Biventricular impact of mild to moderate fetal pulmonary valve stenosis

Guirado, L.; Crispi, F.; Masoller, N.; Bennásar, M.; Marimón, E.; Carretero, Juan; Gratacós, E.; Martínez, Josep M.; Friedberg, Mark K.; Gómez, O.

doi:10.1002/uog.17456

Cited by 20 publications

(25 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Myocardial Hypertrophy with Preserved Cardiac Size Persistent pressure overload induces globular shape but also increased myocardial wall thickness and reduced ventricular cavities (increased relative wall thickness) maintaining a normal outer heart size. This pattern has been described in cases of severe pulmonary stenosis characterized by thicker septal and right myocardial walls together with smaller right ventricular cavity and signs of diastolic dysfunction [11]. The chronic right pressure overload induces right ventricular hypertrophy as well as a more spherical configuration with a smaller inner diameter in order to generate higher force and pressure with lower stress on the individual myocytes and less energy consumption.…”

Section: Globular Shapementioning

confidence: 82%

“…Pressure Overload. Pulmonary/aortic stenosis [5,11], twin-to-twin transfusion syndrome [12][13][14], placental disease [15], and conception by assisted reproductive technologies [16] induce pressure overload and trigger a fetal heart response by initially changing to a more globular shape (to better tolerate wall stress) and subsequently further increas-Fetal Diagn Ther 2020;47:337-344 DOI: 10.1159/000506047 ing the contractile force (myocardial hypertrophy) as well as decreasing the inner diameter of the chamber.…”

Section: Main Determinants Of Fetal Cardiac Remodelingmentioning

confidence: 99%

See 1 more Smart Citation

Main Patterns of Fetal Cardiac Remodeling

et al. 2020

View full text Add to dashboard Cite

The heart is a central organ in the fetal adaptation to an adverse environment. Fetal cardiac changes may persist postnatally and increase the risk of cardiovascular disease in adulthood. Knowledge about fetal cardiac structural as well as functional remodeling has radically improved over the last few years. As it occurs in postnatal life, the fetal heart remodels -changing its structure and shape -to adapt to an insult. Several conditions have been reported to be associated with fetal cardiac remodeling including intrauterine growth restriction, diabetes, exposure to antiretroviral drugs, conception by assisted reproductive technologies, pulmonary stenosis, and other congenital heart diseases. Here we summarized the main observable patterns of cardiac remodeling, i.e., globular shape, hypertrophy without dilation, and hypertrophy with cardiomegaly. We discuss the potential pathophysiology behind different types of remodeling. Defining precisely the distinct patterns of fetal cardiac remodeling is critical for advancing in the understanding of fetal cardiovascular programming and its consequences on adult health, and potentially for the design of preventive strategies that might have an impact on long-term cardiovascular health.

show abstract

Section: Globular Shapementioning

confidence: 82%

Section: Main Determinants Of Fetal Cardiac Remodelingmentioning

confidence: 99%

Main Patterns of Fetal Cardiac Remodeling

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Although fetal RV function assessment remains challenging, our results show that RV FAC is a reproducible parameter that can be readily obtained from a standard apical/basal 2D 4-chamber view. We propose reference ranges from 18 to 41 weeks of gestation, obtained following a strict methodology and adjusted by GA and EFW that could be useful to evaluate RV systolic function in different clinical conditions such as CHD [6][7][8][9], intrauterine growth restriction [10], or conception by assisted reproductive techniques [11]. Fetal RV FAC may thus be a potentially useful parameter for prenatal assessment of RV function.…”

Section: Discussionmentioning

confidence: 99%

“…In fetal life, RV function is critically important due to the unique fetal circulation and dominant RV. In addition to fetal CHD [6][7][8][9], conditions such as fetal growth restriction [10], the use of assisted reproductive techniques [11], twin-to-twin transfusion in monochorionic twin pregnancies [12][13][14], and right-sided congenital diaphragmatic hernia [15] can induce RV morphometric and functional changes, which can persist into childhood [16] leading to cardiovascular dysfunction in adulthood. Therefore, the prenatal assessment of RV performance may be useful not only for fetal monitoring but also for postnatal follow-up [17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

et al. 2019

View full text Add to dashboard Cite

Objectives: Fetal right ventricular (RV) function assessment is challenging due to the RV geometry and limitations of in utero assessment. Postnatally, 2D echocardiographic RV fractional area change (FAC) is used to assess RV global systolic function by calculating the percentage of change in RV area from systole to diastole. Reports on FAC are scarce in prenatal life, and nomograms throughout pregnancy are not available. Our aims were (1) to study prenatal RV FAC feasibility and reproducibility and (2) to construct nomograms for RV FAC and end-diastolic (ED) and end-systolic (ES) RV areas from 18 to 41 weeks of gestation. Methods: Prospective cohort study including 602 low-risk singleton pregnancies undergoing a fetal echocardiography from 18 to 41 weeks of gestation. RV ED and ES areas were measured following standard recommendations for ventricular dimensions and establishing strict landmarks to identify the different phases of the cardiac cycle. RV FAC was calculated as: ([ED area -ES area]/ED area) × 100. RV FAC intra-and inter-observer reproducibility was evaluated in 45 fetuses by calculating the intraclass correlation coefficient (ICC). Parametric regressions were tested to model each parameter against gestational age (GA) and estimated fetal weight (EFW). Results: RV areas and FAC were successfully obtained in ∼99% of fetuses with acceptable reproducibility throughout gestation (RV ED area inter-observer ICC [95% CI] 0.96 [0.93-0.98], RV ES area 0.97 [0.94-0.98], and FAC 0.69 [0.44-0.83]). Nomograms were constructed for RV ED and ES areas and FAC. RV areas showed a quadratic and logarithmic increase with GA and EFW, respectively. In contrast, RV FAC showed a slight quadratic decrease throughout gestation (mean RV FAC ranged from 36% at 18 weeks of gestation [10-90th centiles: 25-47%, respectively] to 29% at 41 weeks [10-90th centiles: 18-40%, Guirado et al. respectively]). The best models for RV areas and FAC were a second-degree polynomial. Conclusions: RV FAC is a feasible and reproducible parameter to assess RV global systolic function in fetal life. We provide reference ranges adjusted by GA and EFW that can be used as normal references for the assessment of RV function in prenatal conditions.

show abstract

“…Since then, technical advances have enabled a notable improvement in the assessment of cardiac structure and function. DOI The concept of cardiac remodeling -defined as changes in size, shape, structure, and function of the heart in order to adapt to an insult [4] -is now being applied in fetal life not only in CHD cases [5] but also in other prenatal conditions, such as fetal growth restriction (FGR) [6], the use of assisted reproductive techniques (ART) [7], exposure to toxics [8], and pregestational diabetes [9]. An adverse prenatal environment during the crucial period of in utero development might have a direct impact on fetal cardiac structure and long-lasting consequences on health [10].…”

Section: Introductionmentioning

confidence: 99%

Nomograms of Fetal Cardiac Dimensions at 18–41 Weeks of Gestation

et al. 2019

View full text Add to dashboard Cite

Objective: There is a need for standardized reference values for cardiac dimensions in prenatal life. The objective of the present study was to construct nomograms for fetal cardiac dimensions using a well-defined echocardiographic methodology in a low-risk population. Methods: This is a prospective cohort study including 602 low-risk singleton pregnancies undergoing a standardized fetal echocardiography to accurately assess fetal cardiac, ventricular, and atrial dimensions. Parametric regressions were tested to model each measurement against gestational age from 18 to 41 weeks of gestation. Results: Nomograms were constructed for fetal cardiac dimensions (transverse and longitudinal diameters and areas) of the whole heart, atria, and ventricles, as well as myocardial wall thicknesses. All dimensions showed a progressive increase with gestational age. The best model for most parameters was a second-degree linear polynomial.Fetal cardiac, ventricular, and atrial diameters and areas were successfully obtained in 98.6% of the fetuses, while myocardial wall thicknesses could be obtained in 96.5% of the population. The results showed excellent interobserver and intraobserver reproducibility (intraclass correlation coefficient, ICC > 0.811 and ICC > 0.957, respectively). Conclusions: We provide standardized and comprehensively evaluated reference values for fetal cardiac morphometric parameters across gestation in a low-risk population. These nomograms would enable the early identification of different patterns of fetal cardiac remodeling.

show abstract

Biventricular impact of mild to moderate fetal pulmonary valve stenosis

Cited by 20 publications

References 36 publications

Main Patterns of Fetal Cardiac Remodeling

Main Patterns of Fetal Cardiac Remodeling

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

Nomograms of Fetal Cardiac Dimensions at 18–41 Weeks of Gestation

Contact Info

Product

Resources

About