Early hemodynamic changes after fetal aortic stenosis valvuloplasty predict biventricular circulation at birth

Prosnitz, Aaron R.; Drogosz, Monika; Marshall, Audrey C.; Wilkins‐Haug, Louise; Benson, Carol B.; Sleeper, Lynn A.; Tworetzky, Wayne; Friedman, Kevin G.

doi:10.1002/pd.5232

Cited by 30 publications

(30 citation statements)

References 23 publications

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“…A study by Selamet Tierney et al in 2007 described the 5/6 area‐length method technique to compute ventricular volumes but did not provide a reference data set for healthy fetuses throughout gestation. This method was used by the same group in a recent publication for assessing ventricular volume but did not provide or reference normal data for comparison with our study . The pulsed Doppler assessment of right and LV CO was first reported by Rizzo and Arduini in 1991, followed by articles by Mielke and Benda in 2001 and Kiserud et al in 2006.…”

Section: Discussionmentioning

confidence: 92%

“…Other techniques that have been described to compute the EDV and ESV are the 5/6 area‐length method and pulsed Doppler measurements of the velocity time integral and aortic and pulmonary annular diameters . A study by Selamet Tierney et al in 2007 described the 5/6 area‐length method technique to compute ventricular volumes but did not provide a reference data set for healthy fetuses throughout gestation.…”

Section: Discussionmentioning

confidence: 99%

“…Although adult cardiologists have improved the measurements of the EDV and ESV with bi-plane and 3-dimensional US, the VOCAL technique used in prior fetal studies did not differ substantially from our single-plane data except for the EDV reported by Uittenbogaard et al 16,[24][25][26] Other techniques that have been described to compute the EDV and ESV are the 5/6 area-length method and pulsed Doppler measurements of the velocity time integral and aortic and pulmonary annular diameters. [27][28][29][30][31] A study by Selamet Tierney et al 27 in 2007 described the 5/6 area-length method technique to compute ventricular volumes but did not provide a reference data set for healthy fetuses throughout gestation. This method was used by the same group in a recent publication for assessing ventricular volume but did not provide or reference normal data for comparison with our study.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Fetal Left Ventricular Size and Function Using Speckle‐Tracking and the Simpson Rule

DeVore

Klas²,

Satou

et al. 2018

J of Ultrasound Medicine

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Objectives This study was conducted to evaluate left ventricular (LV) size and function in healthy fetuses and to test a cohort of fetuses at risk for abnormal function using speckle‐tracking software. Methods Two hundred control fetuses were examined between 20 and 40 weeks’ gestation. With the use of offline speckle‐tracking software, the end‐diastolic and end‐systolic volumes were measured and the following computed: stroke volume (SV), SV per kilogram, cardiac output (CO), CO per kilogram, and ejection fraction. These were regressed against 7 independent variables related to the size, weight, and age of the fetuses. Five fetuses with risk factors for LV dysfunction were examined to sample the validity of the data from the control group. Results The R2 values for measurements of the end‐diastolic volume, SV, and CO correlated with the 7 independent variables of fetal size and age (0.7–0.78), whereas the SV/kg, CO/kg, and ejection fraction had lower R2 values (0.02–0.1). The measurements were normally distributed (Shapiro‐Wilke > 0.5). The 5 fetuses at risk for abnormal LV function had measurements of LV size and function that were consistent with the expected pathologic condition. Conclusions Speckle tracking can provide a comprehensive evaluation of the size and function of the fetal LV.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of Fetal Left Ventricular Size and Function Using Speckle‐Tracking and the Simpson Rule

DeVore

Klas²,

Satou

et al. 2018

J of Ultrasound Medicine

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“…The reasons for only including isolated CHD were that altered neurodevelopment could otherwise be attributed to genetic or syndromic defects. Furthermore, cases with aortic valve stenosis that underwent fetal balloon valvuloplasty were excluded, since fetal brain oxygenation may have changed due to the intervention during pregnancy . Also, strictly minor cases (persistent left caval vein, mild pulmonary stenosis and restrictive foramen ovale) were also excluded, since in these cases, blood flow towards the brain is expected to be uncompromised.…”

Section: Methodsmentioning

confidence: 99%

Cortical development in fetuses with congenital heart defects using an automated brain‐age prediction algorithm

Everwijn

Namburete

Geloven

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Congenital heart defects are associated with neurodevelopmental delay. It is hypothesized that fetuses affected by congenital heart defect have altered cerebral oxygen perfusion and are therefore prone to delay in cortical maturation. The aim of this study was to determine the difference in fetal brain age between consecutive congenital heart defect cases and controls in the second and third trimester using ultrasound. Material and methods Since 2014, we have included 90 isolated severe congenital heart defect cases in the Heart And Neurodevelopment (HAND)‐study. Every 4 weeks, detailed neurosonography was performed in these fetuses, including the recording of a 3D volume of the fetal brain, from 20 weeks onwards. In all, 75 healthy fetuses underwent the same protocol to serve as a control group. The volumes were analyzed by automated age prediction software which determines gestational age by the assessment of cortical maturation. Results In total, 477 volumes were analyzed using the age prediction software (199 volumes of 90 congenital heart defect cases; 278 volumes of 75 controls). Of these, 16 (3.2%) volume recordings were excluded because of imaging quality. The age distribution was 19‐33 weeks. Mixed model analysis showed that the age predicted by brain maturation was 3 days delayed compared with the control group (P = .002). Conclusions This study shows that fetuses with isolated cases of congenital heart defects show some delay in cortical maturation as compared with healthy control cases. The clinical relevance of this small difference is debatable. This finding was consistent throughout pregnancy and did not progress during the third trimester.

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“…In the more recent experience since 2009 (n = 71), probability of technical success (94%), fetal demise (4%), and biventricular circulation (66%) have all improved . Interestingly, recent analyses of our cohort have shown that specific echocardiographic changes, most powerfully anterograde aortic arch flow, within the first 24 hours following the procedure, can predict which cases will result in biventricular circulation in the newborn . Identifying immediate changes such as these are important in terms of counseling families about delivery planning and likely outcomes after birth …”

Section: Outcomes and Secondary Considerationsmentioning

confidence: 99%

Fetal cardiac intervention—Perspectives from a single center

2020

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Fetal cardiac intervention was first proposed in the early 1990s to impact cardiac development and survival of fetuses with fetal aortic stenosis and evolving hypoplastic left heart syndrome (HLHS). Although initial attempts of fetal aortic valvuloplasty were unsuccessful and carried a high rate of morbidity and mortality, our collaborative group at the Brigham and Women's Hospital and Boston Children's Hospital have reinvigorated the procedure using improvements in imaging, anesthesia, balloon catheters, and surgical techniques. Two decades of experience have now allowed us to document the safety of in utero intervention and to achieve a better understanding of the impact of midgestation intervention on developing HLHS. Research into underlying genetics, predictive biomarkers, and ways to incorporate stem cell technology will hopefully allow us to further refine the procedure to most benefit children with this historically lethal disease.

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Early hemodynamic changes after fetal aortic stenosis valvuloplasty predict biventricular circulation at birth

Abstract: Technically successful FAV is associated with immediate improvements in left heart physiology that are predictive of BiV circulation at neonatal discharge.

Cited by 30 publications

References 23 publications

Evaluation of Fetal Left Ventricular Size and Function Using Speckle‐Tracking and the Simpson Rule

Evaluation of Fetal Left Ventricular Size and Function Using Speckle‐Tracking and the Simpson Rule

Cortical development in fetuses with congenital heart defects using an automated brain‐age prediction algorithm

Fetal cardiac intervention—Perspectives from a single center

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