Common Findings in Late‐Gestation Fetal Echocardiography

Abstract

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.

Prevalence and clinical significance of fetal tricuspid regurgitation during the third trimester of pregnancy

“…4 Their results are very similar to those obtained by the present study. In addition, Tague et al 13 studied 40 third trimester fetuses with structurally normal hearts and reported the very high prevalence of trivial and mild tricuspid regurgitation of 80%. The high prevalence of TR reported in this study, different from ours, can be explained by their peak systolic velocity, without criteria of ductal constriction.…”

“…[6][7][8][9][10] Others have reported higher prevalence in late pregnancy. 10,13 Limited information is available regarding normal findings of the fetal heart in late pregnancy. Recent data suggest that the prevalence of mild TR would increase with gestational age and would be a result of the physiologic alterations that occur late in the third trimester.…”

“…Recent data suggest that the prevalence of mild TR would increase with gestational age and would be a result of the physiologic alterations that occur late in the third trimester. 13 The present study aimed to determine the prevalence of TR in low-risk pregnancies in the third trimester of pregnancy and to assess the clinical significance of this finding on neonatal outcome.…”

Fetal Echocardiography: 12 Years Experience at Afic /Nihd

“…Prabharker rajah et al 3 , reported various methods of fetal echocardiography for specific Table-III Obstetrical USG 89 5 1 40 9 3 Maternal alular HD 108 10 0 2 0 0 Father CHD 3 1 0 0 0 0 Father Valvular HD 13 0 0 0 0 0 Maternal DM 106 12 0 3 0 1 Maternal HTN 67 1 2 2 0 2 Maternal Medications 31 3 0 0 0 0 Previous offspring 277 18 4 9 2 5 Family history 94 4 2 1 1 3 Total 818 54 10 57 12 14 lesions and we followed the protocols i: e; 4 chamber view, 3 vessels view, LVOT, RVOT view bicaval and Doppler evaluation as well as M mode. Our study utilized ECEE, 3VT, RVOT and LVOT plus bicaval views 9 , as reported by Nithin et al…”

“…Lucaine elvis et al 14 , Lindsey et al 15 , reported 9.9% AND 7.3% yield of fetal echocardiogram as compared to our results of 8.3% yield of detection of complex cardiac lesions. Lauren tague et al 3 , reported in AIUM the incidence of physiologicalvariationsat 34 weeks gestation in 43 pregnancies due to high referral rate and sensitivity of anomaly scan which can also be applied in our population if we conducted regular fetal echocardiograms with better expertise. They reported the prominence of aortic isthmus 'milddisproportion of AV vales 'tapering of PDA 'aneurysms of premium septum etc.…”