Application of Neonatologist Performed Echocardiography in the Assessment and Management of Neonatal Heart Failure unrelated to Congenital Heart Disease

Abstract

Neonatal heart failure (HF) is a progressive disease caused by cardiovascular and non-cardiovascular abnormalities. The most common cause of neonatal HF is structural congenital heart disease, while neonatal cardiomyopathy represents the most common cause of HF in infants with a structurally normal heart. Neonatal cardiomyopathy is a group of diseases manifesting with various morphological and functional phenotypes that affect the heart muscle and alter cardiac performance at, or soon after birth. The clinical presentation of neonates with cardiomyopathy is varied, as are the possible causes of the condition and the severity of disease presentation. Echocardiography is the selected method of choice for diagnostic evaluation, follow-up and analysis of treatment results for cardiomyopathies in neonates. Advances in neonatal echocardiography now permit a more comprehensive assessment of cardiac performance that could not be previously achieved with conventional imaging. In this review, we discuss the current and emerging echocardiographic techniques that aid in the correct diagnostic and pathophysiological assessment of some of the most common etiologies of HF that occur in neonates with a structurally normal heart and acquired cardiomyopathy and we provide recommendations for using these techniques to optimize the management of neonate with HF.

Fig. 1

Heart function during and after therapeutic hypothermia demonstrated as (a) Peak strain; (b) Peak strain rate; and (c) fractional shortening. X-axis: Day of life. Y-axis: Heart function indices. Bars are means with 95% confidence intervals. *: Significantly higher than asphyxiated neonates at day 1 and 3. ¤: Significantly higher than asphyxiated neonates on day 3 treated at normothermia. #: Significantly lower than cooled neonates at day 3 and day 4 (The bars for peak systolic strain rate from reference are estimates from segment values). Reprinted with permission.

Fig. 2

Examples of Echocardiographic findings in common neonatal cardiomyopathies. Infant of diabetic mother: Hypertrophic cardiomyopathy with asymmetric septal hypertrophy. The ventricular walls are hypertrophied, the cavity is small, and ventricular function is normal or hyperkinetic. Two-dimensional echocardiogram showing septal hypertrophy in hypertrophic cardiomyopathy in the parasternal long axis view (Panel a) and the short axis view (Panel b). Arrhythmia-induced neonatal cardiomyopathy (AINC) with severely dilated cardiomyopathy with LV involvement in the apical 4-chamber view (Panel c) and the parasternal short axis view (Panel d)