Fetal‐TAPSE for Surveillance of Cardiac Function in Growth‐Restricted Fetuses With a Portosystemic Shunt

Abstract

Objectives Congenital portosystemic shunt (CPSS) in a growth‐restricted fetus may lead to cardiac overload and ultimately hemodynamic imbalance. The aim of the study was to describe the application of tricuspid annular plane systolic excursion (TAPSE) for surveillance of cardiac function in growth‐restricted fetuses diagnosed with CPSS. Methods The study group consisted of 7 fetuses with growth restriction diagnosed with CPSS between 2018 and 2020. Patients were followed longitudinally every 2 weeks. Sonographic fetal‐TAPSE (f‐TAPSE) was performed every 2 weeks. At each visit, the following parameters were recorded: estimated fetal weight, biophysical profile, nonstress test, Doppler flow indices, and fetal cardiothoracic index. Postnatal laboratory and imaging tests were retrieved from the medical files. Results Mean gestational age at diagnosis of CPSS was 32 + 1 weeks. Cardiomegaly was observed in all cases. All portosystemic shunts were classified as intrahepatic. Values of f‐TAPSE were above the 95th percentile in 6/7 fetuses at presentation and throughout follow‐up. Gestational age at delivery ranged between 36 + 5 and 38 + 5 weeks. Postnatally, spontaneous closure of the shunt was noted in 2 infants. Transient hyperammonemia was diagnosed in 2 neonates, with no signs of the characteristic complication. Conclusions In growth‐restricted fetuses diagnosed concomitantly with CPSS, f‐TAPSE offers a practical sonographic tool for assessment of cardiac function and may serve as an additional clinical marker for follow‐up. The appearance of cardiomegaly in growth‐restricted fetuses should prompt a dedicated sonographic evaluation of the fetal portal system.

Prenatal ultrasonographic features and follow-up outcomes of 19 cases of congenital intrahepatic portosystemic venous shunts diagnosed during the foetal period

“…Abnormal shunts lead to increased cardiac preload and, thus, enlargement of the heart, which suggests that attention should be given to evaluating cardiac function in patients with IHPSS. Some researchers have proposed the potential benefit of f-TAPSE (tricuspid annular plane contraction drift) for the longitudinal monitoring of growth-restricted foetuses diagnosed concomitantly with cardiomegaly and CPSS [ 23 ].…”

The thrifty phenotype hypothesis: The association between ultrasound and Doppler studies in fetal growth restriction and the development of adult disease

“…Indeed, it has been demonstrated that there is an increase in TAPSE in correlation with liver shunting. 95 On the other hand, it may damage the liver parenchyma secondary to hypoxic changes that adversely regulate insulin-like growth factor-binding protein (IGFBP-1), and may result in liver dysfunction after birth. 96 Congenital intrahepatic portosystemic shunts (IPSS) are abnormal vascular communications between branches of the portal veins and the hepatic veins within the liver.…”