Donetsk Genetic Centre; Ukraine.

Case report

A 24-year-old woman G4P4 was referred to our center at 31st week of her pregnancy with a diagnosis of fetal “hypoplastic left heart syndrome”.

Our examination revealed the following findings:

- Atresia of the tricuspid valve;
- Large ventricle septal defect;
- Interruption of the aortic arch (type C);
- Persistent left superior vena cava.

The case is interesting by uncommon combination of obstructive lesions of both the left and right parts of the heart.

Images 1, 2: The images represent a four-chamber view of the fetal heart with tricuspid atresia and ventricular septal defect (RV - right ventricle, LV - left ventricle, RA - right atrium, LA - left atrium, VSD- ventricular septal defect).

Images 3, 4: The image 3 shows a short-axis view of the heart with the striking pulmonary artery (PA) and thin aorta (Ao). RA - right atrium. The image 4 shows a sagittal view of the ascending aorta (Ao) - typical aortic arch was not depicted due to the interruption of the aortic arch. The cranial continuation of the aorta, that can be seen, is actually the right carotid artery.  Transverse section of the right branch of the pulmonary artery (RPA) and superior vena cava are also visible (svc).

Images 5, 6: The image 5 shows sagittal scan of the pulmonary artery (PA) - the left carotid artery arises from the pulmonary arch. The descending part of the aorta (Ao) can also be seen. The image 6 represents a three-vessel view of the heart. Large pulmonary artery (PA), thin part of the aorta (Ao) and persistent left superior vena cava (left "svc") can be seen.

Image 7: The image 7 represents a color Doppler three-vessel view of the heart. Large pulmonary artery (PA), thin part of the aortic arch (Ao) and persistent left superior vena cava (left "svc") can be seen.

Videos 1, 2: The videos represent a gray scale and color Doppler four-chamber views of the fetal heart with tricuspid atresia and ventricular septal defect.