Reitz Justus G, Meier Johanna M, Berg Christoph, Weber Eva C, Gembruch Ulrich, Wolter Aline, Sterzbecher Vanessa, Bedei Ivonne, Axt-Fliedner Roland
Department of Cardiovascular Surgery, University Hospital Giessen, Justus-Liebig University, Giessen, Germany.
Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital Giessen, Justus-Liebig University, Giessen, Germany.
Arch Gynecol Obstet. 2024 Aug;310(2):817-824. doi: 10.1007/s00404-024-07376-7. Epub 2024 Feb 16.
Critical aortic stenosis (AS) in fetuses may progress to hypoplastic left heart syndrome (HLHS) with need for postnatal single ventricular (SV) palliation. Fetal aortic valvuloplasty (FAV) is performed to achieve postnatal biventricular (BV) circulation. However, the impact of FAV on fetal myocardial function is difficult to measure. Prediction of postnatal circulatory status and, therefore, counseling is challenging.
Retrospective study of fetuses with critical AS who underwent FAV. Global Longitudinal Peak Systolic Strain (GLPSS) of the left ventricle (LV) and right ventricle (RV) were retrospectively analyzed before and after intervention. Fisher's Exact Test and Mann-Whitney-U Test were used for univariant statistical analysis.
23 fetuses with critical AS were included. After intervention fetuses demonstrated more negative LV-GLPSS mean values post- vs. pre-intervention (- 5.36% vs. - 1.57%; p < 0.05). RV-GLPSS was decreased in all fetuses, there was no peri-interventional change. 20 fetuses were born alive. Postnatally, 10 had BV and 10 SV circulation. Improved post-interventional LV-GLPSS strain values correlated with BV outcome (p < 0.05). Pre-interventional continuous LV-GLPSS values correlated with postnatal SV vs. BV outcome (p < 0.05).
In some fetuses, LV myocardial function assessed by speckle tracking echocardiography (STE) improves after FAV. Improved post-interventional LV-GLPSS correlates with biventricular postnatal outcome. Furthermore, pre-interventional LV- and RV-GLPSS correlate with postnatal outcome. Further studies are needed to asses, if pre-interventional STE parameters might predict which fetuses will benefit from FAV with postnatal BV circulation.
胎儿严重主动脉瓣狭窄（AS）可能进展为左心发育不全综合征（HLHS），出生后需要进行单心室（SV）姑息治疗。进行胎儿主动脉瓣成形术（FAV）以实现出生后的双心室（BV）循环。然而，FAV对胎儿心肌功能的影响难以测量。预测出生后的循环状态并因此提供咨询具有挑战性。
对接受FAV的严重AS胎儿进行回顾性研究。回顾性分析干预前后左心室（LV）和右心室（RV）的整体纵向峰值收缩期应变（GLPSS）。采用Fisher精确检验和Mann-Whitney-U检验进行单变量统计分析。
纳入23例严重AS胎儿。干预后，胎儿LV-GLPSS平均值在干预后比干预前更负（-5.36%对-1.57%；p<0.05）。所有胎儿的RV-GLPSS均降低，围手术期无变化。20例胎儿存活出生。出生后，10例有BV循环，10例有SV循环。干预后LV-GLPSS应变值的改善与BV结局相关（p<0.05）。干预前连续的LV-GLPSS值与出生后SV与BV结局相关（p<0.05）。
在一些胎儿中，经斑点追踪超声心动图（STE）评估的LV心肌功能在FAV后有所改善。干预后LV-GLPSS的改善与出生后的双心室结局相关。此外，干预前LV和RV-GLPSS与出生后结局相关。需要进一步研究以评估干预前STE参数是否可以预测哪些胎儿将从FAV及出生后的BV循环中获益。
