title: Case Series: Fetal Pulmonary Vein A-Wave Reversal: An Early Marker of Left-Sided Cardiac Anomalies?
abstract: Background Improvements in congenital heart disease (CHD) screening are needed based on the lack of sensitivity of current screening methods and the understanding that the early detection of certain CHDs may improve outcomes. Fetal venous circulation has caught medical attention, and two studies demonstrated that it is feasible to register pulmonary vein flow velocity waveforms (FVWs) during early gestation. Meanwhile, the latter study proposed pulmonary vein A-wave reversal as a marker of cardiac anomaly. Methods We report a series of six consecutive fetuses with confirmed cardiac anomalies that underwent first-trimester screening, including pulmonary vein FVWs, at our center during 2013. CHD was confirmed by late pregnancy echocardiography, and in three cases fetal autopsies were performed. Result/Discussion The ductus venosus (DV) and nuchal translucency (NT) predicted 50% of CHD cases, whereas the combination of markers identified 66.6% of CHD cases. When adding pulmonary vein assessment, the rate of detection rose to 83.3%. Total five of six cases of CHD had reversal of pulmonary vein A-wave during early pregnancy. The sixth case with CHD and nonreversal of A-wave was described as right ventricle hypoplasia with type 1 tricuspid atresia and persistent ductus arteriosus. Conclusion This is the first series reporting pulmonary vein end-diastolic reversal as a CHD screening add-on during early pregnancy. The addition of pulmonary vein FVW assessment to the current CHD screening bundle could increase the rate detection of cardiac anomalies. This pilot study suggests that pulmonary vein end-diastolic flow reversal favors detection of left-sided CHD over the right-sided ones.
authors.affiliation: Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Ohio.
authors.forename: Aldo L
authors.initials: AL
authors.lastname: Schenone
authors.affiliation: Centro de Estudios Perinatales, Valencia, Venezuela.
authors.forename: G
authors.initials: G
authors.lastname: Giugni
authors.affiliation: Department of Materno-fetal Medicine, University of Tennessee, Memphis.
authors.forename: M H
authors.initials: MH
authors.lastname: Schenone
authors.affiliation: Centro de Estudios Perinatales, Valencia, Venezuela.
authors.forename: L
authors.initials: L
authors.lastname: Diaz
authors.affiliation: Centro de Estudios Perinatales, Valencia, Venezuela.
authors.forename: A
authors.initials: A
authors.lastname: Bermudez
authors.affiliation: Clinical Cardiology, Heart and Vascular Institute, Cleveland Clinic, Ohio.
authors.forename: D
authors.initials: D
authors.lastname: Majdalany
authors.affiliation: Centro de Estudios Perinatales, Valencia, Venezuela.
authors.forename: A
authors.initials: A
authors.lastname: Sosa-Olavarria
keywords: congenital cardiac anomaly; congenital heart disease; fetal heart disease screening; fetal pulmonary vein; first-trimester screening