Fetal Progression of Ebstein’s Anomaly
A fetal echocardiogram was performed at 20 weeks gestational age because of maternal diabetes mellitus and a family history of congenital heart disease. This initial echocardiogram showed mild tricuspid regurgitation originating close to the septum and more apical than usual (Figure 1A). A follow-up fetal echocardiogram at 27 weeks gestational age clearly demonstrated displacement of the tricuspid septal leaflet toward the apex, resulting in moderate tricuspid regurgitation (Figure 1B). Tricuspid regurgitation was severe by 35 weeks gestational age (Figure 1C). Between 33 and 35 weeks gestational age, the cardiothoracic area ratio increased from 33% to 55% (Figure 2A and 2B). Intrauterine fetal death occurred 5 days after the last echocardiogram and only days before a planned cesarean section. Death was attributed to placental abruption. No evidence for hydrops was seen at any time prenatally or at postmortem examination.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.