Isolated Dilation of Right Heart Chambers in Fetal Echocardiography: Correlation with Postnatal Findings in a Quarterly Hospital

Abstract

Background: Despite technological advances in fetal echocardiography, the assessment of the aortic arch is challenging due to the particularities of fetal anatomy and physiology. Both isolated dilatation of right heart chambers, direct visualization and measurements of the aortic arch are related to left obstructive heart disease, such as Coarctation of the Aorta (CoAo). So far, there is still no consensus in the published literature about which echocardiographic finding is of greater value for prenatal diagnosis of these changes. Objectives: To determine possible correlation between right cardiac chambers dilatation and direct aortic arch measurements with the presence of postnatal CoAo. Methods: A retrospective study of fetal and postnatal echocardiograms was carried out at Hospital Israelita Albert Einstein (HIAE) between 2011 and 2017. Morphological and functional parameters of the fetal circulation and the transitional circulation period in the newborn were analyzed. Fetal echocardiogram findings were compared with postnatal echocardiograms (presence or absence of congenital heart disease). Results: Of 2,869 exams performed, 22 fetuses with right chamber dilatation were born at our institution; 20 (90%) had postnatal echocardiogram with normal findings, and only 2 newborns (10%) presented aortic arch obstruction, 1 newborn had critical obstruction and required neonatal intervention. Among all fetal echocardiographic parameters evaluated, only the direct measurement of the aortic isthmus showed correlation with postnatal changes. Conclusion: In our series, isolated dilation of right heart chambers on fetal echocardiography was not associated with CoAo, but the association of right heart chamber dilatation with aortic arch diameter reduction was, however, more studies with larger numbers of patients are still needed.