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Fetal Cardiac Function

  • John SimpsonEmail author

Abstract

Assessment of cardiac function in an integral part of the assessment of the fetal circulation. Cardiac dysfunction can be assessed by standard echocardiographic modalities including 2D, M-mode and Doppler echocardiography. Other techniques may enhance quantification of cardiac function, particularly in a research setting, including tissue Doppler, 3D echocardiography and speckle tracking. Most recently fetal cardiovascular magnetic resonance imaging (CMR) has been applied to the fetal circulation to measure regional blood flow. Accurate measurement of fetal cardiac function can enhance understanding of cardiac dysfunction in the context of structural defects, cardiomyopathies and abnormalities of fetal cardiac loading conditions.

Keywords

Cardiac function Fetus Doppler M-mode Tissue Doppler 3D echocardiography 

Supplementary material

Video 5.1

Normal four chamber view of the heart. There is dynamic function of both the left and right ventricles with complete opening of the tricuspid and mitral valves during diastole (MP4 892 kb)

Video 5.2

Four chamber view with colour flow Doppler showing inflow to both Ventricles (red) and flow out of the left ventricle (blue). There is no mitral or tricuspid valve regurgitation (MP4 904 kb)

Video 5.3

The heart is enlarged and the left ventricle contracts particularly poorly. There is significant mitral and tricuspid valve regurgitation shown by the blue jets (AVI 14613 kb)

Video 5.4

The ultrasound cursor is placed at 90° to the plane of the ventricular septum. This permits visualisation of the motion of both the left and right ventricular free walls on the M-mode trace on the right. The image can be frozen and the end-diastolic and systolic dimensions of the ventricles can be measured to compute the fractional shortening (MP4 1483 kb)

Video 5.5

Four chamber view of the fetal heart. The green lines mark the epicardial and endocardial surfaces of the myocardium which is tracked through the cardiac cycle to allow computation of longitudinal strain (myocardial deformation) (AVI 10650 kb)

Video 5.6

The heart is enlarged. There is prominent flow through the left pulmonary veins (shown in red) due to the presence of a large pulmonary arteriovenous malformation. This leads to volume loading of the heart accounting for its enlargement (MP4 2388 kb)

Video 5.7

Four chamber view of a fetus with non-compaction of the myocardium. There are deep crypts within the myocardium, particularly towards the apex of the left and right ventricles (MP4 3741 kb)

Video 5.8

Four chamber view with colour flow Doppler showing colour entering the crypts within the myocardium which is particularly well seen towards the apex of the left and right ventricles. This feature is pathognomonic of noncompaction of the myocardium (MP4 2758 kb)

References

  1. Comas M, Crispi F. Assessment of fetal cardiac function using tissue Doppler techniques. Fetal Diagn Ther. 2012;32:30–8.  https://doi.org/10.1159/000335028.CrossRefPubMedGoogle Scholar
  2. Germanakis I, Gardiner H. Assessment of fetal myocardial deformation using speckle tracking techniques. Fetal Diagn Ther. 2012;32:39–46.  https://doi.org/10.1159/000330378.CrossRefPubMedGoogle Scholar
  3. Godfrey ME, Messing B, Cohen SM, Valsky DV, Yagel S. Functional assessment of the fetal heart: a review. Ultrasound Obstet Gynecol. 2012;39:131–44.  https://doi.org/10.1002/uog.9064.CrossRefPubMedGoogle Scholar
  4. Hunter LE, Simpson JM. Prenatal screening for structural congenital heart disease. Nat Rev Cardiol. 2014;11:323–34.  https://doi.org/10.1038/nrcardio.2014.34.CrossRefPubMedGoogle Scholar
  5. Kiserud T, Acharya G. The fetal circulation. Prenat Diagn. 2004;24:1049–59.  https://doi.org/10.1002/pd.1062.CrossRefPubMedGoogle Scholar
  6. Maheshwari P, Henry A, Welsh AW. The fetal modified myocardial performance index: is automation the future? Biomed Res Int. 2015;2015:1–9.  https://doi.org/10.1155/2015/215910.CrossRefGoogle Scholar
  7. Michelfelder E, Allen C, Urbinelli L. Evaluation and management of fetal cardiac function and heart failure. Curr Treat Options Cardiovasc Med. 2016;18:55.  https://doi.org/10.1007/s11936-016-0477-3.CrossRefPubMedGoogle Scholar
  8. Simioni C, Nardozza LMM, Araujo Júnior E, Rolo LC, Zamith M, Caetano AC, Moron AF. Heart stroke volume, cardiac output, and ejection fraction in 265 normal fetus in the second half of gestation assessed by 4D ultrasound using spatio-temporal image correlation. J Matern Fetal Neonatal Med. 2011;24:1159–67.  https://doi.org/10.3109/14767058.2010.545921.CrossRefPubMedGoogle Scholar
  9. Simpson J. Echocardiographic evaluation of cardiac function in the fetus. Prenat Diagn. 2004;24:1081–91.  https://doi.org/10.1002/pd.1065.CrossRefPubMedGoogle Scholar
  10. Sivasankaran S, Sharland GK, Simpson JM. Dilated cardiomyopathy presenting during fetal life. Cardiol Young. 2005;15:409–16.  https://doi.org/10.1017/S1047951105000855.CrossRefPubMedGoogle Scholar
  11. Van Mieghem T, DeKoninck P, Steenhaut P, Deprest J. Methods for prenatal assessment of fetal cardiac function. Prenat Diagn. 2009;29:1193–203.  https://doi.org/10.1002/pd.2379.CrossRefPubMedGoogle Scholar
  12. Weber R, Kantor P, Chitayat D, Friedberg MK, Golding F, Mertens L, Nield LE, Ryan G, Seed M, Yoo S-J, Manlhiot C, Jaeggi E. Spectrum and outcome of primary cardiomyopathies diagnosed during fetal life. JACC Heart Fail. 2014;2:403–11.  https://doi.org/10.1016/j.jchf.2014.02.010.CrossRefPubMedGoogle Scholar
  13. Wieczorek A, Hernandez-Robles J, Ewing L, Leshko J, Luther S, Huhta J. Prediction of outcome of fetal congenital heart disease using a cardiovascular profile score. Ultrasound Obstet Gynecol. 2008;31:284–8.  https://doi.org/10.1002/uog.5177.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation TrustLondonUK

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