Two-dimensional speckle tracking echocardiography in fetuses with critical aortic stenosis before and after fetal aortic valvuloplasty

Justus G Reitz; Johanna M Meier; Christoph Berg; Eva C Weber; Ulrich Gembruch; Aline Wolter; Vanessa Sterzbecher; Ivonne Bedei; Roland Axt-Fliedner

doi:10.1007/s00404-024-07376-7

Two-dimensional speckle tracking echocardiography in fetuses with critical aortic stenosis before and after fetal aortic valvuloplasty

Arch Gynecol Obstet. 2024 Feb 16. doi: 10.1007/s00404-024-07376-7. Online ahead of print.

Authors

Justus G Reitz¹, Johanna M Meier², Christoph Berg³, Eva C Weber⁴, Ulrich Gembruch³, Aline Wolter², Vanessa Sterzbecher², Ivonne Bedei², Roland Axt-Fliedner⁵

Affiliations

¹ Department of Cardiovascular Surgery, University Hospital Giessen, Justus-Liebig University, Giessen, Germany.
² Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital Giessen, Justus-Liebig University, Giessen, Germany.
³ Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany.
⁴ Department of Obstetrics and Gynecology, University Hospital Cologne, Cologne, Germany.
⁵ Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital Giessen, Justus-Liebig University, Giessen, Germany. roland.axt-fliedner@gyn.med.uni-giessen.de.

PMID: 38363396
DOI: 10.1007/s00404-024-07376-7

Abstract

Background: Critical aortic stenosis (AS) in fetuses may progress to hypoplastic left heart syndrome (HLHS) with need for postnatal single ventricular (SV) palliation. Fetal aortic valvuloplasty (FAV) is performed to achieve postnatal biventricular (BV) circulation. However, the impact of FAV on fetal myocardial function is difficult to measure. Prediction of postnatal circulatory status and, therefore, counseling is challenging.

Methods: Retrospective study of fetuses with critical AS who underwent FAV. Global Longitudinal Peak Systolic Strain (GLPSS) of the left ventricle (LV) and right ventricle (RV) were retrospectively analyzed before and after intervention. Fisher's Exact Test and Mann-Whitney-U Test were used for univariant statistical analysis.

Results: 23 fetuses with critical AS were included. After intervention fetuses demonstrated more negative LV-GLPSS mean values post- vs. pre-intervention (- 5.36% vs. - 1.57%; p < 0.05). RV-GLPSS was decreased in all fetuses, there was no peri-interventional change. 20 fetuses were born alive. Postnatally, 10 had BV and 10 SV circulation. Improved post-interventional LV-GLPSS strain values correlated with BV outcome (p < 0.05). Pre-interventional continuous LV-GLPSS values correlated with postnatal SV vs. BV outcome (p < 0.05).

Conclusion: In some fetuses, LV myocardial function assessed by speckle tracking echocardiography (STE) improves after FAV. Improved post-interventional LV-GLPSS correlates with biventricular postnatal outcome. Furthermore, pre-interventional LV- and RV-GLPSS correlate with postnatal outcome. Further studies are needed to asses, if pre-interventional STE parameters might predict which fetuses will benefit from FAV with postnatal BV circulation.

Keywords: Fetal Aorta Valvuloplasty; Fetal Aortic Stenosis; Fetal Echocardiography; Myocardial Function; Speckle Tracking.