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

Szwast, Anita; Tian, Zhenjun; McCann, Margaret; Donaghue, Denise; Rychik, Jack

doi:10.1161/circimaging.109.848432

Cited by 109 publications

(123 citation statements)

References 37 publications

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“…A diminished vasoreactive response to maternal hyperoxygenation suggests an abnormal pulmonary vasculature and indicates clinically important restriction at the foramen ovale. 482 Either or both of these assessments are reasonable to obtain for determination if fetal intervention may be beneficial.…”

Section: Hlhs With Restrictive or Intact Atrial Septummentioning

confidence: 99%

“…Management of these fetuses, who are at significant risk of compromise with foramen ovale restriction or closure, can benefit from coordination of care in the delivery room. 175,176,481,547,572,584,585,[588][589][590][591][592][593][594] Fetuses with HLHS identified to have a severely restrictive or intact atrial septum are at increased risk for compromise in the delivery room if fetal pulmonary vein flow shows significant reversed flow suggesting severe left atrial hypertension in the third trimester. 175,176,481,549,572 In 2 studies, 176,481 the ratio of pulmonary vein forward to reversed velocity-time integral was used to determine potential need for intervention.…”

Section: Foramen Ovale-dependent Lesionsmentioning

confidence: 99%

“…Lack of pulmonary vasodilation as measured by the calculated Doppler pulsatility index of the branch pulmonary arteries during the hyperoxia challenge predicted fetuses who needed intervention to open the atrial septum at delivery. 482 Fetuses with d-TGA are dependent on an open foramen ovale for stability at delivery. Fetal echocardiogram features that predict the risk of postnatal closure of the foramen ovale by assessing the anatomy and flow across both the foramen ovale and ductus arteriosus have been reported.…”

Section: Foramen Ovale-dependent Lesionsmentioning

confidence: 99%

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Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

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1,016

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Hlhs With Restrictive or Intact Atrial Septummentioning

confidence: 99%

Section: Foramen Ovale-dependent Lesionsmentioning

confidence: 99%

Section: Foramen Ovale-dependent Lesionsmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

Self Cite

1,016

543

View full text Add to dashboard Cite

show abstract

“…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. Maternal hyperoxia challenge has also been used to further define the affected fetus with potential for pulmonary vasoreactivity suggesting less severe restriction [134]. Finally, when atrial septal restriction evolves late in pregnancy, the outcomes may be better with immediate intervention after delivery [135], and thus whether the risks of fetal intervention are justified in this situation may be questioned.…”

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

confidence: 99%

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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“…Absence of a reduction in the PI with MH was 100% sensitive and 94% specific in predicting the need for an urgent atrial septal procedure, suggesting a role for this technique in the prenatal evaluation of fetuses with HLHS. 3 …”

Section: Vasoreactive Response To Maternal Hyperoxygenation In the Fementioning

confidence: 99%

Circulation: Cardiovascular Imaging Editors' Picks

2012

Circ: Cardiovascular Imaging

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

Cited by 109 publications

References 37 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

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

Circulation: Cardiovascular Imaging Editors' Picks

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