1. Professor of obstetrics & Gynecology, Cairo University Fetal Medicine Unit.
2. Radiology department, Kasr Alainy teaching hospitals, Cairo University, Egypt.
3. Fetal medicine unit, Cairo University, Egypt.

Case report

A 26-year old woman (G2P1) with irrelevant history was referred to our institution due to suspicion of tricuspid atresia in a previous scan. Our ultrasound examination revealed revealed a tetralogy of Fallot in association with cleft of the anterior leaflet of mitral valve.

Based on the hemodynamics the occurrence of pulmonary atresia with VSD is a possibility. The association of the mitral cleft with the huge VSD which is affecting the inlet portion together with the outlet portion raised the suspicion of the partial AVSD.

However the crux was found to be normal by postprocessing of a stored STIC volume. Postnatal follow up of the fetus revealed normal karyotype and the postnatal echocardiography confirmed the integrity of the crux and the cleft of the anterior leaflet of the mitral valve.

Videos 1 and 2: Show discrepancy between both ventricles with inlet VSD in between. The aorta is overriding a malalignment VSD. Sweeping further cephalad demonstrate size discrepancy between aorta and pulmonary artery suggesting pulmonary stenosis. Also demonstrates the crux with the normal differential offset.

Image 1, video 3: color Doppler images showing the retrograde flow in mitral valve and the cleft of the anterior leaflet of the mitral valve.

Images 2 and 3: demonstrating the discrepancy between both ventricle with the VSD in between which is clearly demonstrated by inversion mode in image B2

Images 4-8 and videos 3 and 4: grey-scale imaging with inversion mode rendering of a STIC volume with sonoAVC volume rendering with both systolic and diastolic frames demonstrating aortic overriding

Image 9: three vessels view showing the small sized pulmonary artery.

Video 5: showing the systodiastolic excursion in the pulmonary valve of the small sized pulmonary artery.

Images 10 and 11: glass body rendering of a stored STIC volume showing the normal cross over of the great arteries. A component of retrograde flow in pulmonary artery can be appreciated.

Videos 6 and 7: showing both forward flows in aorta and pulmonary artery with evident retrograde flow in the pulmonary artery together with the forward flow. Note also the size discrepancy between aorta and pulmonary artery.

Image 12: shows the forward flow in the small sized pulmonary artery

Image 13: color Doppler showing forward flow in pulmonary trunk and both pulmonary branches.

Images 14, 15 and 16: color Doppler and glass-body rendering showing the retrograde flow in arterial duct and pulmonary trunk.