Advanced imaging of fetal cardiac function

Abstract

Over recent decades, a variety of advanced imaging techniques for assessing cardiovascular physiology and cardiac function in adults and children have been applied in the fetus. In many cases, technical development has been required to allow feasibility in the fetus, while an appreciation of the unique physiology of the fetal circulation is required for proper interpretation of the findings. This review will focus on recent advances in fetal echocardiography and cardiovascular magnetic resonance (CMR), providing examples of their application in research and clinical settings. We will also consider future directions for these technologies, including their ongoing technical development and potential clinical value.

How automated techniques ease functional assessment of the fetal heart: applicability of two-dimensional speckle-tracking echocardiography for comprehensive analysis of global and segmental cardiac deformation using fetalHQ®

“…A significant correlation between the endoGLS and the gestational age (GA) is controversially debated in the current literature. Both, an increase and a decrease in endoGLS as well as constant values have been reported previously with advancing GA [2,3,10,14,19,25,[27][28][29]. These conflicting data regarding normal reference ranges and changes of endoGLS complicate the interpretation of current results [14].…”

“…The endoGLS, a commonly used deformation parameter [10,14,17], is calculated as the difference in the length of the endocardium from the base of the lateral wall across the apex to the base of the septal wall at end-diastole and end-systole (endoGLS = [(end-systolic endocardial length -end-diastolic endocardial length)/end-diastolic endocardial length] x 100) [19]. In the small fetal heart, measurement of longitudinal global strain appears to be the most accurate and sensitive parameter to visualize pathologies [25], even though others state that the diagnostic and prognostic value of fetal endoGLS has remained uncertain [10]. Because global strain parameters, such as the endoGLS, are less sensitive to local noise and their measurement is more practical, it is considered to be more robust compared to the segmental ones [25,26].…”

“…In the small fetal heart, measurement of longitudinal global strain appears to be the most accurate and sensitive parameter to visualize pathologies [25], even though others state that the diagnostic and prognostic value of fetal endoGLS has remained uncertain [10]. Because global strain parameters, such as the endoGLS, are less sensitive to local noise and their measurement is more practical, it is considered to be more robust compared to the segmental ones [25,26]. There is still limited data available on the normal ranges of endoGLS during pregnancy [2].…”

Fetal MRI-Based Mediastinal Shift Angle (MSA) and Percentage Area of Left Ventricle (pALV) as Prognostic Parameters for Congenital Diaphragmatic Hernia

“…In addition to ECG gating, there are other methods of gating: metric-optimized gating and Doppler ultrasound gating (DUS-gating) [ 17 , 18 ]. With metric-optimized gating, data are recorded at an exaggerated time and a post-processing technique is used to assign the correct heart rate after scanning.…”

“…MR-compatible DUS offers another option. The ultrasound device is based on Doppler waveforms of the heart rate trigger and is directly connected to the MR scanner [ 17 , 18 ]. However, this method is susceptible to movement.…”