PMC3248639_01
Patient 1. a Increased nuchal fold and edema at 12 weeks gestation (white arrows). Bottom panel: Reverse flow in the ductus venosous represents obstruction in the backflow to the right atrium. b Chiari network (white arrows) prolapsing into the right ventricle (RV) through the tricuspid valve. RA right atrium; SVC superior vena cava; AO ascending aorta
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Fig1
At 12 weeks gestation, a fetus presented with increased nuchal translucency thickness, hydrops, and reversed flow in the ductus venosus, as assessed sonographically (Fig. 1a). Fetal echocardiography at 19 weeks gestation showed multiple hyperechogenic structures originating from the inferior vena cava and the posterior wall of the right atrium and prolapsing into the tricuspid valve orifice (Fig. 1b).
PMC3248639_02
Patient 2. a Chiari network (white arrows) prolapsing from the right atrium (RA) via the tricuspid valve (TV) into the right ventricle (RV). SC coronary sinus b Pulsed Doppler signal of the tricuspid valve opening (TVo), the tricuspid valve closure (TVc), and the additional heart tone in early systole (Sx)
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Fig2
Echocardiography showed a thin membranous structure in the right atrium prolapsing through the tricuspid orifice during atrial systole (Fig. 2a; Movie Clip 2) and right-to-left shunting through the patent foramen ovale (PFO). It also clearly showed that the slide of this membranous structure through the tricuspid valve caused the additional heart sound in early systole after the tricuspid valve closure (Fig. 2b; Movie Clip 1).