Fetal transient tricuspid valve regurgitation: sonographic features and clinical evolution

Clerici, Graziano; Romanelli, M; Tosto, Valentina; Цибизова, В. И.; Renzo, Gian Carlo Di

doi:10.1080/14767058.2019.1667326

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…However, it has been suggested that care needs to be taken when assessing if this is true colour flow generated by atrioventricular valvular regurgitation jets or in fact colour Doppler twinkling artefact (which causes a rapidly changing combination of red and blue complexes behind the EIF which may mimic flow) [46]. Transient and mild valvular regurgitation can also be seen in fetuses with no cardiovascular anomaly and can be transient and without pathological significance [47]. Previous research has confirmed rough surfaces, such as that created by microcalcifications or mineralisation in the papillary muscle (which is what EIF is suggested to be) [48,49] is seen to reflect the ultrasound incidence beam and increase pulse duration of received radiofrequency.…”

Section: Discussionmentioning

confidence: 99%

Echogenic intracardiac foci detection and location in the second-trimester ultrasound and association with fetal outcomes: A systematic literature review

Jones,

Battaglia,

Hurt

et al. 2024

PLoS ONE

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Background Echogenic Intracardiac Foci (EIF) are non-structural markers identified during the routine 18–20-week foetal anomaly ultrasound scan yet their clinical significance on future outcomes for the infant is unclear. Objective To examine the association between EIF and risk of preterm birth, chromosomal abnormalities, and cardiac abnormalities. Design A review across four databases to identify English language journal articles of EIF using a cohort study design. All studies were reviewed for quality using the Critical Appraisal Skills Programme (CASP) checklist and data extracted for comparison and analysis. Results 19 papers from 9 different countries were included. Combining these studies showed 4.6% (95% CI = 4.55–4.65%) of all pregnancies had EIF which was on the left in 86% of cases, on the right in 3% of cases and bilaterally in 10%. There was no evidence that EIF was associated with higher rates of preterm birth. However, it is possible that infants with EIF were more likely to be terminated rather than be born preterm as there was a 2.1% (range 0.3–4.2%) rate of termination or death of the foetus after week 20 among those with EIF. There was no evidence that EIF alone is highly predictive of chromosomal abnormalities. There was evidence that EIF is associated with higher rates of minor cardiac abnormalities (e.g. ventricular septal defect, tricuspid regurgitation or mitral regurgitation)) with 5.1% (224 of 4385) of those with EIF showing cardiac abnormalities (3.08% in retrospective studies and 17.85% in prospective studies). However, the risk of cardiac defects was only higher with right-sided EIF and where the EIF persisted into the third trimester. However, this is a rare event and would be seen in an estimated 4 per 10,000 pregnancies. Conclusion EIF alone was not associated with adverse outcomes for the infant. Only persistent EIF on the right side showed evidence of carrying a higher risk of cardiac abnormality and would warrant further follow-up.

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Section: Discussionmentioning

confidence: 99%

Echogenic intracardiac foci detection and location in the second-trimester ultrasound and association with fetal outcomes: A systematic literature review

Jones,

Battaglia,

Hurt

et al. 2024

PLoS ONE

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“…An injury of the tricuspid leaflets or chordate tendinae may result in TR. According to the first publication of functional TR by Respondek [ 11 ], its prevalence in normal heart anatomy was 6.8% and 6.2% by Gembruch [ 14 ], 4.5% by Clerici [ 15 ], 6.7% by Zhou from China [ 16 ], and 5.2% by Wiechec [ 17 ]. The higher prevalence of TR in this study could be attributed to the current “post-COVID-19 era” (eight pregnant women from Table 2 and Table 4 had vaccinations during their pregnancy and another five had COVID-19 symptoms during pregnancy), but this is just a working hypothesis, and no additional details were taken for analysis.…”

Section: Discussionmentioning

confidence: 99%

Fetal Third-Trimester Functional Cardiovascular Abnormalities and Neonatal Elevated Bilirubin Level

Respondek-Liberska,

Sylwestrzak,

Murlewska

et al. 2023

JCM

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Background: The aim of the study was to analyze the neonatal outcomes of fetuses with diagnosed functional cardiovascular abnormalities, also considering the connection with neonatal hyperbilirubinemia. Materials and Methods: It was an observational study of 100 neonates who had fetal echocardiography examinations in the third trimester (mean gestational age during the last echocardiography was 34 ± 3 weeks and mean birth weight was 3550 g). There were two groups: A: normal heart anatomy + no functional anomalies; group B: normal heart anatomy + functional abnormalities. Hyperbilirubinemia was defined as a bilirubin level of >10 mg%. Results: In group A, there were 72 cases and only 5 cases despite having normal heart anatomy and normal heart study that presented additional problems. In group B (28 cases), the prenatal functional findings included tricuspid regurgitation (TR) (15 cases, 53%), pericardial effusion (4 cases, 14%), myocardial hypertrophy (4 cases, 14%), cardiomegaly (2 cases, 7%), abnormal bidirectional blood flow across the foramen ovale (3 cases, 11%), aneurysm of atrial septum (2 case, 7%), abnormal E/A ratio for mitral and tricuspid valve (1 case, 3%), bright spot (3 case, 11%), abnormal Doppler flow in ductus arteriosus compared to aortic arch (difference >60 cm/s) (1 case, 3%), supraventricular tachycardia (SVT) (1 case), and mitral regurgitation (1 case, 3%). In group A (n = 72 cases), bilirubin levels of >10 mg/dL were observed in 8% of newborns. In group B (n = 28), bilirubin levels of > 10 m/dL were observed in 46% of cases and TR was present in group B in 53% of cases (15/28 cases). The difference between group A and B in terms of elevated bilirubin levels was statistically significant (p < 0.001). Conclusions: In the case of fetal normal heart anatomy and normal heart study, a good neonatal outcome may be expected. When fetal cardiovascular functional abnormalities in normal heart anatomy are detected, with special attention paid to tricuspid valve regurgitation, a neonatal elevated bilirubin level (mean 11 mg/dL, range 10–15 mg/dL) may be expected.

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“…TR is frequently detected and is present in about 7% of healthy fetuses [ 5 ]. However, it is also associated with several cardiac and chromosomal abnormalities [ 6 - 8 ]. In association with the baseline parameters of the first-trimester evaluation (maternal age, nuchal translucency (NT) and maternal serum markers, free beta-hCG and PAPP-A), it detects 96% of the cases of trisomy 21 and almost all of the cases of trisomy 13, 18 and Turner syndrome [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

First Trimester Tricuspid Regurgitation: Clinical Significance

Teixeira

Guedes-Martins

2023

CCR

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Tricuspid regurgitation is a cardiac valvular anomaly that consists of the return of blood to the right atrium during systole due to incomplete valve closure. This structure can be visualized on ultrasound between 11 and 14 weeks of gestation in most cases. Despite being a common finding, even in healthy fetuses, the presence of tricuspid regurgitation may be associated with chromosomal and structural abnormalities. The evaluation of tricuspid flow and the presence of regurgitation on first-trimester ultrasound has shown promising results regarding its role in the early detection of aneuploidies, congenital heart defects, and other adverse perinatal outcomes. This review article aims to demonstrate the importance of tricuspid regurgitation as a secondary marker, and consequently, significant benefits of its early detection when added to the combined first-trimester screening. Its value will be discussed, namely its sensitivity and specificity, alone and together with other current markers in the fetal assessment performed in the first-trimester ultrasound.

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Fetal transient tricuspid valve regurgitation: sonographic features and clinical evolution

Cited by 4 publications

References 10 publications

Echogenic intracardiac foci detection and location in the second-trimester ultrasound and association with fetal outcomes: A systematic literature review

Echogenic intracardiac foci detection and location in the second-trimester ultrasound and association with fetal outcomes: A systematic literature review

Fetal Third-Trimester Functional Cardiovascular Abnormalities and Neonatal Elevated Bilirubin Level

First Trimester Tricuspid Regurgitation: Clinical Significance

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