WALL TO WALL HEART FETAL ECHO BY DR HAISSAM AREF , DMS,MSc MD FETAL U/S

In fetal ultrasound, a “wall-to-wall” heart refers to massive cardiomegaly where the heart occupies nearly the entire thoracic cavity, often compressing the lungs. 

Primary Causes

• Ebstein’s Anomaly: The most common cause, characterized by the downward displacement of the tricuspid valve into the right ventricle. This leads to a “giant” right atrium and severe tricuspid regurgitation.
• Tricuspid Valve Dysplasia: A condition where the tricuspid valve is malformed but not necessarily displaced, resulting in similar massive heart enlargement.
• Pulmonary Atresia with Intact Ventricular Septum: Often seen alongside severe tricuspid regurgitation, contributing to the “wall-to-wall” appearance. 

Ultrasound Findings

• Heart Size: The heart typically occupies more than 1/3 of the chest (the normal proportion).
• Atrial Dilation: A voluminous right atrium is a hallmark of this condition.
• Myocardial Thinning: The right ventricular wall may appear significantly thinned due to extreme dilation.