The assessment of cardiac function with tissue Doppler imaging in fetuses with congenital diaphragmatic hernia

Abstract

Introduction: This study aimed to evaluate the cardiac function of fetuses with congenital diaphragmatic hernia by conventional echocardiography and spectral tissue Doppler imaging (s-TDI) and to evaluate the relationship between cardiac function and the severity of pulmonary hypoplasia. We also aimed to investigate the effect of diaphragmatic hernia side on fetal cardiac function.

Methods: Fetal cardiac function were evaluated in 28 fetuses (20 with left-sided and 8 with right-sided) complicated with isolated congenital diaphragmatic hernia (CDH) and 56 gestational age matched control in this single center prospective study. s-TDI measurements were obtained at the right atrioventricular valve annulus. The annular peak velocities and their ratios, the time periods of cardiac cycle and myocardial performance index were calculated.

Results: In comparison to controls, significantly prolonged isovolumetric contraction time (ICT′) and isovolumetric relaxation time (IRT′) and, significantly shortened ejection time (ET′) were observed in fetuses with CDH by s-TDI. Fetuses with CDH also had higher myocardial performance index (MPI′) z-scores compared to controls. There were no significant differences in terms of s-TDI cardiac function parameters between fetuses with right- and left-sided CDH. In correlation analysis, a significant positive correlation was found between ET′ value and o/e LHR.

Conclusion: The signs of both systolic and diastolic altered function were observed in fetuses with CDH with s-TDI independent of the side of the hernia, and a significant positive correlation was observed between fetal cardiac systolic function and the severity of pulmonary hypoplasia.

Keywords:

• Congenital diaphragmatic hernia
• fetal cardiac function
• global cardiac function
• spectral tissue Doppler imaging
• fetal cardiac dysfunction
• pulmonary hypoplasia

Acknowledgement

The authors thank Arzu Baygül for her help with the manuscript and her valuable advice in the statistical analysis.

Disclosure statement

No potential conflict of interest was reported by the authors.