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First detection of superior-type caval vein defect in foetus

Published online by Cambridge University Press:  03 April 2014

Muluneh A. Yiimer ,
Miriam B. Kula  and
Courtney Peshkovsky
Muluneh A. Yiimer
Affiliation:
Children’s Heart Center, Children’s Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, United States of America
Miriam B. Kula
Affiliation:
Children’s Heart Center, Children’s Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, United States of America
Courtney Peshkovsky
Affiliation:
Children’s Heart Center, Children’s Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, United States of America
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Abstract

We present the images of the first superior-type caval vein defect diagnosed in a foetal echocardiogram.

Keywords

Echocardiographyatrial septal defectssuperior vena cavafoetuspulmonary veinssinus venosus
Type
Images in Congential Cardiac Disease
Information
Cardiology in the Young , Volume 24 , Issue 3 , June 2014 , pp. 517 - 519
Copyright
© Cambridge University Press 2014 

We report the first published pictures of superior-type caval vein defect – sinus venosus atrial septal defect – in a foetus. The foetus was 25 weeks and 6 days old and referred for “echogenic foci” and bilateral pyelectasis in a mother who had an abnormal quadruple screen test – α-fetoprotein, human chorionic gonadotropin, unconjugated oestriol, and inhibin A. The echocardiogram was suspicious for a small patent foramen ovale (1.5 mm). Upon further examination in the bicaval view it was confirmed by two-dimensional echocardiogram (Fig 1a) and colour mapping (Fig 1b) that the superior caval vein overrode the left and right atria. The bicaval view is an important view and can be found near the long-axis aortic arch view in a parasagittal plane of the right chest.Reference Chiappa, Cook, Botta and Silverman 1 Postnatal echocardiogram confirmed the diagnosis (Fig 2a and b) and additionally showed the commonly associated partially anomalous pulmonary venous return of the right-upper and right-middle pulmonary veins.

Figure 1 Bicaval view – inferior and superior caval veins in long-axis view – in a 25-week-old foetus with superior-type caval vein defect. ( a ) Two-dimensional foetal echocardiogram showing the overriding superior caval vein and its connection to the right atrium (thin arrow) and the defect allowing connection to the left atrium (thick arrow). ( b ) On colour flow mapping, foetal blood flow from the superior caval vein is seen draining both into the right atrium (thin arrow) and the left atrium (thick arrow).

Figure 2 Subxiphoid sagittal view in the same patient as 1-day-old neonate. ( a ) Two-dimensional neonatal echocardiogram confirms the superior-type caval vein defect. ( b ) Colour flow mapping demonstrates the bi-atrial drainage of the superior caval vein in the neonate. As the superior caval vein’s blood flow enters both atria, that which goes to the right atrium has a smaller orifice and is more directly aligned with the transducer; this flow is seen aliasing.

Financial Support

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

Conflicts of Interest

None.

References

1. Chiappa, EM, Cook, AC, Botta, G, Silverman, NH. Echocardiographic Anatomy in the Fetus. Springer-Verlag Italia, Milan, Italy, 2008.CrossRefGoogle Scholar
Figure 0

Figure 1 Bicaval view – inferior and superior caval veins in long-axis view – in a 25-week-old foetus with superior-type caval vein defect. (a) Two-dimensional foetal echocardiogram showing the overriding superior caval vein and its connection to the right atrium (thin arrow) and the defect allowing connection to the left atrium (thick arrow). (b) On colour flow mapping, foetal blood flow from the superior caval vein is seen draining both into the right atrium (thin arrow) and the left atrium (thick arrow).

Figure 1

Figure 2 Subxiphoid sagittal view in the same patient as 1-day-old neonate. (a) Two-dimensional neonatal echocardiogram confirms the superior-type caval vein defect. (b) Colour flow mapping demonstrates the bi-atrial drainage of the superior caval vein in the neonate. As the superior caval vein’s blood flow enters both atria, that which goes to the right atrium has a smaller orifice and is more directly aligned with the transducer; this flow is seen aliasing.