Intrauterine pulmonary venous flow and restrictive foramen ovale in fetal hypoplastic left heart syndrome

Vasoreactive Response to Maternal Hyperoxygenation in the Fetus With Hypoplastic Left Heart Syndrome

“…None of the HLHS fetuses with appropriate vasoreactivity on the last scan prior to delivery required an urgent intervention on the inter-atrial septum at birth. In fact, two fetuses deemed to have a restrictive inter-atrial communication by previously published criteria3, 26, 28 were vasoreactive in response to MH in late third-trimester testing. At birth, both babies had good oxygen saturations while breathing room air.…”

Functional total anomalous pulmonary venous connection via levoatriocardinal vein

“…Obstruction of the LACV was observed in three patients, in whom fetal echocardiography showed a reversal of the pulmonary venous flow during atrial contraction. The to‐and‐fro pulmonary venous flow pattern is also observed in fetuses with hypoplastic left heart syndrome with restrictive foramen ovale or intact atrial septum through a similar mechanism . In addition, although a few exceptional cases have been reported, right‐to‐left shunt across the foramen ovale is mandatory for survival in a patient with TAPVC …”

Fetal pulmonary venous blood flow velocities in a normal population and new calculated reference values

“…Doppler spectra of the pulmonary vein are of clinical significance in assessing the severity of hypoplastic left heart syndrome . The authors detected three different pulmonary venous Doppler flow spectra in fetuses with hypoplastic left hearts: type A was defined when continuous antegrade triphasic flow was detected during the whole cardiac cycle or there were indications of retrograde flow during atrial contraction.…”

“…The authors showed that neonatal mortality was higher in fetuses with biphasic flow (type C) and high pulsatility in the pulmonary veins, because of intact or restrictive atrial septum. Furthermore, the pulmonary venous Doppler flow pattern could be used to predict postnatal left atrial hypertension and a need for early cardiac surgical intervention, for example, balloon atrial septostomy …”