title: Pilot study of chronic maternal hyperoxygenation and effect on aortic and mitral valve annular dimensions in fetuses with left heart hypoplasia.
abstract: OBJECTIVE
  Acute maternal hyperoxygenation (AMH) results in increased fetal left heart blood flow. Our aim was to perform a pilot study to determine the safety, feasibility and direction and magnitude of effect of chronic maternal hyperoxygenation (CMH) on mitral and aortic valve annular dimensions in fetuses with left heart hypoplasia (LHH) after CMH.
  
  
  METHODS
  Gravidae with fetal LHH were eligible for inclusion in a prospective evaluation of CMH. LHH was defined as: sum of aortic and mitral valve annuli Z-scores < -4.5, arch flow reversal and left-to-right or bidirectional atrial level shunting without hypoplastic left heart syndrome or severe aortic stenosis. Gravidae with an affected fetus and with ≥ 10% increase in aortic/combined cardiac output flow after 10 min of AMH at 8 L/min 100% fraction of inspired oxygen were offered enrollment. Nine gravidae were enrolled from February 2014 to January 2015. The goal therapy was ≥ 8 h daily CMH from enrollment until delivery. Gravidae who were cared for from July 2012 to October 2014 with fetal LHH and no CMH were identified as historical controls (n = 9). Rates of growth in aortic and mitral annuli over the final trimester were compared between groups using longitudinal regression.
  
  
  RESULTS
  There were no significant maternal or fetal complications in the CMH cohort. Mean gestational age at study initiation was 29.6 ± 3.2 weeks for the intervention group and 28.4 ± 1.8 weeks for controls (P = 0.35). Mean relative increase in aortic/combined cardiac output after AMH was 35.3% (range, 18.1-47.9%). Median number of hours per day on CMH therapy was 9.3 (range, 6.5-14.6) and median duration of CMH was 48 (range, 33-84) days. Mean mitral annular growth was 0.19 ± 0.05 mm/week compared with 0.14 ± 0.05 mm/week in CMH vs controls (mean difference 0.05 ± 0.05 mm/week, P = 0.33). Mean aortic annular growth was 0.14 ± 0.03 mm/week compared with 0.13 ± 0.03 mm/week in CMH vs controls (mean difference 0.01 ± 0.03 mm/week, P = 0.75). More than 9 h CMH daily (n = 6) was associated with better growth of the aortic annulus in intervention fetuses (0.16 ± 0.03 vs 0.08 ± 0.02 mm/week, P = 0.014).
  
  
  CONCLUSIONS
  CMH is both safe and feasible for continued research. In this pilot study, the effect estimates of annular growth, using the studied method of delivery and dose of oxygen, were small. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Lara
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Morris
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.|Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Maskatia
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: M
authors.initials: M
authors.lastname: Challman
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA.
authors.forename: M
authors.initials: M
authors.lastname: Nguyen
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: Feagin
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA.
authors.forename: L
authors.initials: L
authors.lastname: Schoppe
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.|Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bhatt
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Sexson-Tejtel
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: K N
authors.initials: KN
authors.lastname: Lopez
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Lawrence
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: S
authors.initials: S
authors.lastname: Andreas
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Belfort
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: R
authors.initials: R
authors.lastname: Ruano
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Ayres
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Altman
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Aagaard
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Becker
mesh_terms: D001021:Aortic Valve; D001024:Aortic Valve Stenosis; D018618:Echocardiography, Doppler, Color; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005865:Gestational Age; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D018496:Hyperoxia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000196:embryology / Q000503:physiopathology*; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000196:embryology / Q000503:physiopathology*; D010865:Pilot Projects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D037841:Pregnant People; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal
keywords: Shone syndrome; borderline left heart; fetal intervention; left heart hypoplasia; maternal hyperoxygenation