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Fetal Echocardiographic Evaluation of Tricuspid Valve and Right Ventricular Function Including Global Longitudinal Strain in Hypoplastic Left Heart Syndrome and Association with Postnatal Outcomes

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Abstract

Despite significant advancements in the care of patients with hypoplastic left heart syndrome (HLHS) morbidity and mortality remain high. Postnatal right ventricular dysfunction and tricuspid regurgitation (TR) are associated with worse outcomes in HLHS. We aim to determine if right ventricle functional parameters and TR on fetal echocardiogram are associated with postnatal outcomes in HLHS patients. Retrospective review was performed on all fetuses with HLHS from 2014 to 2022 at our institution. Initial and follow up fetal echocardiogram measurements of right ventricular myocardial performance index (MPI), fractional area change (FAC) and global longitudinal strain (GLS) were retrospectively measured. The presence and severity of TR was recorded from the fetal echocardiogram reports. Postnatal outcomes including transplant-free survival, hospital length of stay > 30 days after initial palliation and need for bidirectional Glenn at < 4 months were reviewed. Forty-three subjects met inclusion criteria. Mean gestational age at presentation was 26.1 ± 5.9 weeks. Nine subjects died and 3 required heart transplantation. Initial fetal echocardiogram MPI was significantly lower (better) (0.36 ± 0.06 vs 0.44 ± 0.11; p =  < 0.001) and FAC was significantly higher (better) (45 ± 6% vs 40 ± 8%; p = 0.035) in transplant-free survivors. Fetal right ventricular GLS and presence of mild TR were not associated with postnatal outcome. In fetuses with HLHS, abnormal MPI and right ventricular FAC are associated with decreased transplant-free survival. There was no observed association between GLS and postnatal outcomes. To our knowledge this is the first study examining fetal right ventricular function and GLS in HLHS patients and its link to postnatal outcomes.

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Authors and Affiliations

  1. Arkansas Children’s Hospital, University of Arkansas Medical Sciences, Little Rock, AR, USA

    Benjamin Ittleman

  2. Metropolitan Pediatrics, Portland, OR, USA

    Sarah Lowenstein

  3. Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA

    Lindsay A. Edwards

  4. University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Elizabeth Caris

  5. Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA

    Aarti Bhat, Jeffrey Conwell, Mark Lewin & Bhawna Arya

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  1. Benjamin Ittleman
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  2. Sarah Lowenstein
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  3. Lindsay A. Edwards
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  4. Elizabeth Caris
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  5. Aarti Bhat
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  6. Jeffrey Conwell
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  7. Mark Lewin
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  8. Bhawna Arya
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Contributions

All authors contributed to the study conception and design. Preparation, Bhawna Arya, Sarah Lowenstein and Benjamin Ittleman performed data collection and analysis. The first draft of the manuscript was written by Benjamin Ittleman and Bhawna Arya and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Benjamin Ittleman.

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Ittleman, B., Lowenstein, S., Edwards, L.A. et al. Fetal Echocardiographic Evaluation of Tricuspid Valve and Right Ventricular Function Including Global Longitudinal Strain in Hypoplastic Left Heart Syndrome and Association with Postnatal Outcomes. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03453-5

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