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Case Series: Fetal Pulmonary Vein A-Wave Reversal: An Early Marker of Left-Sided Cardiac Anomalies?

Schenone AL, Giugni G, Schenone MH, Diaz L, Bermudez A, Majdalany D, Sosa-Olavarria A - AJP Rep (2015)

Bottom Line: The sixth case with CHD and nonreversal of A-wave was described as right ventricle hypoplasia with type 1 tricuspid atresia and persistent ductus arteriosus.Conclusion This is the first series reporting pulmonary vein end-diastolic reversal as a CHD screening add-on during early pregnancy.This pilot study suggests that pulmonary vein end-diastolic flow reversal favors detection of left-sided CHD over the right-sided ones.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Ohio.

ABSTRACT
Background Improvements in congenital heart disease (CHD) screening are needed based on the lack of sensitivity of current screening methods and the understanding that the early detection of certain CHDs may improve outcomes. Fetal venous circulation has caught medical attention, and two studies demonstrated that it is feasible to register pulmonary vein flow velocity waveforms (FVWs) during early gestation. Meanwhile, the latter study proposed pulmonary vein A-wave reversal as a marker of cardiac anomaly. Methods We report a series of six consecutive fetuses with confirmed cardiac anomalies that underwent first-trimester screening, including pulmonary vein FVWs, at our center during 2013. CHD was confirmed by late pregnancy echocardiography, and in three cases fetal autopsies were performed. Result/Discussion The ductus venosus (DV) and nuchal translucency (NT) predicted 50% of CHD cases, whereas the combination of markers identified 66.6% of CHD cases. When adding pulmonary vein assessment, the rate of detection rose to 83.3%. Total five of six cases of CHD had reversal of pulmonary vein A-wave during early pregnancy. The sixth case with CHD and nonreversal of A-wave was described as right ventricle hypoplasia with type 1 tricuspid atresia and persistent ductus arteriosus. Conclusion This is the first series reporting pulmonary vein end-diastolic reversal as a CHD screening add-on during early pregnancy. The addition of pulmonary vein FVW assessment to the current CHD screening bundle could increase the rate detection of cardiac anomalies. This pilot study suggests that pulmonary vein end-diastolic flow reversal favors detection of left-sided CHD over the right-sided ones.

No MeSH data available.


Related in: MedlinePlus

Fetal autopsy demonstrating the hypoplastic left ventricle. PD, right lung; PI, left lung; VD, right ventricle; VI, left ventricle.
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FI140060-9: Fetal autopsy demonstrating the hypoplastic left ventricle. PD, right lung; PI, left lung; VD, right ventricle; VI, left ventricle.

Mentions: The Doppler evaluation demonstrated tricuspid regurgitation and profound end-diastolic flow reversal of pulmonary vein and DV (Fig. 8). A chorionic villus sampling showed a normal karyotype. Prenatal echography at 18 weeks reported hydropic fetus without cardiac activity. Fetal autopsy revealed a left-sided heart hypoplasia (Fig. 9).


Case Series: Fetal Pulmonary Vein A-Wave Reversal: An Early Marker of Left-Sided Cardiac Anomalies?

Schenone AL, Giugni G, Schenone MH, Diaz L, Bermudez A, Majdalany D, Sosa-Olavarria A - AJP Rep (2015)

Fetal autopsy demonstrating the hypoplastic left ventricle. PD, right lung; PI, left lung; VD, right ventricle; VI, left ventricle.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4502625&req=5

FI140060-9: Fetal autopsy demonstrating the hypoplastic left ventricle. PD, right lung; PI, left lung; VD, right ventricle; VI, left ventricle.
Mentions: The Doppler evaluation demonstrated tricuspid regurgitation and profound end-diastolic flow reversal of pulmonary vein and DV (Fig. 8). A chorionic villus sampling showed a normal karyotype. Prenatal echography at 18 weeks reported hydropic fetus without cardiac activity. Fetal autopsy revealed a left-sided heart hypoplasia (Fig. 9).

Bottom Line: The sixth case with CHD and nonreversal of A-wave was described as right ventricle hypoplasia with type 1 tricuspid atresia and persistent ductus arteriosus.Conclusion This is the first series reporting pulmonary vein end-diastolic reversal as a CHD screening add-on during early pregnancy.This pilot study suggests that pulmonary vein end-diastolic flow reversal favors detection of left-sided CHD over the right-sided ones.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Ohio.

ABSTRACT
Background Improvements in congenital heart disease (CHD) screening are needed based on the lack of sensitivity of current screening methods and the understanding that the early detection of certain CHDs may improve outcomes. Fetal venous circulation has caught medical attention, and two studies demonstrated that it is feasible to register pulmonary vein flow velocity waveforms (FVWs) during early gestation. Meanwhile, the latter study proposed pulmonary vein A-wave reversal as a marker of cardiac anomaly. Methods We report a series of six consecutive fetuses with confirmed cardiac anomalies that underwent first-trimester screening, including pulmonary vein FVWs, at our center during 2013. CHD was confirmed by late pregnancy echocardiography, and in three cases fetal autopsies were performed. Result/Discussion The ductus venosus (DV) and nuchal translucency (NT) predicted 50% of CHD cases, whereas the combination of markers identified 66.6% of CHD cases. When adding pulmonary vein assessment, the rate of detection rose to 83.3%. Total five of six cases of CHD had reversal of pulmonary vein A-wave during early pregnancy. The sixth case with CHD and nonreversal of A-wave was described as right ventricle hypoplasia with type 1 tricuspid atresia and persistent ductus arteriosus. Conclusion This is the first series reporting pulmonary vein end-diastolic reversal as a CHD screening add-on during early pregnancy. The addition of pulmonary vein FVW assessment to the current CHD screening bundle could increase the rate detection of cardiac anomalies. This pilot study suggests that pulmonary vein end-diastolic flow reversal favors detection of left-sided CHD over the right-sided ones.

No MeSH data available.


Related in: MedlinePlus