Case of the week #528

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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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Answer

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
a4
a1
a3
a2

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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