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Vena F, Bartolone M, D'Alberti E, Vasta A, Mazza A, D'Ambrosio V, Mascio DD, Sulce B, Pajno C, Brunelli R, Pizzuti A, Giancotti A. Echocardiographic features and outcome of restrictive foramen ovale in fetuses with and without cardiac malformations: Literature review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:240-248. [PMID: 36468281 DOI: 10.1002/jcu.23304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 06/17/2023]
Abstract
Foramen ovale is a small communication between the left and the right atrium and its restriction is a rare congenital heart anomaly. There is no consensus on diagnosis and management of fetal restrictive foramen ovale (RFO). In our paper we included 11 studies about fetuses affected by isolated RFO, RFO with D-Transposition of the Great Arteries (dTGA) and RFO with hypoplastic left heart syndrome (HLHS). While fetuses affected from HLHS and dTGA with RFO have a poor prognosis, premature RFO in an otherwise structurally normal heart, if found in later gestation, have an overall good outcome.
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Affiliation(s)
- Flaminia Vena
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Martina Bartolone
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Elena D'Alberti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Adele Vasta
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandra Mazza
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Valentina D'Ambrosio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Blerta Sulce
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristina Pajno
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Pizzuti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
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Pulmonary hemorrhage in extremely low birth weight infants: Significance of the size of left to right shunting through a valve incompetent patent foramen ovale. J Perinatol 2022; 42:1233-1237. [PMID: 35851183 DOI: 10.1038/s41372-022-01464-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pulmonary hemorrhage is a rare but severe complication of extremely low birth weight (ELBW) infants. The association of hemodynamically significant patent ductus arteriosus (hsPDA) and the diameter of the foramen ovale (FO) with pulmonary hemorrhage has not been reported. STUDY DESIGN Case control study of ELBW infants with and without pulmonary hemorrhage. Each ELBW infant with an echocardiogram within 48 h of pulmonary hemorrhage was analyzed. RESULT 16 infants with pulmonary hemorrhage were matched with 32 controls by birth weight and gestational age. Echocardiogram showed hsPDA in all infants and those with pulmonary hemorrhage had significantly smaller patent FO [PFO] (1 vs 2.4 mm, p < 0.01) (OR 0.007; 95% CI 0.00007, 0.67 p = 0.03). Incidence of pulmonary hemorrhage was 8.9%. CONCLUSION ELBW infants with hsPDA who experienced pulmonary hemorrhage had a significantly restricted or closed FO. Evaluation of FO should be considered with serial echocardiograms when evaluating for hsPDA.
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Naqvi N, McCarthy KP, Ho SY. Anatomy of the atrial septum and interatrial communications. J Thorac Dis 2018; 10:S2837-S2847. [PMID: 30305943 DOI: 10.21037/jtd.2018.02.18] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Deficiencies in the septum separating the two atrial chambers are among the most common of congenital heart malformations. This article reviews the developmental aspects of the partitioning of the primitive atrium into right and left atrial chambers, the anatomical components of the atrial septum, and deficiencies that produce the various types of interatrial communications. Knowledge of the components of the true atrial septum in the developed heart clarifies the morphology of various types of interatrial communications. The oval fossa defect (also termed secundum ASD) is located within the true septum. The patent foramen ovale (PFO) is a tunnel-like passageway between the free edge of the overlapping ovale fossa valve and its muscular rim. Other defects such as superior and inferior sinus venosus defects, coronary sinus defects, and ostium primum defects lie outside the area of the true septum.
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Affiliation(s)
- Nitha Naqvi
- Paediatric Cardiology, Royal Brompton Hospital, Imperial College London, London, UK
| | - Karen P McCarthy
- Cardiac Morphology, Royal Brompton Hospital, Imperial College London, London, UK
| | - Siew Yen Ho
- Cardiac Morphology, Royal Brompton Hospital, Imperial College London, London, UK
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Gu X, Zhang Y, Han J, Liu X, Ge S, He Y. Isolated premature restriction or closure of foramen ovale in fetuses: Echocardiographic characteristics and outcome. Echocardiography 2018; 35:1189-1195. [PMID: 29756643 DOI: 10.1111/echo.14009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Premature restriction or closure of foramen ovale (FO) in otherwise structurally normal hearts may be associated with right ventricular dilation, tricuspid regurgitation, pericardial effusion, heart failure, even poor perinatal outcomes. Data about these rare conditions are lacking. METHODS We retrospectively reviewed the echocardiographic records of 9704 fetuses seen from 2010 to 2014 in Beijing Anzhen Hospital, a regional and national referral center, to ascertain the presence of restriction or closure of FO. We collected the fetal echocardiography and perinatal outcome data for this group of fetuses with restriction or closure of FO. RESULTS In this large, single-institution cohort (n = 9704), 6707 fetuses seen between 23 and 37 weeks of gestation had normal heart structures; of these, 60 (0.89%) had restrictive FO (rFO) and 5 (0.07%) had closure of FO (cFO). Fetal echocardiographic images showed right atrial dilation in 48 (73.84%), right ventricular dilation in 38 (58.46%), tricuspid regurgitation in 19 (29.23%), and pericardial effusion in 10 (15.38%). Also in this group, 50 (83.3%) with rFO and 4 (80.0%) with cFO had follow-up data. No prenatal deaths occurred in either the rFO or the cFO group, but the neonatal mortality included 1 in the rFO group and 2 in the cFO group. CONCLUSION Premature rFO/cFO are rare in fetuses with otherwise structurally normal hearts. The fetal echocardiographic characteristics include right atrial and ventricular dilated, tricuspid regurgitation, and pericardial effusion. Most fetuses had a good outcome, although there was an association between rFO, especially cFO, with neonatal morality and complications (prematurity, maternal preeclampsia and placental abruption, hydrops fetalis, and necrotizing enterocolitis with perforation).
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Affiliation(s)
- Xiaoyan Gu
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ye Zhang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiancheng Han
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaowei Liu
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuping Ge
- The Heart Center, St. Christopher's Hospital for Children and Drexel University College of Medicine, Philadelphia, PA, USA
| | - Yihua He
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Liu L, He YH, Li ZA, Cui CY, Zhang LZ, Li T, Liao SX, Fan TB, Peng BT, Yao HM, Huang L. Analysis of etiology, chromosome and prognosis for small left heart system development in 69 fetuses. J Matern Fetal Neonatal Med 2015; 29:493-503. [PMID: 25731651 DOI: 10.3109/14767058.2015.1007037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To provide a basis for evaluating the prognosis of small left heart system development in fetuses, we analyzed its related factors. METHODS The fetal echocardiogram was performed in 3859 pregnant women, and then small left heart system development was identified in 69 fetuses. The data of prenatal and postnatal echocardiograms, postnatal cardiac surgical treatment, chromosome and autopsy after induced labor were analyzed in the 69 fetuses. RESULTS Except 1320 cases losing follow-up, 2539 cases had complete data. Among the 2539 cases, small left heart system development was identified in 69 fetuses. Of the 69 fetuses, 12 had hypoplastic left heart syndrome, 20 premature closure of foramen ovale, 13 total anomalous pulmonary venous drainage, 2 common pulmonary vein lumen atresia, 21 aortic coarctation or interruption and 1 right pulmonary hypoplasia. Among the 69 fetuses, chromosome abnormality was found in 7. CONCLUSION There are many etiological factors causing small left heart system development. The prognosis is poor in the fetuses with hypoplastic left heart syndrome, common pulmonary vein lumen atresia, pulmonary hypoplasia, other malformations or/and chromosome abnormality. Fetal echocardiography combined with chromosome examination can provide important bases for making diagnosis and evaluating the prognosis regarding small left heart system development.
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Affiliation(s)
- Lin Liu
- a Department of Cardiovascular Ultrasound , Henan Provincial People's Hospital , Zhengzhou , China
| | - Yi-Hua He
- b Department of Ultrasound , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Zhi-An Li
- b Department of Ultrasound , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Cun-Ying Cui
- a Department of Cardiovascular Ultrasound , Henan Provincial People's Hospital , Zhengzhou , China
| | - Lian-Zhong Zhang
- a Department of Cardiovascular Ultrasound , Henan Provincial People's Hospital , Zhengzhou , China
| | - Tao Li
- c Institute of Medical Genetics, Henan Provincial People's Hospital , Zhengzhou , China
| | - Shi-Xiu Liao
- c Institute of Medical Genetics, Henan Provincial People's Hospital , Zhengzhou , China
| | - Tai-Bing Fan
- d Children's Heart Center, Henan Provincial People's Hospital , Zhengzhou , China , and
| | - Bang-Tian Peng
- d Children's Heart Center, Henan Provincial People's Hospital , Zhengzhou , China , and
| | - Hui-Mei Yao
- e Department of Ultrasound , The Seventh People's Hospital , Zhengzhou , China
| | - Lei Huang
- e Department of Ultrasound , The Seventh People's Hospital , Zhengzhou , China
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Uzun O, Babaoglu K, Ayhan YI, Moselhi M, Rushworth F, Morris S, Beattie B, Wiener J, Lewis MJ. Diagnostic ultrasound features and outcome of restrictive foramen ovale in fetuses with structurally normal hearts. Pediatr Cardiol 2014; 35:943-52. [PMID: 24585219 DOI: 10.1007/s00246-014-0879-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/04/2014] [Indexed: 11/28/2022]
Abstract
Intrauterine foramen ovale (FO) restriction in association with congenital heart disease (CHD) carries a poor prognosis. However, in the absence of CHD, the clinical importance of restrictive FO in the fetus is not well understood. We evaluated the antenatal prevalence, clinical presentation, diagnostic ultrasound features, and outcome of restrictive FO in fetuses without CHD. We reviewed the echocardiographic and clinical records of 23 fetuses diagnosed with a restrictive FO and structurally normal heart between 2001 and 2012. The atrial septum, dimensions of cardiac structures, left and right cardiac output and Doppler interrogation of cardiac flows were examined. The clinical outcomes of all fetuses with restrictive FO were analysed. Restrictive FO was identified in 23 of 1,682 (1.4%) fetuses with no CHD. Enlarged right heart structures (100%), hypermobile or redundant primum atrial septum (91%), increased right-to-left ventricular cardiac output ratio (91%), and posteriorly angulated ductus arteriosus (68%) were the most common echocardiographic findings associated with this rare phenomenon. Additional noncardiac systemic abnormalities were identified in 13 (56%) babies. Seven (30%) neonates developed persistent pulmonary hypertension, and 7 infants died. Antenatal restrictive FO is an underrecognised entity despite being a common cause of right heart dilatation in the fetus. In the absence of CHD, restrictive FO is well tolerated antenatally, but its frequent association with noncardiac abnormalities and pulmonary hypertension in the neonate are noteworthy.
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Affiliation(s)
- Orhan Uzun
- Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, CF14 4XW, Wales, UK,
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Cantinotti M, Assanta N, Murzi B, Iervasi G, Spadoni I. Echocardiographic definition of restrictive patent foramen ovale (PFO). Heart 2013; 100:264-5. [PMID: 24122229 DOI: 10.1136/heartjnl-2013-304992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Li YD, Li ZA, He YH. Premature closure or restriction of the foramen ovale: prenatal diagnosis by directional enhanced flow imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1291-1294. [PMID: 23804352 DOI: 10.7863/ultra.32.7.1291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Premature closure or restriction of the foramen ovale may occur at any time during pregnancy and may be due to various causes. We describe 2 patients with premature closure or restriction of the foramen ovale during the third trimester. In both patients the foramen ovale was detected by directional enhanced flow imaging technology (DeFLOW; Hitachi-Aloka Medical, Ltd, Tokyo, Japan), a novel method of imaging blood flow dynamics. Our findings indicate that D-eFLOW can display blood flow information with higher sensitivity and resolution than conventional methods, helping obstetricians and pregnant women make timely decisions about delivery.
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Affiliation(s)
- Yi-Dan Li
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, 100029 Beijing, China
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