Left and Right Ventricular Function in Fetal Tetralogy of Fallot with Absent Pulmonary Valve

Inamura, Noboru; Kado, Yukiko; Nakajima, Tohru; Kayatani, Futoshi

doi:10.1055/s-2005-866603

Cited by 21 publications

(13 citation statements)

References 10 publications

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“…Inamura et al 15 used the MPI to predict survival in congenital heart disease and found that both the left and right Tei indices were increased in nonsurvivors compared with survivors.…”

Section: Discussionmentioning

confidence: 99%

First-Trimester Fetal Cardiac Function

Russell

McAuliffe

2008

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to establish normal values for fetal heart function in the first trimester. Methods. This was a prospective observational study with institutional ethics approval and written maternal consent. Thirty-two healthy pregnant women were recruited, and transabdominal fetal echocardiography was performed between 12 and 14 completed weeks' gestation. Myocardial function was assessed with the myocardial performance index to assess combined systolic and diastolic function, isovolumetric contraction time to assess systolic function, and isovolumetric relaxation time to assess diastolic function. Mitral and tricuspid inflows were also assessed by determining the ratio between passive and active ventricular filling. The ventricular outflows were also assessed by peak systolic velocities (PSVs) and time velocity integrals (TVIs). Results. The mean gestational age at the time of echocardiography was 13 weeks, and the mean crown-rump length was 79 mm. All fetuses had a normal nuchal translucency measurement (mean, 1.5 mm). The myocardial performance index was the same in the left and right sides of the heart, 0.5. The mean isovolumetric relaxation time and isovolumetric contraction time on the left side of the heart were 41 and 36 milliseconds, respectively. The mean passive/active ventricular filling ratio was 0.6 at both the mitral and tricuspid valves. The mean aortic PSV was 26 cm/s, and mean pulmonary artery PSV was 32 cm/s. The mean aortic outflow TVI was 3.6 cm, and the mean pulmonary outflow TVI was 4.1 cm. Conclusions. This study establishes normal values for cardiac function at 12 to 14 weeks' gestation. These values may assist in assessment of fetal health in early pregnancy. Key words: cardiac function; echocardiography; fetus; first trimester; myocardial performance index. dvances in ultrasound technology have led to improved visualization of the fetus in the first trimester. This has led to increased interest in examining the fetus for abnormalities, with early fetal echocardiography now offered in many units. A recent article on early fetal echocardiography in firsttrimester fetuses found that a satisfactory cardiac examination was possible in 95% of cases, with sensitivity of 70% and specificity of 98% for detection of cardiac defects. 1 Assessment of cardiac function with Doppler examination of the atrioventricular (AV) valves has been performed in early pregnancy. Those studies found that the proportion of the cardiac cycle occupied by both the isovolumetric relaxation time (IVRT) and isovolumetric contraction time (ICT) reduces during the first trimester. [2][3][4] The myocardial performance index (MPI) is a useful noninvasive Doppler-derived method of evaluating combined systolic and diastolic function, first described in

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“…Inamura et al 15 used the MPI to predict survival in congenital heart disease and found that both the left and right Tei indices were increased in nonsurvivors compared with survivors.…”

Section: Discussionmentioning

confidence: 99%

First-Trimester Fetal Cardiac Function

Russell

McAuliffe

2008

Journal of Ultrasound in Medicine

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“…An increased IRT is generally accompanied by a reduced ET, with the ICT the most stable MPI parameter [4]. The MPI has been used to demonstrate fetal cardiac dysfunction in a number of pathologies including maternal diabetes [11,12,13,14,15,16], TTTS [7,17,18,19,20,21,22], congenital heart malformations [23,24,25,26,27,28], pre-eclampsia [29], IUGR [11,30,31,32,33,34], and other fetal conditions [35,36,37,38]. Several studies have proposed methods to improve the repeatability of fetal MPI by defining fixed machine settings [39] and using the clicks of the aortic and mitral valves as landmarks to delineate the constituent time intervals [9,40,41].…”

Section: Introductionmentioning

confidence: 99%

The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

et al. 2015

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Functional cardiovascular assessment is becoming an increasingly important tool in the study of fetal pathology. The myocardial performance index (MPI) is a parameter measuring global myocardial function. Since its introduction, several studies have proposed methods to improve its reproducibility and have constructed normative reference ranges. Fetal heart evaluation using the MPI is technically challenging, requiring specific training and expertise, and a consensus has yet to be reached on the method of delineating the time periods used to calculate the index. Despite these limitations, it has been shown to be a useful and highly sensitive parameter of dysfunction in a number of fetal pathologies. Further research is warranted into the effect of pathology on MPI, parameters of unilateral cardiac strain that utilise MPI, and automation of the MPI to encourage incorporation of the MPI as a useful tool in clinical practice.

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“…One fetus had arrhythmia (supraventricular tachycardia) at the time of diagnosis, but it disappeared gradually after birth. In two cases, we calculated the right ventricular TEI index of the fetus by using inflow Doppler as previously described 6,7 and found that it was elevated (0.61 and 1.92; normal, 0.38 ± 0.04), which suggested the fetal right ventricular dysfunction.…”

Section: Resultsmentioning

confidence: 96%