Characterizing cardiac dysfunction in fetuses with left congenital diaphragmatic hernia. (15th April 2018)

• Record Type: Journal Article
• Authors: Cruz‐Lemini, Mónica; Valenzuela‐Alcaraz, Brenda; Granados‐Montiel, Julio; Martínez, Josep M.; Crispi, Fátima; Gratacós, Eduard; Cruz‐Martínez, Rogelio
• Is Part Of: Prenatal diagnosis. Volume 38:Number 6(2018)
• Page Start: 422
• Page End: 427
• Publication Date: 2018-04-15
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.5253
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract: Objective: To evaluate cardiac function by conventional echocardiography and tissue Doppler imaging in fetuses with left congenital diaphragmatic hernia (CDH). Methods: Conventional echocardiography (myocardial performance index, ventricular filling velocities, and E/A ratios) and tissue Doppler imaging (annular myocardial peak velocities, E/E′ and E′/A′ ratios) in mitral, septal, and tricuspid annulus were evaluated in a cohort of 31 left‐sided CDH fetuses and compared with 75 controls matched for gestational age 2:1. Results: In comparison to controls, CDH fetuses had prolonged isovolumetric time periods (isovolumetric contraction time 35 ms vs 28 ms, P < .001), with higher myocardial performance index (0.49 vs 0.42, P < .001) and tricuspid E/A ratios (0.77 vs 0.72, P = .033). Longitudinal function assessed by tissue Doppler showed signs of impaired relaxation (mitral lateral A′ 8.0 vs 10.1 cm/s, P < .001 and an increased mitral lateral E′/A′ ratio 0.93 vs 0.78, P < .001) in the CDH fetuses as compared with controls, with preserved systolic function. Conclusion: Left CDH fetuses show echocardiographic signs of diastolic dysfunction, probably secondary to fetal heart compression, maintaining a preserved systolic function. Abstract : What is already known about this topic? Fetuses with left CDH have shown decreased left cardiac output, higher strain values, and smaller left heart structures. Tissue Doppler imaging permits evaluation of longitudinal myocardial motion and may be more accurate in describing myocardial function in CDH. What does this study add? This study evaluates for the first time TDI parameters in fetuses with left CDH. Left CDH fetuses show echocardiographic signs of diastolic dysfunction, probably secondary to fetal heart compression, maintaining a preserved systolic function.