Two-dimensional Speckle Tracking Echocardiography in fetuses with critical aortic stenosis before and after intrauterine aortic valvuloplasty

Objective To analyze the impact of intrauterine aortic valvuloplasty in fetuses with critical aortic stenosis (AS) on global longitudinal peak systolic strain (GLPSS) of the left ventricle (LV) using two-dimensional Speckle Tracking (2D STE).

Methods This is a retrospective study of fetuses with critical AS who underwent intrauterine aortic valvuloplasty between 2011 and 2020 in University Hospital Bonn and had pre- and postinterventional ultrasound four-chamber views (4CV) stored. GLPSS of the LV was retrospectively analyzed.

Results 23 fetuses with critical AS were included. The median gestational age at intrauterine aortic valvuloplasty was 26 weeks. Median time between pre-interventional ultrasound 4CV loop and intervention was 3 days, median time between intervention and post-interventional ultrasound 4CV loop was 5 days. Fetuses after intervention demonstrated significantly lower LV-GLPSS mean values post- vs. pre-interventional (−6.35 vs. −0.94%; p<0.05).

Conclusion Intrauterine aortic valvuloplasty in fetuses with critical AS seeks to improve fetal LV function in order to prevent progression from aortic stenosis (AS) to hypoplastic left heart syndrome (HLHS). This study shows that LV myocardial function analyzed by 2D STE is significantly better after intervention. Further studies are needed to investigate whether improved post-interventional ventricular function is related to better postnatal myocardial function and outcome.

Publication History

Article published online:
26 November 2021