Abstract
BackgroundFetal right atrium (RA) dilation is frequently detected in routine screenings while it remains a challenge to clarify the reasons. This study aimed to analyze the cardiac anatomy and hemodynamics of fetal RA dilation and the changes of hemodynamic indexes.MethodsIn the retrospective study, 420 fetuses with RA dilation were included, which were classified into the physiological group (n = 202), volume overload group (n = 142), and the pressure overload group (n = 76). The ratio of right atrium to left atrium (RA/LA) were measured at four-chamber view. Peak velocity of tricuspid regurgitation (VTR) was recorded in each case, if existed.ResultsThe RA/LA ratio in the volume overload group is significantly higher than both the pressure overload group and the physiological group (both P = 0.000) throughout the pregnancy while no difference presents between the pressure overload group and the physiological group (P = 0.694 for 19–31 GW, and P = 0.974 for 32–36 GW, respectively). The VTR in the pressure overload group (3.29 ± 0.58 m/s) is significantly higher than both the volume overload group (1.85 ± 0.45 m/s, P = 0.000) and the physiological group (0.88 ± 0.45 m/s, P = 0.000). The volume overload group shows a significantly higher VTR than the physiological group (P = 0.000). In the volume overload group, the ductal contraction/closure shows a significantly higher VTR than that in the pulmonary valve stenosis/atresia (3.98 ± 0.41 m/s vs. 3.03 ± 0.38 m/s, P = 0.000).ConclusionsA strategy proposed herein is useful to clarify the reasons for RA dilatation by systematically assessing fetal hemodynamics, which may facilitate the sonographers to make an accurate diagnosis of congenital heart disease.
Highlights
Fetal right atrium (RA) dilation is frequently detected in routine screenings while it remains a challenge to clarify the reasons
Right atrium (RA) dilation is frequently detected in routine screenings while it is difficult for sonographers to clarify the reasons of the enlarged chamber, either a normal physiological sign or a secondary event caused by intra-cardiac or extra-cardiac anomalies
We aimed to propose a strategy to clarify the reasons for RA dilatation by systematically evaluating fetal hemodynamics alterations in different conditions
Summary
Fetal right atrium (RA) dilation is frequently detected in routine screenings while it remains a challenge to clarify the reasons. Right atrium (RA) dilation is frequently detected in routine screenings while it is difficult for sonographers to clarify the reasons of the enlarged chamber, either a normal physiological sign or a secondary event caused by intra-cardiac or extra-cardiac anomalies. In the case of fetal pulmonary valve atresia with a well-developed pulmonary artery, the abnormal valve is not evident enough to be observed at first glance while an enlarged RA together with tricuspid regurgitation (TR) could often be identified during routine obstetric examinations. Many scans just stop here with the cardiac lesions resulting in RA dilation not detected, especially in late pregnancy when RA dilatation is always considered as a normal physiological sign
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