Neonatal outcome of cases with isolated prenatal ventricular disproportion with a dominant right ventricle

Abstract

Objectives Isolated prenatal ventricular disproportion with a dominant right ventricle represents a challenge in decision‐making for both physicians and pregnant women. In the current study, we sought to delineate the postnatal outcomes of these cases. Methods This retrospective analysis included consecutive cases of isolated ventricular disproportion identified using complete fetal echocardiography at the Fetal Heart Center of Xinhua Hospital from January 2014 to October 2017. Postnatal cardiac outcome was examined using transthoracic echocardiography within the first 6 months after birth. Results A total of 90 fetuses were included in the final analysis. The median gestational age (GA) at diagnosis was 29 weeks (range 24 to 36). At postnatal examination, cardiac malformations were detected in 39 cases (43.3%), including 25 (27.8%) cases of congenital cardiac septal defects, eight (8.9%) of persistent left superior vena cava, four (4.4%) of left‐sided obstructive diseases, and one (1.1%) case of coronary fistula. Nineteen cases (21.1%) with fetal cardiac malformations had significant lower GA at diagnosis (P = .01) and greater right to left ventricle ratio (1.38 vs 1.30, P = .02). Neonatal surgical intervention was not required in any of the cases. Conclusions Isolated prenatal ventricular disproportion with a dominant right ventricle comprises minor postnatal cardiac malformations and doesn't require neonatal intervention.

Differential diagnosis in disproportion in four‐chamber view in fetus in late pregnancy—Challenging dilemma

“…In study presented by Zhao et al. more than 64% cases of ventricular disproportion were with no cardiac malformation and no explanations for the findings, except the physiological changes 1 …”

“…8,21 Isolated prenatal ventricular disproportion with a dominant right ventricle comprises minor postnatal cardiac malformations and does not require neonatal intervention. 1 Which in contemporary prenatal CHD classifications mean that this could be planned or level of care 3 CHD. [26][27][28] Cardiac asymmetry was present in two-thirds of fetuses with cardiac anomalies diagnosed prenatally.…”

“…19 In study presented by Zhao et al more than 64% cases of ventricular disproportion were with no cardiac malformation and no explanations for the findings, except the physiological changes. 1 The diagnostic accuracy at ultrasound scan varies with the gestational age and is significantly higher in the second compared to the third trimester. 1 As previously noted, ultrasound seems to correlate better with the postnatal diagnosis when problems are detected at earlier gestation, 85% fetuses with cardiac disproportion at second trimester anomaly scan had postnatal confirmation of coarctation of the aorta (CoA) versus 28% when disproportion were detected in the third trimester.…”

“…1 The diagnostic accuracy at ultrasound scan varies with the gestational age and is significantly higher in the second compared to the third trimester. 1 As previously noted, ultrasound seems to correlate better with the postnatal diagnosis when problems are detected at earlier gestation, 85% fetuses with cardiac disproportion at second trimester anomaly scan had postnatal confirmation of coarctation of the aorta (CoA) versus 28% when disproportion were detected in the third trimester. 17 It is not easy to distinguish normal ventricular disproportion with a right dominant ventricle from those with structural malformations.…”

“…Fetal ventricular disproportion is a common finding and referral for fetal echocardiography 1 . Disproportion in four‐chamber view (4CH) in fetal heart can have many causes and be a physiologic finding, or a symptom of functional abnormalities or congenital heart disease (CHD) 2–10 .…”