Prenatal detection of ductal-dependent congenital heart disease: how can things be made easier?
OBJECTIVE
To improve the detection of ductal dependence in fetuses with severe anomalies of the outflow tracts by observing, with directional power Doppler, reverse flow through the aortic arch or ductus arteriosus in a transverse view of the upper mediastinum.


METHODS
A slight cranial move of the ultrasound beam from the three-vessel view allows the transverse view of the aortic arch and ductus arteriosus to be visualized simultaneously. This view is orthogonal to the fetal body axis and parallel to the plane of the four-chamber view. In normal fetuses, directional power Doppler interrogation at this level identifies forward flow in both oblique vessels.


RESULTS
We examined 43 fetuses with cardiac defects. In five of the cases, there was reversed flow in the aortic arch or ductus arteriosus in addition to severe anomalies of the outflow tracts, including four with hypoplastic left ventricle and one with pulmonary atresia.


CONCLUSIONS
Prenatal detection of reversed flow in the aortic arch or ductus arteriosus is associated with complex congenital heart disease with major diminution of forward flow to the corresponding great vessels.
Viñals
F
F
Ultrasound Department, Clinica Sanatorio Alemán, Concepción, Chile. fvinals@ctcinternet.cl
Tapia
J
J
Giuliano
A
A
D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology; D015331:Cohort Studies; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005313:Fetal Death; D005500:Follow-Up Studies; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D011256:Pregnancy Outcome; D018570:Risk Assessment; D015996:Survival Rate; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal / Q000379:methods*