Prenatal diagnosis of unilateral absence of pulmonary artery by echocardiography

Abstract

Objective To analyze the echocardiography features of unilateral absence of pulmonary artery (UAPA) features and improve the prenatal diagnosis accuracy of UAPA by analyzing fetal echocardiography features. Methods Fetal echocardiographic features were analyzed retrospectively in 6 cases with prenatal diagnosis of UAPA between June 2012 and October 2018. At the same time, ultrasonic manifestations of 3 patients whose antenatal examinations were performed in other hospitals and diagnosed as UAPA in our hospital were retrospectively analyzed. The fetal echocardiography characteristics of UAPA were summarized. Results Among the 6 fetuses with UAPA, 4 cases were diagnosed as isolated unilateral absence of proximal right pulmonary artery, 1 was unilateral absence of proximal left pulmonary artery with tetralogy of Fallot (TOF) and 1 was isolated unilateral absence of proximal left pulmonary artery. Characteristic sonographical findings included: ①When other intracardiac abnormalities were absent, the inner diameter and proportion of the heart cavity was normal. ②Multi-view showed that the normal confluence structure disappeared at the branch of the main pulmonary artery, and the diameter of normal pulmonary artery branch was widened. ③On the basis of three vessels and trachea view (3VT), moved the probe up and down to make a transverse scan, two-dimensional and color Doppler flow imaging (CDFI) showed a large vessel (the brachiocephalic trunk artery) originating from the aortic arch which had dual vascular features, it means that it was difficult to distinguish the pulmonary artery branch from the aortic branch. ④On coronal view of the large vessel, two-dimensional and CDFI clearly showed that the large vessel originating from the aortic arch was the brachiocephalic trunk artery, and the pulmonary artery branch connected with the brachiocephalic trunk artery by the ipsilateral vertical arterial duct (DA) which originated from the root of brachiocephalic trunk artery, but the left pulmonary artery branch connected with the ventral side of the aortic arch by the left DA in UAPA fetus with TOF. ⑤Spectrum Doppler of the anomalous vessels of the lungs confirmed that it was the pulmonary artery, and the blood flow of the anomalous PA branch was isolated and no exact connection with the main pulmonary artery. Conclusions UAPA can be accurately diagnosed prenatally by echocardiography. The brachiocephalic trunk artery coronary view is very important for the diagnosis of this disease.Early diagnosis plays an important role in prenatal counseling and prognosis assessment. Key words: Echocardiography; Fetus; Unilateral absence of pulmonarya; Tetralogy of fallot