Visualizable intracardiac flow pattern in fetuses with congenital heart defect: pilot study of blood speckle‐tracking echocardiography

Abstract

ABSTRACTObjectivesBlood‐flow pattern is an essential factor in cardiovascular development. Recently, blood speckle‐tracking echocardiography (BST) based on high‐frame‐rate ultrasound has emerged as a promising technique for the assessment of blood‐flow patterns and properties. The objectives of this study were to determine the feasibility of BST in the fetus and to assess intracardiac blood‐flow patterns of fetuses with a congenital heart defect (CHD) using this technique.MethodsThis was a prospective study consisting of 35 normal fetuses, 35 fetuses with left‐sided obstructive lesion (LSOL) and 35 fetuses with right‐sided obstructive lesion (RSOL). BST images of fetal intracardiac regions of interest (ROIs), including the left ventricle (LV), right ventricle (RV), ascending aorta (AAo), aortic arch (AA), descending aorta (DAo) and pulmonary artery (PA), were obtained and analyzed. The feasibility of BST was assessed, and blood‐flow pattern and number of vortices in the ROIs were recorded.ResultsThe median gestational age of the fetuses was 24.7 weeks (range, 19.6–34.3 weeks). BST was feasible in 81.6% of cases, and the cut‐off value of depth for an adequate BST image was ≤ 7.9 cm. There were no differences in the presence of vortex/turbulent blood flow in the LV or RV among the three groups. Vortex/turbulent blood flow in the AAo was detected in 0% (0/35), 14.3% (5/35) and 57.1% (20/35) of cases in the control, LSOL and RSOL groups, respectively. The respective values were 5.7% (2/35), 14.3% (5/35) and 51.4% (18/35) for the AA; 0% (0/35), 48.6% (17/35) and 0% (0/35) for the DAo; and 0% (0/35), 40.0% (14/35) and 51.4% (18/35) for the PA. With the exception of the DAo in the RSOL group, vortex/turbulent flow in the great artery ROIs was significantly more common in the LSOL and RSOL groups than in controls (P < 0.01). In the LSOL group, the number of vortices in the AAo, AA, DAo and PA was significantly greater compared with that in controls (P < 0.01). In the RSOL group, the number of vortices in the LV, AAo, AA and PA was significantly greater compared with that in controls (P < 0.01).ConclusionsFetuses with CHD were more likely to exhibit vortex/turbulent blood flow and increased number of vortices in the great arteries compared with healthy controls. Further research is needed to determine the biomechanical effect of blood‐flow patterns, especially vortex flow, on fetal cardiovascular structure and function. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.