PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 11844201

Right and left ventricular long-axis function in the fetus using angular M-mode.

J S Carvalho·C O'Sullivan·E A Shinebourne·M Y Henein
View original source ↗Export metadata ↓

Abstract

OBJECTIVE: Long-axis function is determined by the longitudinally oriented myocardial fibers. Postnatally, conventional M-mode is used to assess tricuspid and mitral valve ring movements in relation to the cardiac apex. During fetal life, this is precluded by variable fetal position. We assessed the feasibility of determining right and left ventricular long-axis function in the fetus. METHODS: A prospective, pilot study. The four-chamber view obtained during routine fetal echocardiography was recorded in a cineloop to which B-mode guided M-mode echocardiography was applied using angular M-mode. This allowed retrospective and correct placement of the cursor line from cardiac apex to tricuspid or mitral valve rings. M-mode tracings of the valve ring movements in relation to the apex were derived from the originally stored loop. Data from 18 fetuses (17-29 weeks of gestation) were available for analysis. Total excursion of the valve rings was measured offline. A second cursor line was simultaneously placed in the left ventricular outflow tract during color flow mapping for timing purposes (n = 6). RESULTS: Right and left ventricular long-axis recordings were obtained in 18 and 14 cases, respectively. Total right ventricular excursion was 5.2 mm (SD, 0.9 mm) (range, 3.9-7.2 mm). Total left ventricular free wall excursion was 4.5 mm (SD, 1.1 mm) (range, 3.0-6.8 mm). For paired data, the mean of differences (right ventricle-left ventricle) was 0.8 mm (95% confidence interval 0.5-1.2). The valve rings moved towards the apex during systole (shortening) and away from it during diastole (lengthening). Peak downward movement coincided with cessation of aortic flow and diastolic lengthening with flow through the atrioventricular valves. CONCLUSION: Long-axis function in the fetus is feasible if M-mode angle correction is used. There was no clinically significant difference between tricuspid and mitral valve excursions. The pattern of atrioventricular valve movement is coordinate and similar to that of adults. Long-axis function offers a new avenue to study systolic and diastolic function in the fetus.

Explore related subjects

EchocardiographyFeasibility StudiesFemaleFetal HeartHumansMyocardial ContractionPilot ProjectsPregnancyProspective StudiesVentricular FunctionJournal ArticleResearch Support, Non-U.S. Gov't

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

J S Carvalho, C O'Sullivan, E A Shinebourne, M Y Henein. 2001. Right and left ventricular long-axis function in the fetus using angular M-mode.. https://doi.org/10.1046/j.0960-7692.2001.00587.x

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2003

Mitral valve surgery can now routinely be performed endoscopically.

BACKGROUND: There is an increasing interest in minimally invasive cardiac surgery. METHODS AND RESULTS: Since February 1, 1997 till April 1, 2002, 306 patients underwent endoscopic mitral valve surgery (226 repair, MVP; 80 replacement, MVR). Predominant valve pathology was degenerative in MVP (83.6%) and rheumatic in MVR (65%). Mean age was 61.5+/-12.9 years. Median preoperative functional class (MVP+MVR) and mitral regurgitation (MVP) were II and 4+. Statistical analysis included Kaplan-Meier and Cox regression methods. Mean follow-up was 19.6+/-17.3 months and complete. The procedure was successfully performed in all but 6 patients. Hospital mortality included 3 patients (1%) and was technology related in one. Postoperative morbidity included aggressive re-exploration (8.5%), new onset atrial fibrillation (17.0%), and pacemaker implantation (2.3%). There were 1 early and 10 late reoperations, 5 of which were because of endocarditis. Freedom from mitral valve reoperation at 4 years was 91+/-3.5%. No risk factors for reoperation could be detected. Echocardiographic follow-up showed a median degree of mitral regurgitation (MVP) of 0 and a small paravalvular leak in four patients (MVR). Ninety-four percent of the patients reported no or mild postoperative pain and 99.3% felt they had an esthetically pleasing scar. Ninety-three percent would choose the same procedure again and 46.1% were back at work within 4 weeks. CONCLUSIONS: Endoscopic mitral valve surgery can be performed safely but definitely requires a learning curve. Good results and a high patient satisfaction are guaranteed. It is now our exclusive approach for isolated atrioventricular valve disease.

Echocardiography↗
PubMed2003

Patterns of recurrence of congenital heart disease: an analysis of 6,640 consecutive pregnancies evaluated by detailed fetal echocardiography.

OBJECTIVES: We sought to investigate the pattern of recurrence of congenital heart disease (CHD) where there is one or more affected first-degree relative. BACKGROUND: There are little data on patterns of recurrence of different types of CHD. Analysis of a fetal series allows a high ascertainment of affected cases. METHODS: We performed an analysis of referrals for detailed fetal echocardiography to a tertiary fetal cardiology unit, where there was a first-degree family history of CHD from 1990 to the end of 1999. Data were entered prospectively on a computerized database. Recurrences were exactly concordant if CHD was identical to the index case, and concordant for the group if belonging to a similar group of CHD. RESULTS: A recurrence of CHD was seen in 178 (2.7%) of 6,640 pregnancies. The referral numbers for sibling, maternal, or paternal CHD cases were 5,151, 1,119, and 370, respectively. Exact concordance was seen in 37% of cases (range 0% to 80%), and group concordance was seen in 44%. In families where there were two or more recurrences, the exact concordance rate was 55%. Exact concordance rates were particularly high for isolated atrioventricular septal defects (4 of 5 [80%]) and laterality defects (7 of 11 [64%]). CONCLUSIONS: The concordance rates of different types of CHD vary widely. Accurate diagnosis of the index case is essential for reliable counseling on patterns of recurrence. Minor CHD in the index case does not exclude more severe disease in recurrences. There appears to be significant under-referral for fetal echocardiography in paternal CHD.

Echocardiography↗