REVERSED SHUNTING ACROSS THE DUCTUS-ARTERIOSUS OR ATRIAL SEPTUM IN-UTERO HERALDS SEVERE CONGENITAL HEART-DISEASE

Objectives. This study was performed to define the significance of Dop pler color flow mapping in demonstrating reversal of the direction of the normal physiologic flow across the atrial septum and ductus arteri osus in the human fetus.Background. Reversal of the physiologic shunti ng across the ductus arteriosus or atrial septum in utero (i.e., left to right) can be readily identified by Doppler color flow mapping, com plemented by pulsed and continuous wave Doppler information. Methods. We reviewed echocardiograms recorded at our three institutions from 19 88 to 1993, which displayed reversal of how by Doppler color flow in 5 3 fetuses of gestational age 18 weeks to term. The diagnoses were conf irmed by postnatal echocardiography, operation or autopsy. Reversal of shunting was consistently associated with severe heart disease. Resul ts. Reversed atrial shunting was found with severe left heart obstruct ive lesions, including 19 with hypoplastic left heart syndrome, 3 with critical aortic stenosis, 2 with double outlet right ventricle and 1 each with an interrupted aortic arch, atrioventricular septal defect a nd severe left ventricular dysfunction due to dilated cardiomyopathy. Reversed ductus arteriosus shunting,vas found with severe right heart obstructive lesions, including nine fetuses with pulmonary atresia, si x with severe obstructive tricuspid valve abnormalities, five with sev ere tetralogy of Fallot, four with Ebstein's anomaly and two with sing le ventricle and pulmonary stenosis. Associated cardiac lesions were c ommon in both groups. Only 3 of the 15 infants who were delivered aliv e from the reverse ductus arteriosus shunt group and 4 of 12 from the reverse atrial shunt group still survive. Conclusions. The finding of reversed flow by Doppler color flow mapping during fetal life provides a key to subsequent accurate diagnosis and denotes a spectrum of dise ases with a very poor prognosis.