HDlive Flow Features of Transposition of Great Arteries with Ventricular Septal Defect, Pulmonary Stenosis, and Persistent Left Superior Vena Cava

Toshiyuki Hata¹, Tomomi Yamanishi², Tomomi Kawahara³, Aya Koyanagi⁴, Riko Takayoshi⁵, Takahito Miyake⁶

^1,5,6Department of Obstetrics and Gynecology, Miyake Clinic, Minami-ku, Okayama, Japan; Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Miki, Kagawa, Japan

^2-4Department of Obstetrics and Gynecology, Miyake Clinic, Minami-ku, Okayama, Japan

Corresponding Author: Toshiyuki Hata, Department of Obstetrics and Gynecology, Miyake Clinic, Minami-ku, Okayama, Japan; Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Miki, Kagawa, Japan, Phone: +810878912174, e-mail: hata.toshiyuki@kagawa-u.ac.jp

Received on: 02 August 2022; Accepted on: 10 August 2022; Published on: 26 December 2022

ABSTRACT

Objective: We present HDlive Flow features of transposition of great arteries (TGA) with ventricular septal defect (VSD), pulmonary stenosis (PS), and persistent left superior vena cava (PLSVC) at 21 weeks and 2 days of gestation.

Case description: HD-flow suggested parallel positioning of great arteries exiting the right ventricle, VSD, and PLSVC. HDlive Flow (Silhouette) clearly revealed an aorta exiting the right ventricle and a small pulmonary artery (PS) exiting the left ventricle in parallel. Pulmonary valvar stenosis was also suspected. A blood vessel (PLSVC) on the left side of the small pulmonary artery was noted. HDlive Flow Silhouette with spatiotemporal image correlation clearly showed a shunt flow stream from the right to left ventricle through VSD.

Conclusion: HDlive Flow (Silhouette) may provide additional, useful information for the precise prenatal assessment of complex TGA.

How to cite this article: Hata T, Yamanishi T, Kawahara T, et al. HDlive Flow Features of Transposition of Great Arteries with Ventricular Septal Defect, Pulmonary Stenosis, and Persistent Left Superior Vena Cava. Donald School J Ultrasound Obstet Gynecol 2022;16(4):263-265.

Source of support: Nil

Conflict of interest: None

Keywords: HDliveFlow, Persistent left superior vena cava, Prenatal diagnosis, Pulmonary stenosis, Spatiotemporal image correlation, Transposition of great arteries, Ventricular septal defect

INTRODUCTION

The prenatal three-dimensional (3D) reconstruction of TGA with or without VSD has been performed using power Doppler,¹ the inversion mode,² or HDlive Flow.³^-⁶ Only one study previously reported the 3D reconstruction of TGA with PS using the inversion mode.⁷ Based on the literature, the 3D reconstruction of TGA with PS has not yet been conducted using HDlive Flow. Therefore, we herein described the features of fetal TGA with VSD, PS, and PLSVC on HDlive Flow.

CASE DESCRIPTION

A pregnant 28-year-old Japanese woman, gravida 3, para 1, with a suspected fetal heart anomaly, was referred to our ultrasound clinic at 21 weeks and 2 days of gestation. HD-flow suggested the parallel positioning of great arteries exiting the RV, VSD, and PLSVC (Fig. 1). HDlive Flow Silhouette mode showed the Ao exiting the RV and a small PA exiting the LV in parallel (Figs 2 and 3). Pulmonary valve stenosis was also suspected (Fig. 2). PLSVC was detected on the left side of PA (Figs 2 and 3). A shunt flow stream was observed from the right to the LV through VSD on HDlive Flow Silhouette mode with STIC (Figs 3 and 4). Furthermore, spatial relationships were noted among the right SVC, Ao, PLSVC, and right and left pulmonary arteries (LPA) using HDlive Flow (Fig. 5).

Fig. 1: A HD-flow image of TGA with VSD, PS, and PLSVC at 21 weeks and 2 days of gestation. HD-flow suggests the parallel positioning of great arteries exiting the RV, VSD, and PLSVC. A small PA is noted. Double-outlet RV may be diagnosed based on these findings. Ao, aorta; AoA, aortic arch; LV, left ventricle

Fig. 2: A HDlive Flow image of TGA with VSD, PS, and PLSVC at 21 weeks and 2 days of gestation. HDlive Flow clearly reveals the Ao exiting the RV and a small PA exiting the LV in parallel. Pulmonary valve stenosis (arrow) is also suspected. PLSVC is noted on the left side of the small PA

Fig. 3: A HDlive Flow silhouette mode image of TGA with VSD, PS, and PLSVC at 21 weeks and 2 days of gestation. HDlive Flow silhouette mode clearly shows the Ao exiting the RV and a small PA exiting the LV in parallel. PLSVC on the left side of the small PA is noted. A shunt flow stream (arrow) from RV to LV through a ventricular septal defect is evident. AoA, aorta

Fig. 4: A HDlive Flow silhouette mode image of TGA with VSD, PS, and PLSVC at 21 weeks and 2 days of gestation. A shunt flow stream (arrow) from the RV to LV through VSD is evident. Ao, aorta; AoA, aortic arch; SVC, superior vena cava

Fig. 5: A HDlive Flow image of TGA with VSD, PS, and PLSVC at 21 weeks and 2 days of gestation. HDlive Flow clearly revealed spatial relationships among the right SVC, Ao, PLSVC, and right pulmonary arteries, RPA and LPA. DAo, descending aorta

At 37 weeks and 1 day of gestation, a female infant weighing 2376 gm with a length of 46.5 cm was born vaginally. Umbilical artery pH was 7.162 and Apgar scores at 1 and 5 minute were 4 and 7, respectively. The neonatal echocardiographic diagnosis was TGA with VSD, PS, and PLSVC.

DISCUSSION

The 3D reconstruction of fetal cardiac structures using HDlive Flow provides useful information for precise prenatal assessments of not only normal fetal anatomy,⁸^,⁹ but also congenital fetal diseases.³^,⁶^,⁷ Moreover, HDlive Flow silhouette mode with STIC allows for real-time observations of intracardiac and vascular blood flow streams.³ Based on HD-flow findings, a diagnosis of double-outlet RV was suggested for the present TGA case. However, HDlive Flow silhouette mode showed the Ao exiting the RV and PS exiting the LV in parallel. Pulmonary valve stenosis was also suspected. Moreover, a shunt flow stream from the right to the LV through VSD was noted on HDlive Flow silhouette mode with STIC. Therefore, HDlive Flow silhouette mode may provide useful information for the precise prenatal assessment of complex TGA.

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