Study on the correlation between retrograde ductus arteriosus flow and right ventricular function evaluated by Z-score of tricuspid annular plane systolic excursion in fetuses with Ebstein anomaly

Background: Ebstein anomaly (EA) is a rare congenital heart defect associated with significant perinatal morbidity and mortality, including intrauterine fetal death. Right ventricular (RV) dysfunction plays a key role in the hemodynamic compromise observed in these fetuses. This study aimed to analyze the influence of RV dysfunction evaluated by Free-angle M-mode (FAM) TAPSE Z-score on retrograde ductus arteriosus flow (RDAF) in fetuses with Ebstein anomaly (EA).

Methods: A retrospective cohort study of 30 EA and 60 normal fetuses were enrolled. The EA group was divided into two groups: with RDAF (EA-RDAF group) and without RDAF (EA-NRDAF group). FAM was used to measure TAPSE of EA and normal fetuses, and Z-scores were calculated. The differences of FAM-TAPSE Z score, gestational week (GW), maternal age (MA), and mitral valve-tricuspid valve distance (MTD) between three groups were compared. The correlation and binary logistic regression between FAM-TAPSE Z-score, GW, MA, MTD, and RDAF were analyzed.

Results: FAM-TAPSE Z-score was significantly lower in EA-RDAF group compared to other groups (p < 0.05). FAM-TAPSE Z-score, GW, and MA were negatively correlated with RDAF (p < 0.05), but no correlation was found between TR, MDT, and RDAF (p > 0.05). Multivariate logistic regression showed that FAM-TAPSE Z-score was an independent influencing factor for RDAF (OR = 0.102, p < 0.05).

Conclusions: RV dysfunction is an independent factor leading to RDAF in EA fetus, which provides a feasible theoretical basis for further study on improvement of RV function through intrauterine treatment to delay and prevent the RDAF, to avoid death cycle and improve live-birth rate.

Dr. Xianfeng Guo is an ultrasound medicine specialist specializing in fetal congenital heart disease diagnosis and cardiac function assessment. He holds an MD and is Associate Chief Physician and Master’s Supervisor. Dr. Guo has led multiple research projects and published extensively. He is currently Director of the Ultrasound Department at Shanghai Seventh People’s Hospital, a visiting scholar at London’s Royal Free Hospital, and recognized as a Young Top Innovative Talent, Outstanding Youth, and Academic Leader in Shanghai’s Pudong District. He also serves on the Fetal Cardiology Committee of the Chinese Maternal and Child Health Association.