Fetal circular shunt in Ebstein's anomaly and non-steroidal anti-inflammatory treatment

A circular shunt is a poor prognostic factor associated with Ebstein's anomaly. Targeting the constriction of the ductus arteriosus (DA) in order to limit or resolve the circular shunt, has been shown to improve fetal outcomes. Prenatal non-steroidal anti-inflammatory drugs (NSAIDs) have been known to constrict the DA. Recently, prenatal NSAIDs have been used for that purpose in the treatment of circular shunt. Limited research shows that it may be an effective treatment leading to improved fetal outcomes. In this article, we did an extensive review of literature to describe this therapy's effectiveness and outcomes. 82% of fetuses were able to achieve ductal constriction with prenatal NSAID therapy. For fetuses who achieved ductal constriction, fetal demise was less likely (6%) when compared to those who were unable to achieve the same (50%). Of all the fetuses with hydrops, 50% had resoluation of hydrops with prenatal NSAID treatment.

Atypical Circular Shunt and Diffuse Emphysema in a Fetus with Double-Outlet Right Ventricle and Absent Pulmonary Valve

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APVS is usually associated with agenesis of the ductus arteriosus.

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APVS is frequently accompanied by dilation of the main and branch pulmonary arteries, often leading to tracheal and bronchial compression with varying degrees of respiratory distress.

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A rare variation of APVS with circular shunt physiology is reported, expanding the clinical spectrum of the disease.

Demonstration of circular shunt in fetal Ebstein anomaly

Ebstein's anomaly was diagnosed in a fetus at 24 weeks of gestation. There was significant cardiomegaly and severe tricuspid regurgitation (TR). There was functional pulmonary atresia with severe pulmonary regurgitation (PR) and this was causing a circular shunt. There was no fetal hydrops.

A novel approach to the management of critically ill neonatal Ebstein's anomaly: Veno-venous extracorporeal membrane oxygenation to promote right ventricular recovery

This is the first report of the use of veno-venous extracorporeal membrane oxygenation in a neonate with severe Ebstein's anomaly. The report suggests the use of veno-venous extracorporeal membrane oxygenation in the immediate neonatal period may be a useful therapy in severe Ebstein's anomaly. By providing adequate oxygenation independent of the patient's native pulmonary blood flow, veno-venous extracorporeal membrane oxygenation allows the pulmonary vascular resistance to decrease and may promote right ventricular recovery.

Circular shunt in a pulmonary artery to right atrial tunnel, an anomaly unreported so far

While aortico-right atrial tunnels with left to right shunt from aorta to right atrium are reported widely, pulmonary artery to right atrial tunnels have not been described so far. Such a tunnel will lead to a circular shunt with a recirculation of blood in the right sided cardiac chambers repeatedly bypassing the pulmonary capillary bed. This newly described pulmonary artery to right atrial tunnel was closed nonsurgically with a duct occluder after angiographic delineation.