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Updated: Feb 27, 2026
Murine Fetal Echocardiography
Published on: February 15, 2013
Endocardial Fibroelastosis of the Left Ventricle Affects Right Ventricular Performance in Fetuses with Hypoplastic
Oliver Graupner1, Christian Enzensberger2, Larissa Wieg3
1Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Germany.
Insights
Endocardial fibroelastosis of the left ventricle in hypoplastic left heart syndrome fetuses impacts right ventricular myocardial function. This ventricular-ventricular interaction may affect surgical outcomes.
Area of Science:
- Fetal Cardiology
- Congenital Heart Disease
- Cardiac Physiology
Background:
- Systemic right ventricular (RV) myocardial function is crucial for neonates with hypoplastic left heart syndrome (HLHS).
- The impact of left ventricular endocardial fibroelastosis (LV EFE) on RV function in HLHS fetuses is not well understood.
Purpose of the Study:
- To investigate whether the presence of LV EFE influences the myocardial function of the RV in fetuses diagnosed with HLHS.
Main Methods:
- Prospective study comparing 10 HLHS fetuses with LV EFE, 10 HLHS fetuses without LV EFE, and 10 controls, matched for gestational age.
- Assessed RV myocardial function using M-mode (TAPSE, SF) and Doppler echocardiography (velocities, ratios like E/A, E/e', e'/a', and MPI).
Main Results:
- HLHS fetuses with LV EFE showed significantly lower s' velocities and higher SF compared to HLHS fetuses without LV EFE.
- Group with LV EFE exhibited higher E/A, E/e', e'/a' ratios, and SF compared to controls.
- RV a' velocity increased with gestational age in the LV EFE group, while TAPSE increased with gestation only in the group without LV EFE.
Conclusions:
- Significant differences in RV myocardial function exist between HLHS fetuses with and without LV EFE.
- These findings suggest potential negative ventricular-ventricular interaction in HLHS with LV EFE.
- This interaction may have implications for surgical outcomes in affected neonates.
Purpose:
Myocardial function (MF) of the systemic right ventricle (RV) influences the postnatal course of neonates with hypoplastic left heart syndrome (HLHS). Our study examines whether the presence of endocardial fibroelastosis of the left ventricle (LV EFE) influences MF of the RV in HLHS fetuses.
Materials And Methods:
A prospective study was conducted including 10 controls (group 1), 10 HLHS fetuses with (group 2) and 10 without LV EFE (group 3) - all matched for gestational age. M-mode was used to assess tricuspid plane systolic excursion (TAPSE) and the shortening fraction (SF). PW-Doppler-derived and PW-TDI-derived velocities were assessed. E/A, E/e', e'/a' ratios and the myocardial performance index (mpi') were calculated.
Results:
The examination of MF revealed significantly lower s' velocities (p < 0.05) and higher values for SF in group 2 compared to group 3. e'/a' ratio, et' (ejection time), E wave velocity, E/e' and SF showed significantly higher values in group 2 compared to group 1. In group 2 a' velocity increased significantly over gestational age. In group 3 but not in group 2, TAPSE increased during gestation.
Conclusion:
These significant differences in MF between the groups might lend support to the notion of negative ventricular-ventricular interaction in the case of HLHS with LV EFE possibly influencing surgical outcomes.
