ABSTRACT
OBJECTIVE: Abnormal cardiac axis and/or malposition prompts evaluation of congenital heart disease; however, etiology may be difficult to clarify using obstetrical ultrasound or fetal echocardiography (echo) alone. We aimed to use fetal magnetic resonance imaging (MRI) as a complementary tool to identify causes of cardiac malposition. METHODS: Review of fetuses diagnosed with cardiac malposition by fetal ultrasound and echo was performed. Etiology was classified as either because of heterotaxy syndrome or extracardiac masses. Reclassification was then performed with fetal MRI findings. Results were compared with postnatal diagnoses. RESULTS: Forty-two fetuses were identified as having abnormal cardiac axis and/or malposition. Twenty three of 42 cases (55%) had extracardiac anomalies, while 19 (45%) were because of heterotaxy. Twelve of 42 (29%) cases were reassigned by fetal MRI (five in heterotaxy group and seven in the lung anomaly group). Four cases (33%) had both cardiac disease and extracardiac masses, not previously recognized. Fetal MRI clarified heterotaxy subtype or removed heterotaxy diagnosis in five (26%) patients. Fetal MRI findings were confirmed in 8 of these 12 cases postnatally. CONCLUSION: Fetal MRI is a useful complementary tool to define etiology of cardiac malposition in complex cases for informative prenatal counseling and planning. © 2016 John Wiley & Sons, Ltd.
Subject(s)
Fetal Heart/diagnostic imaging , Heterotaxy Syndrome/diagnostic imaging , Respiratory System Abnormalities/diagnostic imaging , Adult , Echocardiography , Female , Heart Defects, Congenital/diagnostic imaging , Heart Defects, Congenital/etiology , Humans , Lung/abnormalities , Lung/diagnostic imaging , Magnetic Resonance Imaging , Pregnancy , Prenatal Diagnosis , Respiratory System Abnormalities/complications , Retrospective Studies , Ultrasonography, PrenatalABSTRACT
This report describes the clinical course and multi-modality imaging findings in an anti-SSA-antibody-exposed fetus with suspected myocardial inflammation. Postnatal cardiac MRI - using fast acquisition, free-breathing with feed-and-swaddle technique - was used to evaluate for myocardial fibrosis/inflammation. This is the first published report, to our knowledge, of ductal constriction temporally associated with oral dexamethasone therapy in an anti-SSA-antibody-exposed fetus and of the use of this unique postnatal MRI protocol in this setting.