Evaluation Of Ventricular Function In Fetus With Transposition Of Great Arteries By Velocity Vector Imaging

Objective Evaluation of global and segmental strain in both ventricles in the fetal transposition of great arteries by velocity vector imaging.To investigate the effects of different anatomic factors on ventricular function of the fetus with transposition of great arteries.Method We retrospectively identified 49 cases of fetal complete transposition of the great arteries(TGA)and 29 cases of fetal Taussig-Bing anomaly(TBA)encountered from 2015 to 2019 in middle pregnancy and compared findings to 49 controls of comparable gestational age.Postprocessing analysis of the left ventricle and right ventricle were done using velocity vector imaging.Global and regional longitudinal systolic peak velocity,strain and strain rate were generated.The parameters of fetal growth and development,cardiac anatomy and cardiac function were compared in each group.The univariate and multivariate linear regression analysis was established to study the independent influencing factors of LVGLS,LVGLSR,RVGLS and RVGLSR in fetuses with transposition of the great arteries.Fetuses with transposition of the great arteries were grouped according to whether they were combined with ventricular septal defect(VSD),and whether they were combined with pulmonary stenosis(PS).To compare the effects of different anatomical factors on the cardiac function of both ventricles.Result(1)Compared with control group,there was no significant difference in gestational age,fetal heart rate,biparietal diameter,head circumference and abdominal circumference in TGA group and TBA group(P>0.05).(2)Compared with control group,there were statistically significant differences in z-scores of aorta and pulmonary artery in TGA group and TBA group(P<0.05);Compared with the TGA group,the pulmonary artery and left and right pulmonary artery z-score,AO/MPA,LA/RA were statistically different in the TBA group(P<0.05).(3)Compared with control group,global and most regional longitudinal systolic peak velocity,strain and strain rate were decreased in TGA group and TBA group(P<0.05);However,there was no significant difference between TGA group and TBA group(P>0.05).(4)Ventricular septum integrity and pulmonary artery development were independent factors of the biventricular longitudinal systolic strain and strain rate of the transposition of the great arteries fetus.(5)Compared with transposition of the great arteries with intact ventricular septum group,the RVGLVs,RVGLSs,RVGLSRs,LVGLSs and LVGLSRs of the transposition of the great arteries with VSD group were decreased(P<0.05).Compared with transposition of the great arteries with pulmonary artery well developed group,the LVGLVs、LVGLSs、RVGLSs、RVGLSRs of the transposition of the great arteries with PS group were decreased(P<0.05).(6)Compared with TGA with PS and intact ventricular septum group,LVGLVs,RVGLVs and RVGLSs were decreased in TGA with PS and VSD(P<0.05).Compared with TGA with intact ventricular septum and pulmonary artery well developed group,RVGLSs were decreased in TGA with intact ventricular septum and PS group(P<0.05).(7)Compared with TBA with pulmonary artery well developed group,LVGLVs 、LVGLSs 、RVGLSs were decreased in TBA with PS group(P<0.05).Conclusions Early impairment of transposition of the great arteries fetal biventricular cardiac function occurred in middle pregnancy.The PS and VSD were independent factors in the decreased cardiac function of transposition of the great arteries fetus,and the cardiac function is more obviously decreased when transposition of the great arteries fetus combined with VSD or PS.