Pulmonary Vasoreactivity to Materno-Fetal Hyperoxygenation Testing in Fetuses with Hypoplastic Left Heart

Abstract

Purpose: The aim of the study was to describe the response of fetal lung vasculature to maternal hyperoxygenation (MH) in the case of prenatally diagnosed hypoplastic left heart (HLH) with intact or restrictive (IAS/RAS) and without restriction of the atrial septum. Furthermore, the ability of MH to differentiate between newborns with HLH who do not require immediate atrial septostomy and newborns who will undergo immediate left atrial septoplasty after birth was evaluated.

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

Results: A total number of 22 pregnancies with hypoplasia of the left heart structures were included. 6/20 cases presented with an intact or restrictive atrial septum (IAS/RAS). All of these fetuses presented with a reduced LPRA. MH led to an increase in LP in 2/6 cases. The overall 30-day-survival rate was 83.3 % (5/6). In 14/20 fetuses an open septum was detected. 11 cases had a normal LPRA, and the LPRA was reduced in 3/14 fetuses. The overall 30-day-survival rate was 92.9 % (13/14).

Conclusion: MH might be a useful adjunct in the assessment of pulmonary vasculopathy in fetuses with HLH.

Zusammenfassung

Ziel: Bei Feten mit Hypoplastischem Linksherz (HLH) wurde die Reaktion des Lungengefäßsystems auf maternale Hyperoxygenierung (MH) in Abhängigkeit der interatrialen Kommunikation untersucht. Desweiteren wurde die Möglichkeit geprüft, mittels MH zwischen den Neugeborenen mit HLH zu unterscheiden, die einer frühen postnatalen atrialen Septostomie (EAS) bedürfen und solchen, die keine Intervention benötigen.

Material und Methoden: Prospektive Querschnittsstudie mit Feten ≥ 26 SSW und HLH. Die Lungenperfusion (LP) wurde qualitativ mittels Farbdopplersonografie und quantitativ über den Pulsatilitäsindex für Venen (PIV) bestimmt. Die Messungen wurden unter Raumluft atmend (LPRA) und nach 10-minütiger Inhalation von 100 % (LPMH) durchgeführt Der Test war positiv bei Anstieg der Lungenperfusion bzw. negativ bei ausbleibendem Anstieg.

Ergebnisse: Insgesamt wurden 22 Feten mit Hypoplasie der Linksherzstrukturen eingeschlossen. 6/20 Fälle hatten ein intaktes oder restriktives atriales Septum (IAS/RAS) und alle wiesen eine verringerte LPRA auf. MH führte zu einem Anstieg der LP in 2/6 Fällen. Die 30-Tage-Überlebensrate lag bei 83.3 % (5/6). Bei 14/20 Feten war das atriale Septum offen. In 11 Fällen war die LPRA normal, bei 3/14 war sie reduziert. Die 30-Tage-Überlebensrate lag bei 92.9 % (13/14).

Schlussfolgerung: MH könnte in der Beurteilung der pulmonalen Vaskulopathie bei Feten mit HLH hilfreich sein.

Key words

hypoplastic left heart - fetal echocardiography - hyperoxygenation

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