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Fetal cardiac function in pregnancy affected by congenital heart disease: protocol for a multicentre prospective cohort study.

BMC Pregnancy Childbirth

January 2025

Royal Hospital for Women and UNSW, School of Clinical Medicine, Level 0, Royal Hospital for Women, Barker Street (Locked Bag 2000), Sydney, NSW, 2031, Australia.

Background: Congenital heart disease (CHD) is the most common fetal malformation, and it can result first in cardiac remodeling and dysfunction and later in cardiac failure and hydrops. A limited number of studies have evaluated cardiac function in fetuses affected by CHD. Functional parameters could potentially identify fetuses at risk of cardiac failure before its development.

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Introduction: The severity of mitral stenosis (MS) is commonly assessed using mitral valve area (MVA) measured with transthoracic echocardiography (TTE). The dimensionless index (DI) of mitral valve (MV) was recently studied in degenerative MS. We evaluated DI MV in rheumatic MS and studied its relationship with clinical outcomes.

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Background: Superior caval vein obstruction is a rare complication of endocardial pacing lead implantation that can result in a right to left shunt.

Case Summary: A 3-year-old child with type 2 Brugada syndrome presented with mild cyanosis post-endocardial pacing implantation due to evolutionary right superior caval vein obstruction. This obstruction resulted in a right to left shunt across a previously unrecognized patent levo-atrial cardinal vein associated with partial anomalous pulmonary venous drainage.

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Objectives: Multiple techniques have been proposed for functional fetal cardiology, including pulsed-wave (PW) and tissue Doppler imaging (TDI), Myocardial Performance Index (MPI), annular plane systolic excursion (TAPSE/MAPSE) and spatiotemporal image correlation (STIC). We aimed to compare these techniques' achievability and reproducibility to determine their clinical utility for each cardiac side.

Methods: Uncomplicated pregnancies from 22 to 39 weeks were recruited and images and volumes stored for offline analysis.

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Even if rarely detected, right atrial (RA) masses represent a diagnostic challenge due to their heterogeneous presentation. Para-physiological RA structures, such as a prominent Eustachian valve, Chiari's network, and lipomatous atrial hypertrophy, may easily be misinterpreted as pathological RA masses, including thrombi, myxomas, and vegetations. Each pathological mass should always be correlated with adequate clinical, anamnestic, and laboratory data.

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