title: Left ventricular function and geometry in fetuses with severe tricuspid regurgitation.
abstract: OBJECTIVE
  Neonatal congenital tricuspid valve (TV) dysplasia and/or displacement (Ebstein's malformation) with severe tricuspid regurgitation (TR) is a challenging condition in which outcomes are frequently poor. Little is known about left ventricular (LV) function during the perinatal period in patients with congenital TV disease. The objective of this study was to evaluate LV function in fetuses with congenital TV anomalies associated with significant TR.
  
  
  METHODS
  Serial fetal echocardiograms in 16 fetuses with congenital TV dysplasia and/or displacement (five neonatal survivors and 11 fetal or neonatal deaths) were reviewed. LV stroke volume, LV end-diastolic volume (LVEDV), LV end-diastolic dimension (LVIDd), the LV eccentricity index, thoracic and cardiac areas and the cardiothoracic area ratio (CTAR), the right atrium area index, and LV longitudinal strains were compared according to gestational age and clinical outcome.
  
  
  RESULTS
  The gestational age-adjusted LVEDV (Z-score) was lower in late gestation (-1.2 ± 1.2 at last examination ≥ 28 weeks) than earlier in gestation (0.3 ± 1.5 at last examination < 28 weeks) and LV output was lower than reported late-gestation normal values. LV short-axis dimension correlated with LV volume and CTAR. LV mid-septal strain was lower than the normal average of fetal mid-septal strain and correlated with the LV eccentricity index. Among these parameters, only the LV eccentricity index differed between survivors and non-survivors.
  
  
  CONCLUSIONS
  LV function and anatomy are abnormal in fetuses with severe congenital TV anomalies and may be important contributors to outcome.
authors: Department of Cardiology, Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
authors: T
authors: T
authors: Ishii
authors: W
authors: W
authors: Tworetzky
authors: D M
authors: DM
authors: Harrild
authors: E N
authors: EN
authors: Marcus
authors: D B
authors: DB
authors: McElhinney
mesh_terms: D004437:Ebstein Anomaly / Q000000981:diagnostic imaging* / Q000196:embryology / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D005865:Gestational Age; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000196:embryology / Q000503:physiopathology; D006801:Humans; D054238:Perinatal Mortality; D011247:Pregnancy; D012189:Retrospective Studies; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000196:embryology / Q000503:physiopathology; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000196:embryology / Q000503:physiopathology; D016216:Ultrasonography, Prenatal; D016277:Ventricular Function, Left