*Fetal medicine unit – Cairo university- Egypt
**Radiology department, Kasr Alainy teaching hospitals ,Cairo university, Egypt
Case report
A woman (G2p1) come for routine examination at 38 weeks of pregnancy. Our 2D and Doppler examination of the fetal heart revealed findings of atrioventricular discordance with DORV:
- Position of the heart : mesocardia with mild cardiomegaly
- Stomach normally situated in left side
- Position of morphologically right ventricle is anterior to the left side and connected to left atrium through tricuspid valve
-Position of morphologically left ventricle is posterior to the right side and connected to right atrium through mitral vale
-N.B : Valves is connected to ventricles
- Left atrium shows its characterized left atrial appendage ( finger like projection, to the left side)
- Right atrium shows its characterized right atrial appendage (broad pyramidal shaped, to the right side)
So the switch is at the ventricular level
-As the Morphologically right ventricle is more anterior and morphologically left ventricle is more posterior, this means that the ventricles are D looped
Examination of ventriculoarterial connection revealed
-Both aorta and pulmonary arteries are arising from morphologically right ventricle
-Aorta is left anterior and more cephalic to pulmonary artery ( which is right posterior more caudal to aorta)
-The size of aorta is larger than size of pulmonary artery meaning that there is pulmonary stenosis ( mostly mild valvar stenosis)
- AS regard VSD : it is inlet VSD with outlet extension ( no overriding of any great arteries over the septum meaning that both arteries arising completely from right ventricle)
VSD is non –committed VSD ( away from great arteries )
There is severe mitral regurgitation, most properly due to mal function of left ventricle.
SVC and IVC ( superior vena cava and inferior vena cava ) were normally connected to right atrium
- Pulmonary veins were normally connected to left atrium .