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2019-07-18  Case of the week # 501  © Lusine Karapetyan  www.TheFetus.net

Answer to the case of the week # 501
August 1, 2019 - August 15

City hospital named after E.O.Muhin, Moscow ,Russia


Case report
A 32-year-old (G1P0) patient  with unremarkable medical history was sent to our unit for second trimester scan at 20 weeks of pregnancy. 
First trimester screening was reported to be normal.
Our ultrasound revealed the following findings and our diagnosis was anomalous origin of the right pulmonary artery from the ascending aorta with VSD ,which was confirmed after birth .



Images 1-3: 2D images of the fetal heart show right pulmonary artery arising from ascending aorta and ventricular septal defect.
  



Videos 1-6: 2D and STIC images of the fetal heart show right pulmonary artery arising from ascending aorta and ventricular septal defect.

     

Anomalous origin of the right pulmonary artery from the ascending aorta (AORPA) is a rare and potentially fatal kind of congenital cardiovascular anomaly, and frequently accompanied with other abnormalities, such as patent ductus arteriosus (PDA), Tetralogy of Fallot (TOF), atrial septal defect (ASD), ventricular septal defect (VSD), and aortic arch isthmus hypoplasia. 
The pathophysiological characteristic change of AORPA is early and rapid development of pulmonary hypertension. Without receiving surgical correction, the patients have less chance to survive to adulthood. Once the diagnosis of AORPA is confirmed, the patients should receive surgical treatment as soon as possible.



Image 4: illustration showing the anomaluos origin of the righ pulmonary artery from the ascending aorta.
RA: right atrium; LA: left atrium; RV: right ventricle; LV: left ventricle; PA: main pulmonary artery; Ao: aorta; DA: ductus arteriosus; RPA: right pulmonary artery; LPA: left pulmonary artery.


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