Abstract
Objective – to describe a new ultrasound marker of tetralogy of Fallot (TF) in the fetus in the form of the letter "D" in the slice through the trachea and three vessels of the upper mediastinum and to evaluate the frequency of its detection in TF compared to other congenital heart defects (CHD).
Material and methods. Over the 5 year study period on the dates from 14 to 38 weeks of gestation were examined 20 237 women at high risk of developing CHD in the fetus. Standard echocardiography (EchoCG) with color Doppler (CD) included as an assessment of all sections of the heart and analysis of the entire system of the aorta, from the outflow tract of the left ventricle, the projection of the arch in the upper mediastinum to the descending aorta. On three vessels the section of the upper mediastinum extended the ascending aorta and aortic arch looked like the letter "D" instead of the typical «V» connections. The frequency of detection of this sign was assessed in fetuses with TF and with other CHD, as well as in healthy fetuses.
Results. At 3028 (15%) fetuses were diagnosed with a variety of CHD, the average gestational age of diagnosis was 22 (14 to 38) weeks. TF was detected in 113 (3.7%) fetuses, and in the classic variant with a moderate stenosis of pulmonary artery (PA) in 86 (76%) fetuses, with critical pulmonary valve stenosis on the verge of atresia in 19 (17%) fetuses, with agenesis of the pulmonary valve in 8 (7%) of the fetuses. D-link we have seen in the 49/86 (57%) cases of classical TF with a moderate stenosis of the pulmonary artery and in 15/19 (79%) of cases of TF with a critical stenosis on the verge of atresia of the pulmonary valve. None of the cases of TF with the right-hand arch of the aorta, this symptom was not observed. In 8/2915 (0.3%) cases with other complex CHD was observed D-link in that time, as none of the fruit from the normal structure of the heart the symptom was not detected.
Conclusion. Identify when advanced EchoCG of the aorta at the level of the upper mediastinum on the cut in three vessel and trachea in the form of the letter "D" should make the researcher suspected in the fetus of TF, especially in the variant with a critical stenosis on the verge of atresia of the pulmonary valve. This feature can be useful in screening, given the fact that with ordinary routine ultrasound prenatal diagnosis of TF is still rather problematic.
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About the authors
- Gasanova Rena Mamedovna, Cand. Med. Sc., Researcher, Cardiologist, Physician for Ultrasound Diagnostics, orcid.org/0000-0003-3318-1074;
- Bespalova Elena Dmitrievna, Dr. Med. Sc., Professor, Chief of Perinatal Cardiology Center; orcid.org/0000-0002-6360-4245;
- Bockeria Ekaterina Leonidovna, Dr. Med. Sc., Professor, Head of Second Department for Pathology of Newborns and Premature Infants; orcid.org/0000-0002-8809-7913;
- Sypchenko Elena Vyacheslavovna, Cand. Med. Sc., Physician for Ultrasound Diagnostics, orcid.org/0000-0002-8809-7913;
- Bartagova Mariya Nikolaevna, Cand. Med. Sc., Physician for Ultrasound Diagnostics, orcid.org/0000-0002-6425-4048
