The 13 week nuchal thickness showed short limbs, a soft sign for downs syndrome. Week 16 and 18 ultrasounds showed marginal cord insertion on two hematomas. Then week 20, we were told she had a cardiac malformation called a persistant left superior vena cava, what a mouthful!
To understand PLSVC, you first have to know a little bit about normal cardiac anatomy. There is a great breakdown of what it is here. Usually, we have two vena cavas, a superior right and an inferior right. Everyone develops a superior left vena cava at some point during their fetal development, however, usually it is resorbed (kind of like how we all have webbed fingers at one point, but then they get resorbed).
In miss. V's case, the blood from her arms, instead of draining into her superior right vena cava, it went through her PLSVC, which in turn drained into her coronary sinus. All this simply means that it was a variant of normal.
In miss. V's case, the blood from her arms, instead of draining into her superior right vena cava, it went through her PLSVC, which in turn drained into her coronary sinus. All this simply means that it was a variant of normal.
The worry in her case was that there seemed to be a bit less flow going through the aorta because of a compression for the enlarged coronary sinus (it was enlarged because it was receiving extra blood from the PLSVC). When the aorta has lower pressure pulsing through it during development, it sometimes remains a smaller diameter. In certain cases, that can lead to a coarctation of the aorta.
The aorta is the blood vessel that allows all the blood in the heart to be distributed to the rest of the body. A coarctation of the aorta is just a fancy way of saying that it has a smaller diameter. Imagine two pipes: one has a big opening and one is narrower. You can imagine that less fluid can go through the smaller one. You wouldn't want a tiny pipe draining your sink, just like you wouldn't want a tiny aorta draining your heart. It can cause extra stress on the heart trying to push all the blood through the tiny opening and it means not a lot of blood reaches the legs, the kidneys and a bunch of other organs.
The key with the coartation is that if you have a patent ductus arteriosis (PDA), the blood can get carried to the rest of the body that way, through the PDA. So while most babies want to have their PDA closed, when you are worried about a coarctation, you want the PDA to stay open!
Luckily our little princess' PDA remained open for a while. She was followed with weekly ultrasounds until they figured her aorta was big enough that they were no longer worried about a coarctation (fiou!) and then gave her some ibuprofen to close up the PDA. We were some of the lucky ones whose preemie closed up their PDA without the need for surgery and she did not get any of the icky side effects from ibuprofen.
So at the end of the day, our scary cardiac fetal ultrasound just showed a PLSVC, which is a variant of normal and miss V is not considered to have any sort of cardiac problem! It just goes to show that fetal cardiac ultrasounds are far from perfect, so there is a bit of hope if your child had a not so sterling echo if it is regarding coarctation.
Xo
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