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Left ventricular obstruction with restrictive inter-atrial communication leads to retardation in fetal lung

Diane Goltz1, Jean-Marc Lunkenheimer, Mojtaba Abedini

  • 1Department of Pathology, University Hospital of Bonn, Bonn, Germany.

Prenatal Diagnosis
|February 4, 2015
PubMed

Insights

Fetal lung development is disrupted in infants with severe aortic stenosis or hypoplastic left heart syndrome and restricted atrial communication. Early intervention during the second trimester may improve outcomes for these critical conditions.

Area of Science:

  • Cardiovascular Pathology
  • Fetal Development
  • Pulmonary Medicine

Background:

  • Intact atrial septum or highly restrictive inter-atrial communication (I/HRAS) in severe aortic stenosis (SAS) or hypoplastic left heart syndrome (HLHS) leads to adverse outcomes.
  • Increased left atrial pressure significantly impacts fetal lung development.

Purpose of the Study:

  • To investigate the morphological changes in the alveolo-septal lung parenchyma due to increased left atrial pressure in fetuses with SAS/HLHS and I/HRAS.
  • To analyze pulmonary maturation in affected fetuses and neonates.

Main Methods:

  • Retrospective cross-sectional autoptic study of fetal/neonatal lung specimens.
  • Inclusion of 18 patients with SAS/HLHS and I/HRAS, 11 with SAS/HLHS and unrestrictive inter-atrial communications, and 18 controls.
  • Morphometric and immunohistochemical analyses to assess pulmonary maturation.

Main Results:

  • Alveolo-capillary membrane maturation was significantly disturbed from week 23 in I/HRAS fetuses.
  • I/HRAS lungs exhibited angiomatoid hyper-capillarisation and wider inter-airspace mesenchyme.
  • Fibroelastosis of alveolar septae developed in I/HRAS infants with HLHS, despite age-related normalization of mesenchymal diameters.

Conclusions:

  • Fetal lung maturation, specifically alveolo-capillary membrane formation, is severely disordered in SAS/HLHS with I/HRAS.
  • Morphological findings suggest that fetal intervention for I/HRAS should be timed within the second trimester.
Abstract

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