Valley Index as a Predictor of Prenatal Diagnosis of Total Anomalous Pulmonary Venous Connection

Abstract

Plain Language SummaryTotal anomalous pulmonary venous connection (TAPVC) requires urgent intervention after birth. Furthermore, prenatal diagnosis is essential to improve the postnatal clinical course. However, fetuses with TAPVC show no identifying characteristics of the disease in echocardiographic images, producing a low prenatal diagnostic rate. Our research proposes a “valley index” to objectively quantify the low pulsatility of pulmonary venous waveforms in fetuses and serve as an indicator of fetal TAPVC. The study sample consisted of 16 fetuses with TAPVC, including 10 with complex congenital heart disease and 104 healthy fetuses. The valley index was calculated using velocities of the S wave, D wave, and valley between the waves. The valley indices were significantly higher in the groups with supracardiac and infracardiac TAPVC than in the healthy control group; indicating that it was a significant predictor of the two types of TAPVC. The optimal cutoff value of the valley index was calculated, showing high sensitivity and specificity for the detection of fetal TAPVC. Therefore, the valley index may be a useful tool for the prenatal detection of TAPVC.