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Prof Julene S Carvalho Head of Brompton Centre for Fetal Cardiology
Consultant Fetal and Paediatric Cardiologist Professor of Practice, Fetal Cardiology
Molecular & Clinical Sciences Research Institute, SGUL
Big aorta, big pulmonary artery
London 24 January 2020
How big is too big and does it matter?
Vessel size
Big aorta and pulmonary artery
Objectives
• To exclude structural heart disease
• To appreciate relative sizes of the aorta and PA
• To make objective measurements
• To have a plan
Big aorta and pulmonary artery
Objectives
• To appreciate relative sizes of the aorta and PA
PAAo SVC
RT
LT
Vessel number Vessel size Vessel arrangement Vessel alignment
PAAo
SVC
Right
Left
Ant
Post
Big aorta and pulmonary artery
Objectives
• To appreciate relative sizes of the aorta and PA
• To make objective measurements
http://fetal.parameterz.com
http://fetal.parameterz.com
Big aorta and pulmonary artery
Objectives
• To make objective measurements
• To exclude structural heart disease
Big aorta, small PA or both?Case 1- 36 weeks
Tetralogy of Fallot
Case 2- 19 weeks
Small aorta or big PA?
Coarctation
27 weeks 33 weeks
Coarctation
Case 3- 21 weeks
Big pulmonary artery?
Vmax = 2m/s
Pulmonary stenosis
Case 4- 21 weeks
Big aorta
Aortic aliaising
67cm/s
67cm/s
Ao Vmax = 154cm/s
Valvar aortic stenosis
Valvar pulmonary stenosis … mother: likely Noonan
Case 4- 21 weeks
Referred for ‘big pulmonary artery’
No structural abnormality
What next?
Sonographer referral for ‘big aorta’No structural cardiac abnormality
‘Big-gish’ aortaNo structural cardiac abnormality
Z-score = + 1.86
Family history of aortic aneurysm/ dissection
Patient referred for ‘bicuspid aortic valve’ - 23 weeksNo structural cardiac abnormality - ‘aorta a bit big’?
Bicuspid valve?
Patient referred for ‘bicuspid aortic valve’
Normal looking aortic valve at 31-week follow up
Patient self-referred ‘for reassurance’No structural cardiac abnormality - 20 weeks - prominent PA?
http://fetal.parameterz.com
No structural cardiac abnormality - 20 weeks - prominent PA = 4.6mm?
http://fetal.parameterz.com
Big aorta and pulmonary artery
Objectives
• To exclude structural heart disease
• To have a plan
Big aorta and pulmonary arterySummary
• Family history • Consider bicuspid aortic valve • Consider possibility of aortopathy • Consider possibility of genetic syndrome:
• Exclude obvious cardiac abnormality
• Aortic and pulmonary stenosis • Rescan to exclude minor lesions that may evolve
• May still remain unexplained
• Marfan, other collagen disorders • Noonan syndrome (pulmonary stenosis, ? progression)
• Calculate Z-scores and follow up if > +2
Thank you