Two-dimensional speckle tracking echocardiography in fetuses with critical aortic stenosis before and after fetal aortic valvuloplasty.

Publisher: Springer Verlag Country of Publication: Germany NLM ID: 8710213 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-0711 (Electronic) Linking ISSN: 09320067 NLM ISO Abbreviation: Arch Gynecol Obstet Subsets: MEDLINE

Publication: Berlin : Springer Verlag
Original Publication: München : Springer International, c1987-

Aortic Valve Stenosis*/diagnostic imaging ; Aortic Valve Stenosis*/physiopathology ; Echocardiography* ; Ultrasonography, Prenatal* ; Balloon Valvuloplasty*; Humans ; Female ; Retrospective Studies ; Pregnancy ; Hypoplastic Left Heart Syndrome/diagnostic imaging ; Hypoplastic Left Heart Syndrome/physiopathology ; Fetal Heart/diagnostic imaging ; Fetal Heart/physiopathology ; Heart Ventricles/diagnostic imaging ; Heart Ventricles/physiopathology ; Infant, Newborn

Background: Critical aortic stenosis (AS) in fetuses may progress to hypoplastic left heart syndrome (HLHS) with need for postnatal single ventricular (SV) palliation. Fetal aortic valvuloplasty (FAV) is performed to achieve postnatal biventricular (BV) circulation. However, the impact of FAV on fetal myocardial function is difficult to measure. Prediction of postnatal circulatory status and, therefore, counseling is challenging.
Methods: Retrospective study of fetuses with critical AS who underwent FAV. Global Longitudinal Peak Systolic Strain (GLPSS) of the left ventricle (LV) and right ventricle (RV) were retrospectively analyzed before and after intervention. Fisher's Exact Test and Mann-Whitney-U Test were used for univariant statistical analysis.
Results: 23 fetuses with critical AS were included. After intervention fetuses demonstrated more negative LV-GLPSS mean values post- vs. pre-intervention (- 5.36% vs. - 1.57%; p < 0.05). RV-GLPSS was decreased in all fetuses, there was no peri-interventional change. 20 fetuses were born alive. Postnatally, 10 had BV and 10 SV circulation. Improved post-interventional LV-GLPSS strain values correlated with BV outcome (p < 0.05). Pre-interventional continuous LV-GLPSS values correlated with postnatal SV vs. BV outcome (p < 0.05).
Conclusion: In some fetuses, LV myocardial function assessed by speckle tracking echocardiography (STE) improves after FAV. Improved post-interventional LV-GLPSS correlates with biventricular postnatal outcome. Furthermore, pre-interventional LV- and RV-GLPSS correlate with postnatal outcome. Further studies are needed to asses, if pre-interventional STE parameters might predict which fetuses will benefit from FAV with postnatal BV circulation.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

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Keywords: Fetal Aorta Valvuloplasty; Fetal Aortic Stenosis; Fetal Echocardiography; Myocardial Function; Speckle Tracking

Date Created: 20240216 Date Completed: 20240718 Latest Revision: 20240930

20241001

10.1007/s00404-024-07376-7

38363396