title: Ventricular strain in fetuses with aortic stenosis and evolving hypoplastic left heart syndrome before and after prenatal aortic valvuloplasty.
abstract: OBJECTIVE
  The impact of prenatal intervention on fetal cardiac function has not been well defined. We assessed standard ventricular function parameters and strain in fetuses with evolving hypoplastic left heart syndrome (HLHS) treated with fetal aortic valvuloplasty (fAVP).
  
  
  METHODS
  Fetuses with valvar aortic stenosis that underwent fAVP were studied. Echocardiographic images prior to intervention (Pre), within 1 week after fAVP (Post), and at the last prenatal follow-up examination (FU) were analyzed. Left ventricular (LV) circumferential (LVCS) and longitudinal strain (LVLS), right ventricular (RV) longitudinal strain (RVLS), and LV end-diastolic dimension Z-scores (LVIDD-Z) were documented and compared according to postnatal outcome.
  
  
  RESULTS
  Among 57 fetuses studied, the postnatal outcome was biventricular in 23 and univentricular in 34. Prior to fAVP, strain was <4 in most cases, regardless of outcome. Biventricular fetuses had higher LVCS and LVLS segmental strain than univentricular fetuses. Among fetuses with a biventricular outcome, LVCS and LVLS increased as LVIDD-Z decreased in late gestation, whereas LVCS and LVLS remained <4 in univentricular fetuses, although the LVIDD-Z decreased to <0 in all cases. Septal RVLS increased after fAVP in the biventricular but not the univentricular outcome group.
  
  
  CONCLUSIONS
  In utero aortic valve dilation appears to have a beneficial effect on both LV and RV function in some fetuses with evolving HLHS.
authors.affiliation: Department of Cardiology, Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass., USA.
authors.forename: Tetsuko
authors.initials: T
authors.lastname: Ishii
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
authors.forename: David M
authors.initials: DM
authors.lastname: Harrild
authors.forename: Edward N
authors.initials: EN
authors.lastname: Marcus
authors.forename: David J
authors.initials: DJ
authors.lastname: Sahn
authors.forename: Uyen
authors.initials: U
authors.lastname: Truong
authors.forename: Wayne
authors.initials: W
authors.lastname: Tworetzky
mesh_terms: D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D063126:Balloon Valvuloplasty / Q000009:adverse effects*; D004452:Echocardiography; D005332:Fetoscopy / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal