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Graupner O, Wieg L, Enzensberger C, Degenhardt J, Kawecki A, Wolter A, Khalil M, Schranz D, Yerebakan C, Kohl T, Doelle A, Axt-Fliedner R. Funktion des rechten Ventrikels bei Feten mit hypoplastischem Linksherzsyndrom und linksventrikulärer Endokardfibroelastose. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Graupner O, Enzensberger C, Wieg L, Willruth A, Steinhard J, Gembruch U, Doelle A, Bahlmann F, Kawecki A, Degenhardt J, Wolter A, Herrmann J, Axt-Fliedner R. Evaluation of right ventricular function in fetal hypoplastic left heart syndrome by color tissue Doppler imaging. Ultrasound Obstet Gynecol 2016; 47:732-738. [PMID: 26138790 DOI: 10.1002/uog.14940] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 06/23/2015] [Accepted: 06/28/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Postnatal outcome of fetuses with hypoplastic left heart syndrome (HLHS) is determined mainly by right ventricular function. Our study examines whether there are differences in right ventricular function during gestation of fetuses with HLHS compared with healthy fetuses. METHODS A prospective study was conducted including 20 fetuses with HLHS and 20 gestational age-matched controls. Peak systolic and diastolic right ventricular free wall velocities were assessed using color tissue Doppler imaging (c-TDI). Subsequently, isovolumic time intervals, ejection time (ET'), E'/A' ratio and tissue Doppler-derived myocardial performance index (MPI') were calculated. Possible changes to c-TDI indices during the course of pregnancy in both the HLHS group and the control group were investigated. RESULTS Examination of right ventricular function revealed significantly lower E' velocities (13.6 vs 21.0 cm/s; P = 0.017) and E'/A' ratios (0.55 vs 0.76; P = 0.012) and prolonged isovolumic contraction time (ICT') (57.0 vs 45.7 ms; P = 0.008) in the HLHS group compared with healthy fetuses. Furthermore, isovolumic relaxation time and MPI' increased significantly with gestational age in HLHS fetuses but not in controls. Values for systolic and diastolic peak velocities (E', A', S'), ET' and ICT' did not change significantly during gestation in either group. CONCLUSION Right ventricular function in HLHS is altered as early as in fetal life, well before palliative surgery is performed. Future research should provide further insight into ventricular remodeling during gestation in cases of HLHS. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- O Graupner
- Division of Perinatal Medicine, Department of Obstetrics & Gynecology, University Hospital Gießen and Marburg, Justus-Liebig University, Gießen, Germany
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - C Enzensberger
- Division of Perinatal Medicine, Department of Obstetrics & Gynecology, University Hospital Gießen and Marburg, Justus-Liebig University, Gießen, Germany
| | - L Wieg
- Division of Perinatal Medicine, Department of Obstetrics & Gynecology, University Hospital Gießen and Marburg, Justus-Liebig University, Gießen, Germany
| | - A Willruth
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - J Steinhard
- Fetal Cardiology, Heart & Diabetes Center, Ruhr University Bochum, North-Rhine Westphalia, Bad Oeynhausen, Germany
| | - U Gembruch
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - A Doelle
- Toshiba Medical Systems, Neuss, Germany
| | - F Bahlmann
- Department of Obstetrics and Gynecology, Bürgerhospital, Frankfurt, Germany
| | - A Kawecki
- Division of Perinatal Medicine, Department of Obstetrics & Gynecology, University Hospital Gießen and Marburg, Justus-Liebig University, Gießen, Germany
| | - J Degenhardt
- Division of Perinatal Medicine, Department of Obstetrics & Gynecology, University Hospital Gießen and Marburg, Justus-Liebig University, Gießen, Germany
| | - A Wolter
- Division of Perinatal Medicine, Department of Obstetrics & Gynecology, University Hospital Gießen and Marburg, Justus-Liebig University, Gießen, Germany
| | - J Herrmann
- Statistical Consulting Gießen, Gießen, Germany
| | - R Axt-Fliedner
- Division of Perinatal Medicine, Department of Obstetrics & Gynecology, University Hospital Gießen and Marburg, Justus-Liebig University, Gießen, Germany
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Graupner O, Wieg L, Enzensberger C, Degenhardt J, Kawecki A, Wolter A, Khalil M, Schranz D, Yerebakan C, Kohl T, Doelle A, Axt-Fliedner R. Funktion des rechten Ventrikels bei Feten mit hypoplastischem Linksherzsyndrom und linksventrikulärer Endokardfibroelastose. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Graupner O, Wieg L, Enzensberger C, Degenhardt J, Kawecki A, Wolter A, Khalil M, Schranz D, Yerebakan C, Kohl T, Herrmann J, Doelle A, Axt-Fliedner R. Funktion des rechten Ventrikels bei Feten mit hypoplastischem Linksherzsyndrom (HLHS). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1580650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Graupner O, Wieg L, Enzensberger C, Degenhardt J, Kawecki A, Wolter A, Doelle A, Axt-Fliedner R. Funktion des rechten Ventrikels bei Feten mit hypoplastischem Linksherzsyndrom (HLHS). Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Axt-Fliedner R, Graupner O, Kawecki A, Degenhardt J, Herrmann J, Tenzer A, Doelle A, Willruth A, Steinhard J, Gembruch U, Bahlmann F, Enzensberger C. Evaluation of right ventricular function in fetuses with hypoplastic left heart syndrome using tissue Doppler techniques. Ultrasound Obstet Gynecol 2015; 45:670-677. [PMID: 25418127 DOI: 10.1002/uog.14736] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 09/24/2014] [Accepted: 11/17/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The outcome of patients with hypoplastic left heart syndrome (HLHS) is influenced by right ventricular function. This study aimed to investigate whether differences in right ventricular function of fetuses with HLHS are present during gestation. METHODS This was a prospective study comprising 14 fetuses with HLHS (28 measurements obtained in total) and 28 normal control fetuses (31 measurements obtained in total). The two groups were matched for gestational age. Ultrasound M-mode was used to assess displacement of the tricuspid annulus. Spectral Doppler and myocardial tissue Doppler-derived inflow and outflow velocities were assessed. Tricuspid valve peak early wave to peak active wave (E/A) ratio, the early wave to early diastolic annular relaxation velocity (E/E') ratio and the tissue Doppler-derived myocardial performance index (MPI') were calculated. RESULTS E-wave velocity was significantly higher in fetuses with HLHS than in control fetuses (mean, 40.14 cm/s vs 35.47 cm/s; P < 0.05, respectively), and A-wave velocity in fetuses with HLHS showed a tendency for higher values in the right ventricle compared with normal control fetuses, but this did not reach statistical significance (61.16 cm/s vs 54.64 cm/s; P = 0.08). The E/A ratio increased during gestation in controls, but this increase was not seen in HLHS fetuses. Peak annular velocity during atrial contraction (A') and the E/E' ratio were significantly lower in controls than in HLHS fetuses: 9.50 cm/s vs 10.39 cm/s (P < 0.05) and 5.77 vs 7.37 (P < 0.05), respectively. There were no differences for right-ventricular MPI' or tricuspid annular plane systolic excursion between HLHS fetuses and controls. CONCLUSION The results of this study show that altered right ventricular function in HLHS infants may develop antenatally. It is hoped that confirmation of these findings using Doppler-independent techniques will lead to further exploration of ventricular function in HLHS fetuses. Consequently, parental counseling and postnatal management strategies could be influenced.
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Affiliation(s)
- R Axt-Fliedner
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
| | - O Graupner
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
| | - A Kawecki
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
| | - J Degenhardt
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
| | - J Herrmann
- IT Service Center, Statistical Consulting Service Unit, Justus-Liebig-University Giessen, Giessen, Germany
| | - A Tenzer
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
| | - A Doelle
- Toshiba Medical Systems Europe BV, Zoetermeer, The Netherlands
| | - A Willruth
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - J Steinhard
- Praxis Dr. Rosenberg, Dr. Steinhard und Kollegen, Münster, Germany
| | - U Gembruch
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
| | - F Bahlmann
- Department of Obstetrics and Gynecology, Bürgerhospital, Frankfurt, Germany
| | - C Enzensberger
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
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Enzensberger C, Degenhardt J, Tenzer A, Doelle A, Axt-Fliedner R. First experience with three-dimensional speckle tracking (3D wall motion tracking) in fetal echocardiography. Ultraschall Med 2014; 35:566-572. [PMID: 25140494 DOI: 10.1055/s-0034-1384882] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Fetal cardiac function can be quantified by different methods. This is the first approach of real three-dimensional(3 D)-based speckle tracking echocardiography in the fetus to assess different cardiac strain parameters. METHODS We present preliminary results of fetal global myocardial strain analyses. For fetal echocardiography a Toshiba Artida system was used. Based on an apical or basal four-chamber view of the fetal heart, raw data volumes with a high temporal resolution were acquired and digitally stored. RESULTS 8 individual healthy fetuses with an echocardiogram performed between 21 and 37 weeks of gestation were included. The mean temporal resolution was 31.2 ± 4.3 volumes per second (vps). Basic parameters such as longitudinal and circumferential strain as well as advanced 3 D myocardial motion patterns such as area strain, rotation, twist and torsion were assessed. CONCLUSION Currently the assessment of fetal myocardial deformation parameters by 3 D speckle tracking seems to be technically feasible only in individual cases. In the future further development of this technique is necessary to improve its application in fetal echocardiography.
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Affiliation(s)
- C Enzensberger
- Department of OB&GYN, Philipps University, Division of Prenatal Medicine, Marburg
| | - J Degenhardt
- Department of OB&GYN, Justus Liebig University, Division of Prenatal Medicine, Gießen
| | - A Tenzer
- Department of OB&GYN, Justus Liebig University, Division of Prenatal Medicine, Gießen
| | - A Doelle
- Ultrasound, Toshiba Medical Systems, Neuss
| | - R Axt-Fliedner
- Department of OB&GYN, Philipps University, Division of Prenatal Medicine, Marburg
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Enzensberger C, Tenzer A, Doelle A, Degenhardt J, Kohl T, Axt-Fliedner R. Three-dimensional (3D) speckle tracking in fetal echocardiography: A new technology in assessment of fetal heart function. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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