Cerebral Vascular Resistance and Left Ventricular Myocardial Performance in Fetuses with Ebstein's Anomaly

Youfang Chen; Guorong Lv; Boyi Li; Zhenhua Wang

doi:10.1055/s-0028-1103152

American Journal of Perinatology, Table of Contents

Am J Perinatol 2009; 26(4): 253-258
DOI: 10.1055/s-0028-1103152

Cerebral Vascular Resistance and Left Ventricular Myocardial Performance in Fetuses with Ebstein's Anomaly

Youfang Chen¹ , Guorong Lv¹ , Boyi Li¹ , Zhenhua Wang¹

¹Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China

Abstract

ABSTRACT

We sought to determine whether cerebral vascular resistance and left ventricular myocardial performance (LVTei) are abnormal in fetuses with Ebstein's anomaly. The pulsatility index of the middle cerebral artery (MCAPI) and umbilical artery (UAPI), LVTei, left ventricular ejection fraction (LVEF), and fetal cardiovascular profile score in 11 fetuses with Ebstein's anomaly were evaluated by fetal echocardiography. MCAPI/UAPI values were calculated for the Ebstein's anomaly group. The control group included 44 healthy fetuses of uncomplicated pregnancies matched for gestational age (according to 1:4). MCAPI and MCAPI/UAPI were significantly lower in fetuses with Ebstein's anomaly than in controls (all p < 0.001). UAPI and LVTei were higher in fetuses with Ebstein's anomaly than in control fetuses (p < 0.001, p < 0.05, respectively). No significant between group difference was observed for LVEF (p > 0.05). The median cardiovascular profile score (CVPS) for the fetuses with Ebstein's anomaly (median, 7.0; interquartile range [IQR], 5.0 to 8.0) was a full point lower than for controls (median, 10.0; IQR 10.0 to 10.0). This difference was statistically significant (p < 0.001). MCAPI and LVTei were both correlated with fetal CVPS in fetuses with Ebstein's anomaly (correlation coefficient₁ = 0.477, p < 0.05; correlation coefficient₂ = −0.602, p < 0.05). In fetuses with Ebstein's anomaly in utero, cerebral vascular resistance is decreased; global LV performance, as assessed by the Tei index, is abnormal.

KEYWORDS

Ebstein's anomaly - fetal echocardiography - cerebrovascular circulation - Tei index

Full Text

References

REFERENCES

1 Newburger J W, Jonas R A, Wernovsky G et al.. A comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. N Engl J Med. 1993; 329 1057-1064
2 Bellinger D C, Wypij D, Kuban K C et al.. Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation. 1999; 100 526-532
3 Mahle W T, Clancy R R, Moss E M, Gerdes M, Jobes D R, Wernovsky G. Neurodevelopmental outcome and lifestyle assessment in school-aged and adolescent children with hypoplastic left heart syndrome. Pediatrics. 2000; 105 1082-1089
4 Mahle W T, Tavani F, Zimmerman R A et al.. An MRI study of neurological injury before and after congenital heart surgery. Circulation. 2002; 106(suppl 1) I109-I114
5 van Houten J P, Rothman A, Bejar R. High incidence of cranial ultrasound abnormalities in full-term infants with congenital heart disease. Am J Perinatol. 1996; 13 47-53
6 Glauser T A, Rorke L B, Weinberg P M, Clancy R R. Congenital brain anomalies associated with the hypoplastic left heart syndrome. Pediatrics. 1990; 85 984-990
7 Limperopoulos C, Majnemer A, Shevell M I, Rosenblatt B, Rohlicek C, Tchervenkov C. Neurologic status of newborns with congenital heart defects before open heart surgery. Pediatrics. 1999; 103 402-408
8 Ikle L, Hale K, Fashaw L, Boucek M, Rosenberg A A. Developmental outcome of patients with hypoplastic left heart syndrome treated with heart transplantation. J Pediatr. 2003; 142 20-25
9 Kaltman J R, Di H, Tian Z, Rychik J. Impact of congenital heart disease on cerebrovascular blood flow dynamics in the fetus. Ultrasound Obstet Gynecol. 2005; 25 32-36
10 Meise C, Germer U, Gembruch U. Arterial Doppler ultrasound in 115 second- and third-trimester fetuses with congenital heart disease. Ultrasound Obstet Gynecol. 2001; 17 398-402
11 Copel J A, Hobbins J C, Kleinman C S. Can umbilical artery pulsatility index predict the outcome of fetuses with structural heart disease?. J Ultrasound Med. 1991; 10 323-326
12 Jouannic J M, Benachi A, Bonnet D et al.. Middle cerebral artery Doppler in fetuses with transposition of the great arteries. Ultrasound Obstet Gynecol. 2002; 20 122-124
13 Modena A, Horan C, Visintine J, Chanthasenanont A, Wood D, Weiner S. Fetuses with congenital heart disease demonstrate signs of decreased cerebral impedance. Am J Obstet Gynecol. 2006; 195 706-710
14 Dearani J A, Danielson G K. Congenital Heart Surgery Nomenclature and Database Project: Ebstein's anomaly and tricuspid valve disease. Ann Thorac Surg. 2000; 69(suppl) S106-S117
15 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
16 Inamura N, Taketazu M, Smallhorn J F, Hornberger L K. Left ventricular myocardial performance in the fetus with severe tricuspid valve disease and tricuspid insufficiency. Am J Perinatol. 2005; 22 91-97
17 Hernandez-Andrade E, Lopez-Tenorio J, Figueroa-Diesel H et al.. A modified myocardial performance (Tei) index based on the use of valve clicks improves reproducibility of fetal left cardiac function assessment. Ultrasound Obstet Gynecol. 2005; 26 227-232
18 Hung J H, Fu C Y, Hung J. Combination of fetal Doppler velocimetric resistance values predict acidemic growth-restricted neonates. J Ultrasound Med. 2006; 25 957-962
19 Cohn H E, Sacks E J, Heymann M A, Rudolph A M. Cardiovascular responses to hypoxemia and acidemia in fetal lambs. Am J Obstet Gynecol. 1974; 120 817-824
20 Huhta J C. Guidelines for the evaluation of heart failure in the fetus with or without hydrops. Pediatr Cardiol. 2004; 25 274-286
21 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
22 Berman W, Christensen D. Effects of acute preload and afterload stress on myocardial function in newborn and adult sheep. Biol Neonate. 1983; 43 61-66
23 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
24 Pavlova M, Fouron J C, Drblik S P et al.. Factors affecting the prognosis of Ebstein's anomaly during fetal life. Am Heart J. 1998; 135(6 Pt 1) 1081-1085
25 Vettukattil J J, Bharucha T, Anderson R H. Defining Ebstein's malformation using three-dimensional echocardiography. Interact Cardiovasc Thorac Surg. 2007; 6 685-690

Prof. Guorong Lv

Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Zhongshan Rd.

Quanzhou, Fujian, 362000, China

Email: lgr_feus@sina.com; cyf988@126.com