was suspected both pre-and postnatally due to the dominant picture of the accelerated flow velocities, but the patient did not require neonatal surgery. Based on a retrospective review of the case, we tried to explain our prenatal and early postnatal findings. After the exclusion of the structural congenital heart defects as a base of the dilatation of the main pulmonary artery, we should consider other pathophysiological mechanisms presented in the following report.

Prenatal ultrasound assessment of fetal lung development in normal and complicated by fetal and maternal diseases pregnancy

“…That is why many scientists try to rule out noninvasive methods to reach the same or even better predicting results. For this purpose, fetal echocardiography as widely available tools is used in normal and complicated by fetal and maternal diseases pregnancy to assess proper fetal lung development 2–14 …”

“…That was also evaluated in other maternal diseases, interestingly also in the Turkish centers 3,4 . Main pulmonary artery diameter measurement could indirectly predict impaired pulmonary tissue 5,6 . Valuable information could also come from gray‐scale histogram, 9 but only if normal fetal hepatic development is proved.…”

“…For this purpose, fetal echocardiography as widely available tools is used in normal and complicated by fetal and maternal diseases pregnancy to assess proper fetal lung development. [2][3][4][5][6][7][8][9][10][11][12][13][14] Fetal respiratory system is directly influenced by the fetal cardiovascular system and the other way around. The left ventricle is predominantly dedicated to the coronary circulation and upper body, while the right ventricle is the main distributor to the lower part of the body, the placenta and the lungs.…”

“…3,4 Main pulmonary artery diameter measurement could indirectly predict impaired pulmonary tissue. 5,6 Valuable information could also come from gray-scale histogram, 9 but only if normal fetal hepatic development is proved. In cases suspected for unfavorable neonatal respiratory status according to the Menekse Beser, et al results 2 prenatal pharmacotherapy could be considered.…”