Clinical InvestigationCardiac Structure and Function in Fetuses, Neonates, and InfantsRight Ventricular Mechanics in the Fetus with Hypoplastic Left Heart Syndrome
Section snippets
Methods
This cross-sectional retrospective review used the echocardiographic imaging database of the Fetal Heart Program of the Cardiac Center at the Children's Hospital of Philadelphia. Fetal echocardiograms from pregnant women referred for fetal echocardiography between January 2006 and December 2008 were reviewed. Echocardiograms demonstrating diagnoses of HLHS with severe mitral stenosis or atresia and/or severe aortic stenosis or atresia, double-outlet right ventricle, and unbalanced
Results
One hundred two consecutive fetuses with HLHS and HLHS variants presenting for fetal echocardiography between January 2006 and December 2008 were reviewed. Seven of these fetuses had more than mild atrioventricular valve regurgitation, six had restriction across the atrial septum, three had complete heart block, one had hydrops fetalis, and one did not have adequate imaging. All of these fetuses were excluded from analysis. Eighty-four fetuses fulfilled our inclusion criteria, and the first
Discussion
This study demonstrates that in patients with HLHS, RV mechanics differ from normal as early as fetal life, even in the presence of qualitatively normal systolic shortening. First, fetuses with HLHS have enhanced RV noncompliance, reflected by altered tricuspid valve blood pool Doppler velocities. In fetal life, tricuspid valve inflow Doppler patterns normally demonstrate a prominent A wave and a relatively low E/A ratio, reflecting a degree of ventricular impaired ventricular filling.13, 14 In
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Cited by (29)
Speckle-Tracking Echocardiography for the Assessment of Atrial Function during Fetal Life
2020, Journal of the American Society of EchocardiographyCitation Excerpt :Also, Brooks et al.28 showed that the right ventricle has an increased reliance on atrial contraction for ventricular filling in fetuses with hypoplastic left heart syndrome. Other studies of right heart function in this population29,30 would be enhanced by evaluation of right atrial strain. Measurement of atrial function could also improve the comprehensive evaluation of the fetal heart in elusive conditions such as aortic coarctation31 and be helpful in further clarifying fetal diastolic dysfunction that has been demonstrated in diseases such as maternal diabetes mellitus.32
Serial cardiovascular magnetic resonance feature tracking indicates early worsening of cardiac function in Fontan patients
2020, International Journal of CardiologyCitation Excerpt :The septum is often fibrotic and less contractile and abnormalities of septal movement impact global systemic ventricular function [39]. The hypoplastic ventricle in hypoplastic left heart syndrome has been shown to negatively affect diastolic performance of the systemic ventricle [40–42], while hypoplastic ventricle morphology and especially hypertrophy of the interventricular septum are associated with worse outcome [43,44]. The hypoplastic ventricle is often dyskinetic and by only measuring strain in the dominant ventricle, the negative effect of the hypoplastic ventricle on ventricular performance is ignored.
Right Ventricular Systolic-to-Diastolic Time Index: Hypoplastic Left Heart Fetuses Differ Significantly from Normal Fetuses
2016, Journal of the American Society of EchocardiographyCitation Excerpt :Our work contributes to that of multiple investigators who have shown the presence of abnormal cardiac mechanics and time intervals in fetuses with HLHS.4,5,7 Natarajan et al.5 found that fetuses with morphologic LVs and endocardial fibroelastosis had lower E/A ratios, higher E/e′ ratios, and higher Tei indices measured by tissue Doppler than controls. Similarly, Szwast et al.7 showed that fetuses with HLHS had preserved systolic performance and mainly diastolic dysfunction.
Prenatal diagnosis of hypoplastic left heart syndrome: Can we optimize outcomes?
2013, Journal of the American Society of EchocardiographyHypoplastic Left Heart Syndrome: A Review
2023, Cardiology in ReviewEvaluation of right ventricular myocardial deformation properties in fetal hypoplastic left heart by two-dimensional speckle tracking echocardiography
2023, Archives of Gynecology and Obstetrics