Fetal pulmonary venous flow pattern is determined by left atrial pressure: report of two cases of left heart hypoplasia, one with patent and the other with closed interatrial communication

Lenz, F.; Machlitt, A.; Hartung, J.; Bollmann, Rainer; Chaoui, Rabih

doi:10.1046/j.1469-0705.2002.00684.x

Cited by 19 publications

(16 citation statements)

References 19 publications

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“…Our three types of PV flow patterns likely represent a continuum in the degree of LA hypertension, with progressively decreasing early diastolic forward flow and increasing a-wave reversal with worsening LA hypertension. The short, very pulsatile, to-and-fro flow PV flow pattern has only been previously demonstrated in an isolated case report of fetal HLHS with an intact atrial septum (25). The fact that differences in the degree of a-wave reversal observed in type A and B flow patterns did not result in significant clinical differences may reflect only more subtle but not clinically relevant differences in LA pressure, as well as the influence of other variables on PV flow patterns (18,(21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 92%

“…Altered systemic venous flow patterns with increasing a-wave reversal have been shown to correlate with increased right atrial pressures in adults (16) and fetuses (17). Increased a-wave reversal in the pulmonary veins (PVs) has been shown to reflect LA hypertension in adults (18 -24), and preliminary work suggests that it may also reflect LA hypertension in fetal HLHS (15,25). In the present study, we sought to determine whether direct FO measurements and PV patterns correlate with postnatal FO restriction, clinical evidence of LA hypertension, and outcome after birth.…”

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confidence: 98%

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Intrauterine pulmonary venous flow and restrictive foramen ovale in fetal hypoplastic left heart syndrome

Taketazu

Barréa

Smallhorn

et al. 2004

Journal of the American College of Cardiology

117

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Section: Discussionmentioning

confidence: 92%

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confidence: 98%

Intrauterine pulmonary venous flow and restrictive foramen ovale in fetal hypoplastic left heart syndrome

Taketazu

Barréa

Smallhorn

et al. 2004

Journal of the American College of Cardiology

117

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“…Prominent flow reversal in dilated pulmonary veins indicated LA hypertension in all 7 fetuses despite the presence of small decompressing veins in 2 ( Figure 1). 13,14 Two fetuses were hydropic at diagnosis. Three of the fetuses had a small LA with a thick atrial septum, whereas the others had a thin septum bowing into the right atrium.…”

Section: Methodsmentioning

confidence: 99%

Creation of an Atrial Septal Defect In Utero for Fetuses With Hypoplastic Left Heart Syndrome and Intact or Highly Restrictive Atrial Septum

et al. 2004

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Background-Infants born with hypoplastic left heart syndrome and an intact or highly restrictive atrial septum face a neonatal mortality of at least 48% despite early postnatal left atrial decompression and palliative surgery. Prenatal left atrial decompression has been suggested as a means of improving these outcomes. This study reports the feasibility of fetal catheterization to create an interatrial communication and describes technical considerations. Methods and Results-Seven fetuses at 26 to 34 weeks' gestation with hypoplastic left heart syndrome and intact or highly restrictive atrial septum underwent attempted prenatal intervention. Under ultrasound guidance, the atrial septum was approached with a needle introduced percutaneously from the maternal abdominal surface. In 6 of 7 fetuses, the atrial septum was successfully perforated, with balloon dilation of this iatrogenic defect resulting in a small but persistent interatrial communication. There were no maternal complications. One fetus died after the procedure. The remaining fetuses were liveborn at term, although 4 died as neonates. Conclusions-Ultrasound-guided fetal atrial septoplasty consisting of septal puncture and balloon dilation is feasible and can be performed percutaneously to minimize maternal risk. Although we have not demonstrated any positive clinical impact to date, it is our hope that further technical evolution will ultimately enable prenatal left atrial decompression and improvement of outcomes in fetuses with hypoplastic left heart syndrome and intact atrial septum.

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“…Changes in fetal pulmonary venous Doppler (PVD) flow patterns in the setting of left heart obstruction, reflective of left atrial hypertension, 12,13 are now routinely demonstrable by pulsed Doppler evaluation on fetal echocardiography. [13][14][15][16] Moreover, it has been demonstrated that in the fetus with left heart obstruction and RAS, there are changes in pulmonary venous flow patterns 13 associated with the need for emergent atrial septoplasty (EAS) in the newborn period.…”

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confidence: 99%

Predictive Value of Fetal Pulmonary Venous Flow Patterns in Identifying the Need for Atrial Septoplasty in the Newborn With Hypoplastic Left Ventricle

et al. 2005

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Background-Pulmonary venous Doppler (PVD) flow patterns in the fetus with hypoplastic left heart syndrome (HLHS) have been correlated with restrictive interatrial communication or intact atrial septum (RAS) postnatally; however, the ability of PVD to identify the neonate requiring emergent atrial septoplasty (EAS) for severe left atrial hypertension and hypoxemia has not been critically evaluated. It was the purpose of this study to determine the predictive power of fetal PVD in identifying the need for EAS in newborns with HLHS and RAS. Methods and Results-Forty-one patients with fetal PVD flow analysis and postnatally confirmed HLHS were studied.Pulsed-wave assessment of PVD flow included S-, D-, and A-wave velocity, time-velocity integral (VTI) of forward and reverse flow, and S/D velocity and forward/reverse VTI ratio. Neonatal EAS was used as the primary clinical outcome variable. Receiver operating characteristic curves were used to determine cutpoints at which PVD indices best predicted EAS. Cutpoints were evaluated for clinical accuracy and usefulness by use of Bayesian analysis. Eight of 41 subjects underwent EAS. Need for EAS was most accurately predicted by forward/reverse VTI ratio Ͻ5 (sensitivity, 0.88, 95% CI, 0.49 to 0.99; specificity, 0.97, 95% CI, 0.82 to 0.99), which, when present, increases the posttest likelihood of EAS to 74%, assuming a pretest prevalence of 10%. Accuracy and usefulness of other PVD indices were affected by false-positive results. Conclusions-In the fetus with HLHS, a PVD forward/reverse VTI ratio of Ͻ5 is the strongest predictor of the need for EAS in the newborn period. These observations should improve our ability to identify and expectantly manage the fetus with HLHS and RAS.

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Fetal pulmonary venous flow pattern is determined by left atrial pressure: report of two cases of left heart hypoplasia, one with patent and the other with closed interatrial communication

Cited by 19 publications

References 19 publications

Intrauterine pulmonary venous flow and restrictive foramen ovale in fetal hypoplastic left heart syndrome

Intrauterine pulmonary venous flow and restrictive foramen ovale in fetal hypoplastic left heart syndrome

Creation of an Atrial Septal Defect In Utero for Fetuses With Hypoplastic Left Heart Syndrome and Intact or Highly Restrictive Atrial Septum

Predictive Value of Fetal Pulmonary Venous Flow Patterns in Identifying the Need for Atrial Septoplasty in the Newborn With Hypoplastic Left Ventricle

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