Ultraschall Med 2016; 37 - PS9_02
DOI: 10.1055/s-0036-1587906

Impact of endocardial fibroelastosis of the left ventricle on right ventricular function in fetuses with hypoplastic left heart syndrome

O Graupner 1, L Wieg 2, C Enzensberger 3, J Degenhardt 2, A Kawecki 2, A Wolter 2, M Khalil 4, D Schranz 5, C Yerebakan 6, T Kohl 7, A Doelle 8, J Herrmann 9 R Axt-Fliedner 2, on behalf of the Fetal Cardiac Imaging Research Group Germany
  • 1Klinikum rechts der Isar, Technische Universität München, Frauenklinik und Poliklinik, München, Germany
  • 2Justus-Liebig-University, Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Gießen, Germany
  • 3Philipps-University Marburg, Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Marburg, Germany
  • 4Justus-Liebig-University, Department of Pediatric Cardiology, Gießen, Germany
  • 5Justus-Liebig-University, Pediatric Heart Center, Gießen, Germany
  • 6Justus-Liebig-University, Department of Pediatric Heart Surgery, Gießen, Germany
  • 7Justus-Liebig-University, German Center for Fetal Surgery and Minimally-Invasive Therapy, Gießen, Germany
  • 8Toshiba Medical Systems Europe BV, Neuss, Germany
  • 9IT Service Center, Statistical Consulting Service Unit, Gießen, Germany

Purpose: Postnatal outcome of fetuses with hypoplastic left heart syndrome (HLHS) is determined by right ventricular function (RVF). Our study examines, whether there are differences in RVF of HLHS fetuses with endocardial fibroelastosis of the left ventricle (LV EFE) without LV EFE and controls during gestation.

Material and methods: A prospective study was conducted with 10 gestational age matched fetuses in each of the three groups.

M-mode was used to assess displacement of the tricuspid annulus (TAPSE), the ejection fraction (EF) and the shortening fraction (SF). PW-Doppler and PW-TDI derived velocities were assessed. Among others the early wave to early diastolic annular relaxation velocity (E/E') ratio, the early diastolic annular relaxation velocity to late diastolic annular relaxation velocity (E'/A') ratio and the myocardial performance index (MPI') were calculated.

Conventional fetal Doppler parameters, the umbilical and middle cerebral artery pulsatility index (UA-PI, MCA-PI) and the CPR (cerebroplacental ratio) were obtained to test for possible correlations to cardiac function indices.

Results: HLHS fetuses with LV EFE revealed significantly lower peak S' velocities, lower peak A' velocities and higher values for EF and SF compared to those without LV EFE (p < 0.05). Furthermore they showed significantly higher values for peak E wave velocity, E/E' and both EF and SF compared to healthy controls.

In HLHS w/o LV EFE but not in HLHS LV EFE fetuses, TAPSE increased significantly during gestation.

In HLHS fetuses with LV EFE peak A' velocity was significantly negative correlated with UA-PI. HLHS fetuses w/o LV EFE showed significant positive correlations of TAPSE with CPR.

Conclusions: Significant differences in RVF of HLHS fetuses with LV EFE, without LV EFE and healthy controls are present during gestation. These results might lend support to the notion of negative ventricular-ventricular interaction in case of HLHS with LV EFE possibly influencing surgical outcomes.