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Maternal hyperoxygenation and foetal cardiac MRI in the assessment of the borderline left ventricle

  • Sharon Borik (a1), Christopher K. Macgowan (a2) and Mike Seed (a1)

Abstract

Using phase-contrast MRI in a foetus with borderline left ventricular hypoplasia at 37 weeks’ gestation we showed an increase in pulmonary blood flow during maternal hyperoxygenation. The associated increase in venous return to the left atrium, however, resulted in reversal of the atrial shunt, with no improvement in left ventricular output. The child initially underwent single ventricle palliation with a neonatal hybrid procedure, but following postnatal growth of the left ventricle tolerated conversion to a biventricular circulation at 5 months of age. We conclude that when there is significant restriction of filling or outflow obstruction across the left heart, neither prenatal nor postnatal acute pulmonary vasodilation can augment left ventricular output enough to support a biventricular circulation. Chronic pulmonary vasodilation may stimulate the growth of the left-sided structures allowing biventricular repair, raising the intriguing question of whether chronic maternal oxygen therapy might obviate the need for neonatal single ventricle pallation in the setting of borderline left ventricular hypoplasia.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons. org/licenses/by/3.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence to: M. Seed, MD, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. Tel: 416 813 7654 x 204067; Fax: 416 813 7547; E-mail: mike.seed@sickkids.ca

References

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1. Feinstein, JA, Benson, DW, Dubin, AM, et al. Hypoplastic left heart syndrome: current considerations and expectations. J Am Coll Cardiol 2012; 59 (Suppl 1): S142.
2. Tchervenkov, CI, Tahta, SA, Jutras, LC, Beland, MJ. Biventricular repair in neonates with hypoplastic left heart complex. Ann Thorac Surg 1998; 66: 13501357.
3. Colan, SD, McElhinney, DB, Crawford, EC, Keane, JF, Lock, JE. Validation and re-evaluation of a discriminant model predicting anatomic suitability for biventricular repair in neonates with aortic stenosis. J Am Coll Cardiol 2006; 47: 18581865.
4. Grosse-Wortmann, L, Yun, TJ, Al-Radi, O, et al. Borderline hypoplasia of the left ventricle in neonates: insights for decision-making from functional assessment with magnetic resonance imaging. J Thorac Cardiovasc Surg 2008; 136: 14291436.
5. Seed, M, van Amerom, JF, Yoo, SJ, et al. Feasibility of quantification of the distribution of blood flow in the normal human fetal circulation using CMR: a cross-sectional study. J Cardiovasc Magn Reson 2012; 14: 79.
6. Al Nafisi, B, van Amerom, JF, Forsey, J, et al. Fetal circulation in left-sided congenital heart disease measured by cardiovascular magnetic resonance: a case-control study. J Cardiovasc Magn Reson 2013; 15: 65.
7. Prsa, M, Sun, L, van Amerom, J, et al. Reference ranges of blood flow in the major vessels of the normal human fetal circulation at term by phase-contrast magnetic resonance imaging. Circ Cardiovasc Imaging 2014; 7: 663670.
8. Rudolph, AM. Congenital Diseases of the Heart: Clinical-Physiological Considerations, 3rd edn. Wiley-Blackwell, Chichester, UK, 2009.
9. Kohl, T. Chronic intermittent materno-fetal hyperoxygenation in late gestation may improve on hypoplastic cardiovascular structures associated with cardiac malformations in human fetuses. Pediatr Cardiol 2010; 31: 250263.
10. Rasanen, J, Wood, DC, Debbs, RH, Cohen, J, Weiner, S, Huhta, JC. Reactivity of the human fetal pulmonary circulation to maternal hyperoxygenation increases during the second half of pregnancy: a randomized study. Circulation 1998; 97: 257262.
11. Szwast, A, Tian, Z, McCann, M, Donaghue, D, Rychik, J. Vasoreactive response to maternal hyperoxygenation in the fetus with hypoplastic left heart syndrome. Circ Cardiovasc Imaging 2010; 3: 172178.
12. Say, L, Gülmezoglu, AM, Hofmeyr, GJ. Maternal oxygen administration for suspected impaired fetal growth. Cochrane Database Syst Rev 2009; 1: CD000137.
13. Ballard, G, Tibby, S, Miller, O, et al. Growth of left heart structures following the hybrid procedure for borderline hypoplastic left heart. Eur J Echo 2010; 11: 870874.

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Maternal hyperoxygenation and foetal cardiac MRI in the assessment of the borderline left ventricle

  • Sharon Borik (a1), Christopher K. Macgowan (a2) and Mike Seed (a1)

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