Left Ventricular Myocardial Performance in the Fetus with Severe Tricuspid Valve Disease and Tricuspid Insufficiency

ABSTRACT

We sought to determine whether left ventricular (LV) function is abnormal in a fetus with severe tricuspid valve disease (TVD), and whether it may contribute to the outcome. We measured the LV Tei index (including isovolumic relaxation [IRT], contraction, and ejection times) in 31 fetuses with TVD, compared the data with measurements from 32 normal fetuses, and correlated these measurements with pulmonary morphology and outcome. LV Tei index was significantly greater, ejection times shorter, and IRT longer in TVD compared with controls. The Tei index was highest in fetuses with either pulmonary insufficiency or atresia compared with those with forward flow. Finally, LV Tei index was significantly greater in fetuses with fetal (n = 5) or neonatal (n = 9) demise than in neonatal survivors (n = 7). Global LV performance as assessed by the Tei index is abnormal in TVD and likely contribute to the high mortality associated with TVD.

KEYWORDS

Tricuspid valve disease - fetal echocardiography - Tei index, hydrops fetalis

REFERENCES

• 1 Hornberger L K, Sahn D J, Kleinman C S, Copel J A, Reed K L. Tricuspid valve disease with significant tricuspid insufficiency in the fetus: diagnosis and outcome.  J Am Coll Cardiol. 1991;  17 167-173
• 2 Sharland G K, Chita S K, Allan L D. Tricuspid valve dysplasia or displacement in intrauterine life.  J Am Coll Cardiol. 1991;  17 944-949
• 3 Celermajer D S, Bull C, Till J A et al.. Ebstein's anomaly: presentation and outcome from fetus to adult.  J Am Coll Cardiol. 1994;  23 170-176
• 4 Bruckheimer E, Bulbul Z, Pinter E, Gailani M, Kleinman C S, Fahey J T. Inhaled nitric oxide therapy in a critically ill neonate with Ebstein's anomaly.  Pediatr Cardiol. 1998;  19 477-479
• 5 Hsieh Y Y, Lee C C, Chang C C, Tsai H D, Yeh L S, Tsai C H. Successful prenatal digoxin therapy for Ebstein's anomaly with hydrops fetalis. A case report.  J Reprod Med. 1998;  43 710-712
• 6 Starns V A, Pitlick P T, Bernstein D, Griffin M L, Choy M, Shumway N E. Ebstein's anomaly appearing in the neonate: a new surgical approach.  J Thorac Cardiovasc Surg. 1991;  101 1082-1087
• 7 Endo M, Ohmi M, Sato K, Tanaka T, Kakizawa H, Tabayashi K. Tricuspid valve closure for neonatal Ebstein's anomaly.  Ann Thorac Surg. 1998;  65 540-542
• 8 Hornberger L K, Sander S P, Rein A JJT, Spevak J P, Parness I A, Colan S D. Left heart obstructive lesions and left ventricular growth in the midtrimester fetus. A longitudional study.  Circulation. 1995;  92 397-405
• 9 Tei C, Dujardin K S, Hodge D O, Kyle R A, Tajik A J, Seward J B. Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis.  J Am Coll Cardiol. 1996;  28 658-664
• 10 Eidem B W, Tei C, O'Leary P W, Cetta F, Seward J B. Nongeometric quantitative assessmant of right and left ventricular function: myocardial performance index in normal children and patients with Ebstein anomaly.  J Am Soc Echocardiogr. 1998;  11 849-856
• 11 Sahn D J, Lange L, Allen H D et al.. Quantitative real-time cross-sectional echocardiography in the developing normal human fetus and newborn.  Circulation. 1980;  62 588-597
• 12 Reed K L, Meijboom E J, Sahn D J, Scagneli S A, Valdes-Cruz L M, Shenker L. Cardiac Doppler flow velocities in human fetuses.  Circulation. 1986;  73 41-46
• 13 Paladini C S, Chita S K, Allan L D. Prenatal measurement of cardiothoracic ratio in evalution of heart disease.  Arch Dis Child. 1990;  65 20-23
• 14 Pavlova M, Fouron J C, Drblik P D et al.. Factors affecting the prognosis of Ebstein's anomaly during fetal life.  Am Heart J. 1998;  135 1081-1085
• 15 Kanzaki T, Chiba Y. Evaluation of the preload condition of the fetus by inferior vena caval blood flow pattern.  Fetal Diagn Ther. 1990;  5 168-174
• 16 Roberson D A, Silverman N H. Ebstein's anomaly: echocardiographic and clinical features in the fetus and neonate.  J Am Coll Cardiol. 1989;  14 1300-1307
• 17 Oberhoffer R, Cook A C, Lang D et al.. Correlation between echocardiographic and morphological investigations of lesions of the tricuspid valve diagnosed during fetal life.  Br Heart J. 1992;  68 580-585
• 18 Berman W, Christensen D. Effect of acute preload and afterload stress on function in newborn and adult sheep.  Biol Neonate. 1983;  43 61-66
• 19 Theodore A W, Jaroslaw M, Young H S, Wolfram S, Arnold W. Value of positive myocardial technetium-99m-pyrophosphate scintigraphy in the noninvasive diagnosis of cardiac amyloidosis.  Am Heart J. 1982;  103 468-473
• 20 Atkins D L, Clark E B, Marvin Jr W J. Foramen ovale/atrial septum area ratio: a marker of transatrial blood flow.  Circulation. 1982;  66 281-283
• 21 Moller J E, Poulsen S H, Egstrup K. Effect of preload alternations on a new Doppler echocardiographic index of combined systolic and diastolic performance.  J Am Soc Echocardiogr. 1999;  12 1065-1072