Abstract
The evaluation of fetal left ventricular (LV) and right ventricular (RV) functions by 2D echocardiography is challenging. Velocity vector imaging (VVI) is an angle independent speckle tracking technique and it can assess regional and global myocardial strain. It is unknown whether the LV and RV function of the fetus with hypoplastic left heart (HLHS) have already changed in the uterus. This study is to evaluate the regional and global fetal LV and RV strain in HLHS using VVI. 60 healthy fetuses and thirty HLHS fetuses were enrolled for the echocardiographic study. They were divided into two groups according to their gestational age (the second trimester: 20–22weeks and the third trimester: 30–34 weeks) respectively. Digital dynamic four-chamber views were collected and restored for offline analysis. The regional and global LV and RV myocardial strain and T2P global strain were measured. 1) In the normal fetus from the second to the third trimester, there were statistically significant decrease in RV global and regional strain; no statistically significant changes were observed in global and regional strain of LV; 2) as for the HLHS fetus from the second to the third trimester, there were statistically significant decrease in both LV and RV global and regional strain; 3) compared with normal groups, during the second trimester, there were significant decrease in LV global regional strain in HLHS group, but the RV strain was unchanged. During the third trimester, significant decrease in both LV and RV global regional strain was observed. Inter- and intraobserver variability was not significant. Left and right ventricular mechanics of HLHS fetus are different from normal fetus. Prenatal abnormalities in myocardial deformation may be responsible for inefficient cardiac performance and output. These differences precede the imposition of undue loading condition as a consequence of surgical palliation and may offer clues to the development of heart failure at a later stage. VVI may be a useful tool to assess fetal cardiac function.
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