TY - JOUR
T1 - Right Atrial Dysfunction in the Fetus with Severely Regurgitant Tricuspid Valve Disease
T2 - A Potential Source of Cardiovascular Compromise
AU - Howley, Lisa W.
AU - Khoo, Nee Scze
AU - Moon-Grady, Anita J.
AU - Patel, Sonali S.
AU - Alrais, Fayeza
AU - Tworetzky, Wayne
AU - Colen, Timothy
AU - Brooks, Paul
AU - Trines, Jean
AU - Ojala, Tiina
AU - Hornberger, Lisa K.
N1 - Publisher Copyright:
© 2017 American Society of Echocardiography
PY - 2017/6
Y1 - 2017/6
N2 - Background In severe right heart obstruction (RHO), redistribution of cardiac output to the left ventricle (LV) is well tolerated by the fetal circulation. Although the same should be true of severely regurgitant tricuspid valve disease (rTVD) with reduced or no output from the right ventricle, affected fetuses more frequently develop hydrops or suffer intrauterine demise. We hypothesized that right atrium (RA) function is altered in rTVD but not in RHO, which could contribute to differences in outcomes. Methods Multi-institutional retrospective review of fetal echocardiograms performed over a 10-year period on fetuses with rTVD (Ebstein's anomaly, tricuspid valve dysplasia) or RHO (pulmonary atresia/intact ventricular septum, tricuspid atresia) and a healthy fetal control group. Offline velocity vector imaging and Doppler measurements of RA size and function and LV function were made. Results Thirty-four fetuses with rTVD, 40 with RHO, and 79 controls were compared. The rTVD fetuses had the largest RA size and lowest RA expansion index, fractional area of change, and RA indexed filling and emptying rates compared with fetuses with RHO and controls. The rTVD fetuses had the shortest LV ejection time and increased Tei index with a normal LV ejection fraction. RA dilation (odds ratio, 1.27; 95% CI, 1.05–1.54) and reduced indexed emptying rate (odds ratio, 2.49; 95% CI, 1.07–5.81) were associated with fetal or neonatal demise. Conclusions Fetal rTVD is characterized by more severe RA dilation and dysfunction compared with fetal RHO and control groups. RA dysfunction may be an important contributor to reduced ventricular filling and output, potentially playing a critical role in the worsened outcomes observed in fetal rTVD.
AB - Background In severe right heart obstruction (RHO), redistribution of cardiac output to the left ventricle (LV) is well tolerated by the fetal circulation. Although the same should be true of severely regurgitant tricuspid valve disease (rTVD) with reduced or no output from the right ventricle, affected fetuses more frequently develop hydrops or suffer intrauterine demise. We hypothesized that right atrium (RA) function is altered in rTVD but not in RHO, which could contribute to differences in outcomes. Methods Multi-institutional retrospective review of fetal echocardiograms performed over a 10-year period on fetuses with rTVD (Ebstein's anomaly, tricuspid valve dysplasia) or RHO (pulmonary atresia/intact ventricular septum, tricuspid atresia) and a healthy fetal control group. Offline velocity vector imaging and Doppler measurements of RA size and function and LV function were made. Results Thirty-four fetuses with rTVD, 40 with RHO, and 79 controls were compared. The rTVD fetuses had the largest RA size and lowest RA expansion index, fractional area of change, and RA indexed filling and emptying rates compared with fetuses with RHO and controls. The rTVD fetuses had the shortest LV ejection time and increased Tei index with a normal LV ejection fraction. RA dilation (odds ratio, 1.27; 95% CI, 1.05–1.54) and reduced indexed emptying rate (odds ratio, 2.49; 95% CI, 1.07–5.81) were associated with fetal or neonatal demise. Conclusions Fetal rTVD is characterized by more severe RA dilation and dysfunction compared with fetal RHO and control groups. RA dysfunction may be an important contributor to reduced ventricular filling and output, potentially playing a critical role in the worsened outcomes observed in fetal rTVD.
KW - Atrium
KW - Ebstein's anomaly
KW - Fetal echocardiography
KW - Right atrial function
KW - Tricuspid
KW - Velocity vector imaging
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U2 - 10.1016/j.echo.2017.01.002
DO - 10.1016/j.echo.2017.01.002
M3 - Article
C2 - 28410946
AN - SCOPUS:85017386481
SN - 0894-7317
VL - 30
SP - 579
EP - 588
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 6
ER -