Characterizing cardiac dysfunction in fetuses with left congenital diaphragmatic hernia

Area of Science:

• Cardiology
• Fetal Medicine
• Pediatric Surgery

Background:

• Congenital diaphragmatic hernia (CDH) is a serious condition affecting fetal development.
• Cardiac function assessment in fetuses with CDH is crucial for understanding disease impact.
• Conventional echocardiography and tissue Doppler imaging offer insights into fetal cardiac mechanics.

Purpose of the Study:

• To evaluate cardiac function in fetuses with left-sided CDH using echocardiography and tissue Doppler imaging.
• To compare cardiac parameters between fetuses with CDH and healthy controls.

Main Methods:

• A cohort of 31 left-sided CDH fetuses and 75 gestational age-matched controls were studied.
• Conventional echocardiography parameters (MPI, filling velocities, E/A ratios) were assessed.
• Tissue Doppler imaging of mitral, septal, and tricuspid annuli (myocardial velocities, E/E', E'/A') was performed.

Main Results:

• CDH fetuses showed prolonged isovolumetric times and higher myocardial performance index (MPI) compared to controls.
• Tricuspid E/A ratios were significantly higher in CDH fetuses.
• Tissue Doppler revealed impaired relaxation (mitral lateral A', E'/A' ratio) in CDH fetuses, with preserved systolic function.

Conclusions:

• Fetuses with left CDH demonstrate echocardiographic evidence of diastolic dysfunction.
• This dysfunction is likely secondary to fetal heart compression within the thoracic cavity.
• Systolic cardiac function remains preserved in fetuses with left CDH.