case_images: PMC11111948_01
case_images: Abnormal cardiac structure and vascular abnormalities in the fetus. (A,B) 2D grayscale images showing d-TGA combined with a VSD. (C,D) 2D grayscale combined with CDFI showing RAA-MIB. (E,F) 2D grayscale combined with CDFI showing BDA encircling the trachea. (G) 2D grayscale showing that the PLSVC converges into the CS.
case_images: fcvm-11-1389759-g001.jpg
case_images: PMC11111948_01_fcvm-11-1389759-g001.jpg
case_images: F1
case_images: The 2D grayscale imaging showed that the main pulmonary artery (MPA) originated from the left ventricle (LV) and could be seen overriding the interventricular septum, with left and right blood vessels separating at the distal end (Figure 1A). Furthermore, the aorta (Ao) was shown to originate completely from the right ventricle (RV) (Figure 1B). The above signs indicated that the fetus had d-TGA combined with a ventricular septal defect (VSD). 2D grayscale combined with CDFI showed that the Ao was located on the right side of the trachea and that the first blood vessel originating from the Ao was the left innominate artery (LINA) (Figure 1C), which was toward the left shoulder of the fetus. Subsequently, the left common carotid artery (LCCA) and left subclavian artery (LSA) were separated (Figure 1D), indicating RAA-MIB (Supplementary Video S1). Therefore, the BDA completely encircled the trachea, forming an "O"-shaped vascular ring (Figures 1E,F, Supplementary Video S1). In addition, a PLSVC was observed; the 2D grayscale longitudinal plane showed that this vessel converged into the coronary sinus (CS) (Figure 1G). We have provided a pattern diagram to help understand this case (Supplementary Figure S1).
case_images: Cardiovascular abnormalities of this fetus observed using the STIC HD live flow mode and embryonic development patterns based on Edward's double aortic arch system theory. (A) Shown from the anterior view, we used STIC HD live flow mode to observe that the first blood vessel originating from the ascending aorta was the LINA, which then separates into the LCCA and LSA, followed by the RCCA and RSA (*indicates the "O"-shaped vascular ring, ** indicates red blood flow indicates the RDA). (B) Shown from the posterior view, we used STIC HD live flow Silhouette mode to find the RDA (*indicates the "O"-shaped vascular ring). (C) Embryonic development patterns based on Edward's double aortic arch system theory.
case_images: fcvm-11-1389759-g002.jpg
case_images: PMC11111948_01_fcvm-11-1389759-g002.jpg
case_images: F2
case_images: At this point, the RDA was located immediately below the RAA and could only be observed with flickering of the RDA in certain cardiac cycles (Figure 2A, Supplementary Video S2). Different blood flow directions could help distinguish between pulmonary arteries and veins. Due to angle factors, only the first branch of the Ao could be seen (Figure 2B, Supplementary Video S3).
case_images: Edward's DAA system theory and the nine combinations of BDA and aortic arch abnormalities summarized in the literature. (A) Edward's DAA system theory. The dotted line represents regression, and the black solid line represents the preserved primitive arch artery. Reprinted with permission of Radiological Society of North America, from Hanneman et al.. (B) RAA combined with an ILSA. The LSA originates from the LPA via the LDA. (C) RAA-MIB combined with PA. The LPA originates from the LSA via the LDA. (D) RAA-MIB with or without PA. The LPA originates from the LINA via the LDA. (E) RAA combined with an aberrant left subclavian artery (ALSA). The LDA is connected to the LPA and ALSA. (B-E) RDA is connected to the RPA and the DAo. (F) DAA combined with BDA. The LDA is connected to the LPA and left arch, and the RDA is connected to the RPA and right arch. *represents interruption of the aortic arch (IAA) occurring in the right arch; **represents IAA occurring on both sides of the aortic arch. (G) LAA combined with IRSA. The RSA originates from the RPA via the RDA. *represents IAA occurring in the left arch. (H) LAA, RPA originates from the RSA via the RDA, with or without PA. *represents IAA occurring in the left arch. (I) LAA, RPA originates from the INA via the RDA, with or without PA. (J) LAA combined with ARSA, with or without PA. The RDA is connected to RPA and ARSA, respectively. (G-J) LDA is connected to the LPA and the DAo. The shadowed area in panels (C-E) and (H-J) represents PA.
case_images: fcvm-11-1389759-g003.jpg
case_images: PMC11111948_01_fcvm-11-1389759-g003.jpg
case_images: F3
case_images: Different blood flow directions could help distinguish between pulmonary arteries and veins. Due to angle factors, only the first branch of the Ao could be seen (Figure 2B, Supplementary Video S3).