Echocardiographic assessment of hemodynamics in fetus with transposition of the great arteries and intact interventricular septum: Impact on immediate postnatal desaturation.

Autor: Lachaud, M., Charron, M.A., Peyre, M., Carmant, L., Birca, A., Brassard, M., Raboisson, M.J.
Zdroj: Archives of Cardiovascular Diseases Supplements; Sep2018, Vol. 10 Issue 3/4, p284-285, 2p
Abstrakt: Little is known about physiology and distribution of ventricular flows in fetuses with transposition of the great arteries and intact ventricular septum (TGA-IVS), especially regarding the risk for immediate postnatal desaturation. Ductal flow is the result of a complex interaction between left and right ventricular outputs as well as pulmonary and peripheral resistances. Aim Longitudinal hemodynamical assessment of 60 fetuses with TGA-IVS and 150 controls was done 3 times during the pregnancy at 18–22, 28–32 and 35–38 weeks of gestation. We measured the size of the inter-atrial defect and calculated left and right ventricular output as well as systolic and diastolic ductal flow. Fetuses with TGA-IVS were divided into 2 groups depending their postnatal saturation. Fetuses with postnatal saturation < 65% at the upper members were included in group 1. Echocardiographic parameters were compared between the 2 groups. Results Two fetuses had restrictive ductus arteriosus with high velocity flow and were excluded from the calculations, they all had postnatal saturation < 65%. Sixteen additional fetuses had a postnatal saturation < 65%. There was no difference in left or right ventricular output between the groups at first evaluation. At 28–32 weeks, inter-atrial defect was smaller in group 1 (3 ± 0.3 versus 4 ± 0.8 mm, P = 0.012) as well as left ventricular output (221 versus 307 mL/min, P = 0.05). Ductal flow was lower in group 1 after 35 weeks (56 versus 130 mL/min, P = 0.007), mainly due to a decrease in diastolic antegrade flow which was retrograde in group 1 (−7.1 versus 22 mL/min, P < 0.004). A retrograde ductal diastolic flow had a positive predictive value of 89% and a negative predictive value of 86% to predict saturation < 65% at birth. Conclusion At the third trimester, retrograde diastolic flow in the ductus arteriosus could be secondary to low pulmonary resistances but also to decreased left ventricular output in case of small inter-atrial-defect. Fetuses with this ductal profile remain at risk for postnatal inadequate inter-atrial mixing. [ABSTRACT FROM AUTHOR]
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