Larger than expected pulmonary artery during ultrasound
December 28, 2017 11:07 PM   Subscribe

We're expecting a second child, and just went for the regular second-trimester detailed ultrasound. The ultrasound picked up an anomaly in the baby: the pulmonary artery is larger than it should be, in comparison to other major artery (the aorta I think?). What should we make of this?

The pregnancy is about 20 weeks in. We've been scheduled to visit a pediatric cardiologist next week, who will perform a more detailed scan and find out what exactly is going wrong. What should we be expecting from the investigation? How worried should we be? I've tried to find out more online, but the information is pretty scarce. Is this something really serious, or something probably not that serious, or could it go both ways and so there's really no way to know what to expect till the visit?
posted by destrius to Health & Fitness (5 answers total) 1 user marked this as a favorite
Well, it very likely may be a congenital heart defect. You need better scans and a cardiologist to tell you anything real. They did a screening comparing the size of the pulmonary artery to the aorta.

But possible things you might have to deal with are mentioned in this paper (the fetus apparently is thought to have a pulmonary artery/aorta ratio above 1). Many problems are very repairable.
posted by floam at 12:49 AM on December 29, 2017

(Table 2 in the linked paper lists out several possible defects: it is likely not Tetralogy of Fallot (something my father was born with in 1953 and is still alive and kicking today, thanks to repair), because that is associated with a smaller pulmonary artery in the ultrasound, a ratio under 1, but it could potentially be one of the others. Or it could be nothing.)
posted by floam at 1:01 AM on December 29, 2017

I don't think anyone here will be able to tell you anything definite, so it's your third option ("could go both ways so there's really no way to know what to expect till the visit").

I imagine a single diagnostic test might not be sufficient to identify for sure whether there's a problem, so until you see the pediatric cardiologist there will be some uncertainty - I know that sucks enormously and I wish you every strength for dealing with it until you get some answers. Best of luck.

(not an expert, but I used to work in a pediatric cardiology unit and have separately dealt with a great deal of medical uncertainty).
posted by altolinguistic at 6:12 AM on December 29, 2017 [3 favorites]

Hi, I am a midwife (but not a perinatologist, paediatric cardiologist, etc.) and read all of my patients' anatomy scan reports. I'm sorry that you've had a finding that sounds scary and you were not expecting. I agree with floam and alto linguistic above that the fetal echo and report from a specialist will give you the most and best information. It is also possible that the scan you have next week will suggest more scans. But is impossible to say from the information given here and without the further scans and input from the cardiologist. It could indeed be nothing but could be something more serious, but it is impossible to say at this moment. If there is a finding that indicates a heart defect, the cardiologist and/or perinatologist will have lots more information for you on next steps.

Thinking of you and your family and hope you can find some calm while you wait for your scan.

(As an aside, contrary to kalmya's crass and unhelpful comment, I will add that the twenty week scan is not "crap." It is an important tool for checking the anatomic development of mid-gestation pregnancy).
posted by stillmoving at 4:31 PM on December 29, 2017 [2 favorites]

Thanks for all the comments. We saw the doctor today, and the diagnosis is pulmonary valve stenosis (PVS), with moderate regurgitation. Everything else with the heart is absolutely normal. As some of you suspected, we still need more scans to determine how things are going; the next scan will be in 4 weeks time, at which the doctor will see if things are still the same or if it's getting worse. We'll probably be given a clearer picture at that time as to whether an operation is needed, what steps are to be taken, etc.

The doctor is concerned it might be a chromosomal defect, and advises we check with our OB about doing a test for that. We've already done the Harmony test (which tests for some chromonomal defects) and gotten the all clear from that, but it doesn't test all possible defects and in any case is a screening. We are quite worried that it may be a chromosomal problem, as that would mean many more issues than just a (fixable) CHD. But I guess the chances are not very high? Can't find much information indicating the odds of having a chromosomal defect given PVS (it's usually the odds the other way around).

Anyway, we have some answers, but we also have more questions, but I think that's how things always are when it comes to medicine (and I guess life in general). Time will tell.
posted by destrius at 5:34 AM on January 2, 2018 [1 favorite]

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