Premature narrowing or closure of the foramen ovale

Lev, Maurice; Arcilla, René A.; Rimoldi, Horacio J. A.; Licata, Richard H.; Gasul, Benjamin M.

doi:10.1016/0002-8703(63)90126-1

Cited by 83 publications

(22 citation statements)

References 12 publications

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“…In agreement with published evidence, the foramen ovale was considered restrictive if it measured less than 2 mm and/or if turbulent flow or no flow was noted across it [14,16,20] .…”

Section: Postnatal Echocardiographysupporting

confidence: 61%

Prenatal Echocardiographic Assessment of Foramen Ovale Appearance in Fetuses with <smlcap>D</smlcap>-Transposition of the Great Arteries and Impact on Neonatal Outcome

et al. 2016

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Introduction: Neonates with D-transposition of the great arteries (dTGA) may die at birth because of the inadequate intracardiac mixing due to a misdiagnosed restrictive foramen ovale. We reviewed our experience in echocardiographic assessment and perinatal management of fetuses with dTGA searching for new features that may predict the need for urgent balloon atrial septostomy (BAS) immediately after birth. Patients and Methods: We included fetuses diagnosed with dTGA between January 2000 and December 2014. We assessed pre- and postnatal appearance of the foramen ovale, ductus arteriosus and pulmonary veins. Both the diagnostic findings at the time of last prenatal echocardiogram and those findings deriving from a retrospective reevaluation of stored videos were considered. BAS was defined as urgent if performed in neonates with restrictive foramen ovale and severe hypoxemia. Results: We reviewed 40 fetuses with dTGA. 20/40 fetuses received urgent BAS at birth. Not only the restrictive but also the hypermobile and the redundant appearance of the foramen ovale was significantly associated with urgent BAS (p < 0.0001, p = 0.002 and p = 0.0001, respectively). Conclusions: Prenatal evaluation of the foramen ovale appearance in fetuses with dTGA is still challenging. Based on our experience, also the redundant foramen ovale appearance may need urgent BAS at birth.

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“…In agreement with published evidence, the foramen ovale was considered restrictive if it measured less than 2 mm and/or if turbulent flow or no flow was noted across it [14,16,20] .…”

Section: Postnatal Echocardiographysupporting

confidence: 61%

Prenatal Echocardiographic Assessment of Foramen Ovale Appearance in Fetuses with <smlcap>D</smlcap>-Transposition of the Great Arteries and Impact on Neonatal Outcome

et al. 2016

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“…Conversely, none of our group of fetuses had significant stenosis of the oval fossa. We found this point interesting, as it has been theorized that premature closure of the oval fossa could be the cause of the hypoplastic left heart syndrome [10,15]. It was theorized that premature oval fossa closure [20] reported 30 fetuses with aortic stenosis and dilated dysfunctional ventricles; 11 of them had an intact atrial septum by echocardiographic and Doppler criteria.…”

Section: Discussionmentioning

confidence: 80%

Prenatal Diagnosis of Severe Aortic Stenosis

McCaffrey

Sherman

1997

Pediatr Cardiol

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We sought to identify echocardiographic markers that might be useful for managing fetuses with significant aortic stenosis. The study was a retrospective review of fetal echocardiographic studies and postnatal outcomes of all fetuses diagnosed with significant aortic stenosis who did not have a hypoplastic left ventricle on the initial echocardiogram. Where possible, fetal echocardiographic measurements included the aortic, mitral, pulmonary, and tricuspid valve annulus sizes; left ventricular dimensions and volume; septal and left ventricular wall thicknesses; and echocardiographic Doppler interrogation of the left heart and oval fossa. Observations also included an assessment of ascites, pericardial effusion, and endocardial fibroelastosis. Prenatal measurements were compared to postnatal outcomes. Four patients (group 1) had either clinically successful relief of their aortic obstruction (n = 3) or required no intervention (n = 1). Five fetuses evolved to the hypoplastic left heart syndrome (group 2). These infants demonstrated little or no growth in left ventricular, aortic valve, or mitral valve dimensions on serial examination. They also more often exhibited mitral stenosis, severe restriction of interatrial shunting, and early to mid second trimester left ventricular dilatation. Serial measurements of fetal cardiac size and function are helpful for predicting the postnatal outcome of fetuses with aortic stenosis.

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“…Anatomic closure is complete by 1 year in only 50o/o of human infants. 2 In 1963, Lev 4 reported ten cases in which restriction of the foramen ovate was noted at autopsy. Six of the infants had associated mitral atresia.…”

Section: Discussionmentioning

confidence: 99%