Preferential streaming of the ductus venosus and inferior caval vein towards the right heart is associated with left heart underdevelopment in human fetuses with left-sided diaphragmatic hernia

Stressig, R; Fimmers, Rolf; Eising, K.; Gembruch, Ulrich; Kohl, Thomas

doi:10.1136/hrt.2010.196550

Cited by 55 publications

(42 citation statements)

References 11 publications

(10 reference statements)

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“…However, there might be an uncommon angle of pulmonary vein insertion leading to a blood flow through the fossa ovalis. This concept of abnormal insertion angle of veins into the heart has already been proposed for fetuses with left-sided liver-up congenital diaphragmatic hernia [26]. Postnatally, there was also a L-R shunt through the foramen ovale, which is very often seen in completely normal newborns.…”

Section: Discussionmentioning

confidence: 99%

Congenital Idiopathic Dilatation of the Right Atrium: Antenatal Appearance, Postnatal Management, Long-Term Follow-Up and Possible Pathomechanism

et al. 2012

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Introduction: Idiopathic dilatation of the right atrium (IDRA) is a rare abnormality usually detected by chance at any time between antenatal and adult life. It is defined as isolated enlargement of the right atrium in the absence of other cardiac lesions causing right atrial dilatation. IDRA can be associated with atrial arrhythmia and systemic embolism. The clinical presentation shows high variability ranging from the lack of any symptoms up to cardiac failure. Methods/Results: We describe 2 children with antenatally diagnosed IDRA, the intrauterine course in 1 case, the postnatal management and its long-term follow-up. There has been no need for surgical intervention so far because of the lack of arrhythmias and no further progression of right atrial diameters. Thrombus formation in the right atrium, which is a potential risk for pulmonary embolism, led us to initiate anticoagulation in our cases to prevent such complications. Furthermore, we suggest one possible pathomechanism of congenital right atrial dilatation. Conclusion: Optimal management of severe IDRA depends on the individual case. Long-term follow-up of these patients is necessary to monitor a possible further progression of right atrial size and occurrence of arrhythmias. As a possible pathomechanism, a functional partial anomalous pulmonary venous insertion may imitate a structural abnormal pulmonary vein connection in some idiopathic cases of congenital right atrial dilatation.

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Section: Discussionmentioning

confidence: 99%

Congenital Idiopathic Dilatation of the Right Atrium: Antenatal Appearance, Postnatal Management, Long-Term Follow-Up and Possible Pathomechanism

et al. 2012

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“…Left heart underdevelopment [8,114,115] is commonly observed in fetuses with congenital diaphragmatic hernia. This finding has been attributed to compression of the left atrium by herniated abdominal organs (mainly the liver), redistribution of fetal cardiac output, and/or low pulmonary venous return.…”

Section: Research and Clinical Applications Of Fetal Cardiac Functionmentioning

confidence: 99%

Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications

2012

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Fetal echocardiography was initially used to detect structural anomalies but has more recently also been proposed to assess fetal cardiac function. This review summarizes technical issues and limitations in fetal cardiac function evaluation, as well as its potential research and clinical applications. Functional echocardiography has been demonstrated to select high-risk populations and to be associated with outcome in several fetal conditions including intrauterine growth restriction, twin-to-twin transfusion syndrome, maternal diabetes, and congenital diaphragmatic hernia. Fetal heart evaluation is challenging due to the smallness and high heart rate of the fetus and restricted access to the fetus far from the transducer. Due to these limitations and differences in cardiac function which are related to fetal maturation, cardiovascular parameters should be validated in the fetus and used with caution. Despite these precautions, in expert hands and with appropriate ultrasound equipment, evaluation of cardiac function is feasible in most fetuses. Functional fetal echocardiography is a promising tool that may soon be incorporated into clinical practice. Research is warranted to further refine the contribution of fetal cardiac assessment to the diagnosis, monitoring, or prediction of outcomes in various fetal conditions.

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“…, 14 In addition, given the substantial evidence indicating the occurrence of programming of adult cardiovascular disease in fetal life, 15 – 18 cardiac function assessment might help to predict perinatal and long‐term cardiovascular outcomes. Despite fetal heart evaluation being challenging due to the small size of the heart, its high heart rate and restricted access to the fetus in the maternal abdomen, the evaluation of cardiac function is feasible in most fetuses by experienced healthcare professionals, whether they ultrasonographers, obstetricians, cardiologists, perinatologists or radiologists.…”

Section: Importance Of Fetal Cardiac Functionmentioning

confidence: 99%

“…Fetal cardiac function has been proposed as selection criteria to predict progression to hypoplastic left heart syndrome and eligibility for prenatal cardiac intervention in critical aortic stenosis 44 . Functional echocardiography can be also useful for the better understanding and prognosis of other congenital heart diseases or primary cardiomyopathies. Cardiac adaptation to extracardiac anomalies : The heart is a central organ in fetal adaptive mechanisms to disease, and cardiac dysfunction (due to heart compression, volume/pressure overload or direct insult to the myocardium) is recognised as being among the central pathophysiologic features of intrauterine growth restriction, 25 , 50 maternal diabetes, 45 , 56 twin‐to‐twin transfusion syndrome, 10 congenital diaphragmatic hernia (CDH) 5 , 14 and other fetal anomalies such as congenital cystic adenomatoid malformation, sacrococcygeal teratoma or arteriovenous malformations, Dows' syndrome, absence of the DV, lower urinary tract obstruction with massive bladder distension, fetal anemia and preterm rupture of membranes, particularly in cases with intra‐amniotic infection 45 46 …”

Section: Importance Of Fetal Cardiac Functionmentioning

confidence: 99%

Ultrasound assessment of fetal cardiac function

Crispi

Valenzuela-Alcaráz

Cruz‐Lemini

et al. 2013

Australas J Ultrason Med

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Introduction: Fetal heart evaluation with US is feasible and reproducible, although challenging due to the smallness of the heart, the high heart rate and limited access to the fetus. However, some cardiac parameters have already shown a strong correlation with outcomes and may soon be incorporated into clinical practice. Materials and Methods: Cardiac function assessment has proven utility in the differential diagnosis of cardiomyopathies or prediction of perinatal mortality in congenital heart disease. In addition, some cardiac parameters with high sensitivity such as MPI or annular peak velocities have shown promising results in monitoring and predicting outcome in intrauterine growth restriction or congenital diaphragmatic hernia. Conclusion: Cardiac function can be adequately evaluated in most fetuses when appropriate expertise, equipment and time are available. Fetal cardiac function assessment is a promising tool that may soon be incorporated into clinical practice to diagnose, monitor or predict outcome in some fetal conditions. Thus, more research is warranted to further define specific protocols for each fetal condition that may affect cardiac function.

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Preferential streaming of the ductus venosus and inferior caval vein towards the right heart is associated with left heart underdevelopment in human fetuses with left-sided diaphragmatic hernia

Cited by 55 publications

References 11 publications

Congenital Idiopathic Dilatation of the Right Atrium: Antenatal Appearance, Postnatal Management, Long-Term Follow-Up and Possible Pathomechanism

Congenital Idiopathic Dilatation of the Right Atrium: Antenatal Appearance, Postnatal Management, Long-Term Follow-Up and Possible Pathomechanism

Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications

Ultrasound assessment of fetal cardiac function

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