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. 2022 Jul 30;11(15):4456.
doi: 10.3390/jcm11154456.

Evaluation of Right Ventricular Function and Myocardial Microstructure in Fetal Hypoplastic Left Heart Syndrome

Jing Ma  1   2   3 , Yaping Yuan  4   5 , Li Zhang  1   2   3 , Shizhen Chen  4   5   6 , Haiyan Cao  1   2   3 , Liu Hong  1   2   3 , Juanjuan Liu  1   2   3 , Xiaoyan Song  1   2   3 , Jiawei Shi  1   2   3 , Yi Zhang  1   2   3 , Li Cui  1   2   3 , Xin Zhou  4   5   6 , Mingxing Xie  1   2   3
Affiliations

Evaluation of Right Ventricular Function and Myocardial Microstructure in Fetal Hypoplastic Left Heart Syndrome

Jing Ma et al. J Clin Med. .

Abstract

Right ventricular (RV) function is one of the critical factors affecting the prognosis of fetuses with hypoplastic left heart syndrome (HLHS). Our study objectives included assessment of cardiac function and comprehensive measurement of cardiac microstructure. We retrospectively studied 42 fetuses diagnosed as HLHS by echocardiography. Myocardial deformation of the right ventricular wall was calculated automatically in offline software. Postmortem cardiac imaging for three control fetal hearts and four HLHS specimens was performed by a 9.4T DTI scanner. Myocardial deformation parameters of the RV (including strain, strain rate, and velocity) were significantly lower in HLHS fetuses (all p < 0.01). FA values increased (0.18 ± 0.01 vs. 0.21 ± 0.02; p < 0.01) in HLHS fetuses, but MD reduced (1.3 ± 0.15 vs. 0.88 ± 0.13; p < 0.001). The HLHS fetuses’ RV lateral base wall (−7.31 ± 51.91 vs. −6.85 ± 31.34; p = 0.25), middle wall (1.71 ± 50.92 vs. −9.38 ± 28.18; p < 0.001), and apical wall (−6.19 ± 46.61 vs. −11.16 ± 29.86, p < 0.001) had HA gradient ascent but HA gradient descent in the anteroseptal wall (p < 0.001) and inferoseptal wall (p < 0.001). RV basal lateral wall HA degrees were correlated with RVGLS (R2 = 0.97, p = 0.02). MD values were positively correlated with RVGLS (R2 = 0.93, p = 0.04). Our study found morphological and functional changes of the RV in HLHS fetuses, and cardiac function was related to the orientation patterns of myocardial fibers. It may provide insight into understanding the underlying mechanisms of impaired RV performance in HLHS.

Keywords: cardiac diffusion tensor imaging; fetal echocardiography; hypoplastic left heart syndrome; myocardial microstructural; right ventricular function.

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Conflict of interest statement

The authors declared that they have no conflict of interest relating to this work.

Figures

Figure 1
Figure 1
Correlation between RVGLS and LVEDD z-score. RVGLS, right ventricle global longitudinal strain; LVEDD z-score, left ventricular end diastolic dimension z-score.
Figure 2
Figure 2
(A) FA map in normal fetuses. (B) FA map in HLHS fetuses. (C) FA values increased in HLHS fetuses.
Figure 3
Figure 3
(A) MD map in normal fetuses. (B) MD map in HLHS fetuses. (C) MD values decreased in HLHS fetuses.
Figure 4
Figure 4
(A,B) Whole heart fiber tracking in a normal fetus. (A) from ventral view, (B) from apical view. (D,E) the whole heart fiber tracking in an HLHS fetus D from ventral view and (E) from apical view. (C) HA map in normal fetus. (F) HA map in HLHS fetus.
Figure 5
Figure 5
(A) HA gradient in normal fetus. (B) HA gradient in HLHS fetus. (C) HA gradient in an HLHS fetus with LV dilation.
Figure 6
Figure 6
(A) Correlation between MD and RVGLS (%) in HLHS fetuses. (B) Correlation between HA degrees of the right ventricle basal lateral wall and RVGLS (%) in HLHS fetuses.
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