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. 1991 Dec;66(6):419–424. doi: 10.1136/hrt.66.6.419

Left ventricular dysfunction in the fetus: relation to aortic valve anomalies and endocardial fibroelastosis.

G K Sharland 1, S K Chita 1, N L Fagg 1, R H Anderson 1, M Tynan 1, A C Cook 1, L D Allan 1
PMCID: PMC1024814  PMID: 1837727

Abstract

OBJECTIVE--To examine the relation between a characteristic form of left ventricular dysfunction in the fetus and abnormalities of the aortic valve and endocardial fibroelastosis of the left ventricle. DESIGN--A retrospective study to examine the correlation between echocardiographic findings in the fetus and postnatal or necropsy findings. SETTING--Tertiary referral centre for fetal echocardiography. PATIENTS--Thirty fetuses showing a characteristic echocardiographic picture of left ventricular dysfunction. MAIN OUTCOME MEASURES--The relation between the prenatal echocardiographic features and the postnatal and necropsy findings. RESULTS--At presentation the size of the left ventricular cavity was normal or enlarged in all cases. The measurements of the orifice of the aortic root and mitral valve were either normal or small for the gestational age. The echocardiographic diagnosis made at presentation was critical aortic stenosis in all cases. At necropsy or postnatal examination the aortic valve was dysplastic and stenotic in 15 cases and the left ventricle had become hypoplastic in one of these. Aortic atresia was present in seven patients, three of whom had a hypoplastic left ventricle. In six patients the aortic valve was bicuspid although not obstructive. One of these patients had hypoplasia of the aortic arch and one had a hypoplastic left ventricle but in the remaining four patients endocardial fibroelastosis of the left ventricle was the only abnormality found. No follow up information was available in two. Of 26 patients for whom there was postmortem information, 24 had evidence of some degree of endocardial fibroelastosis of the left ventricle. Sequential observations showed that five cases developed into the hypoplastic left heart syndrome. CONCLUSIONS--This type of left ventricular dysfunction in the fetus is the result of an overlap of diseases, including primary left ventricular endocardial fibroelastosis, critical aortic stenosis, and the hypoplastic left heart syndrome.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allan L. D., Chita S. K., Al-Ghazali W., Crawford D. C., Tynan M. Doppler echocardiographic evaluation of the normal human fetal heart. Br Heart J. 1987 Jun;57(6):528–533. doi: 10.1136/hrt.57.6.528. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Allan L. D., Crawford D. C., Anderson R. H., Tynan M. J. Echocardiographic and anatomical correlations in fetal congenital heart disease. Br Heart J. 1984 Nov;52(5):542–548. doi: 10.1136/hrt.52.5.542. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Atkins D. L., Clark E. B., Marvin W. J., Jr Foramen ovale/atrial septum area ratio: a marker of transatrial blood flow. Circulation. 1982 Aug;66(2):281–283. doi: 10.1161/01.cir.66.2.281. [DOI] [PubMed] [Google Scholar]
  4. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  5. Huhta J. C., Carpenter R. J., Jr, Moise K. J., Jr, Deter R. L., Ott D. A., McNamara D. G. Prenatal diagnosis and postnatal management of critical aortic stenosis. Circulation. 1987 Mar;75(3):573–576. doi: 10.1161/01.cir.75.3.573. [DOI] [PubMed] [Google Scholar]
  6. Kenny J. F., Plappert T., Doubilet P., Saltzman D. H., Cartier M., Zollars L., Leatherman G. F., St John Sutton M. G. Changes in intracardiac blood flow velocities and right and left ventricular stroke volumes with gestational age in the normal human fetus: a prospective Doppler echocardiographic study. Circulation. 1986 Dec;74(6):1208–1216. doi: 10.1161/01.cir.74.6.1208. [DOI] [PubMed] [Google Scholar]
  7. Kleinman C. S., Hobbins J. C., Jaffe C. C., Lynch D. C., Talner N. S. Echocardiographic studies of the human fetus: prenatal diagnosis of congenital heart disease and cardiac dysrhythmias. Pediatrics. 1980 Jun;65(6):1059–1067. [PubMed] [Google Scholar]
  8. Latson L. A., Cheatham J. P., Gutgesell H. P. Relation of the echocardiographic estimate of left ventricular size to mortality in infants with severe left ventricular outflow obstruction. Am J Cardiol. 1981 Nov;48(5):887–891. doi: 10.1016/0002-9149(81)90354-4. [DOI] [PubMed] [Google Scholar]
  9. Maxwell D., Allan L., Tynan M. J. Balloon dilatation of the aortic valve in the fetus: a report of two cases. Br Heart J. 1991 May;65(5):256–258. doi: 10.1136/hrt.65.5.256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Paladini D., Chita S. K., Allan L. D. Prenatal measurement of cardiothoracic ratio in evaluation of heart disease. Arch Dis Child. 1990 Jan;65(1 Spec No):20–23. doi: 10.1136/adc.65.1_spec_no.20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Robertson M. A., Byrne P. J., Penkoske P. A. Perinatal management of critical aortic valve stenosis diagnosed by fetal echocardiography. Br Heart J. 1989 Apr;61(4):365–367. doi: 10.1136/hrt.61.4.365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Zeevi B., Keane J. F., Castaneda A. R., Perry S. B., Lock J. E. Neonatal critical valvar aortic stenosis. A comparison of surgical and balloon dilation therapy. Circulation. 1989 Oct;80(4):831–839. doi: 10.1161/01.cir.80.4.831. [DOI] [PubMed] [Google Scholar]

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