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. 2021 Nov;10(11):3068-3074.
doi: 10.21037/tp-21-488.

Prenatal ultrasound diagnosis and management of fetal aortopulmonary septal defects: a case series

Junjian Yu  1 , Kang Liu  1 , Weichang Xu  1 , Jianxian Xiong  1 , Xuehong Zhong  1 , Shuo Hu  1 , Wentong Li  1
Affiliations

Prenatal ultrasound diagnosis and management of fetal aortopulmonary septal defects: a case series

Junjian Yu et al. Transl Pediatr. 2021 Nov.

Abstract

Background: To investigate the prenatal ultrasound diagnosis and management of patients with aortopulmonary septal defects (APSDs).

Methods: A total of 8 fetuses with APSDs who underwent fetal echocardiography at our hospital from January 2015 to January 2019 were retrospectively included in this study.

Results: Among the 8 fetuses, there were 4 cases of type I APSD, 3 cases were type II, and 1 case was type III. Among the 8 cases, there were 2 cases of simple APSD. There were echocardiographic characteristics that were common to all 3 types of APSD. This included defects between the ascending aorta and the trunk of the pulmonary artery in the short-axis section of the aorta, and in the three vessels and the three-vessel trachea section. Furthermore, the "V"-shaped structure confluence point of all APSD cases was positioned more forward than normal in the three-vessel trachea section. Type I APSD can be better characterized by the cross-section of the double outflow tract of the aorta and the pulmonary artery, which is close to the aortic valve and pulmonary valve. Type II APSD can be clearly diagnosed by the short-axis view of the aorta. Since the defect between the aorta and the pulmonary artery is distant from the aortic valve and pulmonary valve, the defect does not involve the bifurcation of the pulmonary artery and may be associated with an ectopic origin of the right pulmonary artery. Type III APSD is similar to a permanent arterial trunk, and the space between the ascending aorta and the trunk of the pulmonary artery is completely missing. Color and pulse Doppler showed shunt flow in the defects.

Conclusions: APSD can be diagnosed and classified by fetal echocardiography. This, together with the presence or absence of fetal intracardiac and extracardiac deformities, can provide valuable prenatal information to pregnant women and their families, which may facilitate timely diagnosis and timely surgical treatment after birth.

Keywords: Prenatal ultrasound; aortopulmonary septal defect (APSD); classification.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/tp-21-488). JY reports funding from the Education Department Science and Technology Research Project of Jiangxi Provincial (Youth Project) (190821). The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Representative ultrasound images of a type I aortopulmonary septal defect case in utero. APSD represents the main pulmonary artery window; red upward arrow indicates the main pulmonary septal defect; red downward arrow indicates the shunt, main pulmonary septal defect type I, located proximal to the aortic valve. PA, pulmonary artery; AO, aorta; APSD, aortopulmonary septal defect.
Figure 2
Figure 2
Representative ultrasound images of a type II aortopulmonary septal defect case in utero. APSD represents the main pulmonary artery window; red upward arrow indicates the main pulmonary septal defect and the shunt between the right pulmonary artery and the aorta. The defect is located between the right pulmonary artery and the aorta, away from the pulmonary valve. PA, pulmonary artery; AO, aorta; APSD, aortopulmonary septal defect.
Figure 3
Figure 3
A representative ultrasound image showing the common characteristics in all 3 types of fetal aortopulmonary septal defect. APSD represents the main pulmonary artery window; red upward arrow indicates the main pulmonary septal defect, and the confluence point of the V-shaped structure of the three-vessel trachea section is forward from normal. PA, pulmonary artery; AO, aorta; SVC, superior vena cava; APSD, aortopulmonary septal defect.
See this image and copyright information in PMC

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