To investigate the prenatal ultrasound and clinical features of fetal anomalous connection of the ductus venosus (DV) nd evaluate their clinical significance and value.

A retrospective analysis was conducted on clinical data from 64 fetuses diagnosed with anomalous DV connection by prenatal ultrasound at Chongqing Health Center for Women and Children between January 2017 and June 2024. Prenatal ultrasound features, associated structural anomalies, genetic examinations, and pregnancy outcomes were analyzed.

Among the 64 cases of anomalous connection of the DV included, 56.25% (36/64) had abnormal connection to the inferior vena cava, 9.38% (6/64) demonstrated abnormal connection to the coronary sinus, 21.88% (14/64) exhibited abnormal connection to the hepatic vein, and 12.50% (8/64) showed abnormal connection to the right atrium; 23 (23/64, 35.94%) had isolated anomalous DV connection, 32 had other complex cardiovascular abnormalities, 20 had other extracardiac abnormalities, and 11 had both intracardiac and extracardiac abnormalities; 10 underwent serological screening for Down's syndrome (2 of which were high-risk), and 26 underwent amniocentesis, with 7 cases showing abnormal results; 26 pregnancies were terminated, and 38 resulted in live births. Thirty-seven of the live-born infants showed spontaneous closure of the DV during follow-up with no obvious developmental abnormalities (20 of them had isolated anomalous DV connection). One infant died of pulmonary hemorrhage after birth, with anomalous DV connection combined with large ventricular septal defect and single umbilical artery. Notably, the live birth rate in the isolated DV anomalous connection group (20/23, 86.96%) was significantly higher than that in the group with associated structural anomalies (18/41, 43.90%) (P=0.001).

Prenatal ultrasound can identify anomalous DV connection and evaluate associated structural anomalies, and is of great value in the diagnosis of abnormal DV course. Fetal anomalous DV connection may be complicated by cardiac and extracardiac anomalies and is associated with potential chromosomal abnormalities. Isolated anomalous DV connection has a favorable prognosis.