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Fetal Pulmonary Venous Doppler Patterns in Hypoplastic Left Heart Syndrome: Relationship to Atrial Septal Restriction
  1. Kavitha Chintala (kchintal{at}dmc.org)
  1. Children's Hospital of Michigan, United States
    1. Zhiyun Tian
    1. Children's Hospital of Philadelphia, United States
      1. Wei Du
      1. Children's Hospital of Michigan, United States
        1. Denise Donaghue
        1. Children's Hospital of Philadelphia, United States
          1. Jack Rychik (rychik{at}email.chop.edu)
          1. Children's Hospital of Philadelphia, United States

            Abstract

            Objective PVD patterns are abnormal in fetuses with HLHS with restricted foramen ovale (rFO) when compared to healthy fetuses. The objective of this study was to define PVD patterns in HLHS fetuses with an unrestricted or patent foramen ovale (pFO).

            Design Twenty-seven fetuses with HLHS and 66 healthy fetuses underwent echocardiography between 19 and 38 weeks of gestation. The pulmonary venous peak systolic (S), diastolic (D) and atrial reversal (A) velocities were measured; S/D ratio, velocity time integral of forward (VTIf) and reversed (VTIr) flows and VTIr expressed as percentage of VTIf (%R) were calculated. Independent examiners classified HLHS subjects into HLHS-pFO and HLHS-rFO (rFO or intact atrial septum).

            Setting A tertiary referral center for pediatric cardiology with a fetal heart program

            Results Compared to healthy controls, HLHS-pFO group (n=16) had higher S (32.9 ± 3.2 vs. 23.5 ± 1.6 cm/s [adjusted mean ± S.E]; p=0.01), A (10.5 ± 3.4 vs. 0.17 ± 1.6 cm/s; p=0.01), VTIr (0.78 ± 0.3 vs. 0.01 ± 0.13 cm; p=0.01) and %R (14.2 ± 3.2 % vs.-1.3 ± 1.5%; p<0.0001). D velocity, S/D and VTIf showed no difference. In HLHS-rFO, further increase in S, A, VTIr and %R, decrease in D, increase in S/D and no change in VTIf were noted.

            Conclusions PVD flow patterns are abnormal in HLHS even in the absence of rFO, suggesting that factors other than impaired left atrial egress play a role. Future studies of PVD patterns can provide important insights into left atrial dynamics, pulmonary venous return and pulmonary vascular development in fetal HLHS.

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