Myocardial strain abnormalities in fetuses with pulmonary atresia and intact ventricular septum.


Cohen J, Binka E, Woldu K, Levasseur S, Glickstein J, Freud LR, Chelliah A, Chiu JS, Shah A.

Ultrasound Obstet Gynecol. 2019 Apr;53(4):512-519. doi: 10.1002/uog.19183. Epub 2019 Mar 12.

PMID: 30043402


Take Home Points:

  • Myocardial strain is a technique to objectively assess fetal ventricular function compared with standard 2D echocardiography.
  • Fetuses with pulmonary atresia/intact ventricular septum have decreased global longitudinal strain of both the left and right ventricles compared with controls
  • Combining LV and RV global longitudinal strain assessments with other. echocardiographic parameters, listed in Table 3, may allow development of a scoring system to predict presence of RV dependent coronary circulation and may provide valuable prognostic information for prenatal counseling.

Comment from Dr. Shelby White (Tucson AZ), section editor of Fetal Cardiology Journal Watch:  Pulmonary atresia with intact ventricular septum (PA/IVS) has a wide range of potential outcomes, based in part on the presence of abnormal communications between the right ventricle and the coronary arteries, most severely the presence of right ventricle-dependent coronary circulation (RVDCC).  Myocardial strain analysis has been used in fetal echocardiography as a sensitive way to identify ventricular dysfunction compared with more subjective measures.  This technique uses speckle-tracking to assess myocardial deformation and is reported as a negative number, with a lower absolute value indicating worse strain/worse ventricular function. This study sought to identify differences in myocardial strain in fetuses with PA/IVS compared with controls and in PA/IVS fetuses with and without RVDCC.


57 fetuses with PA/IVS were analyzed, mean gestational age of 26.3 + 5 weeks.  Left ventricular global longitudinal strain (LV-GLS) was significantly decreased in PA/IVS compared with controls, P < 0.001.  Right ventricular global longitudinal strain (RV-GLS) was also significantly decreased in PA/IVS, P < 0.0001; it was also more difficult to measure as only 42 fetuses had images sufficient for speckle tracking.


Among fetuses with PA/IVS, LV-GLS was decreased in those with RVDCC (Table 3).  The only difference in outcomes that was identified was a decreased RV-GLS in fetuses that had single ventricle palliation compared with biventricular repair.