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Alterations in cardiac output in fetuses with congenital heart disease

Neeta Sethi1, Jiaxiang Gai2, James Bost2

  • 1Division of Cardiology, Children's National Hospital, Washington, District of Columbia, USA.

Prenatal Diagnosis
|June 14, 2022
PubMed

Insights

Fetuses with two-ventricle congenital heart disease (CHD) show higher combined cardiac output (CCO). Single ventricle (SV) physiology can compensate but may not fully meet demands in severe CHD.

Area of Science:

  • Cardiovascular Physiology
  • Fetal Medicine
  • Pediatric Cardiology

Background:

  • Severe congenital heart disease (CHD) alters fetal blood flow patterns.
  • Previous studies on fetal combined cardiac output (CCO) in CHD are limited by small sample sizes and lack of longitudinal data.
  • Understanding hemodynamic alterations in fetuses with CHD is crucial for diagnosis and management.

Purpose of the Study:

  • To evaluate CCO in fetuses with CHD.
  • To determine the impact of single ventricle (SV) physiology on fetal blood flow.
  • To assess the influence of aortic obstruction on cardiovascular hemodynamics in CHD fetuses.

Main Methods:

  • Prospective study of 141 fetuses with CHD and 118 controls.
  • Fetal echocardiography performed in mid- and late-gestation.
  • Combined cardiac output (CCO) calculated and indexed to estimated fetal weight.

Main Results:

  • Fetuses with two-ventricle (2V) CHD had significantly higher CCO than controls and SV CHD fetuses.
  • Fetuses with SV-CHD had CCO similar to controls.
  • 2V-CHD with aortic obstruction showed higher CCO than SV-CHD with aortic obstruction.

Conclusions:

  • The single ventricle (SV) can compensate to increase CCO in CHD.
  • This compensation may be insufficient to meet the increased blood flow demands of severe CHD.
  • Altered hemodynamics in CHD fetuses require further investigation for optimal management.
Abstract

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