Abstract
BackgroundPostnatal outcome of fetuses with hypoplastic left heart syndrome (HLHS) is mainly determined by right ventricular function. In the present study we used spatio-temporal image correlation (STIC) to assess right ventricular function of fetuses with HLHS.MethodsThree-dimensional ultrasound with STIC technique was used to acquire heart images from fetuses that had HLHS and the normal controls, between 24+0 and 37+6 weeks of gestation. Right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV) were determined using the virtual organ computer-aided analysis software, and the parameters of right ventricular function were calculated.ResultsBoth RVEDV and RVESV were found to be significantly higher in fetuses with HLHS as compared to that in normal controls (P < 0.001). There were no significant differences in the parameters between fetuses with and without a visible left ventricular cavity (P > 0.05). Compared to fetuses with HLHS plus mild tricuspid regurgitation (TR), fetuses with HLHS plus severe TR exhibited lower right ventricular stroke volume (RVSV), right ventricular cardiac output (RVCO) and standardized RVCO (P < 0.05). The right ventricular ejection fraction (RVEF) was significantly lower in HLHS fetuses that had severe TR (P < 0.001).ConclusionAs the right ventricle is solely responsible for maintenance of circulation, the right ventricular systolic function undergoes compensatory enhancement in fetuses with HLHS and mild TR, compared to that in normal controls. Size of the left ventricle does not significantly affect the right ventricular function in HLHS. However, right ventricular systolic function may be impaired prenatally in HLHS fetuses that have severe TR.
Highlights
Postnatal outcome of fetuses with hypoplastic left heart syndrome (HLHS) is mainly determined by right ventricular function
Success rate of spatio-temporal image correlation (STIC) volume acquisition Among the 180 control fetuses, satisfactory STIC volume set was obtained in 151 cases (83.89 %): 55 cases between the 24+0 and 27+6 weeks, 51 cases between the 28+0 and 31+6 weeks, and 45 cases between the 32+0 and 37+6 weeks
Fetal Right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV) and other right cardiac function parameters were calculated in these cases (Figs. 1a and 2a)
Summary
Postnatal outcome of fetuses with hypoplastic left heart syndrome (HLHS) is mainly determined by right ventricular function. In the present study we used spatio-temporal image correlation (STIC) to assess right ventricular function of fetuses with HLHS. The hypoplastic left heart syndrome encompasses a spectrum of cardiac malformations that are characterized by significant underdevelopment of the components of the left heart and the aorta, including the left ventricular cavity and mass [1]. Four-dimensional spatio-temporal image correlation (STIC), which correlates the three-dimensional volume with cardiac phase, has been extensively used in screening and diagnosis of fetal cardiac defects [5,6,7,8,9,10,11,12,13,14].
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