Postnatal Left Ventricular Diastolic Function After Fetal Aortic Valvuloplasty

Abstract

Fetal aortic balloon valvuloplasty (FAV) has shown promise in altering in utero progression of aortic stenosis to hypoplastic left heart syndrome. In patients who achieve a biventricular circulation after FAV, left ventricular (LV) compliance may be impaired. Echocardio-graphic indexes of diastolic function were compared between patients with biventricular circulation after FAV, congenital aortic stenosis (AS), and age-matched controls. In the neonatal period, patients with FAV had similar LV, aortic, and mitral valve dimensions but more evidence of endocardial fibroelastosis than patients with AS. Patients with FAV underwent more postnatal cardiac interventions than patients with AS (p = 0.007). Mitral annular early diastolic tissue velocity (E′) was lower in patients with FAV and those with AS and controls in the neonatal period and over follow-up (p <0.001). Septal E′ was similar among all 3 groups in the neonatal period. In follow-up patients, with FAV had lower septal E′ than patients with AS or controls (p <0.001). Early mitral inflow velocity/E′ was higher in patients with FAV as neonates and at follow-up (p <0.001). Mitral inflow pulse-wave Doppler-derived indexes of diastolic function were similar between groups. In conclusion, echocardiographic evidence of LV diastolic dysfunction is common in patients with biventricular circulation after FAV and persists in short-term follow-up. LV diastolic dysfunction in this unique population may have important implications on long-term risk of left atrial and subsequent pulmonary hypertension.

Pediatric Pulmonary Hypertension

“…Interestingly, echocardiographic evidence of LV diastolic dysfunction is common in patients with biventricular circulation after fetal aortic valvuloplasty and persists in short-term follow-up. 456 …”

Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications

“…The exception is DV, which is already being used in clinical practice for staging TTTS [94] or monitoring early FGR [32]. Another example is the integration of some cardiac function parameters (mitral inflow and myocardial contractility) into the inclusion criteria for fetal valvuloplasty in critical aortic stenosis [56,57]. Additionally, some cardiac parameters have already shown a strong correlation with outcome and may soon be incorporated into clinical practice.…”

“…Monophasic mitral inflow and qualitative left ventricular dysfunction are included in the selection criteria to predict progression to hypoplastic left heart syndrome and eligibility for prenatal intervention [56]. Additionally, left ventricle diastolic dysfunction including TDI peak velocity assessment has been suggested as a prognostic marker of poor long-term outcome in these cases [57]. …”

Ultrasound assessment of fetal cardiac function

“…– 5 , 7 Although research efforts have recently recognised the potential value of monitoring cardiac function for clinical management, most parameters are still in the research phase. The exception is DV, which is already being used in clinical practice for staging twin‐to‐twin transfusion syndrome 57 or monitoring early‐onset intrauterine growth restriction 9 58 Another example is the integration of some cardiac function parameters (mitral inflow and myocardial contractility) in the inclusion criteria for fetal valvuloplasty in critical aortic stenosis 57 …”

“…The exception is DV, which is already being used in clinical practice for staging twin‐to‐twin transfusion syndrome 57 or monitoring early‐onset intrauterine growth restriction 9 58 Another example is the integration of some cardiac function parameters (mitral inflow and myocardial contractility) in the inclusion criteria for fetal valvuloplasty in critical aortic stenosis 57 59 Additionally, some cardiac parameters have already shown a strong correlation with outcome and may soon be incorporated into clinical practice.…”