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Fetal Physiologic tricuspid insufficiency, Dextroposition, and Pulmonar...
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Fetal Physiologic tricuspid insufficiency, Dextroposition, and Pulmonary Artery Hypoplasia

We live in Virginia but we take our son to CHOP after birth due to his multiple problems that we couldn't get answers to here until we went to CHOP. He has a cardiologist there and also has Moebius Syndrome. But I do have a question and I thought instead waiting until we see the doctor again I would ask on here.

Our son's heart looks great on Cardiac MRI. Our son has dextroposition, left pulmonary artery hypoplasia, left pumonary hypoplasia, and a systemic collateral blood supply to the lower left lobe.

As a fetus, they did not see the dextroposition here in Virginia. He had enlarded kidneys (hydronephrosis) and they couldn't see the cardiac outflow tracts on ultrasound. So I was referred to a high risk OB who saw pericardial effusion and hydronephrosis. They referred him to a pediatric cardiologist here in Virginia. By the time of this ultrasound by the cardiologist there wasn't any pericardial effusion. They still didn't see the dextroposition and told me that there was a little bit of backwards flow that they normally do not see in a fetus but is normal in a newborn so they felt it was normal and told me everything was okay.

But today, I just found the fetal cardiac ultrasound report and it says "by color flow mapping there is physiologic Tricuspid insufficiency. This is considered to be a normal finding." I am very curious as to how this relates to dextroposition and left pulmonary artery hypoplasia. I look up the physiologic Tricuspid insuffienciency and was wondering if this was the extra blood flow that was flowing back into the heart as it met the hypoplastic left pulmonary artery? Would this still have been considered a normal finding if they knew he had dextroposition and left pulmonary artery hypoplasia?
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773655_tn?1340656399
The tricuspid valve is the valve on the right side of the heart that lets the blood into the right sided ventricle (pumping chamber).  When you do echocardiograms on children, we very commonly see a small amount of leakage that is termed "physiologic".  Now that fetal echocardiograms are getting more sensitive, we occassionally note this mild leakage in the fetal tricuspid valve as well.  When we see that, we usually have to make sure that the RV is pumping well and that the patent ductus arteriosus (PDA) is widely patent.  So the description of "physiologic tricuspid regurgitation" in a fetus would not be unusual.  It would not be related to the dextroposition of the heart.  Hope this helps.
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Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
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