Factors affecting the prognosis of Ebstein's anomaly during fetal life

Павлова, М. С.; Fouron, Jean‐Claude; Drblik, Susan Pamela; Doesburg, Nicolaas H. van; Bigras, Jean‐Luc; Smallhorn, Jeffrey; Harder, James A.; Robertson, Murray

doi:10.1016/s0002-8703(98)70076-6

Cited by 67 publications

(43 citation statements)

References 12 publications

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“…The prenatal diagnosis of Ebstein anomaly appears to be associated with a less favorable prognosis than the diagnosis in the neonatal or pediatric groups. 5,11,[15][16][17] In addition, follow-up for hydrops and arrhythmias would be important if this diagnosis were suspected. 2,5 The displacement of the mitral and tricuspid valves in the fetus is most often evaluated in a subjective manner.…”

Section: Discussionmentioning

confidence: 99%

The Normal Offset of the Tricuspid Septal Leaflet in the Fetus

Vettraino

Huang²,

Comstock

2002

J of Ultrasound Medicine

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Objective. To quantify the normal distance between the insertion of the medial leaflets of the mitral valve and tricuspid valve in the fetal heart. This mitral valve-tricuspid valve distance was compared with the distance from known cases of Ebstein anomaly. Methods. An apical 4-chamber view was obtained at end diastole in fetuses between 18 and 41 weeks' gestation. Calipers were placed parallel to the ventricular septum, with 1 caliper on the medial insertion of the mitral valve and a second caliper on the medial insertion of the tricuspid valve. The distance recorded was plotted against gestational age. Statistical analysis was performed by descriptive and linear regression techniques. Results. One hundred forty-five fetuses were studied. The mean ± SD mitral valve-tricuspid valve distance in the second trimester was 2.8 ± 0.9 mm with a range of 1.2 to 5.0 mm; in the third trimester it was 4.6 ± 1.1 mm with a range of 2.2 to 6.9 mm. Regression analysis showed that with each 1-week increase in gestational age, there was an increase of 0.15 mm in separation between the medial leaflets of the mitral valve and tricuspid valve (β = 0.15 ± 0.011). Conclusions. A positive correlation between mitral valve-tricuspid valve distance and advancing gestational age was found. The reference range described allows for the identification of a fetal heart with normal variation in the mitral valve-tricuspid valve distance. Further downward displacement of the medial tricuspid cusp suggests the possibility of Ebstein anomaly. Key words: Ebstein anomaly; fetal echocardiography; tricuspid valve. he prenatal evaluation of fetal anatomic structures includes a 4-chamber view of the fetal heart. In the normal fetal heart, the tricuspid valve and mitral valve are offset; the tricuspid valve has an apical displacement in relation to the mitral valve. The relationship of the atrioventricular (AV) valves in the fetal heart is evaluated in a subjective manner. Occasionally, there can be difficulty in determining whether the observed displacement is within a normal range. In Ebstein anomaly, the medial leaflet and sometimes the posterior leaflet of the tricuspid valve are located closer to the apex of the heart than normal. [1][2][3][4] Although this cardiac anomaly is rare, it can lead to heart failure in the antenatal period and can be difficult to repair. [5][6][7][8] Prenatal suggestion of this anomaly can facilitate a more detailed evaluation in the prenatal and neonatal periods and can allow for the education of parents to the potential implications of Ebstein anomaly.

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Section: Discussionmentioning

confidence: 99%

The Normal Offset of the Tricuspid Septal Leaflet in the Fetus

Vettraino

Huang²,

Comstock

2002

J of Ultrasound Medicine

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“…For instance, tracking of ventricular stroke volumes and outputs relative to gestational age or fetal biometric indices using normative data facilitates the evaluation of conditions associated with high cardiac output states, including twin pregnancies complicated by twin reversed arterial perfusion or fetal anemia, both before and after fetal intervention 11,12 , with serial data assisting in determining the timing and efficacy of intervention. Assessment of fetal cardiac output compared with normal data can provide insight into changes in the fetal circulation in compromised pregnancies, as previously documented for placental insufficiency 13 and Ebstein's anomaly of the tricuspid valve, in which evolution of left heart dysfunction and reduced combined cardiac output ejected from the left ventricle may contribute to the high rate of fetal hydrops and spontaneous intrauterine demise 14 .…”

Section: Quantification and Standardization Of Measurementsmentioning

confidence: 98%

Role of quantitative assessment in fetal echocardiography

Hornberger

2009

Ultrasound in Obstet & Gyne

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“…This can lead to increasing central venous pressures and eventual hydrops. In addition, altered left ventricular filling and consequent reduced output [69] probably impact critically the ability of the fetus to respond to acute physiologic changes resulting in an increased risk of sudden demise, particularly in the early third trimester. Associated supraventricular tachyarrhythmias compromise the fetal heart further by reducing the filling time of the left ventricle.…”

Section: Fetal Heart Failurementioning

confidence: 99%

Fetal Echocardiography

Hornberger

2009

Echocardiography in Pediatric and Congenital Heart Disease

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Factors affecting the prognosis of Ebstein's anomaly during fetal life

Cited by 67 publications

References 12 publications

The Normal Offset of the Tricuspid Septal Leaflet in the Fetus

The Normal Offset of the Tricuspid Septal Leaflet in the Fetus

Role of quantitative assessment in fetal echocardiography

Fetal Echocardiography

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