Prenatal diagnosis of congenitally calcified tricuspid valve with postnatal follow-up and outcomes

Figures

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  Figure 1. Fetal echocardiography images at 31 weeks of gestation. (a and b) Apical 4-chamber view showing a 10 mm × 8.5 mm hyperechoic mass (solid arrow) lesion involving the tricuspid valve, completely occluding the tricuspid inflow. (c and d) Severe hypoplasia of the right ventricle with no antegrade flow across the tricuspid valve. The right atrium was decompressed by flow through the foramen ovale (arrow). (e and f) Three-vessel view demonstrating the pulmonary artery and its branches; (g) Color Doppler showing reverse flow in the pulmonary artery, suggesting possible duct-dependent pulmonary circulation. LV: Left ventricle, PA: Pulmonary artery, Ao: Aorta, RV: Right ventricle

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  Figure 2. Postnatal echocardiography on day 1 of life. (a) Apical 4-chamber view and (b) modified subcostal view, profiling the hyperechoic tricuspid valve (solid arrows); (c) Parasternal short axis demonstrating the patent ductus arteriosus supplying the branch pulmonary arteries. RA: Right atrium, LA: Left atrium, LV: Left ventricle, PDA: Patent ductus arteriosus, RV: Right ventricle

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  Figure 3. Postoperative echocardiography following tricuspid valve exploration. (a and b) Apical 4-chamber view profiling the mild inflow across the tricuspid valve along with tricuspid regurgitation; (c) Continuous-wave Doppler across the tricuspid valve showing a low flow gradient. RA: Right atrium, LA: Left atrium, LV: Left ventricle, RV: Right ventricle

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  Figure 4. (a-c) Histopathological images (hematoxylin and eosin stain) of tricuspid valve specimen showing multiple dystrophic calcification (solid arrows), fibrosis (asterick), and myxoid changes within valvar tissue (arrow head)

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  Graphical Representation 1. The prenatal and postnatal echocardiographic findings of a congenitally calcified tricuspid valve–fetal echo reveals hyperechogenic tricuspid obstruction with right ventricular hypoplasia; postnatal imaging demonstrates dense valve calcification confirmed on histopathology, leading to single-ventricle palliation