Prenatal Diagnosis of Fetal Heart Malformation With Abnormal Number of Pulmonary Artery Branches as the Initial Clue

Objectives Assess prenatal ultrasound's diagnostic value in fetal cardiac anomalies using an abnormal number of pulmonary artery (PA) branches as an initial clue. Methods Retrospective analysis of 20 fetuses with an abnormal number of PA branches on ultrasound, comparing prenatal ultrasonic findings with postnatal echocardiography, computed tomography (CT), surgery, autopsy, and genetic tests. Summarized ultrasonographic characteristics and occurrence frequencies in 3‐vessel trachea (3VT), 3‐vessel PA branch, and innominate artery (INA) coronary section. Results In total, abnormal PA branches included: 1 branch (15 cases: 7 pulmonary artery sling [PAS], 4 unilateral absence of pulmonary artery [UAPA], 4 anomalous origin of 1 pulmonary artery from ascending aorta [AOPA]); 3 branches (2 cases: 1 isolated left subclavian artery [ILSA], 1 isolated left innominate artery [ILINA], absent right ductus arteriosus); 4 branches (3 cases: 2 ILSA, 1 ILINA, double ductus arteriosus). Associated anomalies: tetralogy of Fallot, persistent left superior vena cava, ventricular septal defect, Berry syndrome, and nasal bone dysplasia. Postnatal confirmations were achieved via autopsy (9 cases), imaging/surgery (10 cases), or lost (1 case). Genetic tests (14 cases) were normal. Detection: 63.2% (3VT section), 100% (3‐vessel PA branch section), 57.9% (INA coronary section). Conclusion The 3VT, 3‐vessel PA branch, and INA coronary section are key for the diagnosis of fetal cardiac malformations with abnormal PA branches. The spatiotemporal image correlation with high‐definition (STIC‐HD) live flow sonography can aid in visualizing the vascular connection linked to these anomalies. Identifying features of 1/3/4 PA branches facilitates a systematic assessment of fetal cardiac defects primarily characterized by aberrant PA branching.