Prenatal diagnosis of ventriculocoronary fistula.
BACKGROUND
Cardiac anomalies may be associated with abnormal coronary vascular connections. We report the prenatal diagnosis of ventriculocoronary fistula in three fetuses with associated cardiac anomalies.


METHODS
Fetal echocardiography was performed in three patients referred for suspected cardiac anomaly. Two-dimensional fetal echocardiography was complemented by color Doppler flow imaging and spectral Doppler in all cases.


RESULTS
A ventriculocoronary fistula was diagnosed in three patients referred at 22, 23 and 32 weeks. The first patient had hypoplastic left heart associated with transposition of the great arteries and pulmonary atresia with an intact interventricular septum. The coronary fistula arose from the transposed aorta to the left ventricle. In two patients ventriculocoronary fistula was found in association with pulmonary atresia and an intact interventricular septum. In all cases there was bidirectional flow within the fistula (diastolic blood flow towards the ventricle with reversal during ventricular systole). The pregnancy with hypoplastic left heart with transposition, and one of those with pulmonary atresia resulted in neonatal death and stillbirth, respectively. In the third instance the ventriculocoronary fistula was verified by postpartum cardiac angiography. The infant initially received a Blalock-Taussig shunt, subsequently replaced by a bidirectional Glenn shunt, and was doing well at the time of writing.


CONCLUSIONS
A ventriculocoronary fistula can be identified prenatally by color and spectral Doppler. This anomaly should be sought in fetuses with outflow tract obstructive cardiac lesions and an intact interventricular septum. Prenatal diagnosis allows early angiography postnatally. Delineation of coronary vascular regions may therefore facilitate preoperative planning.
Baschat
A A
AA
Center for Advanced Fetal Care, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, USA. aabaschat@hotmail.com
Love
J C
JC
Stewart
P A
PA
Gembruch
U
U
Harman
C R
CR
D000328:Adult; D001011:Aorta / Q000002:abnormalities*; D017809:Fatal Outcome; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal; D016157:Vascular Fistula / Q000000981:diagnostic imaging*