Behavior of septum primum mobility in third-trimester fetuses with myocardial hypertrophy

Echocardiographic features and outcomes of fetuses with isolated restrictive foramen ovale or redundant foramen ovale flap using atrial septum excursion index

PURPOSE

This study was designed to investigate the application value of the atrial septum excursion index (ASEI) in fetuses with isolated restrictive foramen ovale (RFO) or redundant foramen ovale flap (RFOF) and the outcomes of these fetuses.

METHODS

This was a retrospective study. Healthy pregnant women who were examined by antenatal fetal echocardiography from January 1, 2019 to December 31, 2021, at Sir Run Run Shaw Hospital were enrolled. One hundred seventy-seven (177) fetuses were categorized into three groups by diagnosis: (1) RFOF (n = 33), (2) RFO (n = 21), and (3) normal (n = 123). Fetal echocardiographic features and postnatal outcomes were collected.

RESULTS

The median ASEIs were 0.50 (range, 0.41-0.65) in the control group, 0.76 (range, 0.67-0.88) in the RFOF group and 0.31 (range, 0.14-0.35) in the RFO group, and the differences were significant (p < 0.001). The ratios of right atrium/left atrium, right ventricle/left ventricle, and pulmonary artery diameter to aorta diameter (PA/AO) and the pulmonary annulus Z-scores were greater in fetuses with RFOF and RFO than in the controls (p < 0.05). Twenty-seven of 33 fetuses (87.9%) with RFOF and 19 of 21 fetuses (90.5%) with RFO had good outcomes after birth.

CONCLUSION

The ASEI may be a new tool for quantitatively assessing the mobility of foramen ovale flaps in fetuses with isolated RFOF or RFO.

Fetal septum primum excursion (SPE) and septum primum excursion index (SPEI) as sonomarkers of fetal anemia: using hemoglobin Bart's fetuses as a study model

OBJECTIVES

The objectives the study are to evaluate the effectiveness of septum primum excursion (SPE) and SPEI (SPE index, a ratio of SPE to left atrial diameter) in predicting fetal hemoglobin (Hb) Bart's disease and to determine the correlation between Hb levels and SPE/SPEI METHODS: The database of Cardio-STIC volume datasets (VDSs) of fetuses at risk of Hb Bart's disease at 18 to 22 weeks was assessed. The VDSs were blindly analyzed offline for measurements of SPE and SPEI.

RESULTS

Of 180 VDSs recruited, 44 were acquired from fetuses with Hb Bart's disease, while 136 were derived from unaffected fetuses. SPE and SPEI was inversely correlated with Hb levels (p < 0.0001). The SPE and SPEI were significantly higher in the affected group (4.1 + 1.1 mm vs 3.0 + 0.8 mm and 0.61 + 1.1 vs 0.49.1 + 0.1, respectively). SPE, at cut-off 1.3 multiple of median, gave a sensitivity and specificity of 75.0% and 72.7%, respectively, but less than a sensitivity (81.4%) and specificity (95.4%) of middle cerebral artery peak systolic velocity.

CONCLUSIONS

In anemic fetuses, SPE and SPEI was inversely correlated with Hb level. Additionally, SPE, better than SPEI, may be used as an adjunctive sonographic sign to predict Hb Bart's disease but its accuracy of prediction is not good enough to be used independently or as a diagnostic test. © 2016 John Wiley & Sons, Ltd.

Reference ranges for fetal septum primum excursion from 14 to 40 weeks' gestation

OBJECTIVES

The purpose of this study was to establish reference ranges for septum primum excursion and the septum primum excursion index.

METHODS

Normal singleton pregnancies with certain dates from 14 to 40 weeks' gestation were enrolled to acquire spatiotemporal image correlation volume data sets. The stored data sets were subsequently displayed offline to measure septum primum excursion and the left atrium diameter. The measured values were regressed to identify the best-fitted model as a function of gestational age and biparietal diameter.

RESULTS

A total of 624 volumes were successfully measured, and normal reference ranges for predicting means and standard deviations of septum primum excursion and the septum primum excursion index were established based on best-fitted equations. The septum primum excursion index was relatively constant throughout pregnancy (mean ± SD, 0.474 ± 0.082), whereas septum primum excursion increased with gestational age and biparietal diameter as follows: (1) septum primum excursion = -6.30 + 0.667 × gestational age - 0.009 × gestational age(2); SD of septum primum excursion = 0.219 + 0.02 × gestational age; and (2) septum primum excursion = -3.342 + 1.933 × biparietal diameter - 0.102 × biparietal diameter(2); SD of septum primum excursion = 0.330 + 0.065 × biparietal diameter. Percentile charts for predicting septum primum excursion and equations for Z score calculation were also provided.

CONCLUSIONS

Normal reference ranges for fetal septum primum excursion and the septum primum excursion index have been provided. These normative data may be useful tools for assessment of hemodynamics through the foramen ovale or left ventricular diastolic function.

Aortic isthmus blood flow in fetuses of diabetic mothers

OBJECTIVE

To test the hypothesis that the aortic isthmus flow index (IFI) is lower in fetuses of diabetic mothers than in fetuses of nondiabetic mothers.

STUDY DESIGN

We performed a cross-sectional observational study to assess the IFI in fetuses, with (n = 13) and without (n = 37) myocardial hypertrophy, of mothers with diabetes mellitus and in fetuses of nondiabetic mothers (n = 23). Analysis of variance and Tukey test were used to assess differences among the groups.

RESULTS

There were no differences in maternal or gestational age among the groups. In fetuses of diabetic mothers, the mean IFI in fetuses with myocardial hypertrophy was 1.19 ± 0.06, and in fetuses without it was 1.18 ± 0.09. The mean IFI in fetuses of nondiabetic mothers was 1.32 ± 0.07 (P < 0.001).

CONCLUSIONS

The IFI in fetuses of diabetic mothers is lower than in fetuses of nondiabetic mothers, possibly as a result of a decreased left ventricular compliance.

Dynamics of the septum primum in fetuses with intrauterine growth restriction

PURPOSE

To test the hypothesis that the linear displacement of the septum primum (SP) is lower in fetuses with intrauterine growth restriction (IUGR) than in fetuses with appropriate growth for gestational age (AGA).

METHODS

In a cross-sectional study, the ratio between the SP displacement and left atrial diameter (excursion index [EI]) was compared in 27 fetuses with IUGR (group 1), 24 fetuses with AGA of hypertensive mothers (group 2), and 35 controls (group 3). Flow through the atrioventricular (AV) valves and the umbilical artery resistance index (RI) were also compared.

RESULTS

Irrespective of gestational age, mean EI in group 1 (0.41 +/- 0.07) was significantly lower than in group 2 (0.48 +/- 0.07; p < 0.001) and than in group 3 (0.50 +/- 0.06; p < 0.001), with no significant differences between groups 2 and 3. In fetuses over 30 weeks of gestation of group 1, EI was lower (0.38 +/- 0.05) than in group 2 (0.49 +/- 0.07) and group 3 (0.51 +/- 0.06; p < 0.001). There was significant inverse correlation between EI and RI (r = 0.46; p < 0.01) and no correlation between EI and AV flow velocities.

CONCLUSIONS

SP mobility is reduced in fetuses over 30 weeks with IUGR compared with AGA fetuses. These findings may depend on alterations of left ventricular diastolic function and are correlated to the degree of placental insufficiency.

Left atrial shortening fraction in fetuses with and without myocardial hypertrophy in diabetic pregnancies

OBJECTIVE

To test the hypothesis that, in diabetic pregnancies, left atrial shortening fraction (LASF) is decreased in fetuses with myocardial hypertrophy, compared to those without hypertrophy and to fetuses of non-diabetic mothers.

METHODS

Fetal echocardiography was performed in women with pre-existing or gestational diabetes and in non-diabetic controls between 25 weeks' gestation and term. LASF was calculated using the formula: (end-systolic diameter-end-diastolic diameter)/end-systolic diameter, and data were compared between diabetic women with and without fetal myocardial hypertrophy and controls.

RESULTS

The study population comprised 53 diabetic women and 45 controls. Out of the 53 fetuses of diabetic women, 14 had myocardial hypertrophy and 39 had normal septal thickness. Gestational age at the time of examination did not differ significantly between the control group and the two diabetic subgroups (P = 0.57). Fetuses with myocardial hypertrophy presented a mean ( +/- SD) LASF of 0.32 +/- 0.11, those without myocardial hypertrophy 0.46 +/- 0.12, and those of normal mothers 0.53 +/- 0.09 (P < 0.001). A significant inverse linear correlation was observed between LASF and septal thickness (r = - 0.51, P < 0.001).

CONCLUSIONS

In diabetic pregnancies, LASF is lower in fetuses with myocardial hypertrophy than it is in those without hypertrophy and in fetuses of non-diabetic women, suggesting that LASF could be a useful alternative parameter in the assessment of fetal diastolic function.

Assessment of diastolic ventricular function in fetuses of diabetic mothers using tissue Doppler

OBJECTIVE

To identify the presence of ventricular diastolic dysfunction by tissue Doppler in fetuses of diabetic mothers, with or without septal hypertrophy, in comparison to fetuses of nondiabetic mothers.

METHODS

A contemporary transverse study in fetuses with a gestational age between 25 weeks to term, studying diastolic function by assessment using tissue Doppler and pulsed wave Doppler of the atrioventricular diastolic flow. The mothers of the fetuses all had previous or gestational diabetes, and were referred to the Fetal Cardiology Unit of the Institute of Cardiology in Porto Alegre, Brazil. We analysed variance with the Student-Neumann-Keuls post hoc test. An alfa of 0.05 was considered significant for statistical analysis.

RESULTS

The mean myocardial velocities of the E'and A' waves at the mural mitral annulus, in fetuses of diabetic mothers with myocardial hypertrophy, were, respectively, 7.00 plus or minus 1.6 centimetres per second, and 10.24 plus or minus 3.3 centimetres per second. In the fetuses of diabetic mothers group without myocardial hypertrophy, the comparable values were 7.19 plus or minus 2.4 centimetres per second and 10.77 plus or minus 3.77 centimetres per second, respectively. In the control group, they were 4.81 plus or minus 0.85 centimetres per second and 8.01 plus or minus 2.2 centimetres per second. The difference between the velocities in fetuses of diabetic mothers and in fetal normal mothers was statistically significant (p less than 0.05). Statistically significant differences were also observed in E' and A' diastolic waves at the aortic mitral annulus, as well as for the tricuspid annulus when tissue Doppler assessment was carried out in the same sample. The mean ratio between the E and E' of mitral and tricuspid waves in the control fetuses of normal mothers was significantly higher than in fetuses of diabetic mothers.

CONCLUSION

Pulsed tissue Doppler, when used in fetuses of diabetic mothers and compared with fetuses of nondiabetic mothers, shows evidence of impaired diastolic function, independently of the presence of myocardial hypertrophy.