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Review
. 2022 Feb;38(2):319-329.
doi: 10.1007/s10554-021-02407-9. Epub 2021 Sep 20.

4D imaging of fetal right ventricle-feasibility study and a review of the literature

M Pasieczna  1 , J Duliban  2 , A Grzyb  2   3 , J Szymkiewicz-Dangel  3
Affiliations
Review

4D imaging of fetal right ventricle-feasibility study and a review of the literature

M Pasieczna et al. Int J Cardiovasc Imaging. 2022 Feb.

Abstract

Functional analysis of the fetal cardiovascular system is crucial for the assessment of fetal condition. Evaluation of the right ventricle with standard 2D echocardiography is challenging due to its complex geometry and irregular muscle fibers arrangement. Software package TOMTEC 4D RV-Function is an analysis tool which allows assessment of right ventricular function based on volumetric measurements and myocardial deformation. The aim of this study was to determine the feasibility of this method in fetal echocardiography. The retrospective study was conducted in the high-flow Referral Center for Fetal Cardiology. We recorded 4D echocardiographic sequences of 46 fetuses with normal hearts. Following parameters were calculated: end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF), right ventricle longitudinal free-wall (RVLS free-wall) and septal strain (RVLS septum). Tei index was calculated as a standard measure or RV function for comparison. 4D assessment was feasible in 38 out of 46 fetuses (83%). RV volumetric parameters-EDV, ESV and SV-increased exponentially with gestational age. Functional parameters-RV Tei index, EF and strains-were independent of gestational age. Mean EF was 45.2% (± 6%), RV free-wall strain was - 21.2% and RV septal strain was - 21.5%. There was a statistically significant correlation between septal and free-wall strains (r = 0.51, p = 0.001) as well as between EF and RV free-wall strain (r = - 0.41, p = 0.011). 4D RV assessment is feasible in most fetuses. Its clinical application should be further investigated in larger prospective studies.

Keywords: 4D echocardiography; Fetal cardiac function; Fetal echocardiography; Myocardial strain; Right ventricle; Right ventricular volume.

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Conflict of interest statement

Authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Assessment of RV volume and function using TOMTEC 4D RV-Function software: a location of landmarks in right and left ventricle. b example of right ventricle volumetric and functional parameters results
Fig. 2
Fig. 2
Correlation of right ventricle end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) with gestational age
Fig. 3
Fig. 3
Correlation of RVLS free-wall and RVLS septum with gestational age
Fig. 4
Fig. 4
Bland–Altman plots for intra and interobserver agreement
Fig. 5
Fig. 5
Comparison between our results of EDV and ESV measurement with data available in the literature
See this image and copyright information in PMC

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