Cerebral vascular resistance and left ventricular myocardial performance in fetuses with Ebstein's anomaly

Area of Science:

• Cardiology
• Fetal Medicine
• Pediatric Cardiology

Background:

• Ebstein's anomaly is a congenital heart defect affecting the tricuspid valve.
• Fetal cardiovascular assessment is crucial for understanding the impact of congenital heart disease.
• Cerebral vascular resistance and myocardial performance are key indicators of fetal well-being.

Purpose of the Study:

• To investigate cerebral vascular resistance and left ventricular myocardial performance in fetuses diagnosed with Ebstein's anomaly.
• To compare these parameters between fetuses with Ebstein's anomaly and healthy controls.

Main Methods:

• Fetal echocardiography was used to evaluate 11 fetuses with Ebstein's anomaly and 44 matched healthy controls.
• Key parameters measured included middle cerebral artery pulsatility index (MCAPI), umbilical artery pulsatility index (UAPI), left ventricular myocardial performance index (LVTei), left ventricular ejection fraction (LVEF), and fetal cardiovascular profile score (CVPS).
• MCAPI/UAPI ratios were calculated to assess relative cerebral blood flow.

Main Results:

• Fetuses with Ebstein's anomaly exhibited significantly lower MCAPI and MCAPI/UAPI ratios compared to controls (P < 0.001).
• Elevated UAPI (P < 0.001) and LVTei (P < 0.05) were observed in the Ebstein's anomaly group, indicating increased vascular resistance and impaired myocardial function.
• The fetal cardiovascular profile score was significantly lower in fetuses with Ebstein's anomaly (P < 0.001).
• MCAPI and LVTei showed significant correlations with fetal CVPS.

Conclusions:

• Fetuses with Ebstein's anomaly demonstrate decreased in utero cerebral vascular resistance.
• Global left ventricular performance, assessed by the Tei index, is abnormal in these fetuses.
• These findings suggest significant alterations in fetal cardiovascular regulation associated with Ebstein's anomaly.