Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-18T21:15:13.088Z Has data issue: false hasContentIssue false
  • English
  • Français

Main pulmonary artery cross-section ratio is low in fetuses with tetralogy of Fallot and ductus arteriosus-dependent pulmonary circulation

Published online by Cambridge University Press:  12 January 2017

Hironori Ebishima ,
Kenichi Kurosaki ,
Jun Yoshimatsu  and
Isao Shiraishi
Hironori Ebishima*
Affiliation:
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
Kenichi Kurosaki
Affiliation:
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
Jun Yoshimatsu
Affiliation:
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
Isao Shiraishi
Affiliation:
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
*
Correspondence to: H. Ebishima, MD, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan. Tel: +81 66833 5012; Fax: +81 66834 9535; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

This study aimed to determine fetal echocardiographic features of tetralogy of Fallot in association with postnatal outcomes.

Methods

The Z-scores of the main and bilateral pulmonary arteries and the aorta were measured, and the following variables were calculated in 13 fetuses with tetralogy of Fallot: pulmonary artery-to-aorta ratio and main pulmonary artery cross-section ratio – the main pulmonary artery diameter squared divided by the sum of the diameter squared of the left and right pulmonary arteries. Fetuses were classified as having ductus arteriosus-dependent or ductus arteriosus-independent pulmonary circulation.

Results

We included two infants with pulmonary atresia and six infants with ductus-dependent pulmonary circulation, who underwent systemic-to-pulmonary shunt surgeries at ⩽1 month of age. The Z-scores of the main pulmonary artery and the pulmonary artery-to-aorta ratio in fetuses with ductus-dependent pulmonary circulation were lesser than those in fetuses with ductus independence, but not significantly. The main pulmonary artery cross-section ratio in fetuses with ductus dependence was significantly lesser (0.65±0.44 versus 1.56±0.48, p<0.005). Besides, the flow of the ductus arteriosus was directed from the aorta to the pulmonary artery in the ductus arteriosus-dependent group during the fetal period.

Conclusions

The main pulmonary artery cross-section ratio was the most significant variable for predicting postnatal outcomes in fetuses with tetralogy of Fallot.

Keywords

Tetralogy of Fallotfetal echocardiographycross-sectional areapulmonary artery diameterductus arteriosus dependent
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1162 - 1166
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Rychik, J, Ayres, N, Cuneo, B, et al. American Society of Echocardiography guidelines and standards for performance of the fetal echocardiogram. J Am Soc Echocardiogr 2004; 17: 803–810.CrossRefGoogle ScholarPubMed
2. Yoo, SJ, Lee, YH, Kim, ES, et al. Three-vessel view of the fetal upper mediastinum: an easy means of detecting abnormalities of the ventricular outflow tracts and great arteries during obstetric screening. Ultrasound Obstet Gynecol 1997; 9: 173–182.Google Scholar
3. Wong, SF, Ward, C, Lee-Tannock, A, Le, S, Chan, FY. Pulmonary artery/aorta ratio in simple screening for fetal outflow tract abnormalities during the second trimester. Ultrasound Obstet Gynecol 2007; 30: 275–280.CrossRefGoogle ScholarPubMed
4. Markowitz, RI, Fahey, JT, Hellenbrand, WE, Kopf, GS, Rothstein, P. Bronchial compression by a patent ductus arteriosus associated with pulmonary atresia. Am J Roentgenol 1985; 144: 535–540.CrossRefGoogle ScholarPubMed
5. Hornberger, LK, Sanders, SP, Sahn, DJ, et al. In utero pulmonary artery and aortic growth and potential for progression of pulmonary outflow tract obstruction in tetralogy of Fallot. J Am Coll Cardiol 1995; 25: 739–745.CrossRefGoogle ScholarPubMed
6. Bhawna, A, Stepanie, ML, Kristal, W, Julie, SG, Howard, FA, Ismee, AW. Fetal echocardiographic measurements and need for neonatal surgical intervention in tetralogy of Fallot. Pediatr Cardiol 2014; 35: 810–816.Google Scholar
7. Rudolph, AM, Heymann, MA, Spitznas, U. Hemodynamic considerations in the development of narrowing of the aorta. Am J Cardiol 1972; 30: 514–525.CrossRefGoogle ScholarPubMed
8. Schneider, C, McCrindle, BW, Carvalho, JS, Hornberger, LK, McCarthy, KP, Daubeney, PE. Development of Z-scores for fetal cardiac dimensions from echocardiography. Ultrasound Obstet Gynecol 2005; 26: 599–605.CrossRefGoogle ScholarPubMed
9. Pasquini, L, Mellander, M, Seale, A, et al. Z-scores of the fetal aortic isthmus and duct: an aid to assessing arch hypoplasia. Ultrasound Obstet Gynecol 2007; 29: 628–633.CrossRefGoogle ScholarPubMed
10. Sokol, J, Bohn, D, Lacro, RV, et al. Fetal pulmonary artery diameters and their association with lung hypoplasia and postnatal outcome in congenital diaphragmatic hernia. Am J Obstet Gynecol 2002; 186: 1085–1090.Google Scholar
11. Shinebourne, EA, Babu-Narayan, SV, Carvalho, JS. Tetralogy of Fallot: from fetus to adult. Heart 2006; 92: 1353–1359.Google Scholar
12. Hove, JR. Quantifying cardiovascular flow dynamics during early development. Pediatr Res 2006; 60: 6–13.Google Scholar
13. Langille, BL, O’Donnell, F. Reductions in arterial diameter produced by chronic decreases in blood flow are endothelium-dependent. Science 1986; 231: 405–407.Google Scholar
14. Di Stephano, I, Koopmans, DR, Langille, BL. Modulation of arterial growth of the rabbit carotid artery associated with experimental elevation of blood flow. J Vasc Res 1998; 35: 1–7.CrossRefGoogle Scholar