Cerebral Vascular Resistance and Left Ventricular Myocardial Performance in Fetuses with Ebstein's Anomaly

ABSTRACT

We sought to determine whether cerebral vascular resistance and left ventricular myocardial performance (LVTei) are abnormal in fetuses with Ebstein's anomaly. The pulsatility index of the middle cerebral artery (MCAPI) and umbilical artery (UAPI), LVTei, left ventricular ejection fraction (LVEF), and fetal cardiovascular profile score in 11 fetuses with Ebstein's anomaly were evaluated by fetal echocardiography. MCAPI/UAPI values were calculated for the Ebstein's anomaly group. The control group included 44 healthy fetuses of uncomplicated pregnancies matched for gestational age (according to 1:4). MCAPI and MCAPI/UAPI were significantly lower in fetuses with Ebstein's anomaly than in controls (all p < 0.001). UAPI and LVTei were higher in fetuses with Ebstein's anomaly than in control fetuses (p < 0.001, p < 0.05, respectively). No significant between group difference was observed for LVEF (p > 0.05). The median cardiovascular profile score (CVPS) for the fetuses with Ebstein's anomaly (median, 7.0; interquartile range [IQR], 5.0 to 8.0) was a full point lower than for controls (median, 10.0; IQR 10.0 to 10.0). This difference was statistically significant (p < 0.001). MCAPI and LVTei were both correlated with fetal CVPS in fetuses with Ebstein's anomaly (correlation coefficient₁ = 0.477, p < 0.05; correlation coefficient₂ = −0.602, p < 0.05). In fetuses with Ebstein's anomaly in utero, cerebral vascular resistance is decreased; global LV performance, as assessed by the Tei index, is abnormal.

KEYWORDS

Ebstein's anomaly - fetal echocardiography - cerebrovascular circulation - Tei index

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