title: Left ventricular remodelling in outflow tract obstructive lesions during fetal life.
abstract: OBJECTIVE
  Left ventricular (LV) remodelling in prenatally diagnosed LV outflow tract obstructive lesions such as aortic stenosis and aortic coarctation is important for prenatal counselling and postnatal management. The purpose of this study was to document the spectrum and the progression of different LV remodelling patterns and to identify prenatal markers of hypoplastic left heart syndrome (HLHS).
  
  
  METHODS
  We studied 29 fetuses with LV outflow tract obstruction: 13 with isolated aortic stenosis, 14 with isolated aortic coarctation and two with combined aortic stenosis and aortic coarctation. Echocardiographic evaluation was performed 4 and 8 weeks after the first observation and at birth.
  
  
  RESULTS
  None of the fetuses had HLHS (LV end-diastolic diameter z score higher than -2) at first prenatal echocardiography (24.5 + or - 3.6 weeks). Fetuses were divided into two groups: group A (n = 25) with a LV end-diastolic volume at birth > 20 ml/m(2); group B (n = 4) with a LV end-diastolic volume at birth < 20 ml/m(2) (LV hypoplasia). At first echocardiographic evaluation, the two groups showed a significantly different aorta to pulmonary ratio (0.44 + or - 0.08 vs. 0.86 + or - 0.14; P < 0.001); other LV echocardiographic features were not significantly different. The growth of the mitral (0.10 + or - 0.02 vs. 0.43 + or - 0.28 mm/week; P < 0.02) and aortic annulus (0.08 + or - 0.01 vs. 0.26 + or - 0.14 mm/week; P < 0.05) was significantly slower in group B.
  
  
  CONCLUSIONS
  Our data suggest that LV outflow tract obstruction can progressively evolve in HLHS during pregnancy. A smaller aorta to pulmonary ratio was the only significant difference at initial echocardiographic evaluation in the two groups. Moreover, serial echocardiographic examinations are necessary to recognize fetuses at risk for HLHS caused by a subnormal growth rate of the mitral and aortic annulus.
authors.affiliation: Chair of Cardiology, Second University of Naples, V. Monaldi Hospital, Naples, Italy. mic.dalto@tin.it
authors.forename: Michele
authors.initials: M
authors.lastname: D'Alto
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pacileo
authors.forename: Dario
authors.initials: D
authors.lastname: Paladini
authors.forename: Emanuele
authors.initials: E
authors.lastname: Romeo
authors.forename: Berardo
authors.initials: B
authors.lastname: Sarubbi
authors.forename: Dominga
authors.initials: D
authors.lastname: Cardaropoli
authors.forename: Concetta
authors.initials: C
authors.lastname: Ricci
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D005260:Female; D005313:Fetal Death; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000379:methods; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D016216:Ultrasonography, Prenatal; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D020257:Ventricular Remodeling / Q000502:physiology*