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Persistent Left Superior Vena Cava Significance in Prenatal Diagnosis-Case Series
Mircea-Octavian Poenaru1,2, Bashar Haj Hamoud3, Romina-Marina Sima1,2
1Department of Obstetrics and Gynecology, The 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Insights
Persistent left superior vena cava (PLSVC) occurs in 0.31% of births. While often isolated with a good outcome, prenatal diagnosis necessitates extended fetal examination to rule out other congenital anomalies.
Area of Science:
- Cardiology
- Fetal Medicine
- Congenital Anomalies
Background:
- Persistent left superior vena cava (PLSVC) is a congenital heart anomaly with a prevalence of 0.3-0.5%.
- Prenatal identification of PLSVC is crucial for comprehensive fetal assessment.
- PLSVC can be associated with other congenital heart diseases in up to 8% of cases.
Purpose of the Study:
- To evaluate the incidence of PLSVC in a specific population.
- To assess the association between PLSVC and prenatal morbidity (cardiac and extracardiac anomalies).
- To determine the adequacy of standard prenatal scans in excluding cardiac anomalies when PLSVC is detected.
Main Methods:
- Retrospective analysis of anomaly scans performed over a 2-year interval.
- Evaluation of incidence and association with cardiac/extracardiac anomalies based on national guidelines.
- Review of postnatal outcomes for affected newborns.
Main Results:
- The incidence of PLSVC in the study population was 0.31%.
- A low association was found between PLSVC and other cardiac or extracardiac anomalies.
- Standard prenatal echocardiographic views were insufficient to rule out cardiac anomalies in the presence of PLSVC.
- Only one infant required postnatal surgery for total anomalous pulmonary venous return; all infants showed normal development at 2 years.
Conclusions:
- Prenatal diagnosis of PLSVC, while often associated with a good isolated outcome, requires an extended fetal examination to exclude other anomalies.
- Awareness of PLSVC's good prognosis when isolated is important for parental counseling.
- Standard prenatal screening views may not be sufficient for complete cardiac evaluation when PLSVC is identified.
Abstract:
The persistent left superior vena cava (PLSVC) is a congenital heart anomaly reported in 0.3-0.5% of the general population and can be associated with congenital heart diseases in up to 8% of cases. Prenatal identification of PLSVC is important to prompt an extended cardiac and extracardiac fetal examination. We retrospectively reevaluated anomaly scans performed in our unit in a 2-year interval according to the national guidelines to evaluate the incidence of PLSVC and its association with prenatal morbidity. In our population, the incidence of PLSVC was 0.31%, and we found a low association with cardiac and extracardiac anomalies. The standard sections (three-vessel and trachea view, four-chamber view and outflow tract's view) are insufficient to exclude cardiac anomalies whenever PLSVC is found. In our case series, only one newborn required postnatal surgery for total pulmonary vein anomaly, and at 2 years of life all babies had a normal evolution. Prenatal diagnosis of PLSVC can raise counseling issues; therefore, awareness of its good outcome when isolated and need for an extended examination to rule out other anomalies is very important.
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