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Copeland H, Knezevic I, Baran DA, Rao V, Pham M, Gustafsson F, Pinney S, Lima B, Masetti M, Ciarka A, Rajagopalan N, Torres A, Hsich E, Patel JK, Goldraich LA, Colvin M, Segovia J, Ross H, Ginwalla M, Sharif-Kashani B, Farr MA, Potena L, Kobashigawa J, Crespo-Leiro MG, Altman N, Wagner F, Cook J, Stosor V, Grossi PA, Khush K, Yagdi T, Restaino S, Tsui S, Absi D, Sokos G, Zuckermann A, Wayda B, Felius J, Hall SA. Donor heart selection: Evidence-based guidelines for providers. J Heart Lung Transplant 2023; 42:7-29. [PMID: 36357275 PMCID: PMC10284152 DOI: 10.1016/j.healun.2022.08.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023] Open
Abstract
The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.
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Affiliation(s)
- Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery Lutheran Hospital, Fort Wayne, Indiana; Indiana University School of Medicine-Fort Wayne, Fort Wayne, Indiana.
| | - Ivan Knezevic
- Transplantation Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David A Baran
- Department of Medicine, Division of Cardiology, Sentara Heart Hospital, Norfolk, Virginia
| | - Vivek Rao
- Peter Munk Cardiac Centre Toronto General Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael Pham
- Sutter Health California Pacific Medical Center, San Francisco, California
| | - Finn Gustafsson
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sean Pinney
- University of Chicago Medicine, Chicago, Illinois
| | - Brian Lima
- Medical City Heart Hospital, Dallas, Texas
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Civilisation Diseases and Regenerative Medicine, University of Information Technology and Management, Rzeszow, Poland
| | | | - Adriana Torres
- Los Cobos Medical Center, Universidad El Bosque, Bogota, Colombia
| | | | | | | | | | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Heather Ross
- University of Toronto, Toronto, Ontario, Canada; Sutter Health California Pacific Medical Center, San Francisco, California
| | - Mahazarin Ginwalla
- Cardiovascular Division, Palo Alto Medical Foundation/Sutter Health, Burlingame, California
| | - Babak Sharif-Kashani
- Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MaryJane A Farr
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luciano Potena
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | | | | | | | | | | | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kiran Khush
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Susan Restaino
- Division of Cardiology Columbia University, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Steven Tsui
- Department of Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniel Absi
- Department of Cardiothoracic and Transplant Surgery, University Hospital Favaloro Foundation, Buenos Aires, Argentina
| | - George Sokos
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Brian Wayda
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Joost Felius
- Baylor Scott & White Research Institute, Dallas, Texas; Texas A&M University Health Science Center, Dallas, Texas
| | - Shelley A Hall
- Texas A&M University Health Science Center, Dallas, Texas; Division of Transplant Cardiology, Mechanical Circulatory Support and Advanced Heart Failure, Baylor University Medical Center, Dallas, Texas
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Lopes KRM, Bartsota M, Doughty V, Carvalho JS. Single left superior vena cava: antenatal diagnosis, associated anomalies and outcomes. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:640-645. [PMID: 35656845 PMCID: PMC9828089 DOI: 10.1002/uog.24966] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To describe the associated cardiac and extracardiac findings and estimate the prevalence of single left superior vena cava (LSVC) among fetuses referred for fetal echocardiography. METHODS This was a retrospective case series of fetuses diagnosed with situs solitus and single LSVC at the Brompton Centre for Fetal Cardiology, London, UK, from October 2006 to December 2020. Prenatal and postnatal outcome data were collected. Prenatal diagnosis was based on abnormal vessel alignment at the three-vessel view and/or three-vessel-and-trachea view, showing a vessel to the left of the pulmonary artery (i.e. the LSVC) and absence of the usual vessel to the right of the ascending aorta (i.e. the right superior vena cava), and further visualization of the LSVC draining into the coronary sinus. RESULTS Of 19 968 fetal echocardiograms performed during the study period, 34 cases of single LSVC were identified (a prevalence of 0.17%). Of these, 32 pregnancies had a live birth, one was lost to follow-up and one resulted in intrauterine demise. Single LSVC was isolated in 79.4% of cases. No major congenital heart disease was identified. One fetus showed mild isthmus hypoplasia, with no aortic coarctation postnatally. Two fetuses had umbilical vessel abnormalities. A genetic abnormality was found in one case (15q24.1-q24.2 deletion). CONCLUSIONS Antenatal diagnosis of single LSVC in the setting of situs solitus is usually a benign isolated finding. Nevertheless, investigation of other cardiac, extracardiac and genetic disorders should be considered. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K. R. M. Lopes
- Brompton Centre for Fetal CardiologyRoyal Brompton and Harefield HospitalsLondonUK
- Fetal Medicine UnitSt George's University Hospitals NHS Foundation TrustLondonUK
| | - M. Bartsota
- Brompton Centre for Fetal CardiologyRoyal Brompton and Harefield HospitalsLondonUK
| | - V. Doughty
- Brompton Centre for Fetal CardiologyRoyal Brompton and Harefield HospitalsLondonUK
| | - J. S. Carvalho
- Brompton Centre for Fetal CardiologyRoyal Brompton and Harefield HospitalsLondonUK
- Fetal Medicine UnitSt George's University Hospitals NHS Foundation TrustLondonUK
- Cardiovascular Clinical Academic GroupSt George's University of London Molecular and Clinical Sciences Research InstituteLondonUK
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Keleş A, Yılmaz O, Dağdeviren G, Çelik ÖY, Yücel A, Şahin D. Persistent Left Superior Vena Cava: Why is Prenatal Diagnosis Important? Fetal Pediatr Pathol 2022; 41:592-602. [PMID: 34106033 DOI: 10.1080/15513815.2021.1933662] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
ObjectiveTo investigate fetal anomalies and pregnancy outcomes in pregnancies with persistent left superior vena cava (PLSVC) to provide assistance in prenatal counseling.MethodsCases diagnosed with PLSVC between January 2015 and January 2020 were obtained from the hospital's electronic system and were analyzed retrospectively.ResultsTwenty-seven cases were analyzed. The prevalence of PLSVC among congenital heart diseases (CHD) was 6.9%. Conotruncal anomalies and renal anomalies were the most common accompanying cardiac and extracardiac anomalies, respectively. Chromosomal abnormality was detected in one fetus.In the postpartum period coarctation of aorta (CoA) was found in one fetus.ConclusionsWhen PLSVC is detected during prenatal ultrasonography, fetal anatomy should be carefully examined because of the anomalies that may accompany it. Prenatal genetic counseling should be given especially to cases with additional anomalies. In isolated cases, cardiac anatomy should be evaluated with repeated echocardiography because of the risk of CoA.
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Affiliation(s)
- Ayşe Keleş
- Perinatology Department, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Osman Yılmaz
- Pediatric Cardiology Department, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Gülşah Dağdeviren
- Perinatology Department, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Özge Yücel Çelik
- Perinatology Department, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Aykan Yücel
- Perinatology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Şahin
- Perinatology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
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Poenaru MO, Hamoud BH, Sima RM, Valcea ID, Chicea R, Ples L. Persistent Left Superior Vena Cava Significance in Prenatal Diagnosis—Case Series. J Clin Med 2022; 11:jcm11144020. [PMID: 35887792 PMCID: PMC9316240 DOI: 10.3390/jcm11144020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
The persistent left superior vena cava (PLSVC) is a congenital heart anomaly reported in 0.3–0.5% of the general population and can be associated with congenital heart diseases in up to 8% of cases. Prenatal identification of PLSVC is important to prompt an extended cardiac and extracardiac fetal examination. We retrospectively reevaluated anomaly scans performed in our unit in a 2-year interval according to the national guidelines to evaluate the incidence of PLSVC and its association with prenatal morbidity. In our population, the incidence of PLSVC was 0.31%, and we found a low association with cardiac and extracardiac anomalies. The standard sections (three-vessel and trachea view, four-chamber view and outflow tract’s view) are insufficient to exclude cardiac anomalies whenever PLSVC is found. In our case series, only one newborn required postnatal surgery for total pulmonary vein anomaly, and at 2 years of life all babies had a normal evolution. Prenatal diagnosis of PLSVC can raise counseling issues; therefore, awareness of its good outcome when isolated and need for an extended examination to rule out other anomalies is very important.
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Affiliation(s)
- Mircea-Octavian Poenaru
- Department of Obstetrics and Gynecology, The ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-O.P.); (L.P.)
- The “Bucur” Maternity—‘Saint John’ Hospital, 040294 Bucharest, Romania;
| | - Bashar Haj Hamoud
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany;
| | - Romina-Marina Sima
- Department of Obstetrics and Gynecology, The ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-O.P.); (L.P.)
- The “Bucur” Maternity—‘Saint John’ Hospital, 040294 Bucharest, Romania;
- Correspondence:
| | | | - Radu Chicea
- Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550024 Sibiu, Romania;
| | - Liana Ples
- Department of Obstetrics and Gynecology, The ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-O.P.); (L.P.)
- The “Bucur” Maternity—‘Saint John’ Hospital, 040294 Bucharest, Romania;
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Jeong ER, Kang EJ, Jeun JH. Pictorial Essay: Understanding of Persistent Left Superior Vena Cava and Its Differential Diagnosis. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:846-860. [PMID: 36238921 PMCID: PMC9514584 DOI: 10.3348/jksr.2021.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/01/2022] [Accepted: 02/21/2022] [Indexed: 06/16/2023]
Abstract
Persistent left superior vena cava (PLSVC) is a rare congenital, thoracic, and vascular anomaly. Although PLSVCs generally do not have a hemodynamic effect, several types of PLSVC and some cardiac anomalies may manifest with clinical symptoms. The presence of PLSVC can render catheterization via left subclavian access difficult when placing a pacemaker or central venous catheter. As such, recognizing a PLSVC that is typically incidentally discovered can prevent complications such as vascular injury. Differentiating vessels found in a similar location as PLSVC is necessary when performing thoracic vascular procedures. This pictorial essay explains the multi-detector CT findings of a PLSVC, and provides a summary of other blood vessels that require differentiation during thoracic vascular procedures.
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Mudaraddi RR, Greiss HF, Manickam NK. A Rare Case Report of Unusual Path of Left Internal Jugular Central Line. DUBAI MEDICAL JOURNAL 2021. [DOI: 10.1159/000513278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Central venous cannulation is the most common procedure performed in perioperative setting and intensive care unit. Many case reports reported unusual positioning of central line catheters. Here, we would like to report a case of central line path in persistent left superior vena cava, a rare entity with a course similar to the right internal jugular central line. Preoperative computed tomography chest showed duplex superior vena cava which was not reported.
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Mudaraddi RR, Greiss HF. A rare case report of unusual path of left internal jugular central line. Indian J Anaesth 2021; 65:176-178. [PMID: 33776103 PMCID: PMC7983817 DOI: 10.4103/ija.ija_639_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Hany Fewzi Greiss
- Department of Anaesthesiology, Rashid Hospital and Trauma Centre, Dubai, United Arab Emirates
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Acherman RJ, Evans WN, Restrepo H. Prenatal Diagnosis of Absent Right Superior Vena Cava in Referrals for Fetal Echocardiography. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-020-00279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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9
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Özsürmeli M, Büyükkurt S, Sucu M, Arslan E, Akçabay Ç, Mısırlıoğlu S, Kayapınar M, Özbarlas N, Demir SC, Evrüke C. Prenatal diagnosis of persistent left superior vena cava: a retrospective study of associated congenital anomalies. Turk J Obstet Gynecol 2019; 16:23-28. [PMID: 31019836 PMCID: PMC6463432 DOI: 10.4274/tjod.galenos.2019.02679] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/06/2019] [Indexed: 12/02/2022] Open
Abstract
Objective: To evaluate persistent left superior vena cava (PLSVC) cases according to associated cardiac, extracardiac, and chromosomal anomalies in the prenatal period and to review their outcomes. Materials and Methods: The data of patients with a prenatal diagnosis of PLSVC between January 2013 and December 2017 were reviewed retrospectively. Results: Data of 32 cases were reviewed. Nineteen (60%) cases were associated with cardiac defects, 5 (15%) were associated with both cardiac and extracardiac defects, and 8 (25%) had no associated anomalies. Two fetuses had karyotype anomalies. All patients with isolated PLSVC survived. Among the cases associated with extracardiac anomalies, cardiac anomalies, and with both extracardiac and cardiac anomalies, the survival rate was 40%, 40%, and 25%, respectively. Outcome was more favorable in cases with isolated PLSVC (100% vs. 40%). Conclusion: Prenatally diagnosed PLSVC is associated with cardiac and extracardiac anomalies in the majority of cases. The prognosis is good in isolated cases, but worsens when accompanied by cardiac or extracardiac anomalies.
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Affiliation(s)
- Mehmet Özsürmeli
- University of Health Sciences, Derince Training and Research Hospital, Clinic of Obstetrics and Gynecology, Kocaeli, Turkey
| | - Selim Büyükkurt
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Mete Sucu
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Erol Arslan
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Çiğdem Akçabay
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Selahattin Mısırlıoğlu
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Masum Kayapınar
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Nazan Özbarlas
- Çukurova University Faculty of Medicine, Department of Pediatrics, Pediatric Cardiology Unit, Adana, Turkey
| | - Süleyman Cansun Demir
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Cüneyt Evrüke
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
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Tyrak KW, Holda J, Holda MK, Koziej M, Piatek K, Klimek-Piotrowska W. Persistent left superior vena cava. Cardiovasc J Afr 2017; 28:e1-e4. [PMID: 28759082 PMCID: PMC5558145 DOI: 10.5830/cvja-2016-084] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 09/15/2016] [Indexed: 11/06/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) is the most common congenital malformation of thoracic venous return and is present in 0.3 to 0.5% of individuals in the general population. This heart specimen was dissected from a 35-year-old male cadaver whose cause of death was determined as non-cardiac. The heart was examined and we found a PLSVC draining into the coronary sinus. The right superior vena cava was present with a small-diameter ostium. An anomalous pulmonary vein pattern was observed; there was a common trunk to the left superior and left inferior pulmonary veins (diameter 17.8 mm) and an additional middle right pulmonary vein (diameter 2.7 mm) with two classic right pulmonary veins. The PLSVC draining into the coronary sinus had led to its enlargement, which could have altered the cardiac haemodynamics by significantly reducing the size of the left atrium and impeding its outflow via the mitral valve.
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Affiliation(s)
- Kamil W Tyrak
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.
| | - Jakub Holda
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz K Holda
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Piatek
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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Mogra R. Simplifying ultrasound assessment of the fetal heart: Incorporating the complete Three Vessel View into routine screening. Australas J Ultrasound Med 2015; 16:168-175. [PMID: 28191193 PMCID: PMC5030054 DOI: 10.1002/j.2205-0140.2013.tb00243.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: As our experience and ultrasound resolution have improved significantly in last 30 years it is possible to detect most of the major cardiac abnormalities prenatally with high degree of accuracy. Method: Current screening techniques have poor detection rate for congenital heart diseases (CHD) and nearly half of the major cardiac abnormalities mainly of Great Arteries goes unrecognised. A high detection rate for major CHDs can be achieved in a screening setting by improving techniques of routine screening in the low risk population. Conclusion: This article summarises the alternative strategies to examine the outflow tracts and Great Arteries, its correct interpretation and examples of abnormal views.
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Affiliation(s)
- Ritu Mogra
- RPA Women and Babies Royal Prince Alfred Hospital Sydney Ultrasound for Women Sydney New South Wales Australia
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12
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Du L, Xie HN, Zhu YX, Li LJ, Peng R, Zheng J. Fetal persistent left superior vena cava in cases with and without chromosomal anomalies. Prenat Diagn 2014; 34:797-802. [PMID: 24711103 DOI: 10.1002/pd.4380] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/18/2014] [Accepted: 04/03/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The objectives of this study are to determine and compare the prevalence of persistent left superior vena cava (PLSVC) in chromosomally normal and abnormal fetuses and to evaluate the potential of PLSVC as a screening marker for chromosomal abnormalities. METHODS Women undergoing routine fetal sonographic examinations were evaluated once for the presence of PLSVC. PLSVC was diagnosed on the basis of the identification of an additional vessel in the left of the pulmonary artery in a three-vessel trachea view. Associated abnormalities, karyotypes, and outcomes were analyzed. RESULTS A total of 164 (0.7%, 164/25 171) cases of PLSVC were detected and successfully followed-up. The detection rates were 0.5% (81/17 535) and 1.1% (83/7636) in the low-risk and high-risk cases, respectively. The incidence of PLSVC was lower among the chromosomally or clinically normal (0.4%, 110/24 914) compared with chromosomally abnormal fetuses (7.8%, 20/257, p < 0.001). Additional defects were identified in 90% (18/20) of the PLSVC fetuses with chromosomal anomalies, a rate that was higher than those fetuses with chromosomal normal (61.8%, 68/110). CONCLUSIONS Persistent left superior vena cava is more common among chromosomally abnormal than normal fetuses, and PLSVC fetuses with other defects are more highly associated with chromosomal disorders than isolated PLSVC fetuses. Isolated PLSVC is a benign vascular anomaly and may not affect outcomes.
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Affiliation(s)
- Liu Du
- Department of Ultrasonic Medicine and Fetal Medical Centre, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Esmer AÇ, Yüksel A, Calı H, Ozsürmeli M, Omeroğlu RE, Kalelioğlu I, Has R. Prenatal diagnosis of persistent left superior vena cava and its clinical significance. Balkan Med J 2014; 31:50-4. [PMID: 25207167 DOI: 10.5152/balkanmedj.2014.9426] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 12/26/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Persistent left superior vena cava (PLSVC) is a variant of systemic venous return which is observed in 0.3% of autopsies in the general population and in 4-8% of patients with congenital heart disease. AIMS To evaluate associated cardiac, extracardiac and chromosomal anomalies in prenatally diagnosed cases of PLSVC and to review their outcome. STUDY DESIGN Retrospective comparative study. METHODS The data of patients with a prenatal diagnosis of PLSVC between May 2008 and January 2013 were reviewed retrospectively. RESULTS Data of 31 cases were reviewed. Fifteen (48.4%) cases were associated with cardiac defects and 17 (54.8%) cases had associated extracardiac sonographic or postpartum findings. Two fetuses had karyotype anomalies. Outcome was significantly more favorable in cases not associated with cardiac defects in comparison to those associated with cardiac anomalies (84.6% vs. 33.3%, p=0.009). All cases with isolated PLSVC survived, while among the cases associated with extracardiac anomalies, with cardiac anomalies and with both extra-cardiac and cardiac anomalies, the survival rate was 75%, 50% and 22.2%, respectively. The most frequent group of cardiac anomalies associated with PLSVC was septal defects and VSD was the most common heart defect individually, being observed in nine fetuses. CONCLUSION Prenatally diagnosed PLSVC is associated with cardiac and extracardiac anomalies in the majority of cases. Outcome is significantly worse if PLSVC is associated with a cardiac defect, and the prognosis is excellent in isolated cases.
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Affiliation(s)
- Aytül Çorbacıoğlu Esmer
- Department of Obstetrics and Gynecology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - Atıl Yüksel
- Department of Obstetrics and Gynecology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - Halime Calı
- Department of Obstetrics and Gynecology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Ozsürmeli
- Department of Obstetrics and Gynecology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - Rukiye Eker Omeroğlu
- Department of Pediatric Cardiology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - Ibrahim Kalelioğlu
- Department of Obstetrics and Gynecology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - Recep Has
- Department of Obstetrics and Gynecology, İstanbul University Faculty of Medicine, İstanbul, Turkey
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Abstract
The routine use of four-chamber screening of the fetal heart was pioneered in the early 1980s and has been shown to detect reliably mainly univentricular hearts in the fetus. Many conotruncal anomalies and ductal-dependent lesions may, however, not be detected with the four-chamber view alone and additional planes are needed. The three-vessel and tracheal (3VT) view is a transverse plane in the upper mediastinum demonstrating simultaneously the course and the connection of both the aortic and ductal arches, their relationship to the trachea and the visualization of the superior vena cava. The purpose of the article is to review the two-dimensional anatomy of this plane and the contribution of colour Doppler and to present a checklist to be achieved on screening ultrasound. Typical suspicions include the detection of abnormal vessel number, abnormal vessel size, abnormal course and alignment and abnormal colour Doppler pattern. Anomalies such as pulmonary and aortic stenosis and atresia, aortic coarctation, interrupted arch, tetralogy of Fallot, common arterial trunk, transposition of the great arteries, right aortic arch, double aortic arch, aberrant right subclavian artery, left superior vena cava are some of the anomalies showing an abnormal 3VT image. Recent studies on the comprehensive evaluation of the 3VT view and adjacent planes have shown the potential of visualizing the thymus and the left brachiocephalic vein during fetal echocardiography and in detecting additional rare conditions. National and international societies are increasingly recommending the use of this plane during routine ultrasound in order to improve prenatal detection rates of critical cardiac defects.
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Higuchi T, Kuroda K, Iida M, Murakoshi Y, Furukawa R, Matsuoka M, Tanaka M. Prenatal diagnosis of persistent left and absent right superior vena cava. J Med Ultrason (2001) 2013; 40:261-3. [PMID: 27277246 DOI: 10.1007/s10396-012-0413-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/16/2012] [Indexed: 11/26/2022]
Abstract
We report a case of persistent left superior vena cava (LSVC) with absent right superior vena cava (RSVC) diagnosed prenatally. At 27 weeks' gestation, routine fetal ultrasonography showed an abnormal four-chamber view. Fetal echocardiography revealed a markedly enlarged coronary sinus in the four-chamber view. An absent RSVC and a persistent LSVC were demonstrated in the three-vessel view. No additional cardiac malformations were seen before birth. Postnatal imaging confirmed the prenatal diagnosis. The combination of persistent LSVC and absent RSVC without any other cardiac malformations is an extremely rare cardiac anomaly and less commonly detected in utero. Identification of a dilated coronary sinus in the four-chamber view, with atypical features in the three-vessel view, may lead to the antenatal diagnosis of this condition.
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Affiliation(s)
- Takayuki Higuchi
- Department of Obstetrics and Gynecology, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki, Kanagawa, 210-0013, Japan.
| | - Keiko Kuroda
- Department of Obstetrics and Gynecology, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki, Kanagawa, 210-0013, Japan
| | - Miho Iida
- Department of Obstetrics and Gynecology, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki, Kanagawa, 210-0013, Japan
| | - Yukitaka Murakoshi
- Department of Obstetrics and Gynecology, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki, Kanagawa, 210-0013, Japan
| | - Ritsuko Furukawa
- Department of Pediatrics, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan
| | - Megumi Matsuoka
- Department of Pediatrics, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Saha S, Paoletti D, Robertson M. Persistent left superior vena cava - considerations in fetal, pediatric and adult populations. Australas J Ultrasound Med 2012; 15:61-66. [PMID: 28191144 PMCID: PMC5025113 DOI: 10.1002/j.2205-0140.2012.tb00228.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Persistent left superior vena cava (LSVC) is the commonest congenital anomaly of the thoracic venous system. It is within the group of anomalous systemic venous return (ASVR) and the group is subdivided in cephalic, involving the superior vena cava (SVC) and caudal, involving the inferior vena cava (IVC) types. It is also important to recognise that there can be a persistent LSVC with or without a normal right superior vena cava (RSVC). In most cases, a persistent LSVC drains into the right atrium via the coronary sinus without any clinical symptoms. In this article we discuss embryology, diagnostic and further management approaches and a review of the literature related to persistent LSVC.
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Affiliation(s)
- Sumi Saha
- Department of Obstetrics and Gynaecology Australian National University Medical School Canberra Australian Capital Territory 0200 Australia
| | - Debra Paoletti
- Fetal Medicine Unit Division of Women Youth and Children Canberra Hospital Garran Australian Capital Territory 2605 Australia
| | - Meiri Robertson
- Department of Obstetrics and GynaecologyAustralian National University Medical SchoolCanberraAustralian Capital Territory0200Australia; Fetal Medicine Unit Division of Women Youth and ChildrenCanberra HospitalGarranAustralian Capital Territory2605Australia
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Barrea C, Ovaert C, Moniotte S, Biard JM, Steenhaut P, Bernard P. Prenatal diagnosis of abnormal cardinal systemic venous return without other heart defects: a case series. Prenat Diagn 2011; 31:380-8. [PMID: 21254147 DOI: 10.1002/pd.2699] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 12/09/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To describe fetal spectrum and echocardiographic characteristics of anomalous systemic venous return (ASVR, cardinal veins) without other structural heart defects (isolated ASVR), evaluate associated extracardiac and genetic anomalies and review neonatal outcome. METHODS From 2003 to 2009, 369 consecutive fetuses were diagnosed with cardiac malformation, including 27 cases with an isolated ASVR. The following variables were collected: type of ASVR, extracardiac anomalies, karyotype and short-term outcome. RESULTS The most common forms of ASVR were persistent left superior vena cava (SVC) (n = 15) and interrupted inferior vena cava (IVC) (n = 6). The other ASVR types were a persistent left SVC without a right SVC (n = 4), bilateral agenesis of the SVC with cephalic venous drainage toward the IVC through the azygos system (n = 1) and total ASVR to the coronary sinus (n = 1). Genetic disorders were confirmed in five cases, all with a persistent left SVC, with extracardiac anomalies present in four of them. Ten other patients had extracardiac anomalies detected prenatally or postnatally. When available, ASVR diagnosis was confirmed postnatally in all cases. CONCLUSION Isolated ASVRs can be accurately diagnosed prenatally and are frequently associated with extracardiac and genetic anomalies. A detailed morphological ultrasound and fetal karyotype should be suggested. Neonatal outcome was mainly related to the associated anomalies.
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Affiliation(s)
- Catherine Barrea
- Pediatric Cardiology Unit, Department of Pediatrics, Cliniques universitaires Saint Luc, UCL, Brussels, Belgium.
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Yagel S, Kivilevitch Z, Cohen SM, Valsky DV, Messing B, Shen O, Achiron R. The fetal venous system, Part II: ultrasound evaluation of the fetus with congenital venous system malformation or developing circulatory compromise. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:93-111. [PMID: 20205158 DOI: 10.1002/uog.7622] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The human fetal venous system is well-recognized as a target for investigation in cases of circulatory compromise, and a broad spectrum of malformations affecting this system has been described. In Part I of this review, we described the normal embryology, anatomy and physiology of this system, essential to the understanding of structural anomalies and the sequential changes encountered in intrauterine growth restriction and other developmental disorders. In Part II we review the etiology and sonographic appearance of malformations of the human fetal venous system, discuss the pathophysiology of the system and describe venous Doppler investigation in the fetus with circulatory compromise.
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Affiliation(s)
- S Yagel
- Obstetrics and Gynecology Ultrasound Center, Hadassah-Hebrew University Medical Centers, Mt Scopus, Jerusalem, Israel.
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Jacob M, Sokoll A, Mannherz HG. A case of persistent left and absent right superior caval vein: An anatomical and embryological perspective. Clin Anat 2010; 23:277-86. [PMID: 20169608 DOI: 10.1002/ca.20945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The relatively common persistent left superior caval vein (LSCV) is in most cases associated with doubling of the superior caval vein. A persistent LSCV with absent right superior caval vein (RSCV)-a rather rare event-was found during our course of gross anatomy. The LSCV drained into an enlarged coronary sinus, which was partly accompanied by an apparent "double" sinus of normal size draining into this enlarged coronary sinus. Histological and immunofluorescence studies using antibodies against smooth and cardiac muscle actins were performed. The terminal part of the LSCV near the opening into the right atrium contained cardiac actin as expected for a normal derivative of the left sinus horn. Previously only one case of doubled coronary sinus with LSCV has been reported and this abnormality was explained by splitting of the sinus. In our case, the partly doubled coronary sinus had the structure of coronary veins. Mechanical forces have been invoked for the obliteration of the LSCV. Therefore, we examined thirteen human embryos from 15 mm to 32 mm crown-rump length. In one embryo, we found a persistent LSCV together with an enormously enlarged left atrium. Contrary to previous suggestions our data indicate that during normal development a compression of the left anterior cardinal vein does not sufficiently explain the obliteration of the left and the persistence of the right vein. We therefore believe that beside a left dominated blood flow of head and arm, genes for left-right signaling may have to be taken into consideration.
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Affiliation(s)
- Monika Jacob
- Department of Anatomy and Embryology, Ruhr University Bochum, Bochum, Germany
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Jaramillo JF, Estrada Perea MH, Muriel YY. Persistencia de la vena cava superior izquierda. Diagnóstico e importancia prenatal. REVISTA COLOMBIANA DE CARDIOLOGÍA 2010. [DOI: 10.1016/s0120-5633(10)70221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Barrea C, Biard JM, Hutchings G, Bernard P. Prenatal diagnosis of isolated total anomalous systemic venous return to the coronary sinus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:117-119. [PMID: 20033996 DOI: 10.1002/uog.7516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Freund M, Stoutenbeek P, ter Heide H, Pistorius L. 'Tobacco pipe' sign in the fetus: patent left superior vena cava with absent right superior vena cava. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:593-594. [PMID: 18690613 DOI: 10.1002/uog.5392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Jeanty P, Chaoui R, Tihonenko I, Grochal F. A review of findings in fetal cardiac section drawings. Part 3: the 3-vessel-trachea view and variants. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:109-117. [PMID: 18096736 DOI: 10.7863/jum.2008.27.1.109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The goal of this presentation is to review some of the common and rare fetal heart abnormalities and to provide an easy approach to these findings with the schematic drawings. METHODS Over the past 10 years, we collected cases in which the common views of the heart were abnormal and the differential diagnoses that existed for each. This presentation shows the normal sonographic sections and then variations of these sections and the associated anomalies. We used illustrative drawings to present these findings, enabling us to point out the main sonographic features of abnormalities of the heart. RESULTS This work reviews 21 fetal heart abnormalities in schematic drawings. CONCLUSIONS This short review highlights several of the anomalies that can be recognized on the common sonographic views. The drawings tend to simplify the findings but should serve as a basis for those doing fetal echocardiography when they encounter an unusual finding.
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Galindo A, Gutiérrez-Larraya F, Escribano D, Arbues J, Velasco JM. Clinical significance of persistent left superior vena cava diagnosed in fetal life. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:152-61. [PMID: 17616965 DOI: 10.1002/uog.4045] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To determine the prevalence and clinical significance of persistent left superior vena cava (PLSVC) in fetuses with and without cardiac and extracardiac anomalies. METHODS Charts and recorded images were reviewed from high-risk patients who underwent fetal echocardiography between January 2000 and December 2005. This retrospective study included 54 fetuses with confirmed PLSVC who were diagnosed based on the presence of an additional vessel identified to the left of the pulmonary artery in the three-vessel view of the heart. Associated congenital heart defects (CHDs), extracardiac abnormalities, including first trimester nuchal translucency (NT) thickness, and fetal/postnatal outcome were analyzed. RESULTS Of 5,737 referrals, 5,233 had a normal heart, and PLSVC was observed in 10 of these fetuses (0.2%; Group 1). CHDs were present in 504 and PLSVC was observed in 44 of these cases (9%). In the latter group, 18/44 (41%) fetuses had heterotaxy syndrome (Group 2) where the most common structural heart defects were atrioventricular septal defect and double-outlet right ventricle. Fetuses without heterotaxy syndrome (Group 3) accounted for 26/44 (59%) cases of CHDs associated with PLSVC. In this group of fetuses the most common CHDs were left outflow tract obstructive defects and conotruncal anomalies. Increased NT was observed in 29%, without differences among the three groups. The survival rates among fetuses in Groups 1, 2 and 3 were 100%, 44% and 50%, respectively. After excluding patients who underwent pregnancy termination, there were no significant differences in the survival rates among the groups, probably due to the small size of the samples. CONCLUSIONS PLSVC is associated with CHDs. The identification of PLSVC should prompt a thorough examination of the fetus to identify additional cardiac and extracardiac anomalies. The prognosis of affected fetuses largely depends on whether or not the PLSVC is associated with a CHD.
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Affiliation(s)
- A Galindo
- Ultrasound and Fetal Physiopathology Unit, Department of Obstetrics and Gynaecology, Hospital Universitario '12 de Octubre', Madrid, Spain.
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Bibliography. Current world literature. Maternal-fetal medicine. Curr Opin Obstet Gynecol 2007; 19:196-201. [PMID: 17353689 DOI: 10.1097/gco.0b013e32812142e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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