Z Geburtshilfe Neonatol 2013; 217 - V11_3
DOI: 10.1055/s-0033-1361256

Cardiac function and pulmonary vasoreactivity to maternal hyperoxygenation (MH) in fetuses with Hypoplastic Left Heart (HLH)

C Enzensberger 1, A Tenzer 1, J Degenhardt 1, J Ritgen 2, R Stressig 2, T Kohl 3, R Axt-Fliedner 1
  • 1Division of Prenatal Medicine, Department of OB/GYN, Justus-Liebig-University, Gießen, Germany
  • 2Prenatal Medicine and Genetics, praenatal.de, Cologne, Germany
  • 3German Center for Fetal Surgery and Minimally-Invasive Therapy, Gießen, Germany

Objective: Prospective analysis of RV function in fetuses with HLH compared to normal fetuses. In addition firstly to describe the response of fetal lung vasculature to MH in case of prenatally diagnosed HLH, secondly to evaluate the ability of MH to differentiate between newborns with HLH without need for immediate atrial septostomy and newborns who will undergo immediate left atrial septoplasty after birth, thirdly to compare these data with pulmonary venous Doppler flow spectra and 2-D evaluation of the interatrial communication in case of HLH.

Methods: Cross-sectional prospective study of fetuses ≥26 weeks of gestation with prenatally diagnosed HLH. Pulsed wave tissue Doppler measurements were applied. Lung perfusion (LP) was qualitatively assessed by colour Doppler interrogation and LP was quantitatively measured by using the PIV. Measurements were performed both the mother breathing room air (LPRA) and after receiving 100% oxygen for 10 minutes via face mask (LPMH). The oxygen test was defined as positive if MH led to an increase and it was defined as negative if MH did not lead to an increase in lung perfusion, respectively.

Results: 28 fetuses with HLH and 215 fetuses without CHD were enrolled. TEI-Indices of RV in fetuses without CHD and fetuses with HLH showed no significant differences (p = 0.932). Twenty cases were included with measurement of lung perfusion.

In 13/20 cases (65%) the oxygen test was defined as positive. Overall 30-day-survival rate was 92.3% (12/13). In 7/20 fetuses (35%) the oxygen test was defined as negative. Overall 30-day-survival rate was 85.7% (6/7). For a negative oxygen test and the prediction of EAS, there was a sensitivity and specificity of 100% and 72.2%, respectively.

Conclusions: Short MH does not seem to alter Tei Indices of the RV. Analysis of cardiac function in fetuses with HLH might become important for the estimation of outcome or selection of surgical palliation in affected fetuses.