In Utero Evidence of Impaired Somatic Growth in Hypoplastic Left Heart Syndrome
We hypothesized that fetuses with hypoplastic left heart syndrome (HLHS) have impaired growth compared to expected growth for gestational age. This is a retrospective cohort study including singleton fetuses with isolated HLHS identified from a single, referral center’s ultrasound database. To account for variable timing of ultrasounds, z-scores for gestational age were assigned for each biometric parameter. We identified 169 fetuses, of which 96 had more than one ultrasound. The median number of ultrasound evaluations per fetus was 2 (range 1–5). The mean gestational age at time of last ultrasound was 33.7 ± 4.3 weeks with a range of 20.4–39.6 weeks. While fetal growth restriction (11%) and microcephaly (3%) were relatively rare, mean z-scores at the time of last ultrasound for estimated fetal weight (mean difference z-score −0.20, p = 0.04) and head circumference (−0.28, p = 0.02) were lower than at the time of the initial ultrasound. Impaired somatic growth, defined as a decrement in z-score of 0.5 or more over time, was common (32%). There is a deceleration in somatic and head growth in fetuses with hypoplastic left heart syndrome that can be identified by routine ultrasound evaluation.
KeywordsCongenital heart disease Fetal growth Hypoplastic left heart syndrome Microcephaly Ultrasound
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Given the restrospective nature of this study, formal consent is not required.
- 12.Karamlou T, McCrindle BW, Blackstone EH et al (2010) Lesion-specific outcomes in neonates undergoing congenital heart surgery are related predominantly to patient and management factors rather than institution or surgeon experience: a Congenital Heart Surgeons Society Study. J Thorac Cardiovasc Surg 139:569–577CrossRefPubMedGoogle Scholar
- 20.Marino BS, Lipkin PH, Newburger JW et al (2012) American Heart Association Congenital Heart Defects Committee, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, and Stroke Council. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement form the American Heart Association. Circulation 126:1143–1172CrossRefPubMedGoogle Scholar