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Case report

The following images and videos show a case of prenatal "restriction" of the foramen ovale and its aneurysm. The patient was scanned at 37+0 weeks of gestation. Interestingly an intermittent reversed flow was seen at the level of foramen ovale having left-to-right direction. As no other signs of premature closure of the foramen ovale were seen, we presumed the phenomenon was caused by narrowing of the foramen ovale. The newborn was delivered one week later and is doing well.

We have discussed the case with Moshe Bronshtein (Haifa, Israel) and he presumed the "reversed" flow at the level of the foramen ovale (blue flow on the image 2) may actually be just projection of an unroofed coronary sinus. Postnatally the anomaly was not found. Another explanation could be the swirling of blood in the space under the foramen ovale flap

Images 1, 2, and 3:  37+0 weeks of gestation. The image 1 shows a transverse scan of the fetal heart at the level of the foramen ovale. Aneurysm of the foramen ovale can be seen - a bright echo (arrow) seen within the foramen ovale is probably just turbulence within the foramen ovale imitating accessory flap. The image 2 shows reversed flow (blue color) within the foramen ovale, probably caused by its narrowing and causing certain degree of restriction of the flow. The image 3 shows M-mode of the foramen ovale flap with its biphasic movement.

Videos 1, 2: 37+0 weeks of gestation. The video 1 shows transverse scan of the fetal heart at the level of the foramen ovale. Aneurysm of the foramen ovale can be seen. Reversed flow (blue color) within the foramen ovale is probably caused by its narrowing and certain degree of restriction of the flow. The video 2 shows transverse scan of the fetal heart at the level of the foramen ovale. Aneurysm of the foramen ovale can be seen - a bright echo (arrow) seen within the foramen ovale is probably just turbulence within the foramen ovale imitating accessory flap.