Abstract
BackgroundTo observe myocardial deformations in fetuses with isolated lower urinary tract obstruction (LUTO) and identify the correlation between myocardial deformation and the severity of obstruction.MethodsThe strain (S), strain rate in systole (SRs) and strain rate in diastole (SRd) of the left and right ventricles at the first examination were prospectively analyzed and compared between fetuses with isolated LUTO and gestational age (GA)-matched normal control fetuses. Multiple regression analyses were used to assess the obstructive factors for impaired strain and strain rate, and the independent variables included bladder volume, sum of the bilateral pelvic diameters, sum of the bilateral ureteral diameters, mean bilateral renal artery pulsatility index, and amniotic fluid index.ResultsThirty-six fetuses with isolated LUTO and 36 normal controls were enrolled. Overall, decreased S, SRs and SRd of both ventricles were noted in fetuses with LUTO (p < 0.001). Moreover, S and SR were significantly negatively related to distended bladder volume (p < 0.001).ConclusionsFetuses with LUTO demonstrated decreased left and right myocardial deformation, and this impaired cardiac dysfunction was correlated with the urinary bladder volume. Evaluating the myocardial deformation in fetal LUTO could provide information to aid in parental counselling and intervention monitoring.
Highlights
To observe myocardial deformations in fetuses with isolated lower urinary tract obstruction (LUTO) and identify the correlation between myocardial deformation and the severity of obstruction
A total of 59 fetuses with suspected LUTO were initially enrolled, but 23 cases were excluded, including 2 with excessive fetal movement resulting in poor echocardiographic images, 11 without follow-up, 6 with postnatally confirmed nonobstructive lesions and 4 with congenital syndrome
Our study showed significantly decreased strain and strain rates in systole and diastole of both ventricles, indicating overall myocardial dysfunction in fetal LUTO
Summary
To observe myocardial deformations in fetuses with isolated lower urinary tract obstruction (LUTO) and identify the correlation between myocardial deformation and the severity of obstruction. The diagnostic accuracy is challenging, fetal LUTO can be detected by screening ultrasonography during the late first and second trimesters of pregnancy, characteristically presenting megacystis, various degrees of hydronephrosis and dilated ureters, macro- or Cardiovascular dysfunction in the LUTO, triggered by an increased afterload accompanied by bladder compression and a compressed iliac artery, involves reduced pulmonary venous return due to lung dysplasia and the stimulation of neuro-hormonal mechanisms and may contribute to renal dysfunction and worse outcomes. There are no detailed data on the characteristics of myocardial deformations in fetuses with isolated LUTO. In this study, we aimed to (1) observe biventricular myocardial deformations in fetuses with isolated LUTO with giant bladder and (2) identify the correlation between myocardial deformation and the severity of LUTO
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