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Left ventricular obstruction with restrictive inter‐atrial communication leads to retardation in fetal lung maturation
Author(s) -
Goltz Diane,
Lunkenheimer JeanMarc,
Abedini Mojtaba,
Herberg Ulrike,
Berg Christoph,
Gembruch Ulrich,
Fischer HansPeter
Publication year - 2015
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.4559
Subject(s) - hras , hypoplastic left heart syndrome , fetus , lung , medicine , cardiology , pregnancy , endocardium , biology , heart disease , colorectal cancer , cancer , kras , genetics
Objective Intact atrial septum or highly restrictive inter‐atrial communication (I/HRAS) combined with either severe aortic stenosis (SAS) or hypoplastic left heart syndrome (HLHS), respectively, is associated with adverse outcome. This study focusses on changes in alveolo‐septal lung parenchyma due to increased left atrial pressure. Method In a retrospective cross‐sectional autoptic study, we investigated fetal/neonatal lung specimens of 18 patients with SAS/HLHS with I/HRAS, 11 patients with SAS/HLHS and unrestrictive inter‐atrial communications and 18 controls. Pulmonary maturation was investigated by means of morphometric and immunohistochemical analyses. Results In a comparison of all three groups, alveolo‐capillary membrane maturation was significantly disturbed in I/HRAS fetuses from week 23 of pregnancy on. I/HRAS lungs showed angiomatoid hyper‐capillarisation and significantly wider inter‐airspace mesenchyme. Differences in width ranged between 34.58 µm (95% CI: 11.41–57.75 µm) and 46.74 µm (95% CI: 13.97–79.50 µm) in the second and third trimesters. In I/HRAS infants with HLHS, inter‐airspace mesenchymal diameters steadily normalised with age; however, significant fibroelastosis of alveolar septae developed. Conclusion Fetal lung maturation with respect to alveolo‐capillary membrane formation is severely disordered in patients with SAS/HLHS with I/HRAS. Our findings indicate that, from a morphological point of view, timing of fetal invention in fetuses with I/HRAS should be fixed within the second trimester of pregnancy. © 2015 John Wiley & Sons, Ltd.