In the 1970s, diagnosing anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) was often uncertain using imaging alone; however, with the advances in high-frequency transducers, advanced image processing, and other ultrasound modalities such as Doppler colour flow imaging, tissue Doppler imaging, and speckle tracking to asses regional wall motion abnormalities, modern echocardiography now permits accurate diagnosis of ALCAPA with greater certainty. Although many consider ultrasound to be the only imaging test necessary if there is a question as to the diagnosis, other imaging modalities such as MRI, CT, and cardiac catheterisation with angiography remain valuable complementary tests, especially in older patients.

Twin reversed arterial perfusion (TRAP) syndrome is a rare but severe complication of monozygotic monochorionic twin pregnancies. The outcome is invariably fatal for the abnormal twins and for 50-75% of the normal co-twins. The prenatal diagnosis of the TRAP always has to be presumed in a multiple pregnancy within which a twin pair grows whenever cardiac activity can not be proved echographically. We present discuss – based upon literature research – pathogenic mechanisms, pathologic-anatomic, echographic diagnosis and management of these high-risk pregnancies.