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

Fetal Aorta Valvuloplasty Fetal Aortic Stenosis Fetal Echocardiography Myocardial Function Speckle Tracking

Journal

Archives of gynecology and obstetrics
ISSN: 1432-0711
Titre abrégé: Arch Gynecol Obstet
Pays: Germany
ID NLM: 8710213

Informations de publication

Date de publication:
16 Feb 2024
Historique:
received: 05 12 2023
accepted: 02 01 2024
medline: 16 2 2024
pubmed: 16 2 2024
entrez: 16 2 2024
Statut: aheadofprint

Résumé

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. 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. 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). 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.

Sections du résumé

BACKGROUND 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 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 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 CONCLUSIONS
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.

Identifiants

DOI: 10.1007/s00404-024-07376-7 PMID: 38363396
pubmed: 38363396
doi: 10.1007/s00404-024-07376-7
pii: 10.1007/s00404-024-07376-7
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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Auteurs

Justus G Reitz (JG)

Department of Cardiovascular Surgery, University Hospital Giessen, Justus-Liebig University, Giessen, Germany.

Johanna M Meier (JM)

Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital Giessen, Justus-Liebig University, Giessen, Germany.

Christoph Berg (C)

Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany.

Eva C Weber (EC)

Department of Obstetrics and Gynecology, University Hospital Cologne, Cologne, Germany.

Ulrich Gembruch (U)

Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany.

Aline Wolter (A)

Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital Giessen, Justus-Liebig University, Giessen, Germany.

Vanessa Sterzbecher (V)

Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital Giessen, Justus-Liebig University, Giessen, Germany.

Ivonne Bedei (I)

Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital Giessen, Justus-Liebig University, Giessen, Germany.

Roland Axt-Fliedner (R)

Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital Giessen, Justus-Liebig University, Giessen, Germany. roland.axt-fliedner@gyn.med.uni-giessen.de.
ORCID: 0000-0001-7842-846X

Classifications MeSH