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

To determine whether a fetal right ventricular (RV) free-wall pericardial effusion (PE) is associated with alterations of ventricular geometry and function.

Retrospective review of 1373 second- and third-trimester fetuses between 20 and 39 weeks of gestation was done to identify fetuses with a PE. Diastolic function was assessed via pulsed Doppler of RV and left ventricular (LV) inflow tracts, with monophasic filling in the presence of contralateral biphasic inflow classified as abnormal. End-diastolic RV and LV area, width, length, and sphericity were measured as well as systolic function. Z-score equivalent percentiles were computed for the above measurements. Statistical comparisons used published normative controls, with abnormalities defined as z-score equivalent percentiles (<10th or >90th percentile). Segmental movement of the ventricular free wall and septum was classified as hyperkinetic, hypokinetic, akinetic, and paradoxical.

Four-chamber view (4CV), RV, and LV area, length, and mid-chamber width <10^th percentile was more frequent than controls. Diastolic disturbance was selective to the RV: 87% (26/30) showed a monophasic tricuspid A-waveform with preserved mitral inflow. Systolic assessment revealed decreased (<10th percentile) RV and LV fractional area change, mid-chamber fractional shortening, as well as LV cardiac output and ejection fraction to be more frequent than controls as well as global and free-wall strain >90th percentile. Segmental analysis demonstrated high rates of paradoxical septal motion (33% LV, 73% RV) and regional akinesis.

A localized right free-wall PE is associated with altered chamber geometry, selective diastolic impairment, discordant systolic deformation, and frequent paradoxical septal motion.