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Characterizing cardiac dysfunction in fetuses with left congenital diaphragmatic hernia
Author(s) -
CruzLemini Mónica,
ValenzuelaAlcaraz Brenda,
GranadosMontiel Julio,
Martínez Josep M.,
Crispi Fátima,
Gratacós Eduard,
CruzMartínez Rogelio
Publication year - 2018
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.5253
Subject(s) - isovolumetric contraction , medicine , congenital diaphragmatic hernia , cardiology , fetus , doppler imaging , fetal echocardiography , diastole , gestational age , cardiac function curve , tricuspid valve , pregnancy , prenatal diagnosis , blood pressure , heart failure , biology , genetics
Objective To evaluate cardiac function by conventional echocardiography and tissue Doppler imaging in fetuses with left congenital diaphragmatic hernia (CDH). Methods Conventional echocardiography (myocardial performance index, ventricular filling velocities, and E/A ratios) and tissue Doppler imaging (annular myocardial peak velocities, E/E′ and E′/A′ ratios) in mitral, septal, and tricuspid annulus were evaluated in a cohort of 31 left‐sided CDH fetuses and compared with 75 controls matched for gestational age 2:1. Results In comparison to controls, CDH fetuses had prolonged isovolumetric time periods (isovolumetric contraction time 35 ms vs 28 ms, P < .001), with higher myocardial performance index (0.49 vs 0.42, P < .001) and tricuspid E/A ratios (0.77 vs 0.72, P = .033). Longitudinal function assessed by tissue Doppler showed signs of impaired relaxation (mitral lateral A′ 8.0 vs 10.1 cm/s, P < .001 and an increased mitral lateral E′/A′ ratio 0.93 vs 0.78, P < .001) in the CDH fetuses as compared with controls, with preserved systolic function. Conclusion Left CDH fetuses show echocardiographic signs of diastolic dysfunction, probably secondary to fetal heart compression, maintaining a preserved systolic function.