In fetuses with congenital lung masses, decreased ventricular and atrioventricular valve dimensions are associated with lesion size and clinical outcome

Prenat Diagn. 2020 Jan;40(2):206-215. doi: 10.1002/pd.5612. Epub 2019 Dec 1.

Abstract

Introduction: The clinical importance of mass effect from congenital lung masses on the fetal heart is unknown. We aimed to report cardiac measurements in fetuses with congenital lung masses and to correlate lung mass severity/size with cardiac dimensions and clinical outcomes.

Methods: Cases were identified from our institutional database between 2009 and 2016. We recorded atrioventricular valve (AVVz) annulus dimensions and ventricular widths (VWz) converted into z scores, ratio of aortic to total cardiac output (AoCO), lesion side, and congenital pulmonary airway malformation volume ratio (CVR). Respiratory intervention (RI) was defined as intubation, extracorporeal membrane oxygenation (ECMO), or use of surgical intervention prior to discharge.

Results: Fifty-two fetuses comprised the study cohort. Mean AVVz and VWz were below expected for gestational age. CVR correlated with ipsilateral AVVz (RS = -.59, P < .001) and ipsilateral VWz (-0.59, P < .001). Lower AVVz and AoCO and higher CVR were associated with RI. No patient had significant structural heart disease identified postnatally.

Conclusion: In fetuses with left-sided lung masses, ipsilateral cardiac structures tend to be smaller, but in our cohort, there were no patients with structural heart disease. However, smaller left-sided structures may contribute to the need for RI that affects a portion of these fetuses.

MeSH terms

  • Aortic Valve / diagnostic imaging
  • Aortic Valve / pathology
  • Cardiac Output
  • Echocardiography
  • Extracorporeal Membrane Oxygenation
  • Female
  • Fetal Heart / diagnostic imaging*
  • Fetal Heart / pathology
  • Fetal Heart / physiopathology
  • Gestational Age
  • Heart Defects, Congenital / diagnostic imaging*
  • Heart Defects, Congenital / etiology
  • Heart Defects, Congenital / therapy
  • Heart Valves / diagnostic imaging*
  • Heart Valves / pathology
  • Humans
  • Hydrops Fetalis / diagnostic imaging
  • Hydrops Fetalis / etiology
  • Infant, Newborn
  • Intubation, Intratracheal
  • Lung Diseases / complications
  • Lung Diseases / congenital
  • Lung Diseases / diagnostic imaging*
  • Lung Diseases / therapy
  • Magnetic Resonance Imaging
  • Mitral Valve / diagnostic imaging
  • Mitral Valve / pathology
  • Organ Size
  • Pregnancy
  • Pulmonary Valve / diagnostic imaging
  • Pulmonary Valve / pathology
  • Respiration, Artificial / statistics & numerical data
  • Stroke Volume
  • Tricuspid Valve / diagnostic imaging
  • Tricuspid Valve / pathology
  • Ultrasonography, Prenatal