Prenatal diagnosis conventional/four-dimensional direct volume rendering fetal echocardiography pregnancy and postnatal outcomes of isolated anomalous course of left brachiocephalic vein.

BACKGROUND

Advances in fetal echocardiography, including conventional 2-dimensional (D) and 3-D/4-D imaging techniques, have improved our understanding of upper mediastinal vessels.

OBJECTIVE

To study the prenatal imaging characteristics, pregnancy, and postnatal outcomes in fetuses with an isolated anomalous course of the left brachiocephalic vein.

MATERIALS AND METHODS

This retrospective study, conducted between October 2019 and July 2024, examined fetuses with an isolated anomalous course of the left brachiocephalic vein. These cases underwent conventional 2-D and 3-D/4-D spatiotemporal image correlation echocardiography at Sowmi Pediatric Heart Centre, Tirunelveli, India. The inclusion criteria encompassed all fetuses with an isolated anomalous course of the left brachiocephalic vein, whereas those with associated congenital heart defects or missing postnatal follow-up were excluded from the analysis.

RESULTS

A total of 2,083 fetal echocardiograms were performed during the study period. In total, 331 fetal cardiac abnormalities were detected. Twelve fetuses with isolated anomalous course of left brachiocephalic vein were included in the study. Intrathymic left brachiocephalic vein was observed in nine fetuses, extrathymic left brachiocephalic vein in two fetuses, and retroaortic left brachiocephalic vein in one fetus. Quadruple marker screening in five cases yielded normal results. Invasive genetic testing performed in the case with retroaortic left brachiocephalic vein showed normal findings. Postnatally, no dysmorphism was observed in any fetus. All fetuses were delivered at term, had an uneventful postnatal period, underwent at least 3 months of follow-up, and were reassured.

CONCLUSION

Though the indication for referral for this fetal extracardiac anomaly was to rule out critical congenital heart disease, proper prenatal imaging of this benign finding will avoid unnecessary confusion, in utero referral to tertiary pediatric heart center for delivery and invasive genetic tests.