EP07.06: In the first trimester with Slowflow HD and outflow coronal section scanning were used to diagnose a severe congenital heart disease

At 14 weeks the fetal heart was found to be a mirror right heart, and AVSD, and the common atrioventricular valve regurgitation blood flow signal was seen; the four pulmonary veins converged into a trunk and went to the left side of the left atrium, suspected PTA; slowflow HD could not display normally on the outflow tract coronal section. After transvaginal ultrasonography, she was preliminarily diagnosed with mirror right heart, AVSD, PTA type A3?TAPVC?PLSVC. Ten days later, the corrected diagnosis PTA type A3 was: DORV, pulmonary artery dysplasia and body-pulmonary collateral vascularisation. At 19 weeks the ultrasound diagnosis was: mixed right heart (atrioventricular connection abnormality), AVSD, DORV, Pulmonary artery dysplasia with systemic pulmonary collateral vascularisation, DA back perfusion, PLSVC, TAPVC. At 20 weeks in Beijing Anzhen Hospital, the ultrasound report was: not localised (right atrial isomerism possibility), right heart, AVSD, PA with coarse collateral blood supply, TAPVC (mixed possibility), PLSVC, which were basically consistent with our main diagnosis. After the induction of labour, the child underwent full external testing, and the results were negative. This case of complex CHD showed abnormalities of the four-chamber heart and outflow tract in the first trimester, especially the ectopic heart increased the difficulty of diagnosis, the outflow tract was disturbed by the thick collateral vessels, and it was not easy to distinguish the shape and distribution of the left and right outflow tracts. Through the retrospective analysis and repeated study of this case, we realised that severe CHD has serious anatomical abnormalities in the first trimester, and how to make a clear diagnosis still requires us through transvaginal ultrasound, with variety of blood flow display modes, combined with the diagnostic mode of outflow coronal section and so on. Whether the early diagnosis is correct, time will give the best answer!