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

Taketazu, Mio; Barréa, Catherine; Smallhorn, Jeffrey F.; Wilson, Gregory J.; Hornberger, Lisa K.

doi:10.1016/j.jacc.2004.01.033

Cited by 117 publications

(50 citation statements)

References 31 publications

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“…[13][14][15][16] Moreover, it has been demonstrated that in the fetus with left heart obstruction and RAS, there are changes in pulmonary venous flow patterns 13 associated with the need for emergent atrial septoplasty (EAS) in the newborn period. 10 In our experience, however, there is significant variability in the pulmonary venous flow patterns even among fetuses with RAS ultimately requiring EAS in the newborn period ( Figure 1). These observed differences led us to question: at what point along the spectrum of pulmonary venous flow alterations does the need for neonatal atrial septoplasty become most predictable?…”

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confidence: 76%

“…Persistent mortality despite relief of RAS in these patients may be partly a result of muscularization of the pulmonary arteries and arterialization of the pulmonary veins because of chronic in utero pulmonary venous hypertension. 2,9,10 The high morbidity and mortality in this patient population, coupled with evidence that these infants have potentially irreversible histological changes in the small lung vessels, has led some centers to pursue in utero therapies to decompress the left atrium and improve interatrial left-to-right shunting in the fetus with HLHS and RAS. 11 Identification of the fetus with HLHS and RAS may now, therefore, affect perinatal management decisions as well as parental counseling.…”

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confidence: 99%

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Predictive Value of Fetal Pulmonary Venous Flow Patterns in Identifying the Need for Atrial Septoplasty in the Newborn With Hypoplastic Left Ventricle

et al. 2005

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Background-Pulmonary venous Doppler (PVD) flow patterns in the fetus with hypoplastic left heart syndrome (HLHS) have been correlated with restrictive interatrial communication or intact atrial septum (RAS) postnatally; however, the ability of PVD to identify the neonate requiring emergent atrial septoplasty (EAS) for severe left atrial hypertension and hypoxemia has not been critically evaluated. It was the purpose of this study to determine the predictive power of fetal PVD in identifying the need for EAS in newborns with HLHS and RAS. Methods and Results-Forty-one patients with fetal PVD flow analysis and postnatally confirmed HLHS were studied.Pulsed-wave assessment of PVD flow included S-, D-, and A-wave velocity, time-velocity integral (VTI) of forward and reverse flow, and S/D velocity and forward/reverse VTI ratio. Neonatal EAS was used as the primary clinical outcome variable. Receiver operating characteristic curves were used to determine cutpoints at which PVD indices best predicted EAS. Cutpoints were evaluated for clinical accuracy and usefulness by use of Bayesian analysis. Eight of 41 subjects underwent EAS. Need for EAS was most accurately predicted by forward/reverse VTI ratio Ͻ5 (sensitivity, 0.88, 95% CI, 0.49 to 0.99; specificity, 0.97, 95% CI, 0.82 to 0.99), which, when present, increases the posttest likelihood of EAS to 74%, assuming a pretest prevalence of 10%. Accuracy and usefulness of other PVD indices were affected by false-positive results. Conclusions-In the fetus with HLHS, a PVD forward/reverse VTI ratio of Ͻ5 is the strongest predictor of the need for EAS in the newborn period. These observations should improve our ability to identify and expectantly manage the fetus with HLHS and RAS.

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confidence: 76%

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confidence: 99%

Predictive Value of Fetal Pulmonary Venous Flow Patterns in Identifying the Need for Atrial Septoplasty in the Newborn With Hypoplastic Left Ventricle

et al. 2005

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“…We and others have demonstrated that pulmonary venous Dopplers show reduced forward flow in early diastole and increasing reversed flow in atrial systole with increasing left atrial hypertension [132,133]. Altered pulmonary venous Dopplers with only forward flow in ventricular systole and reversed flow in atrial systole is associated with critical cyanosis after delivery necessitating truly emergent atrial septoplasty, whereas the presence of even a small amount of forward flow in early diastole may identify the fetus in whom intervention may not be necessary for several hours to days, if at all.…”

Section: Intervention For Restrictive or Intact Atrial Septum In The mentioning

confidence: 64%

Fetal Echocardiography and Prenatal Cardiovascular Interventions – An Update (2012)

Hornberger

Moon‐Grady²,

Tworetzky³

2012

J Clin Exp Cardiolog

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Fetal echocardiography has evolved considerably over the past 1-2 decades into an exciting field that bridges maternal-fetal medicine with neonatology and pediatric cardiology. With significant advances in imaging technology and experience in prenatal diagnosis, details of the cardiac pathology can now be defined much as it is postnatally; however, unique aspects of the fetal circulation limit our ability to consistently define lesion severity and to predict the evolution of cardiac defects after birth. Serial assessment has provided an understanding of the antenatal natural history of fetal heart disease, which has led to improved counseling and perinatal/neonatal management strategies. More recently, this field has focused on improving our evaluation of fetal arrhythmias, exploring the pathophysiology of fetal heart failure, detecting heart defects at earlier gestational ages, identifying novel interventions to alter the development and progression of severe disease, and investigating strategies to optimize prenatal and neonatal care in an effort to improve perinatal outcome of affected pregnancies. In this paper we will review the current state of the art of fetal/perinatal cardiology and the advances that have occurred in the field largely over the past decade.

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“…For example, damage such as vascular dysplasia and macrovascular dysplasia may occur due to abnormal hemodynamics during the fetal period, resulting in severe pathological changes, including single ventricle defects and severe heart dysfunction, occurring, which may lead to mortality (5)(6)(7)(8)(9). In particular, previous studies have identified severe coarctation of the aorta or aortic atresia, causing dysplasia of the aortic arch or left ventricle (7); pulmonary atresia or tricuspid atresia with an intact ventricular septum, resulting in right ventricular dysplasia; Ebstein's malformation of the tricuspid valve, resulting in functional pulmonary atresia (6); and severe damage to the vascular bed of the fetal lung as forms of secondary damage (5,8,9). These may be avoided by in utero correction of primary defects, which may potentially preserve fetal development (10).…”

Section: Introductionmentioning

confidence: 99%

Assessing the impact of total extracorporeal circulation on hemodynamics in an ovine fetal model

Xiao

Zhuang

Zhou

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The present study aimed to evaluate the impact of total extracorporeal circulation on hemodynamics and placental function in an ovine fetal model. Mid-term ovine fetuses (n=6) underwent extracorporeal circulation (30 min), cardioplegic arrest (20 min) and monitoring (120 min). The ascending aorta and umbilical cords of the fetuses were occluded during the bypass and an extracorporeal membrane oxygenator was used as the oxygen source. Biventricular intracardiac pressures, echocardiographic data, blood gas levels and placental function variables were recorded, and statistical analysis was performed using the repeated-measure analysis of variance test. The data indicated that fetal heart rate and blood pressure at 30, 60, 90 and 120 min following the bypass were stable relative to pre-arrest baseline (pre-bypass) values (P>0.05). However, end diastolic pressures in the ovine right ventricles post-bypass were significantly increased at 30, 60, 90 and 120 min relative to pre-bypass pressures (P<0.05). The pulsatility index also increased at 30 min post-bypass relative to the pre-bypass score (0.91±0.06 vs. 0.61±0.14; P=0.007). The mean resistivity index at all time points post-bypass was consistent with the pre-bypass score (P>0.05), while the mean Tei index values for the left and right ventricles post-bypass were significantly higher at all time points relative to pre-bypass values (P<0.05). The pre-bypass fetal blood pH, SaO 2 , base excess and lactate values were maintained during arrest (P>0.05). Fetal hemodynamics and placental function additionally remained stable for up to 2 h upon reperfusion following total extracorporeal circulation and cardioplegic arrest. Collectively these data suggest that the reproducible ovine fetal model may be useful in the evaluation of fetal cardiac surgery.

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

Abstract: Prenatal PV flow patterns in HLHS identify the fetus at risk of severe LA hypertension at birth.

Cited by 117 publications

References 31 publications

Predictive Value of Fetal Pulmonary Venous Flow Patterns in Identifying the Need for Atrial Septoplasty in the Newborn With Hypoplastic Left Ventricle

Predictive Value of Fetal Pulmonary Venous Flow Patterns in Identifying the Need for Atrial Septoplasty in the Newborn With Hypoplastic Left Ventricle

Fetal Echocardiography and Prenatal Cardiovascular Interventions – An Update (2012)

Assessing the impact of total extracorporeal circulation on hemodynamics in an ovine fetal model

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