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Case of the Week #528

Moshe Bronshtein

Affiliation: Haifa, Rambam, Israel

Posting Dates:  December 11, 2020 - December 30, 2020

Case Report: The patient presented with a suspected cardiac anomaly at 15 weeks gestation. First trimester screening for Down syndrome was low. Our ultrasound examination revealed the following findings:

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Answer

We present a case of  Pulmonary Atresia with ventricular septal defect and major aortopulmonary collateral arteries (MAPCA), also known as severe tetralogy of Fallot or tetralogy of Fallot with pulmonary atresia.

The following images explains the cardiac anomaly:
(MPA: Main Pulmonary Artery, A or AOR: Aorta; S: Interventricular Septum)

Our imaging demonstrates the following findings:

  • Membranous Ventricular Septal Defect
  • Overriding aorta, normal size
  • Small sized main pulmonary artery with reversed flow on color doppler
  • Pulmonary arteries arising from the descending aorta, known as major aortopulmonary collateral arteries (MAPCA)
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Image 1: Reversed isthmus ductal flow, which is a sign of pulmonary atresia. A major aortopulmonary collateral artery (MAPCA) is visible
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Image 2: Overriding aorta (S-interventricular septum; AOR-aorta)
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Image 3: Small main pulmonary artery (MPA-main pulmonary artery; A-aorta)

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