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The implications for fetal outcome of an abnormal arrangement of the abdominal vessels

Published online by Cambridge University Press:  14 April 2005

Lucia Pasquini ,
Tony Tan ,
Siew Yen Ho  and
Helena Gardiner
Lucia Pasquini
Affiliation:
Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, United Kingdom
Tony Tan
Affiliation:
Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, United Kingdom
Siew Yen Ho
Affiliation:
Faculty of Medicine, Imperial College, Royal Brompton Hospital and Harefield NHS Trust, London, United Kingdom
Helena Gardiner
Affiliation:
Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, United Kingdom Faculty of Medicine, Imperial College, Royal Brompton Hospital and Harefield NHS Trust, London, United Kingdom
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Abstract

In a prospective audit of consecutive referrals for fetal echocardiography between 1997 and 2003, we documented all instances of an abnormal arrangement of the abdominal vessels. We then established the structure of the heart in these fetuses, noting any extra-cardiac associations, and the eventual outcomes.

We found a cardiac abnormality in 572 of the 2,136 fetuses examined during this period (27 percent), with 16 (0.8 percent) having an abnormal arrangement of the abdominal great vessels. Mirror-imaged arrangement was found in 3, while the arrangement suggested right isomerism in 6, and left isomerism in 7. Of these 16 fetuses, 14 had cardiac malformations. Isomerism of the right atrial appendages was found in 7 fetuses, all with either a right-sided stomach or cardiac apex, and 6 with a common atrioventricular junction guarded by a common valve. Only 1 of these fetuses survived. Of the 3 fetuses with mirror-imaged abdominal great vessels, 2 also had mirror-imaged atrial arrangement, while the 3rd had isomeric right appendages. Only one of 7 fetuses with an abdominal great vein posterior to the aorta had bilateral left atrial appendages. The remaining 6 had usual atrial arrangement, with normal pulmonary venous connections in all but one, who had infra-diaphragmatic totally anomalous pulmonary venous connection. Of these fetuses, 2 had coarctation of the aorta, and 2 others had complex cardiac malformations resulting in neonatal death. One died in childhood from biliary atresia, and three are alive.

Abnormal arrangements of the abdominal great vessels, therefore, were found in 0.8 percent of our total fetuses, and in 2.4 percent of those with cardiac malformations. Those with an abnormal arrangement of the abdominal vessels combined with an abnormal arrangement of the atrial appendages, however, made up only 0.5 percent and 1.6 percent, respectively. While screening for an abnormal arrangement of the abdominal vessels overestimated the incidence of left, but not right, isomerism of the atrial appendages, it did predict the presence of important extra-cardiac malformations that required urgent recognition and management after birth.

Keywords

Fetal heartabdominal situsisomerismechocardiographybiliary atresia
Type
Original Article
Information
Cardiology in the Young , Volume 15 , Issue 1 , January 2005 , pp. 35 - 42
Copyright
2005 Cambridge University Press

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