Tetralogy of Fallot with pulmonary stenosis - antenatal

Case contributed by Bahman Rasuli
Diagnosis certain

Presentation

Primigravida for 28-week scan. 12 week and 18 week scans were normal.

Patient Data

Age: 25 years
Gender: Female

Transverse planes of the fetal chest in grayscale at the level of the four-chamber view revealed:

  • large ventricular septal defect (VSD)
  • dilated overriding aorta with antegrade flow
  • small pulmonary artery (PA) with the antegrade flow when compared to the dilated aorta due to pulmonary stenosis
  • right ventricular hypertrophy

Case Discussion

There are a number of different subtypes of tetralogy of Fallot:

  • tetralogy of Fallot with pulmonary stenosis (75%)
  • tetralogy of Fallot with pulmonary atresia (20%)
  • dysplastic (absent/ring) pulmonary valve syndrome (5%).

This case demonstrates the typical findings of the tetralogy of Fallot with pulmonary stenosis on the standard fetal echo views. The key feature that differentiates this from the pulmonary atresia subtype is the presence of the pulmonary trunk on the right ventricular outflow tract (RVOT) view with the antegrade flow.

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