Prenatal diagnosis of ventriculo-coronary communications in a second-trimester fetus using transvaginal and transabdominal color Doppler sonography
Prenatal diagnosis of ventriculo-coronary communications in a second-trimester fetus using transvaginal and transabdominal color Doppler sonography
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DOI：
10.1046/j.1469-0705.1997.09030194.x
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发表时间：
1997-03-01
影响因子：
7.1
通讯作者：
Bollmann, R
中科院分区：
文献类型：
--
作者：
Chaoui, R;Tennstedt, C;Bollmann, R
我们报告了与肺闭锁和室间隔完整相关的脑室-冠状动脉通讯的产前诊断。妊娠17周时经阴道彩色多普勒超声诊断，19周时经腹部超声确诊。彩色多普勒显示发育不全的右心室远端与右冠状动脉之间的交通，该血管的路线位于心脏外壁。频谱多普勒评估显示该血管有双向动脉血流。心外骨骼异常（手足裂）也被发现并归类为指外胚层发育不良裂（EEC）综合征。这导致父母选择终止妊娠。所有发现均经尸检证实。体视显微镜还显示了冠状动脉系统和与右心室管腔的主要连接的畸形。据我们所知，这是第一份使用经阴道彩色多普勒识别妊娠中期胎儿冠状动脉畸形的报告。早期的出现使我们能够研究合并缺陷的病理生理顺序。进一步的研究可能会阐明脑室-冠状动脉通信是否继发于肺闭锁和室间隔完整，是由于心室压力增加，还是导致宫内肺闭锁的主要缺陷，或者这两种缺陷是否同时出现。
We report on the prenatal diagnosis of ventriculo-coronary communication associated with pulmonary atresia and an intact interventricular septum. The diagnosis was made by transvaginal color Doppler sonography at 17 weeks' gestation and confirmed by transabdominal sonography at 19 weeks. Color Doppler demonstrated the communication between the distal hypoplastic right ventricle and the right coronary artery, with the course of this vessel situated along the outer heart wall. Spectral Doppler assessment showed bidirectional arterial flow in this vessel. Extracardiac skeletal anomalies (cleft hands and feet) were also detected and classified as an ectrodactyly-ectodermal dysplasia clefting (EEC) syndrome. This led the parents to opt for termination of pregnancy. All findings were confirmed on autopsy. Using stereomicroscopy the malformations of the coronary system and main connections to the lumen of the right ventricle were additionally demonstrated.To our knowledge this is the first report on the identification of coronary artery malformations in a midtrimester fetus using transvaginal color Doppler. The early appearance enabled us to investigate the pathophysiological sequence of the combined defect. Further investigation might elucidate whether ventriculo-coronary communications arise secondary to pulmonary atresia and intact interventricular septum, due to increased ventricular pressure, or are the primary defect leading to intrauterine pulmonary atresia or, indeed, whether both defects appear simultaneously.