Evaluation of right ventricular function in fetuses with hypoplastic left heart syndrome using tissue Doppler techniques

Axt-Fliedner, R; Graupner, O; Kawecki, A; Degenhardt, J; Herrmann, Jens; Tenzer, A; Doelle, A; Willruth, A.; Steinhard, J.; Gembruch, Ulrich; Bahlmann, Franz; Enzensberger, C

doi:10.1002/uog.14736

Cited by 24 publications

(29 citation statements)

References 47 publications

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“…Therefore, published tissue velocities vary and cannot be used interchangeably. Absolut values of s´ velocities in both groups were comparable, suggesting a preserved systolic function of the right ventricle in fetuses with HLHS, which is in line with our previous results 12,13 . Second, we found highest tissue velocities at the base of the heart at the atrioventricular valve level significantly decreasing towards the apex of the heart within the right ventricle in HLHS and normal fetuses.…”

confidence: 91%

“…The institutional review board approved this study (protocol number 209/11). Inclusion and exclusion criterias for control and HLHS fetuses were as previously described 12 . For the final analysis, a total of 20 HLHS fetuses (of a total cohort of 32 HLHS fetuses during the study period) and 20 gestational age-matched controls were included.…”

Section: Methodsmentioning

confidence: 99%

“…For the final analysis, a total of 20 HLHS fetuses (of a total cohort of 32 HLHS fetuses during the study period) and 20 gestational age-matched controls were included. The cohort was in part analysed previously describing PW-TDI and c-TDI techniques, demographic data were described before 12,13 .…”

Section: Methodsmentioning

confidence: 99%

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Segmental Myocardial Displacement and Tissue Velocity Analysis of the Right Ventricle in Hypoplastic Left Heart Syndrome Fetuses and Controls Using Color Tissue Doppler Imaging (C-TDI)

Graupner

Enzensberger

Wieg

et al. 2017

Prenatal Cardiology

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Introduction: The long-term outcome of patients with HLHS (hypoplastic left heart syndrome) is mainly determined by right ventricular function. Our study examines, whether there are differences in segmental right ventricular myocardial displacement and tissue velocities of fetuses with HLHS compared to healthy fetuses during gestation.Materials and methods: A prospective study was conducted including 20 fetuses with HLHS and 20 gestational age matched controls. c-TDI (colour tissue Doppler imaging) derived systolic and diastolic velocities as well as myocardial displacement were assessed in three different locations of the right ventricle (RV). A ROI (region of interest) was placed in the basal, middle and apical part of the myocardium. Possible changes of c-TDI indices in the course of pregnancy and between the three different segments were investigated in both groups.Results: HLHS fetuses showed significantly lower e' velocities measured in the basal and middle part of the RV compared to healthy controls (p < 0.05). Basal displacement showed significantly lower values in HLHS fetuses compared to controls. In control fetuses but not in HLHS fetuses there was a significant increase of basal diastolic velocities and displacement in the course of pregnancy. According to myocardial velocities and displacement values there was a significant decrease from the base of the fetal heart to the apex pointed in both groups.Conclusions: An altered right ventricular myocardial function in HLHS fetuses within different myocardial segments could be demonstrated. An apicobasal gradient with higher velocity and displacement values in the basal part of RV myocardium could be found in both groups. The technique may be of value in the prenatal assessment of myocardial function, however its role as a monitoring tool and outcome predictor needs to be defined.

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confidence: 91%

Section: Methodsmentioning

confidence: 99%

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Segmental Myocardial Displacement and Tissue Velocity Analysis of the Right Ventricle in Hypoplastic Left Heart Syndrome Fetuses and Controls Using Color Tissue Doppler Imaging (C-TDI)

Graupner

Enzensberger

Wieg

et al. 2017

Prenatal Cardiology

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“…Second, prenatal detection of High‐risk HLHS had the worse neonatal outcome (23.5% hospital mortality), a finding that has been reported previously by our group and others . Third, altered prenatal right ventricular function, which has been recently elaborated, might also have a role in pre‐ and postintervention hospital mortality …”

Section: Discussionsupporting

confidence: 78%

Prenatal diagnosis of functionally univentricular heart, associations and perinatal outcomes

et al. 2016

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“…Surgery is the only effective treatment. Therefore, evaluation of preoperative right ventricular function in fetuses with HLHS could provide valuable information for prenatal counseling and guide timely and effective clinical intervention after birth [4]. …”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Zhou

Zhao

et al. 2015

Cardiovasc Ultrasound

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BackgroundPostnatal outcome of fetuses with hypoplastic left heart syndrome (HLHS) is mainly determined by right ventricular function. In the present study we used spatio-temporal image correlation (STIC) to assess right ventricular function of fetuses with HLHS.MethodsThree-dimensional ultrasound with STIC technique was used to acquire heart images from fetuses that had HLHS and the normal controls, between 24+0 and 37+6 weeks of gestation. Right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV) were determined using the virtual organ computer-aided analysis software, and the parameters of right ventricular function were calculated.ResultsBoth RVEDV and RVESV were found to be significantly higher in fetuses with HLHS as compared to that in normal controls (P < 0.001). There were no significant differences in the parameters between fetuses with and without a visible left ventricular cavity (P > 0.05). Compared to fetuses with HLHS plus mild tricuspid regurgitation (TR), fetuses with HLHS plus severe TR exhibited lower right ventricular stroke volume (RVSV), right ventricular cardiac output (RVCO) and standardized RVCO (P < 0.05). The right ventricular ejection fraction (RVEF) was significantly lower in HLHS fetuses that had severe TR (P < 0.001).ConclusionAs the right ventricle is solely responsible for maintenance of circulation, the right ventricular systolic function undergoes compensatory enhancement in fetuses with HLHS and mild TR, compared to that in normal controls. Size of the left ventricle does not significantly affect the right ventricular function in HLHS. However, right ventricular systolic function may be impaired prenatally in HLHS fetuses that have severe TR.

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Evaluation of right ventricular function in fetuses with hypoplastic left heart syndrome using tissue Doppler techniques

Abstract: Objective The outcome of patients with hypoplastic left heart syndrome (HLHS) is influenced by right ventricular function. This study aimed to investigate whether differences in right ventricular function of fetuses with HLHS are present during gestation. Methods

Cited by 24 publications

References 47 publications

Segmental Myocardial Displacement and Tissue Velocity Analysis of the Right Ventricle in Hypoplastic Left Heart Syndrome Fetuses and Controls Using Color Tissue Doppler Imaging (C-TDI)

Segmental Myocardial Displacement and Tissue Velocity Analysis of the Right Ventricle in Hypoplastic Left Heart Syndrome Fetuses and Controls Using Color Tissue Doppler Imaging (C-TDI)

Prenatal diagnosis of functionally univentricular heart, associations and perinatal outcomes

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

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