Prenatal Diagnosis of Isolated Foramen ovale Obstruction

Hagen, August; Albig, Matthias; Schmitz, L.; Hopp, H. Esteban; Baalen, Andreas van; Becker, Rolf; Entezami, Michael

doi:10.1159/000081373

Cited by 35 publications

(6 citation statements)

References 12 publications

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“…One might speculate that an isolated occlusion of the FO without additional restrictive lesions would affect mostly the development of left heart structures as a result of poor LA and LV filling, whereas additional restriction on either the RV outflow or the ductal level might favor a phenotype of RV dilation, tricuspid regurgitation and hydrops fetalis [20][21][22] . Nowlen et al proposes that early (primary) closure of the FO, due to abnormal development of the atrial septum, results in LV hypoplasia 9 and that late FO closure is more of a secondary event to aortic stenosis and LV dilation.…”

Section: Discussionmentioning

confidence: 99%

Induction of left ventricular hypoplasia by occluding the foramen ovale in the fetal lamb

Wong

Veldman

Sasi

et al. 2020

Sci Rep

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Disturbed fetal haemodynamics often affects cardiac development and leads to congenital cardiac defects. Reduced left ventricular (LV) preload in the fetus may result in hypoplastic LV, mitral and aortic valve, mimicking a moderate form of hypoplastic left heart complex. We aimed to induce LV hypoplasia by occluding the foramen ovale (FO) to reduce LV preload in the fetal sheep heart, using percutaneous trans-hepatic catheterisation. Under maternal anaesthesia and ultrasound guidance, hepatic venous puncture was performed in six fetal lambs (0.7-0.75 gestation). A coronary guidewire was advanced into the fetal inferior vena cava, right and left atrium. A self-expandable stent was positioned across the FO. An Amplatzer Duct Occluder was anchored within the stent for FO occlusion. Euthanasia and postmortem examination was performed after 3 weeks. Nine fetuses were used as age-matched controls. Morphometric measurements and cardiac histopathology were performed. Compared with controls, fetal hearts with occluded FO had smaller LV chamber, smaller mitral and aortic valves, lower LV-to-RV ratio in ventricular weight and wall volume, and lower number of LV cardiomyocyte nuclei. We conclude that fetal fo occlusion leads to a phenotype simulating LV hypoplasia. this large animal model may be useful for understanding and devising therapies for LV hypoplasia.

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Section: Discussionmentioning

confidence: 99%

Induction of left ventricular hypoplasia by occluding the foramen ovale in the fetal lamb

Wong

Veldman

Sasi

et al. 2020

Sci Rep

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“…However, the DP decreases at 35–40 gestational weeks, which may be related to the gradual closure of the FO in the late stage of pregnancy. A number of scholars have noted that fetal hemodynamics may be altered when the FO size is smaller than normal (8–16). In the current study, we observed the FO of DGWs in detail, by dividing the 958 cases into different groups, which provided referred evidence for certain fetuses accompanied with congenital heart growth restriction or early closure of the FO.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of an ROC curve of the size of the antepartum foramen ovale in the prediction of puerperal atrial septal defect

Liu

et al. 2013

Experimental and Therapeutic Medicine

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The aim of this study was to determine the diagnostic value of an ROC curve of the antepartum foramen ovale (AFO) size and the ratio of FO size to aorta (AO) size (FO/AO) for the prediction of puerperal atrial septal defect in different gestational weeks (DGWs). A total of 958 cases were divided into five groups according to number of gestational weeks. Comparisons of FO size, AO size and FO/AO were determined by variance analysis. The correlations between FO size, AO size and gestational age were determined using regression analysis and comparisons between atrial septal defect (ASD) diagnosed in DGWs and normal cardiac FO size and FO/AO were analyzed by t-test. ROC curve analysis was used for FO size and FO/AO to predict the demarcation point of puerperal ASD (pASD). The differences between FO size and AO size in the five groups at DGWs were statistically significant (P=0.000). The sizes of FO and AO increased with gestational age. The differences among pASD, normal cardiac FO size and FO/AO were statistically significant (P=0.000). FO size in the five DGW groups (18–22, 23–26, 27–30, 31–34 and 35–40 weeks) was able to predict the demarcation points of pASD, which were 5.02, 5.15, 6.55, 8.55 and 7.90 mm, respectively. The prediction of pASD with AFO size and FO/AO was accurate and may provide reliable reference values in the clinic.

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“…The flap of FO is usually redundant or fixed bulging in the left atrium, also called atrial septal aneurysm (ASA). Several cases of restrictive FO or ASA have been prenatally diagnosed [ 2 , 3 , 4 , 5 , 6 ]. It is frequently described as an uncommon finding, although in one large study a prevalence of 7.6% was reported [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

The Accelerated Right Ventricular Failure in Fetal Anemia in the Presence of Restrictive Foramen Ovale

et al. 2022

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Objective: To describe serious hemodynamic changes secondary to anemia in the case of restrictive foramen ovale (FO). Case: A 43-year-old pregnant woman, G4P0030, underwent fetal echocardiography at 35 weeks of gestation and was found to have (1) restrictive FO; (2) poor right ventricular function; (3) unbalanced hemodynamics; (4) fetal anemia (high MCA-PSV and hepatosplenomegaly). Acid-elution test indicated feto-maternal hemorrhage. Cesarean section was performed for postnatal blood transfusion. Nevertheless, the newborn developed heart failure and died after partial blood exchanges. Conclusions: Insights gained from this study are as follows: (1) Restrictive FO in structurally normal hearts can modify fetal response to anemia differently, by unequally distributing blood volume, leading to much more deteriorating right ventricular function. (2) To make decisions for intrauterine or extrauterine treatment in cases of anemia-associated heart failure, several factors must be taken into account such as gestational age, fetal cardiac function, and placental function. Because of the hyperdynamic state of newborns immediately after birth, delivery can deteriorate the compromised heart to irreversible failure. Intrauterine transfusion for a well-prepared heart just before delivery may be the best option since the baby should be well oxygenated at the time of delivery.

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Prenatal Diagnosis of Isolated Foramen ovale Obstruction

Cited by 35 publications

References 12 publications

Induction of left ventricular hypoplasia by occluding the foramen ovale in the fetal lamb

Induction of left ventricular hypoplasia by occluding the foramen ovale in the fetal lamb

Diagnostic value of an ROC curve of the size of the antepartum foramen ovale in the prediction of puerperal atrial septal defect

The Accelerated Right Ventricular Failure in Fetal Anemia in the Presence of Restrictive Foramen Ovale

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