Cardiology Department, Polish Mothers’ Memorial Hospital, Research Institute, Lodz, Poland.
Kardiol Pol. 2011;69(2):146-51.
The presence of foetal major aortopulmonary collateral arteries (MAPCAs) is associated with adverse outcome, therefore early diagnosis is essential.
To evaluate the usefulness of foetal echocardiography in the diagnosis and evaluation of MAPCAs in foetuses with pulmonary atresia, as well as to assess the effects of prenatal diagnosis on the management of neonates with pulmonary atresia.
From 11,678 examined foetuses, we retrieved 15 cases of patients with MAPCAs and congenital heart defects which had been diagnosed by foetal echocardiography (1994-2008), using 2D echocardiography + color-Doppler (CD) + pulsed Doppler (2DD) and spatio-temporal image correlation (STIC) techniques. In 13 patients, MAPCAs were confirmed after birth based on angiography.
In all cases, vessels corresponding to MAPCAs were visible in longitudinal view with CD, and in three cases were additionally confirmed by STIC technique. In nine cases one, in four cases two, and in two cases three MAPCAs were suspected. In two cases, MAPCAs were not confirmed after birth; one due to misdiagnosis secondary to aberrant right subclavian artery, and one because of abnormal ductus arteriosus course coexistent with right aortic arch.
In foetuses with pulmonary atresia, it is possible to find MAPCAs with current technology (both 2D + CD, power angiography and real time-3D echocardiograophy [4D]). The differential diagnosis (MAPCAs or other vessels) should be included. Although prenatal diagnosis does not change the obstetrical management, it is important information for a paediatric cardiologist. Early neonatal angiography might be of great value not only in confirming MAPCAs, but also in performing cardiac intervention and in some cases preventing future heart failure.
胎儿主肺动脉侧支动脉（MAPCAs）的存在与不良预后相关，因此早期诊断至关重要。
评估胎儿超声心动图在肺动脉闭锁胎儿中 MAPCAs 的诊断和评估中的作用，并评估产前诊断对肺动脉闭锁新生儿管理的影响。
从 11678 例检查胎儿中，我们检索了 15 例通过胎儿超声心动图（1994-2008 年）诊断的 MAPCAs 合并先天性心脏病患者，使用二维超声心动图+彩色多普勒（CD）+脉冲多普勒（2DD）和时空关联成像（STIC）技术。在 13 例患者中，根据血管造影在出生后证实了 MAPCAs。
在所有病例中，CD 下均可在纵向视图中看到与 MAPCAs 对应的血管，在 3 例中还可通过 STIC 技术进一步确认。在 9 例中怀疑有 1 条、在 4 例中怀疑有 2 条、在 2 例中怀疑有 3 条 MAPCAs。在 2 例中，出生后未证实 MAPCAs；1 例是由于异常右锁骨下动脉导致误诊，1 例是由于伴发右主动脉弓的异常动脉导管路径导致。
在肺动脉闭锁胎儿中，目前的技术（二维+CD、功率血管造影和实时三维超声心动图[4D]）可以发现 MAPCAs。应包括鉴别诊断（MAPCAs 或其他血管）。尽管产前诊断不会改变产科管理，但对于儿科心脏病专家来说是重要的信息。早期新生儿血管造影不仅对证实 MAPCAs 具有重要价值，而且对心脏介入治疗和某些情况下预防未来心力衰竭也具有重要价值。
