An Integrated and Automated Tool for Quantification of Biomechanics in Fetal and Neonatal Echocardiography

BackgroundHypoplastic left heart syndrome (HLHS) presents diagnostic and prognostic challenges while progressing toward heart failure (HF). Understanding the fetal and neonatal HLHS biomechanics, including novel hydrodynamic parameters, could help better planning of the long-term management of HLHS patients. ObjectivesCompare fetal and neonatal HLHS cardiac biomechanics against normal subjects using echocardiography. MethodsWe performed a retrospective study of 10 HLHS patients with echocardiograms at 33-weeks gestation and at the first week post-birth and 12 age-matched controls. We used in-house developed analysis algorithms to quantify ventricular biomechanics from four-chamber B-mode and color Doppler scans. Cardiac morphology, hemodynamics, tissue motion, deformation, and flow parameters were measured. ResultsTissue motion, deformation, and index measurements did not reliably capture biomechanical changes. Stroke volume and cardiac output were nearly twice as large for the HLHS right ventricle (RV) compared to the control RV and left ventricle (LV) due to RV enlargement. The enlarged RV exhibited disordered flow with higher energy loss (EL) compared to prenatal control LV and postnatal control RV and LV. Furthermore, the enlarged RV demonstrated elevated vortex strength (VS) compared to both the control RV and LV, prenatally and postnatally. The HLHS RV showed reduced relaxation with increased early filling velocity (E) compared prenatally to the LV and postnatally to the control RV and LV. Furthermore, increased recovery pressure ({Delta}P) was observed between the HLHS RV and control RV and LV, prenatally and postnatally. ConclusionsThe novel hydrodynamic parameters more reliably capture the HLHS alterations in contrast to traditional parameters.