Prenatal diagnosis of ventriculocoronary fistula

Background Cardiac anomalies may be associated with abnormal coronary vascu lar connections. We report the prenatal diagnosis of ventriculocoronary fis tula in three fetuses with associated cardiac anomalies. Materials and Methods Fetal echocardiography was performed in three patients referred for suspected cardiac anomaly. Two-dimensional fetal echocardiography was comp lemented by color Doppler flow imaging and spectral Doppler in all cases. Results A ventriculocoronary, fistula was diagnosed in three patients refer red at 22, 23 and 32 weeks. The first patient had hypoplastic left heart as sociated with transposition of the great arteries and pulmonary atresia wit h an intact interventricular septum. The coronary fistula arose from the tr ansposed aorta to the left ventricle. In two patients ventriculocoronary fi stula was found in association with pulmonary, atresia and an intact interv entricular septum. hr all cases there was bidirectional flow within the fis tula (diastolic blood flow towards the ventricle with reversal during ventr icular systole). The pregnancy with hypoplastic left heart with transpositi on, and one of those with pulmonary atresia resulted in neonatal death and stillbirth, respectively. In the third instance the ventriculocoronary fist ula was verified by postpartum cardiac angiography. The infant initially re ceived a Blalock-Taussig shunt, subsequently replaced by a bidirectional Gl enn shunt, and was doing well at the time of writing. Conclusion A ventriculocoronary fistula can be identified prenatally by col or and spectral Doppler. This anomaly should be sought in fetuses with outf low tract obstructive cardiac lesions and an intact interventricular septum . Prenatal diagnosis allows early angiography postnatally. Delineation of c oronary, vascular regions may therefore facilitate preoperative planning.