Right-Sided Fetal Pericardial Effusion Is Associated With Ventricular Dysfunction and Paradoxical Septal Motion

Area of Science:

• Cardiovascular imaging and fetal medicine.
• Pediatric cardiology and congenital heart disease research.

Background:

• Fetal pericardial effusion (PE) can impact cardiac function.
• Understanding the specific effects of right ventricular (RV) free-wall PE is crucial for fetal well-being.

Purpose of the Study:

• To investigate the association between fetal RV free-wall PE and alterations in ventricular geometry and function.
• To characterize the impact of localized PE on fetal cardiac mechanics.

Main Methods:

• Retrospective review of 1373 fetuses (20-39 weeks gestation).
• Assessment of RV and left ventricular (LV) diastolic function using Doppler inflow patterns.
• Measurement of ventricular dimensions, sphericity, and systolic function (fractional area change, shortening).
• Analysis of segmental wall motion and strain, with abnormalities defined by Z-score percentiles.

Main Results:

• Fetuses with RV free-wall PE showed smaller RV and LV dimensions and length compared to controls.
• Diastolic dysfunction was primarily observed in the RV, characterized by monophasic tricuspid inflow.
• Systolic function was impaired, with decreased fractional area change and cardiac output, alongside increased strain.
• Paradoxical septal motion and regional akinesis were frequently noted in both ventricles.

Conclusions:

• Localized right free-wall PE is associated with significant alterations in fetal cardiac geometry.
• The condition leads to selective diastolic impairment of the right ventricle.
• Discordant systolic deformation and frequent paradoxical septal motion are key findings in affected fetuses.