Aortic Coarctation: A Comprehensive Analysis of Shape, Size, and Contractility of the Fetal Heart

Abstract

Background: An integrated assessment of the size and shape of the 4-chamber view (4-CV) and right and left ventricles (RV and LV) as well as the function of the RV and LV in fetuses with coarctation of the aorta (CoA) has not yet been conducted. Objectives: We evaluated the size and shape of the 4-CV, RV, and LV, and function of the RV and LV, to identify a profile for fetuses with CoA when compared to a control population. Methods: 50 CoA fetuses were compared to 200 controls. This was a retrospective case series comparing the 4-CV of CoA fetuses and controls. The 4-CV end-diastolic area, length, width, and sphericity index were measured to determine the configuration of the 4-CV. Speckle-tracking analysis was used to compute the RV and LV end-diastolic area, length, 24-segment sphericity index, 24-segment transverse width, and the following functional parameters:(1) fractional area change; (2) global, lateral, and septal strain;(3) basal-apical, lateral, and septal annular displacement and fractional shortening; and (4) 24-segment transverse width fractional shortening. Using 5 and 95% reference intervals, the CoA fetal measurements were classified; from these, the odds ratio was computed between the fetuses with CoA and the controls. p < 0.05 was considered significant. Results: In fetuses with CoA, the 4-CV was spherical in shape, increased in area and width, and decreased in length. Abnormal CoA sphericity indices reflected a flatter LV and a more spherical RV. The LV area, length, and width, and RV length were decreased. The transverse width of the RV was increased. RV and LV global, longitudinal, and transverse contractility were depressed. Conclusions: The results demonstrate previously unappreciated differences in the shape, size, and function of the heart in fetuses with CoA. These differences may assist examiners in identifying fetuses with CoA.

Main Patterns of Fetal Cardiac Remodeling

“…2d). This eccentric hypertrophy is usually associated with mild pericardial effusion, decreased longitudinal function, impaired relaxation [14,27], and abnormal regional deformation [28], with preserved ejection fraction in most cases. The pathophysiology of cardiac remodeling and dysfunction under placental insufficiency has been proposed to be caused by complex interactions [15].…”

“…Apart from the above mentioned, other patterns of fetal cardiac remodeling have also been reported describing ventricular elongation or hypoplasia, thinning of the ventricular walls, asymmetric remodeling, endocardial fibroelastosis, etc. [25][26][27][28][29][30][31][32].…”

A “holistic” sonographic view on congenital heart disease: How automatic reconstruction using fetal intelligent navigation echocardiography eases unveiling of abnormal cardiac anatomy part II—Left heart anomalies

“…In contrast to HLH, the apex is still formed by the LV, and the myocardial contractility seems to be normal in CoA. However, DeVore et al described the 4CV view to be more spherical in shape, increased in area and width, and decreased in length during speckle tracking analysis 41 . A recent meta‐analysis stated that adoption of multiparametric diagnostic models integrating different US signs may assist examiners in identifying fetuses with CoA.…”

“…However, DeVore et al described the 4CV view to be more spherical in shape, increased in area and width, and decreased in length during speckle tracking analysis. 41 A recent meta-analysis stated that adoption of multiparametric diagnostic models integrating different US signs may assist examiners in identifying fetuses with CoA. Interestingly, a persistent left superior vena cava, a ventricular septal defect, and a bicuspid aortic valve were not associated with an increased risk for this anomaly.…”

Using speckle‐tracking echocardiography to assess fetal myocardial deformation: are we there yet? Yes we are!

“…Lastly, we have reported a number of cardiac measurements derived from speckle‐tracking analysis of the right and left ventricular endocardium that analyze ventricular size, shape and contractility. This analysis, a relatively new adaptation of speckle‐tracking assessment, enables the examiner to obtain numerous cardiac measurements from a single endocardial tracing of each ventricle, which takes less than 3 min, and is now commercially available on ultrasound platforms dedicated primarily to fetal evaluation.…”