Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot.
Siegmund AS, Willems TP, Pieper PG, Bilardo CM, Gorter TM, Bouma BJ, Jongbloed MRM, Sieswerda GT, Roos-Hesselink JW, van Dijk APJ, van Veldhuisen DJ, Dickinson MG.
J Cardiovasc Magn Reson. 2020 Jul 16;22(1):52. doi: 10.1186/s12968-020-00645-9.
Take Home Point:
- This study suggests that pre-existing reduced right ventricular ejection fraction in repaired tetralogy of Fallot patients is associated with impaired uteroplacental circulation
Commentary from Dr. Inga Voges (Kiel, Germany), section editor of Pediatric Cardiology Journal Watch: In this interesting study the authors investigated the association of pre-pregnancy right and left ventricular functional and uteroplacental Doppler flow parameters in pregnant women with repaired Tetralogy of Fallot (ToF).
31 pregnant women with repaired ToF presenting at ≤20 weeks of gestation and who underwent cardiovascular magnetic resonance (CMR) imaging ≤2 years before pregnancy were included (Table 1). Uteroplacental Doppler flow measurements including the pulsatility index (PI) of the uterine and umbilical arteries were performed at 20 and 32 weeks of gestation. CMR studies were used to analyse end-diastolic and end-systolic biventricular volumes, stroke volume, ejection fraction, ventricular mass and RV/LV volume ratio.In addition, CMR flow measurements in the pulmonary artery and aorta were used to analyse cardiac output and regurgitation fraction.
The most important finding was that a reduced RVEF before pregnancy was significantly
associated with higher umbilical artery PI at 32 weeks of gestation (Figure 1). RVEF was also significantly lower in patients with high PI. Further studies evaluating the clinical impact are needed.