HOW EXACTLY WE CAN DIFFERENTIATE PULMONARY ATRESIA WITH VENTRICULAR SEPTAL DEFECT AND TRUNCUS ARTERIOSUS IN THE PRENATAL STAGE. THE RESULTS OF THE FIVEYEAR STUDY
Objective. To evaluate the accuracy of prenatal echocardiography in the differential diagnosis between common arterial trunk (CAT) and pulmonary atresia with ventricular septal defect (PA VSD) and to track the combination of these defects with chromosomal and extracardiac pathology. Material and methods. We conducted a retrospective analysis of 88 fetuses with a single vessel that “rests” above the VSD and a poorly visualized right ventricular outflow tract without obvious direct flow. The database also revealed information on the type of blemish, the duration of pregnancy, the peculiarities of the structure of the trunk valve, the presence of other vascular, chromosomal and extracardiac anomalies, postnatal outcome. In difficult for visualization cases, four-dimensional (4D) echocardiography was used in the program STIC (spatiotemporal image correlation). Results. The overall diagnostic accuracy was 84.1%. Chromosomal and extracardiac anomalies were detected in 15.9% of cases. In the PA VSD group, the open arterial duct and major aortopulmonary collateral arteries (MAPCAs) were visualized in 86.3 and 33.3% of cases, respectively. MAPCAs was significantly more common with the right aortic arch, in 58.3% of cases. Conclusions. Prenatal differentiation of CAT and PA VSD can now be achieved in the main cases. If there is a suspicion of PA VSD, MAPCAs should be looked for, since they are, according to the world literature, associated with a higher risk of microdeletion 22q11.2 and complicate postpartum treatment.