The prevalence and clinical significance of tricuspid valve regurgitation in normally grown fetuses and those with intrauterine growth retardation

Abstract

The aim of this study was to assess the prevalence and clinical significance of fetal tricuspid valve regurgitation. In a cross-sectional study, 289 normally grown singleton fetuses with normal heart anatomy, normal estimated weight for gestational age, normal amniotic fluid volume and normal flow velocity waveforms in the umbilical and middle cerebral arteries and umbilical vein were examined. A further 31 singleton fetuses with intrauterine growth retardation (estimated fetal weight below the 3rd centile) were analyzed. Semiquantification of the tricuspid valve regurgitation by spatial and temporal parameters was performed in the four-chamber view by color Doppler flow imaging and by color Doppler M-mode echocardiography (M-Q mode). The prevalence of fetal tricuspid valve regurgitation among normally grown fetuses was 6.23% (n = 18). In all cases, the tricuspid regurgitation was part-systolic (non-holosystolic, early and mid-systolic tricuspid regurgitation) and showed little spatial expansion of the jet as examined by color Doppler flow imaging (no jet reached the opposite atrial wall, the area of tricuspid regurgitation being less than 25% of the atrial area). The maximum velocity of the regurgitant jets was below 2 m/s with one exception. There was no statistically significant correlation between gestational age and occurrence of tricuspid regurgitation (U test, p > 0.05). Re-examination of 14 of the 18 fetuses with tricuspid regurgitation showed that tricuspid regurgitation was a transient phenomenon in these instances. The fetal outcome in the presence of tricuspid valve regurgitation was normal. Regurgitations of the mitral, pulmonary and aortic valves were excluded in all 289 fetuses. Only two of the 31 fetuses (6.45%) with intrauterine growth retardation showed tricuspid valve regurgitation. In one fetus the tricuspid regurgitation ws only part-systolic. In the other severely compromised fetus with highly abnormal flow velocity waveforms in the arterial and venous side of the fetal circulation, cardiac dilatation with holosystolic tricuspid and holosystolic mitral regurgitation occurred immediately before intrauterine death. Fetal tricuspid valve regurgitation was a frequent finding during Doppler echocardiography. Although it may be a sign of increased preload, afterload or cardiac dysfunction, in most cases tricuspid valve regurgitation is an isolated transient finding with little temporal and spatial expansion, and it may be physiological.

Prenatal diagnosis of Marfan syndrome

“…In contrast, more than 20 years ago, the family history prompted the correct diagnosis in a case with similar markers 9 . Whether the mild tricuspid regurgitation in our case was a coincidence or a causally related finding is therefore difficult to establish as mild tricuspid regurgitation occurs in up to 6% of normal fetuses in the second trimester 11 . However, it can be suggested from the combined experience of these cases that the cardiac abnormalities in fetuses with MS will most probably be detectable by the end of the second trimester.…”

Fetal echo cardiography: the state of the art of the state of the heart

“…Reports emerged on pulmonary arterial and venous flow, on measurements across the fetal shunts such as the ductus arteriosus and foramen ovale, and even on the coronary artery and venous systems 37,[41][42][43][44][45][46][47][48][49][50] . The quantification of tricuspid valve insufficiency was shown to reveal valuable information on etiology and prognosis [51][52][53][54] . The pathological conditions investigated are no longer confined to fetal heart defects but have expanded to include other fetal conditions involving the cardiovascular system.…”

Follow-Up on 107 Fetuses with Normal Us + Echo After 37TH Week of Gestation

“…There were just a few papers focusing on the functional abnormalities in normal heart anatomy, such as: tricuspid valve regurgitation and pulmonary regurgitation. [12][13][14] .…”