Abstract 18382: Left Ventricular Septal Mechanics in Fetal Ebstein’s Anomaly
Introduction: Fetal Ebstein’s anomaly and tricuspid valve dysplasia (EA/TVD) are associated with high perinatal mortality. Qualitative left ventricular (LV) dysfunction and abnormal ventriculo-ventricular interactions have been implicated in poor EA/TVD outcomes. We sought to examine global and segmental LV function in fetal EA/TVD. We hypothesize dyssynchrony importantly contributes to LV dysfunction in affected fetuses.
Methods: This was a retrospective case-control study of EA/TVD diagnosed in two fetal cardiology programs. LV six segment function was analysed from a four chamber view using Vector Velocity Imaging in EA/TVD and compared to findings in healthy fetuses. Global (GLS) and segmental longitudinal strain, strain rate and inward and outward radial displacement were measured. We compared standard deviation of time to peak (T2PSD) to a novel index of global dyssynchrony (DI) (Figure 1).
Results: We analysed 32 EA/TVD and 10 similar gestation control fetuses. GLS was reduced in EA/TVD compared with control (EA/TVD -11.4+/-5.1, Ctrl -13.7+/-1.6, p=0.039). Segmental strain, GLS T2PSD and global and segmental strain rate were similar in EA/TVD and controls. The GLS DI was increased in EA/TVD (EA/TVD 18±22, Ctrl 6±7, p=0.033). Increased basal septal radial outwards displacement and inward radial displacement T2PSD were associated with increased radial DI (Table 1).
Conclusion: Fetal EA/TVD have normal LV segmental strain but reduced GLS secondary to significant mechanical dyssynchrony. Correlation of the DI with outcome in a larger cohort may lead to better prediction of intrauterine and neonatal risk in order to guide management strategies.
Author Disclosures: L.G. Eckersley: None. L. Howley: None. T. Colen: None. P. Brooks: None. N. Khoo: None. L.K. Hornberger: None.
- © 2016 by American Heart Association, Inc.