Retrospective Study Of Advanced Dramatic Flow Imaging For Diagnosis Of Fetal Total Anomalous Pulmonary Venous Drainage

Objective: Advanced Dramatic Flow Imaging(ADF)mode was applied to examine total anomalous pulmonary venous drainage(TAPVD)in fetus,by which we sought to compare ADF and traditional two-dimensional CDFI and define the advantages and weakness of both methods in diagnosis of fetal TAPVD.The present study aimed to explore the diagnostic value of ADF in fetal TAPVD,and provide a more sensitive detection method for the diagnosis of TAPVD.Methods:Retrospective analysis was performed on fetal echocard iography and clinical data of 84 cases diagnosed as TAPVD by prenatal fetal heart screening in Hebei Children's Hospital and Hebei Provincial Maternity Hospital from January 2014 to January 2019.All pregnant women were examined with both ADF and CDFI modes.The parameters were observed and compared as following: structural symmetry of the left and right ventricles,common pulmonary venous cavity,obstruction of common pulmonary venous cavity,the types of anomalous pulmonary venous drainage(Cardiac Type,Intracardiac Type,Subcardiac Type and Mixed Type),surgical treatment,pregnancy termination,and autopsy results.The differences between two methods in TAPVD typing and drainage pathway tracing were compared.Results:1.Among 84 cases of TAPVD,31 cases had live birth(31/84,91%);autopsy was performed in 48 death cases(48/84,57.14%);and 5 cases lost follow-up(5/84,5.95%).Only these 79 cases of TAPVD were included in the analysis.All 79 cases of fetal TAPVD were confirmed after birth or by autopsy,which included 25 cases of cardiac type(25/79,31.64%),41 cases of intracardiac type(41/79,51.89%),11 cases of subcardiac type(11/79,13.92%),2 cases of mixed type(2/79,2.38%).In these 79 cases of TAPVD,20 cases were classified as simple type(20/79,25.32%),and 59 cases as complicate type with intracardiac malformation(59/79,74.68%).2.Application of ADF had accurately detected the reflux site in 77 cases(77/79,97.47%),with 2 cases(2/79,2.53%)inaccurate.Meanwhile,application of CDFI had accurately detected the reflex site in 70 cases(70/79,88.61%),with 9 cases inaccurate(9/79,11.39%).3.Application of ADF had accurately detected the reflux pathway in 77 cases(77/79,97.47%),with 2 cases(2/79,2.53%)inaccurate.Meanwhile,application of CDFI had accurately detected the reflex pathway in 69 cases(69/79,87.34%),with 10 cases inaccurate(10/79,12.66%).Conclusion:1.ADF demonstrated significantly higher tracking accuracy of TAPVD typing and drainage pathway than CDFI,as it yielded more detailed and more accurate information of anomalous pulmonary venous connection than two-dimensional CDFI.2.ADF provides reliable supplemental methods for prenatal diagnosis of TAPVD,which has substantial clinical importance.