Cardiac output and blood flow redistribution in fetuses with D‐loop transposition of the great arteries and intact ventricular septum: insights into pathophysiology

Godfrey, Max E; Friedman, Kevin G.; Drogosz, Monika; Rudolph, Abraham M.; Tworetzky, Wayne

doi:10.1002/uog.17370

Cited by 20 publications

(38 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, we found the diameters of fetal TGA‐PV annuli to be significantly larger than controls from 27 weeks and also larger than the control AoV annuli from 23 weeks onwards. A previous study has also shown PV Z ‐scores smaller than the AoV Z ‐scores (−0.65 vs +1.13), in TGA fetuses with IVS, in concordance with our findings. Furthermore, the fetal TGA‐AoV annuli were not smaller than control PV annuli as may be expected if only flow determines annular growth.…”

Section: Discussionsupporting

confidence: 93%

“…A corresponding leveling in the prenatal PV‐ Z ‐score was seen from 35 weeks onwards. Godfrey et al have also described a significant reduction in the PV annular Z ‐score in fetal TGA between the second and third trimesters . The reason for this is not entirely clear.…”

Section: Discussionmentioning

confidence: 98%

“…The pulmonary and systemic circulations are in parallel not series, and blood with a higher saturation is ejected into the pulmonary circulation instead of the systemic circulation . Historically, low prenatal TGA detection rates have contributed to a relatively limited knowledge of fetal TGA pathophysiology . With the inclusion of additional views in prenatal screening protocols, the prenatal detection rate of TGA is improving .…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Historically, low prenatal TGA detection rates have contributed to a relatively limited knowledge of fetal TGA pathophysiology. 4 With the inclusion of additional views in prenatal screening protocols, the prenatal detection rate of TGA is improving. 5 Fetal cardiologists are required to discuss long-term postoperative outcomes of TGA more frequently.…”

Section: Introductionmentioning

confidence: 99%

“…Z-scores based on data from Vigneswaran et al 21 from 35 weeks onwards. Godfrey et al have also described a significant reduction in the PV annular Z-score in fetal TGA between the second and third trimesters 4. The reason for this is not entirely clear.After 30 weeks, the proportion of the CCO passing through the lungs and oval fossa is stable in normal fetal hearts, but the pulmonary vascular resistance increases 32.…”

mentioning

confidence: 98%

See 4 more Smart Citations

Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo‐aortic root dilatation

et al. 2019

View full text Add to dashboard Cite

ObjectivesDocumentation of semilunar valve growth in fetal transposition of the great arteries (TGA) and the relationship between neo‐aortic root (NAoR) dilatation, a cause for postoperative reinterventions after the arterial switch operation (ASO), and pulmonary valve (PV) annulus dimensions prenatally.MethodsThis retrospective multicenter observational study included TGA fetuses suitable for ASO. Semilunar valve annuli pre‐ASO and NAoR diameters (post‐ASO) were measured. Trends in annulus diameters were analyzed using a linear mixed‐effects model and compared with normal values. Prenatal semilunar valve Z‐scores were correlated with NAoR diameters post‐ASO.ResultsWe included 137 TGA fetuses (35.8% with significant ventricular septal defects [VSDs]). One hundred twenty‐one underwent ASO. Fetal TGA‐PV diameters were significantly larger than control aortic valve (AoV) and PV annuli from 23 and 27 weeks, respectively, especially when a VSD was present. Fetal TGA‐AoV annuli were significantly larger than control AoV and PV annuli from 26 and 30 weeks, respectively. Z‐scores of fetal TGA‐PV and NAoR diameter at last follow‐up correlated significantly (P < .001 at 26‐30 wk).ConclusionFetal TGA semilunar valve annuli are larger than control annuli, especially when there is a significant VSD. Factors besides postoperative hemodynamics, including fetal anatomy, PV Z‐score, prenatal flow, connective tissue properties, and genetics, may influence the risk for late reintervention in these fetuses.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 98%

See 3 more Smart Citations

Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo‐aortic root dilatation

et al. 2019

View full text Add to dashboard Cite

show abstract

Impact of ductus arteriosus constriction and restrictive foramen ovale on global hemodynamics for term fetuses with d‐TGA

Zhang

Haneishi

2019

Numer Methods Biomed Eng

View full text Add to dashboard Cite

The ductus arteriosus (DA) constriction and restrictive foramen ovale (FO) are known as the leading cause of compromise and death of fetuses with dextro‐transposition of the great arteries (d‐TGA). Although the d‐TGA fetal hemodynamics is of great importance in making diagnosis and management of the congenital heart defect, it remains poorly understood, particularly in terms of abnormal DA and FO. In this study, we developed a closed‐loop 0‐1D multiscale model of the fetal cardiovascular system (CVS) specified for the d‐TGA circulation and conducted a systematic study of the impact of the DA constriction and restrictive FO on fetal hemodynamics. We found that the DA constriction led to a pronounced increase in the pulmonary artery pressure, pulmonary and mitral valve (PV and MV) regurgitation as well as left heart volume; the restrictive FO was responsible for reducing MV E/A ratio, ie, the ratio of peak early filling and late diastolic filling velocities, and PV peak systolic flow (PSV) but could increase both aortic valve (AV) PSV and aortic isthmus systolic index (ISI). Moreover, the amount of blood flowing through the DA was observed equivalent to that through the FO; the influence of DA constriction on the cerebral and placental perfusions are larger than that of the FO. Our results demonstrate that the proposed fetal cardiovascular model may be a useful tool for studying the underlying mechanisms associated with d‐TGA fetal circulation and providing insights into its complex physiology and pathology.

show abstract

Alterations in cardiac output in fetuses with congenital heart disease

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Cardiac output and blood flow redistribution in fetuses with D‐loop transposition of the great arteries and intact ventricular septum: insights into pathophysiology

Cited by 20 publications

References 44 publications

Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo‐aortic root dilatation

Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo‐aortic root dilatation

Impact of ductus arteriosus constriction and restrictive foramen ovale on global hemodynamics for term fetuses with d‐TGA

Alterations in cardiac output in fetuses with congenital heart disease

Contact Info

Product

Resources

About