Case of the Week #528

Moshe Bronshtein, MD

Source contributor: Haifa, Rambam, Israel

First trimester screening test risk for Down syndrome was low.We suspected a heart anomaly at 14WG+6days.Our ultrasound examination revealed the following findings:

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The following images explains the cardiac anomaly:
(MPA: Main Pulmonary Artery, A or AOR: Aorta; S: Interventricular Septum)

  • membranous Ventricular Septal Defect
  • overriding aorta, normal size
  • small sized main pulmonary artery, with reversed flow on color doppler
  • there are probably pulmonary arteries arising from the descending aorta: MAPCA Major AortoPulmonary Collateral Arteries

Therefore our diagnosis was Pulmonary Atresia with VSD and MAPCAs(This situation is also called "severe tetralogy of fallot" or "tetralogy of fallot with pulmonary atresia).

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