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Related Experiment Video

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Establishment and Confirmation of a Postnatal Right Ventricular Volume Overload Mouse Model

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Right ventricular function in fetal hypoplastic left heart syndrome.

Paul A Brooks¹, Nee S Khoo, Andrew S Mackie

¹Fetal and Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women and Children's Health Research and Mazankowski Alberta Heart Institutes, University of Alberta, Edmonton, AB, Canada.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography

|July 17, 2012

Summary

Fetal hypoplastic left heart syndrome (HLHS) shows a more spherical right ventricle (RV) with reduced longitudinal contraction. These changes, similar to postnatal findings, suggest early ventricular remodeling in utero.

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Published on: October 28, 2020

Area of Science:

Cardiology
Fetal Medicine
Pediatric Cardiology

Background:

Systemic right ventricle (RV) in palliated hypoplastic left heart syndrome (HLHS) exhibits reduced longitudinal compared to circumferential deformation.
This altered contraction pattern resembles the normal left ventricle, potentially enhancing RV pumping efficiency.

Purpose of the Study:

To investigate whether these altered RV contraction patterns in HLHS are detectable prenatally.
To test the hypothesis of prenatal onset of ventricular remodeling in HLHS.

Main Methods:

Retrospective analysis of echocardiograms from 48 fetuses with HLHS.
Comparison with control fetuses with normal right and left ventricles.
Assessment of ventricular function using Velocity Vector Imaging, tissue deformation, 2D echocardiography, and Doppler parameters.

Main Results:

HLHS fetuses displayed reduced RV longitudinal velocity, strain, and displacement, with increased radial displacement.
The ratio of longitudinal to circumferential deformation was significantly lower in HLHS fetuses, comparable to normal left ventricles.
Elevated tricuspid inflow A-wave velocity, duration, and fraction, along with increased RV Tei index and inferior vena cava A-wave reversal, were observed in HLHS.

Conclusions:

The fetal RV in HLHS adopts a more spherical shape due to increased diameter.
Reduced longitudinal deformation and increased reliance on atrial contraction for filling characterize the fetal RV in HLHS.
These prenatal findings mirror postnatal observations, indicating that ventricular remodeling in HLHS begins during fetal development.