Umbilical artery systolic to diastolic ratio is associated with growth and myocardial performance in infants with hypoplastic left heart syndrome. (28th November 2013)

• Record Type: Journal Article
• Authors: Miller, Thomas A.; Joss‐Moore, Lisa; Menon, Shaji C.; Weng, Cindy; Puchalski, Michael D.
• Is Part Of: Prenatal diagnosis. Volume 34:Number 2(2014:Feb.)
• Page Start: 128
• Page End: 133
• Publication Date: 2013-11-28
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.4268
• Languages: English
• ISSNs: 0197-3851

Abstract

<abstract abstract-type="main"> <title>ABSTRACT</title> <sec id="pd4268-sec-0001" sec-type="section"> <title>Objective</title> <p>Despite standardization in care, heterogeneity in outcomes persists for infants with hypoplastic left heart syndrome (HLHS). One potential factor is <italic>in utero</italic> stressors. Uteroplacental insufficiency (UPI) induces systemic vascular and myocardial adaptations in the absence of structural heart disease. The effect of UPI in HLHS is unknown.</p> </sec> <sec id="pd4268-sec-0002" sec-type="section"> <title>Methods</title> <p>We retrospectively analyzed infants undergoing Norwood palliation for HLHS from 2007 to 2012. We compared the umbilical artery systolic to diastolic (SD) ratio to growth outcomes and postoperative right ventricular function.</p> </sec> <sec id="pd4268-sec-0003" sec-type="section"> <title>Results</title> <p>Forty three infants met our inclusion criteria. Fetuses without a declining SD ratio with advancing gestational age had asymmetric birth biometry, defined as birth weight minus head circumference z scores (−0.9 vs −0.05, <italic>p</italic> < 0.01). The SD ratio near the end of gestation negatively correlated with asymmetric birth biometry (<italic>R</italic> = −0.521, <italic>p</italic> < 0.01) and interstage growth (<italic>R</italic> = −0.49, <italic>p</italic> = 0.04). Males with higher SD ratios had a greater postoperative incidence of abnormal right ventricular function.</p> </sec> <sec id="pd4268-sec-0004" sec-type="section"> <title>Conclusions</title> <p>A higher umbilical artery SD ratio was associated with asymmetric prenatal growth, poor weight gain, and decreased myocardial performance in infants with HLHS. Better understanding of UPI's effects on cardiovascular development and metabolism in HLHS will help identify new strategies for targeting morbidity in this high risk population. © 2013 John Wiley & Sons, Ltd.</p> </sec> </abstract>