Objective
Fetal echocardiography (FE) provides detailed information about cardiac structure and function in-utero. Limited information is available regarding normal findings late in pregnancy. We therefore sought to identify and describe common cardiac findings in late gestation.
Methods
Fetuses with structurally normal hearts were identified in mid-gestation within a subset of pregnant women in a prospective study. Atrioventricular valves (AV), right and left atrium (RA/LA), aortic isthmus (AoI) and ductus arteriosus (DA) dimensions and flow abnormalities, aneurysm of septum primum, and presence/grade of tricuspid regurgitation (TR) were assessed throughout pregnancy. Linear and logistic regression analyses were used to characterize change in quantitative and qualitative FE parameters by gestational age.
Results
40 fetuses between 24 and 38 weeks gestational age (GA) were studied. Each had a FE study completed before and after 34 weeks gestation that were compared. Tricuspid/mitral valve and RA/LA ratios increased with GA (p<0.001). More frequently noted after 34 weeks GA were tapering of the DA (2.5% vs. 32%), prominent AoI diastolic flow (5% vs. 67%), prominent DA diastolic flow (2.5% vs. 25%), trivial/mild TR (35% vs. 80%), and aneurysm of septum primum (37% vs 80%). These findings all increased linearly with GA (p<0.001).
Conclusion
AV valve and RA/LA disproportion, mild DA tapering, prominent AoI and DA diastolic flow, trivial/mild TR, and aneurysm of septum primum are frequently identified after 34 weeks GA. This suggests that these FE findings in isolation are likely normal and are a result of the physiologic alterations that occur late in the third trimester.
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