Prenatal Diagnosis of Fetal Heart Failure

Abstract

Fetal heart failure (FHF) is a condition of inability of the fetal heart to deliver adequate blood flow for tissue perfusion in various organs, especially the brain, heart, liver and kidneys. FHF is associated with inadequate cardiac output, which is commonly encountered as the final outcome of several disorders and may lead to intrauterine fetal death or severe morbidity. Fetal echocardiography plays an important role in diagnosis of FHF as well as of the underlying causes. The main findings supporting the diagnosis of FHF include various signs of cardiac dysfunction, such as cardiomegaly, poor contractility, low cardiac output, increased central venous pressures, hydropic signs, and the findings of specific underlying disorders. This review will present a summary of the pathophysiology of fetal cardiac failure and practical points in fetal echocardiography for diagnosis of FHF, focusing on essential diagnostic techniques used in daily practice for evaluation of fetal cardiac function, such as myocardial performance index, arterial and systemic venous Doppler waveforms, shortening fraction, and cardiovascular profile score (CVPs), a combination of five echocardiographic markers indicative of fetal cardiovascular health. The common causes of FHF are reviewed and updated in detail, including fetal dysrhythmia, fetal anemia (e.g., alpha-thalassemia, parvovirus B19 infection, and twin anemia-polycythemia sequence), non-anemic volume load (e.g., twin-to-twin transfusion, arteriovenous malformations, and sacrococcygeal teratoma, etc.), increased afterload (intrauterine growth restriction and outflow tract obstruction, such as critical aortic stenosis), intrinsic myocardial disease (cardiomyopathies), congenital heart defects (Ebstein anomaly, hypoplastic heart, pulmonary stenosis with intact interventricular septum, etc.) and external cardiac compression. Understanding the pathophysiology and clinical courses of various etiologies of FHF can help physicians make prenatal diagnoses and serve as a guide for counseling, surveillance and management.

Monochorionic triplet pregnancy complicated by conjoined twins and early twin–twin transfusion syndrome

“…Fusion is a catastrophic event for the embryos and produces other secondary malformations, such as omphalocele, cleft lip and palate (Spencer, 2000a). In our case, there were several early hemodynamic alterations in twin A: asymmetrical heart cavities, tricuspid valve regurgitation, reverse A-wave in ductus venosus, absent end-diastolic flow in the umbilical artery, umbilical vein with triphasic pulsatile flow, skin edema, increased NT, and the appearance of polyhydramnios, which support the diagnosis of heart failure (Huhta & Paul, 2010;Srisupundit et al, 2023). This heart failure may be due to some unrecognized congenital heart disease, but it is rare that it causes such early failure.…”

New Findings in the Multidisciplinary Management of a Fetal Intrapericardial Teratoma: A Case Report

“…Hemodynamic decompensation severity is graded on a score of 10 points, wherein a score of 10 denotes no heart failure [28]. Points are assigned for each echocardiographic characteristic; points are deducted for abnormal findings (Table 1 1 point is deducted for absent end-diastolic flow, 2 points are deducted for reversed end-diastolic flow [29]. Such cases should be managed with regular followup assessment by a multidisciplinary team working in a maternal-fetal unit.…”

Maternal Oxygen Inhalation Affects the Fetal Hemodynamic in Low-Risk with Uncomplicated Late Pregnancy

“…For the shortening fraction (SF) calculated with M-mode, the end of diastole (EDD) and end systole (ESD) of both ventricles was measured, respectively. The SF can be calculated separately for each ventricle using the following formula: EDD -ESD/EDD [12,13,23,24] The pulsed doppler mode was used in E/A ratio and modi ed myocardial performance index (Mod-MPI) assessment. The rapid lling phase of diastole with E wave velocities(E) and atrial contraction during ventricular lling with A wave velocities(A) were measured under the 4-chamber view, respectively.…”