Arq Bras Cardiol: Imagem cardiovasc 2021; 34(4): eabc262
Prenatal Diagnosis of Circular Shunt: A Rare Complication of Ebstein’s Anomaly
DOI: 10.47593/2675-312X/20213404eabc262
Circular shunt is a condition in which blood from a cardiac chamber is diverted through the heart to return to the original chamber without reaching the pulmonary capillary bed. A 27-year-old pregnant woman, G1, P0, A0, 25 gestational weeks, was referred for fetal echocardiography due to an increased cardiac area on morphological obstetric ultrasound in the second trimester. She had no comorbidities, and early pregnancy ultrasound findings were normal.
A 25-week fetal echocardiogram showed cardiomegaly, attachment of the tricuspid valve septal leaflet to the interventricular septum, and significant tricuspid insufficiency compatible with Ebstein’s anomaly (). A small pericardial effusion was seen and Huhta cardiovascular score was 6. An adequate pulmonary artery diameter (Z-score 1.9) was noted () with no anterograde flow, only retrograde flow coming from the ductus arteriosus characteristic of a circular shunt. At 29 gestational weeks, fetal hydrops was observed, with zero umbilical artery diastolic flow and a Huhta score of 4 (). Fetal death occurred at 30 gestational weeks.
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