Unusual Combination of Anomalous Connection of the Left Pulmonary Veins and Aortic Arch Anomaly Presenting as Abnormal Three Vessel View in the 2nd Trimester US Scan

Abstract

Partial anomalous pulmonary venous drainage is often missed antenatally unless a complex congenital heart defect is associated. Likewise, isolated fetal coarctation of aorta has only a 60–70% chance to be diagnosed in the second trimester. The combination of these two conditions (PAPVC and COA), in the absence of situs abnormality or syndromic association is rare and not much reported in the literature. We are reporting a fetal heart which presented with apparent hypoplasia of the left ventricle and ascending aorta, as well as significant dilatation of the right atrium, right ventricle and pulmonary artery at 22 weeks of gestation. To begin with, we strongly suspected a left sided obstructive lesion until we noticed a 4th channel in the three vessel view (3VV) and dilated innominate vein in the absence of a dilated coronary sinus in the 4 chamber view. This led to a diagnosis of supracardiac PAPVC in combination with an arch anomaly. The pregnancy was continued up to 37–38 weeks when she underwent C-section for an obstetric indication. The baby underwent surgical intervention postnatally.

Keywords

PAPVC - Coarctation of Aorta, Fetal Cardiac Anomaly