Prenatal Diagnosis of Isolated Redundant Foramen Ovale: A Case Report

Devadasan, Shyama; Batra, Manav; Balakrishnan, Bijoy; Sreeja, P. S.; Swapneel, N. Patil; Gopinathan, K. K.

doi:10.1007/s40556-018-0169-z

Cited by 4 publications

(8 citation statements)

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“…In normal fetal hearts, a RFOF has been reported to occur in roughly one third of the cases with a restrictive FO 7 . Restrictive FO has been investigated widely in the presence of CHD, because of the association with poor fetal and neonatal outcome 1–4 , while its occurrence in normal fetal hearts and in association with RFOF has been reported less often 5–10 . The fact that ventricular disproportion might occur in cases with RFOF but without evidence of a restrictive FO was not evident from these studies 5–9 and has been described only rarely 10 .…”

Section: Introductionmentioning

confidence: 85%

“…Restrictive FO has been investigated widely in the presence of CHD, because of the association with poor fetal and neonatal outcome [1][2][3][4] , while its occurrence in normal fetal hearts and in association with RFOF has been reported less often [5][6][7][8][9][10] . The fact that ventricular disproportion might occur in cases with RFOF but without evidence of a restrictive FO was not evident from these studies [5][6][7][8][9] and has been described only rarely 10 . This possibly causal relationship is of importance, because ventricular disproportion is one of the indirect sonographic signs possibly associated with coarctation of the aorta (CoA) [11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

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Redundancy of foramen ovale flap may mimic fetal aortic coarctation

Vena

Donarini

Scala

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives To assess the relationship between presence of a redundant foramen ovale flap (RFOF), in the absence of a clearly restrictive foramen ovale, and ventricular disproportion, in three groups of fetuses: (1) those with a final diagnosis of aortic coarctation (CoA); (2) those referred for suspicion of ventricular disproportion and/or CoA which did not develop CoA postnatally; and (3) normal fetuses. Methods This was a retrospective study including 73 fetuses: 12 with a final diagnosis of isolated CoA; 30 referred for suspicion of ventricular disproportion and/or CoA, which did not develop CoA postnatally; and 31 normal fetuses. Four‐dimensional volume datasets and clips were assessed offline. Maximum diameters of the FOF (FOFD), left atrium (LAD), right atrium, left and right ventricles and, when available, aortic isthmus, were measured, as were areas of the FOF (FOFA), left atrium (LAA) and right atrium. The left/right ratios for all segments of the heart, as well as the FOFD/LAD ratio and FOFA/LAA ratio, were calculated. Regression analysis was performed to assess the relationship between RFOF and ventricular disproportion and means were compared by ANOVA. Results Repeatability was fair, with all variables having an intraclass correlation coefficient ≥ 83%. In the pooled group of fetuses with no CoA found at birth (normal fetuses plus those with ventricular disproportion (n = 61)), there was a significant linear correlation between redundancy of the FOF and degree of ventricular disproportion (P < 0.01 and P < 0.05 for diameter and area ratios, respectively). Categorizing the FOF redundancy, FOFD/LAD ratio ≥ 0.65 was significantly associated with ventricular disproportion (P = 0.006). Based on the degree of FOF prominence, we described four categories of redundancy, ranging from no redundancy/ventricular disproportion (Stage 0) to severe redundancy/ventricular disproportion with transient obstruction of the foramen ovale or mitral orifice (Stage III). Comparing cases without neonatal evidence of coarctation but FOFD/LAD ratio ≥ 0.65 vs those with neonatal evidence of coarctation, there was no statistically significant difference in the degree of ventricular disproportion or in the Z‐score of the aortic isthmus maximum diameter. Conclusions This study demonstrates that: (1) there is an association between RFOF and ventricular disproportion, independent of the association with a restrictive foramen ovale, and (2) the presence of a RFOF may mimic CoA. In fact, it causes both ventricular disproportion and a significant reduction in the diameter of the aortic isthmus, associated in some cases also with reversed isthmic flow. Future prospective studies are needed to evaluate whether focusing the sonologist's attention on the appearance of the foramen ovale may reduce the rate of false‐positive diagnosis of CoA. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Introductionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Redundancy of foramen ovale flap may mimic fetal aortic coarctation

Vena

Donarini

Scala

et al. 2020

Ultrasound in Obstet & Gyne

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“…An isolated RFOF is rare and easily overlooked in prenatal ultrasound examinations. The incidence of isolated RFOF detected by ultrasonography is only 0.6-1.7% [9,10]. To date, only two cases of prenatal diagnosis have been reported, including one case by Hagen et al [9] and one by Devadasan et al [10].…”

Section: Discussionmentioning

confidence: 99%

“…Approximately one-third of isolated RFO have a redundant foramen ovale ap (RFOF) [7]. Fetuses with isolated RFOF have better outcomes than those with isolated RFO, but few studies have explored the ultrasonographic features of RFOF [8][9][10]. In addition, some studies have shown that the ultrasonographic features of RFOF are similar to those of aortic coarctation (CoA), which often leads to a false positive diagnosis [8].…”

Section: Introductionmentioning

confidence: 99%

Ultrasonographic Features and Clinical Significance of Fetal Isolated Redundant Foramen Ovale Flap

Lyu

Zhang

et al. 2022

Preprint

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Background Little is known about the ultrasonographic features of fetal isolated redundant foramen ovale flap (RFOF). Additionally, false positive diagnosis of aortic coarctation (CoA) may be related to the presence of an RFOF. This study aimed to explore the ultrasonographic features of RFOF and its differential diagnosis with CoA. Methods This was a retrospective cohort study that included 54 fetuses: 15 with isolated RFOF, 9 with CoA, and 30 normal fetuses of matched gestational age. The correlations of foramen ovale flap diameter (FOFD)/left atrial diameter (LAD) with right atrial diameter (RAD)/LAD, right ventricular diameter (RVD)/left ventricular diameter (LVD), and pulmonary artery diameter (PAD)/aortic diameter (AoD) were analyzed, and a quadratic regression model was established. Differences in FOFD/LAD, RAD/LAD, RVD/LVD, PAD/AoD, and aortic isthmus diameter were compared among the three groups. Results (1) Noticeable RAD/LAD, RVD/LVD, and PAD/AoD increases, aortic arch dysplasia, and aortic isthmus narrowing were found in the RFOF group (all p < 0.05); ductus arteriosus aneurysm and premature atrial beats were also observed. (2) As the RFOF severity increased, the atrial and ventricular asymmetry and disproportion between the pulmonary artery and aorta became more pronounced (r = 0.825, 0.862, 0.846, all p < 0.001). (3) Other than the FOFD/LAD, no significant differences in the RAD/LAD, RVD/LVD, PAD/AoD, or aortic isthmus diameter were found between fetuses with an RFOF and fetuses with CoA (p > 0.05). Conclusions Isolated RFOF has specific ultrasound features, and the degree of disproportion between the left and right heart is consistent with the severity of RFOF. Measurement and calculation of FOFD/LAD may help distinguish between RFOF and CoA.

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“…CoA has been classically defined as a narrowing of the aorta in the region of the ligamentum arteriosum (11), representing a spectrum of aortic narrowing from a discrete constriction of the AOi to tubular hypoplasia, with many variations between these two extremes (12) The exact pathogenesis of RFOF remains unclear, but it may be related to a localized developmental abnormality (13) or intrauterine myocarditis (14). RFOF is associated with several congenital malformations, including fetal hydrops and atrial arrhythmias (15).…”

Section: Discussionmentioning

confidence: 99%