Enhanced coronary blood flow and abnormal blood flow in the aortic isthmus in severe fetal anemia

Coronary arteries are not normally visualized by fetal echocardiograms. Reversal of flow in the transverse aortic arch is most often seen in association with severe coarctation. We describe a case of a near-term fetus whose fetal echocardiogram showed very prominent coronary arteries and severe reversal of flow in the transverse aorta suggestive of a coarctation who was postnatally confirmed to have normal intracardiac and aortic anatomy. We discuss the pitfalls in clinical diagnosis in this case to alert pediatric cardiologists of transient perturbations in physiology masquerading as heart disease.