Left ventricular diastolic function and characteristics in fetal aortic stenosis

Area of Science:

• Cardiology
• Fetal Medicine
• Pediatric Cardiology

Background:

• Fetal aortic stenosis (AS) can progress to hypoplastic left heart syndrome.
• Fetal aortic balloon valvuloplasty (FAV) aims to prevent this progression.
• Left ventricular (LV) diastolic dysfunction (DD) is a common complication after FAV.

Purpose of the Study:

• To evaluate LV diastolic function in fetuses with AS undergoing FAV.
• To compare LV diastolic parameters between FAV patients and controls.
• To identify LV factors associated with DD in FAV patients and assess changes post-FAV.

Main Methods:

• Echocardiographic assessment of LV diastolic function in 20 fetuses post-FAV and 40 controls.
• Comparison of pre- and post-FAV diastolic parameters in 16 patients.
• Analysis of factors associated with LV diastolic dysfunction.

Main Results:

• Fetuses post-FAV exhibited universally abnormal LV diastolic parameters compared to controls.
• Worse LV diastolic function correlated with increased LV volume, sphericity, endocardial fibroelastosis, and lower LV pressure.
• Post-FAV, there was a trend towards improved mitral inflow patterns and increased septal E'.

Conclusions:

• Fetuses with midgestation AS demonstrate significant diastolic dysfunction.
• LV morphology, endocardial fibroelastosis, and LV pressure are associated with the severity of diastolic dysfunction.
• FAV may lead to some improvement in diastolic function, but significant dysfunction persists.