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Maternal Hyperoxygenation Improves Left Heart Filling In The Fetus With Atrial Septal Aneurysm Causing Impediment To Left Ventricular Inflow.
MedLine Citation:
PMID:  25296951     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: Aneurysm of the atrial septum (AAS) with excessive excursion of septum primum into the left atrium is an uncommon, relatively benign fetal condition associated with impediment to left ventricular (LV) filling and the appearance of a slender but apex-forming LV on fetal echocardiography. Impediment to filling can be severe creating the image of LV hypoplasia with retrograde aortic flow. We hypothesize that maternal hyperoxygenation (MH), by increasing fetal pulmonary venous return, alters atrial septal position, improves LV filling, and normalizes aortic flow in AAS.
METHODS: Fetal echocardiography was performed, prior to and at 10 minutes of MH, in twelve fetuses with AAS who were referred for LV hypoplasia. Atrial septal excursion (ASE), LV and right ventricular (RV) sphericity index (SI), and direction of flow in the aortic isthmus by Doppler, were measured.
RESULTS: With MH, ASE decreased (0.76 ± 0.17 to 0.53 ± 0.23, p < 0.01) consistent with increased pulmonary venous return, LV SI increased (0.29 ± 0.06 to 0.42 ± 0.06, p < 0.001) indicating increased LV filling, and the direction of aortic isthmus flow changed from retrograde in all cases before MH, to anterograde in 10 and bidirectional in 2. RV SI did not change (0.53 ± 0.13 to 0.52 ± 0.10, p = 0.7).
CONCLUSIONS: In AAS, short term MH increases pulmonary venous return, substantially alters LV geometry, and promotes anterograde flow in the aortic isthmus. This demonstrates proof of concept that maternal hyperoxgenation can improve filling of the left side of the fetal heart in AAS.
Authors:
Alexandra Channing; Anita Szwast; Shobha Natarajan; Karl Degenhardt; Zhiyun Tian; Jack Rychik
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-10-9
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2014 Oct 
Date Detail:
Created Date:  2014-10-9     Completed Date:  -     Revised Date:  2014-10-10    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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