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[Prenatal restriction of the foramen ovale]
L P Zimmer1, R F Dillenburg, A P Dornelles
1Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre.
Insights
Restriction of fetal foramen ovale blood flow can cause severe heart defects. Early prenatal diagnosis and assessment of interatrial flow are crucial for timely intervention and improved outcomes.
Area of Science:
- Cardiology
- Fetal Medicine
- Pediatric Cardiology
Background:
- Fetal intracardiac circulation relies on unimpeded blood flow through the foramen ovale.
- Restriction of foramen ovale flow is a critical cardiac abnormality with potential postnatal complications.
Observation:
- A fetus presented with foramen ovale restriction leading to severe tricuspid regurgitation and right ventricular hypocontractility.
- The tricuspid valve was morphologically normal, indicating flow restriction as the primary cause.
Findings:
- Prenatal diagnosis identified foramen ovale restriction as the cause of significant fetal cardiac dysfunction.
- Postnatal assessment revealed complete resolution of clinical findings after delivery.
Implications:
- Complete assessment of interatrial flow in high-risk fetuses is essential for early detection.
- Prompt diagnosis and intervention can mitigate severe cardiac sequelae in newborns.
- Understanding foramen ovale dynamics is key to managing fetal cardiac abnormalities.
Abstract:
The parallel arrangement of the fetal intracardiac circulation requires unrestricted flow of blood through the foramen ovale in the atrial septum. Restriction to this flow is a significant cardiac abnormality, with potentially serious sequelae in post-natal life. A wide spectrum of abnormalities has been associated to the restriction of flow through the foramen ovale, including enlargement of right atrium, hypertrophy of right ventricle, enlargement of tricuspid valve annulus, hypoplastic syndrome of left heart, non-immune hydrops fetalis and supraventricular tachycardias. We report the diagnosis and follow-up of a fetus identified in the prenatal period, in whom the restriction of the foramen ovale originated severe tricuspid regurgitation and severe right ventricular hypocontractility, despite the morphologically normal tricuspid valve. After delivery, there was complete resolution of the clinical findings. The paramount importance of complete assessment of interatrial flow in high risk fetuses, allowing for the early detection and intervention, is emphasized.