Alterations in cardiac output in fetuses with congenital heart disease

Abstract

Objective Fetuses with severe congenital heart disease (CHD) have altered blood flow patterns. Prior work to assess fetal combined cardiac output (CCO) is limited by sample size and lack of longitudinal gestational data. Our aim was to evaluate CCO in CHD fetuses to determine whether the presence of single ventricle (SV) physiology or aortic obstruction impacts fetal blood flow and cardiovascular hemodynamics. Method Prospective study including singleton fetuses with CHD (n = 141) and controls (n = 118) who underwent a mid‐ and late‐gestation fetal echocardiogram. Ventricular cardiac output was calculated using the standard computation. Combined cardiac output was derived as the sum of the right and left cardiac outputs and indexed to estimated fetal weight. Results Fetuses with two ventricle (2V) CHD had significantly higher CCO compared to controls and SV CHD fetuses. Fetuses with SV‐CHD had similar CCO compared to controls. Fetuses with 2V‐CHD and aortic obstruction had significantly higher CCO than fetuses with SV‐CHD and aortic obstruction. Conclusion Our findings suggest that the SV can compensate and increase CCO despite the lack of a second functioning ventricle, however, the degree of compensation may be insufficient to support the increased blood flow needed to overcome the hemodynamic and physiologic alternations seen with severe CHD.

Advanced imaging of fetal cardiac function

“…A key component of the assessment of ventricular function by CMR is ventricular volumetry, whereby the endocardial and epicardial borders of the ventricles are contoured throughout a stack of cine MR images to measure right and left ventricular myocardial mass, end-systolic, end-diastolic and therefore stroke volumes as well as ejection fractions and CVO ( 31 , 161 ). In late gestation anesthetized fetal sheep, ventricular volumetry can be obtained using a standard balanced steady state free precession (bSSFP) sequence with contiguous short axis cine images acquired using the blood pressure waveform obtained from an arterial catheter for cardiac triggering.…”

Cardiovascular Effects of a Thoracoamniotic Shunt in a Fetus Affected by Isolated Right Congenital Diaphragmatic Hernia and Hydrops

“…reliable and reproducible method to evaluate systolic function [13]. Biventricular CCO, resulting from the sum of each ventricle's cardiac output, has been described as a trustworthy measure of fetal myocardial function, even in cases of cardiac adaptation to extracardiac anomalies [14].…”

Evaluation of fetal cardiac output in preterm premature rupture of membranes

“…A decrease in CO is indicative of decreased ventricular filling or contractility which is responsible for the majority of cases of fetal heart failure, including structural heart defects 19 . Fetal CO studies are available for several clinical conditions, such as intrauterine growth restriction, congenital anomalies and twin‐to‐twin transfusion syndrome 20–22 . Recent studies have focused on the assessment of fetal cardiac function by myocardial performance index (MPI) and pulsed doppler measurements in PPROM.…”

“…19 Fetal CO studies are available for several clinical conditions, such as intrauterine growth restriction, congenital anomalies and twin-to-twin transfusion syndrome. [20][21][22] Recent studies have focused on the assessment of fetal cardiac function by myocardial performance index (MPI) and pulsed doppler measurements in PPROM. Alterations in diastolic cardiac function associated with higher delta E/A ratio in both ventricles and higher left ventricular compliance leading to increased premature filling of both ventricles have been demonstrated compared with normal fetuses.…”