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Elbistanli C, Yozgat Y, Dogan MS, Yozgat CY, Kütük MS. Prenatal Detection and Postnatal Outcome of Persistent Left Superior Vena Cava and Agenesis of Ductus Venosus Associated with Postnatal Bovine Aortic Arch. Z Geburtshilfe Neonatol 2024; 228:294-297. [PMID: 38122805 DOI: 10.1055/a-2219-9889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Isolated agenesis of ductus venosus (ADV) is usually a benign condition, but it may be associated with cardiovascular defects, hydrops, growth restriction, and chromosomal abnormalities. Additionally, persistent left superior vena cava (PLSVC) and bovine aortic arch are relatively common fetal anomalies. To the author's knowledge, this is the first report of prenatal detection of DV agenesis and PLSVC associated with the postnatal bovine aortic arch with a hypoplastic transverse aortic arch. CASE A 25-year-old, G2P1 woman was referred to our department at 31 weeks due to fetal growth restriction and short femur. On fetal echocardiography, DV could not be viewed via two-dimensional (2D) and Doppler ultrasound (US) imaging; there was also evidence of the co-occurrence of PLSVC and an aortic arch anomaly. We revealed the intrahepatic continuation of the umbilical vein. A weekly follow-up program was scheduled for the patient and the rest of the pregnancy was uneventful. Postnatal, thorax computer tomography and transthoracic echocardiography (TTE) demonstrated PLSVC and bovine aortic arch associated with hypoplastic transverse aortic arch. Routine echocardiographic examinations revealed that the blood flow of the aortic arch had increased gradually, and the male infant's aortic arch had significantly widened and reached the normal range until the baby was discharged from the hospital. CONCLUSION DV agenesis and PLSVC are usually benign conditions but underlying serious heart diseases may accompany them. Therefore, in situations like ours, a prenatal aortic arch evaluation is of capital importance. Postnatal hemodynamic changes should be taken into consideration in the management of these cases. This is the first example in the literature that these abnormalities co-existed in one case.
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Affiliation(s)
| | - Yılmaz Yozgat
- Pediatric Cardiology, Istanbul Medipol Universitesi, Istanbul, Turkey
| | - Mehmet Said Dogan
- Pediatric Radiology, Istanbul Medipol Universitesi, Istanbul, Turkey
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Ungureanu A, Nagy RD, Constantin C, Gheonea IA, Iliescu DG. Prenatal Diagnosis and Prognosis of Abdominal Arteriovenous Fistulae: A Comprehensive Case Series and Systematic Review. Diagnostics (Basel) 2024; 14:826. [PMID: 38667471 PMCID: PMC11048791 DOI: 10.3390/diagnostics14080826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
This study had two main objectives. Firstly, we conducted a thorough literature review on the prenatal diagnosis of abdominal congenital arteriovenous fistulas (CAVFs) involving the abdominal aorta and hepatic arteries. Secondly, we aimed to provide detailed descriptions of eight additional cases diagnosed at our medical center and assess the outcome of this anomaly for informed counseling. We conducted a systematic search of online databases using specific keywords like "outcome", "ultrasound", "intrahepatic fistulae", and "fetal venous anomalies", focusing on studies published between 1998 and 2023. We selected 10 relevant articles and analyzed 13 cases. Additionally, we conducted a five-year prospective study in two referral centers, identifying eight CAVF cases with an incidence rate of 0.16%. Among the 21 cases evaluated, 11 resulted in live births, all of which received treatment. However, four cases (36.3%) had poor postnatal outcomes and neonatal demise due to heart failure. Prenatal signs of poor fetal hemodynamics, including cardiomegaly or hydrops, were observed in 52.3% of cases, regardless of outcome. Our findings highlight the rarity of this vascular malformation and emphasize the importance of effective treatment to avoid unfavorable outcomes. The long-term effectiveness of prenatal treatment or postnatal embolization remains uncertain, with liver transplantation being considered the most reliable treatment option.
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Affiliation(s)
- Anda Ungureanu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.U.); (D.G.I.)
- Department of Cardiology, University Emergency County Hospital Craiova, 200642 Craiova, Romania
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania
| | - Rodica Daniela Nagy
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania
- Department of Obstetrics and Gynecology, University Emergency County Hospital Craiova, 200642 Craiova, Romania
| | - Cristian Constantin
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.C.); (I.A.G.)
| | - Ioana Andreea Gheonea
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.C.); (I.A.G.)
| | - Dominic Gabriel Iliescu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.U.); (D.G.I.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania
- Department of Obstetrics and Gynecology, University Emergency County Hospital Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Tamai K, Ohkura T, Takeuchi A, Nakamura M, Kageyama M. Congenital intrahepatic portosystemic shunt with spontaneous resolution in a newborn with severe fetal growth restriction. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:816-818. [PMID: 36647193 DOI: 10.1002/jcu.23428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 06/02/2023]
Abstract
Owing to the advances in ultrasound, there are increasing reports of intrahepatic portosystemic shunt (IPSS) diagnosis in utero. However, few neonatal cases of IPSS diagnosed by abdominal ultrasonography screening at birth have been reported. This case demonstrated abdominal ultrasonography at birth was useful for the early detection of congenital IPSS.
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Affiliation(s)
- Kei Tamai
- Division of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takahiro Ohkura
- Division of Pediatric Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Akihito Takeuchi
- Division of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Makoto Nakamura
- Division of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Misao Kageyama
- Division of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan
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Jimenez-Gomez J, Güizzo JR, Betancourth Alvarenga J, Santiago Martínez S, Gaspar Perez M, Pina Perez S, Beltrán VP, Loverdos I, Esteva Miró C, Jimenez Arribas P, Sanchez Vazquez B, San Vicente Vela B, Álvarez García N, Nuñez García B. Correlation of Prenatal and Postnatal Diagnosis in Umbilical-Portal-Systemic Venous Shunts. Eur J Pediatr Surg 2023; 33:90-95. [PMID: 36610389 DOI: 10.1055/s-0042-1760379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Umbilical-portal-systemic venous shunts (UPSVS) are rare anomalies in the development of the fetal venous system. There are several postnatal and prenatal classifications of hepatic venous anomalies but the link between them is missing. We aimed to review the prenatal to postnatal diagnosis correlation in UPSVS at our center. METHODS It is a retrospective study of patients diagnosed with UPSVS between 2019 and 2021 at our institution. Demographic, obstetric, genetic, and neonatal data were reviewed with special focus on prenatal and postnatal ultrasounds. RESULTS A total of seven patients were diagnosed with UPSVS at a median of 24 (20-34) weeks of gestational age. All patients were male and 62% were Caucasian. None of the patients had chromosomopathies or cardiac anomalies. One patient had renal ectopia, another one had a single umbilical artery, and a third one suffered from intrauterine growth retardation. An umbilico-systemic shunt (USS) was found in two patients and a ductus venosus-systemic shunt (DVSS) in the rest. Patients with USS were diagnosed postnatally with intrahepatic portosystemic shunts. One of the DVSS patients was transferred to another hospital and the other four had normal postnatal cardiac ultrasounds, with normal abdominal ultrasounds in two patients and lack of postnatally abdominal control in the other two. All babies were found to be doing well at a median follow-up of 1 month (0-24). CONCLUSION There is a knowledge gap in the natural history of UPSVS between fetal and neonatal life. Building bridges between prenatal and postnatal research is mandatory in order to understand these rare anomalies.
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Affiliation(s)
- Javier Jimenez-Gomez
- Department of Pediatric Surgery, Hospital de Sabadell, Sabadell, Barcelona, Spain
| | | | | | | | - Mireia Gaspar Perez
- Department of Pediatric Surgery, Hospital de Sabadell, Sabadell, Barcelona, Spain
| | - Silvia Pina Perez
- Department of Obstetrics and Gynecology, Hospital de Sabadell, Sabadell, Barcelona, Spain
| | | | - Inés Loverdos
- Deparment of Pediatrics, Hospital de Sabadell, Sabadell, Barcelona, Spain
| | - Clara Esteva Miró
- Department of Pediatric Surgery, Hospital de Sabadell, Sabadell, Barcelona, Spain
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