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'I-shaped' sign instead of 'V-shaped' sign in the upper mediastinum: a novel potential marker for the antenatal diagnosis of d-transposition of the great arteries.
MedLine Citation:
PMID:  23023957     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objectives: To investigate the 'I-shaped' sign as a novel echocardiographic marker for antenatal diagnosis of d-transposition of the great arteries (dTGA) in routine cardiac examination, and to compare its prevalence in dTGA, other congenital heart diseases (CHDs), and normal structural hearts. Methods: This retrospective evaluation involved 1,134 pregnant women undergoing fetal echocardiography to screen for CHD over a 4-year period. An 'I-shaped' sign was defined as the characteristic appearance of the aortic arch resembling the letter 'I' from the most anterior to most posterior descending aorta in three-vessel-trachea view. The frequency of this sign was evaluated in dTGA, other cardiac defects, and normal cardiac structures. Results: CHD was diagnosed in 671 cases (59.1%), of which 31 (4.6%) had dTGA. The 'I-shaped' sign was observed in 30/31 (96.7%) cases of dTGA, compared to 31/640 (4.8%) with other cardiac anomalies, including single ventricle with pulmonary atresia or severe pulmonary stenosis, hypoplastic left heart syndrome with aortic atresia, corrected transposition of great arteries, or double outlet right ventricle with malposition of great arteries. The sign was detected significantly more frequently in the dTGA group compared to the normal and other CHD groups (both P < 0.001(. The 'I-shaped' sign demonstrated 96.7% sensitivity and 97.1% specificity for diagnosis of dTGA. Importantly, the 'I-shaped' sign was never observed in fetuses with normal structural hearts. Conclusions: Detection of an extremely long vessel with a marked 'I-shape' raises suspicion of cardiac anomaly, especially dTGA. This marker may therefore aid prenatal diagnosis of dTGA during general ultrasound examination. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Authors:
Yoichiro Ishii; Noboru Inamura; Yukiko Kawazu; Futoshi Kayatani; Hirokazu Arakawa
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-1
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
Department of Pediatric Cardiology Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan; Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan. yishii@pj8.so-net.ne.jp.
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