Evaluation of right ventricular function in fetal hypoplastic left heart syndrome using spatio-temporal image correlation (STIC)

Zhang, Jing; Zhou, Qing; Zhao, Yili; Peng, Qinghai; Gong, Zheli; Long, Xiangdang

doi:10.1186/s12947-016-0056-5

Cited by 7 publications

(7 citation statements)

References 27 publications

(25 reference statements)

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“…Although fetal RV function assessment remains challenging, our results show that RV FAC is a reproducible parameter that can be readily obtained from a standard apical/basal 2D 4-chamber view. We propose reference ranges from 18 to 41 weeks of gestation, obtained following a strict methodology and adjusted by GA and EFW that could be useful to evaluate RV systolic function in different clinical conditions such as CHD [6][7][8][9], intrauterine growth restriction [10], or conception by assisted reproductive techniques [11]. Fetal RV FAC may thus be a potentially useful parameter for prenatal assessment of RV function.…”

Section: Discussionmentioning

confidence: 99%

“…In fetal life, RV function is critically important due to the unique fetal circulation and dominant RV. In addition to fetal CHD [6][7][8][9], conditions such as fetal growth restriction [10], the use of assisted reproductive techniques [11], twin-to-twin transfusion in monochorionic twin pregnancies [12][13][14], and right-sided congenital diaphragmatic hernia [15] can induce RV morphometric and functional changes, which can persist into childhood [16] leading to cardiovascular dysfunction in adulthood. Therefore, the prenatal assessment of RV performance may be useful not only for fetal monitoring but also for postnatal follow-up [17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

et al. 2019

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Objectives: Fetal right ventricular (RV) function assessment is challenging due to the RV geometry and limitations of in utero assessment. Postnatally, 2D echocardiographic RV fractional area change (FAC) is used to assess RV global systolic function by calculating the percentage of change in RV area from systole to diastole. Reports on FAC are scarce in prenatal life, and nomograms throughout pregnancy are not available. Our aims were (1) to study prenatal RV FAC feasibility and reproducibility and (2) to construct nomograms for RV FAC and end-diastolic (ED) and end-systolic (ES) RV areas from 18 to 41 weeks of gestation. Methods: Prospective cohort study including 602 low-risk singleton pregnancies undergoing a fetal echocardiography from 18 to 41 weeks of gestation. RV ED and ES areas were measured following standard recommendations for ventricular dimensions and establishing strict landmarks to identify the different phases of the cardiac cycle. RV FAC was calculated as: ([ED area -ES area]/ED area) × 100. RV FAC intra-and inter-observer reproducibility was evaluated in 45 fetuses by calculating the intraclass correlation coefficient (ICC). Parametric regressions were tested to model each parameter against gestational age (GA) and estimated fetal weight (EFW). Results: RV areas and FAC were successfully obtained in ∼99% of fetuses with acceptable reproducibility throughout gestation (RV ED area inter-observer ICC [95% CI] 0.96 [0.93-0.98], RV ES area 0.97 [0.94-0.98], and FAC 0.69 [0.44-0.83]). Nomograms were constructed for RV ED and ES areas and FAC. RV areas showed a quadratic and logarithmic increase with GA and EFW, respectively. In contrast, RV FAC showed a slight quadratic decrease throughout gestation (mean RV FAC ranged from 36% at 18 weeks of gestation [10-90th centiles: 25-47%, respectively] to 29% at 41 weeks [10-90th centiles: 18-40%, Guirado et al. respectively]). The best models for RV areas and FAC were a second-degree polynomial. Conclusions: RV FAC is a feasible and reproducible parameter to assess RV global systolic function in fetal life. We provide reference ranges adjusted by GA and EFW that can be used as normal references for the assessment of RV function in prenatal conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

et al. 2019

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“…Fetal cardiac function can be affected by a variety of conditions and prenatal interventions. Accurate assessment of fetal cardiac function could help to understand the process of fetal heart disease, improve the accuracy of diagnosis, and determine prenatal interventions[2,5,6,16,19,20,22,23,26,30-39]. Two-dimensional ultrasound is still the traditional gold standard for diagnosis of fetal congenital heart diseases[17,20,21] but has a number of limitations in the quantitative evaluation of fetal ventricular volume and cardiac function.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of right ventricular volume and systolic function in normal fetuses using intelligent spatiotemporal image correlation

Sun¹,

Cai²,

Xie³

2019

WJCC

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BACKGROUND Heart defects are the most common congenital malformations in fetuses. Fetal cardiac structure and function abnormalities lead to changes in ventricular volume. As ventricular volume is an important index for evaluating fetal cardiovascular development, an effective and reliable method for measuring fetal ventricular volume and cardiac function is necessary for accurate ultrasonic diagnosis and effective clinical treatment. The new intelligent spatiotemporal image correlation (iSTIC) technology acquires high-resolution volumetric images. In this study, the iSTIC technique was used to measure right ventricular volume and to evaluate right ventricular systolic function to provide a more accurate and convenient evaluation of fetal heart function. AIM To investigate the value of iSTIC in evaluating right ventricular volume and systolic function in normal fetuses. METHODS Between October 2014 and September 2015, a total of 123 pregnant women received prenatal ultrasound examinations in our hospital. iSTIC technology was used to acquire the entire fetal cardiac volume with off-line analysis using QLAB software. Cardiac systolic and diastolic phases were defined by opening of the atrioventricular valve and the subsequent closure of the atrioventricular valve. The volumetric data of the two phases were measured by manual tracking and summation of multiple slices and recording of the right ventricular end-systolic volume and the right ventricular end-diastolic volume. The data were used to calculate the right stroke volume, the right cardiac output, and the right ejection fraction. The correlations of changes between the above-mentioned indices and gestational age were analyzed. The right ventricular volumes of 30 randomly selected cases were measured twice by the same sonographer, and the intra-observer agreement measurements were calculated. RESULTS Among the 123 normal fetuses, the mean right ventricular end-diastolic volume increased from 0.99 ± 0.34 mL at 22 wk gestation to 3.69 ± 0.36 mL at 35 +6 wk gestation. The mean right ventricular end-systolic volume increased from 0.43 ± 0.18 mL at 22 wk gestation to 1.36 ± 0.22 mL at 35 +6 wk gestation. The mean right stroke volume increased from 0.62 ± 0.29 mL at 22 wk gestation to 2.33 ± 0.18 mL at 35 +6 wk gestation. The mean right cardiac output increased from 92.23 ± 40.67 mL/min at 22 wk gestation to 335.83 ± 32.75 mL/min at 35 +6 wk gestation. Right ventricular end-diastolic volume, right ventricular end-systolic volume, right stroke volume, and right cardiac output all increased with gestational age and the correlations were linear ( P < 0.01). Right ejection fraction had no apparent correlation with gestational age ( P > 0.05). CONCLUSION Fetal right ventricular vol...

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“…In screening for fetal anomalies, ultrasonography is generally used during the 16 th -18 th gestational weeks. [3] Although the critical events of organogenesis are completed in weeks 3-8 of the embryonic period, the growth that occurs in the next several weeks allows improved resolution of fetal anatomy. Echocardiography provides the information required for surgical planning or for recommending no intervention in severely ill infants.…”

Section: Discussionmentioning

confidence: 99%

“…The standard "4-chamber cardiac view" used for screening of congenital heart disease demonstrates either a small left side or an echogenic left ventricle from endocardial fibroelastosis. [3] Prenatal diagnosis of HLHS, however, has not been demonstrated to improve surgical outcomes. Prenatal diagnosis of HLHS affords the opportunity for counselling and perinatal planning.…”

Section: Introductionmentioning

confidence: 99%

Prenatal Imaging of Congenital Fetal Anomalies: A Case Series

Ravikanth¹,

Sarkar²,

Kumar³

et al. 2017

AIMDR

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Hypoplastic left heart syndrome (HLHS) comprises 2 to 3 percent of all congenital heart disease. HLHS is uniformly lethal if left untreated; however, there is currently an estimated 70 percent 5-year survival rate for infants who undergo surgical correction. The hypoplastic left heart syndrome encompasses a spectrum of cardiac malformations that are characterized by significant underdevelopment of the components of the left heart and the aorta, including the left ventricular cavity and mass. Its main anatomical characteristics include mitral stenosis or atresia, aortic stenosis or atresia, and hypoplasia of left ventricle. The apex of the heart is usually formed by the right ventricle. The right ventricle is the single functional ventricle maintaining fetal circulation in these patients.After births, due to decreased pulmonary vascular resistance and closure of the ductus arteriosus, infants with HLHS develop a constellation of symptoms that include cyanosis, dyspnea, heart failure, hypoxemia and acidosis. Surgery is the only effective treatment. Unfortunately, even when treated, this disease is associated with significant morbidity including an increased risk of thrombotic complications, decrease in exercise tolerance, and neuro-developmental impairment. Continuous intravenous prostaglandin E1 is used to maintain a PDA to allow adequate systemic perfusion. Nitrogen may be used in some centers to decrease inspired oxygen which increases pulmonary arterial resistance. This therapy encourages systemic rather than pulmonary blood flow and enhances systemic perfusion. Double outlet right ventricle (DORV) is a type of ventriculoarterial connection in which both the aorta and pulmonary artery arise entirely or predominantly from the right ventricle (RV). The only outlet from the left ventricle (LV) is a ventricular septal defect (VSD). DORV is usually associated with concordant atrioventricular connections with the right atrium draining into the RV and the left atrium draining into the LV. DORV is almost always associated with a VSD and occasionally with an atrial septal defect. Transposition of great arteries is characterized by both the outflows being parallel to each other at the origin. On color Doppler, they show similar color flows, indicating that the direction of flow in both the great vessels is same. Most atrial septal defects involve either the septum primum or septum secundum. Primum atrial septal defect is the simplest form of the atrioventricular septal defect. Secundum atrial septal defect which is the commonest are usually isolated septal defects, but may be related to other cardiac anomalies like mitral, tricuspid, pulmonary or aortic atresia and are occasionally found as part of syndromes like Holt-Oram syndrome.

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Evaluation of right ventricular function in fetal hypoplastic left heart syndrome using spatio-temporal image correlation (STIC)

Cited by 7 publications

References 27 publications

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

Evaluation of right ventricular volume and systolic function in normal fetuses using intelligent spatiotemporal image correlation

Prenatal Imaging of Congenital Fetal Anomalies: A Case Series

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