Chronic Intermittent Materno-Fetal Hyperoxygenation in Late Gestation May Improve on Hypoplastic Cardiovascular Structures Associated with Cardiac Malformations in Human Fetuses

摘要

Hypoplasia of cardiovascular structures is a common finding in fetuses with cardiac malformations. Materno-fetal hyperoxygenation (HO) during late gestation promotes venous return to the fetal heart. This analysis in human fetuses sought to define whether this “loading” effect might improve hypoplastic cardiovascular dimensions. Fifteen late-gestation fetuses presented with varying degrees of hypoplastic cardiovascular structures. In these cases, chronic intermittent materno-fetal HO was administered during periods ranging from 8 to 33 days. Cardiac measurements were taken before and at the end of treatment and translated into Z-scores as well as plotted on normal growth charts. During the treatment period, chronic intermittent materno-fetal HO was associated with improved dimensions of ≥1 hypoplastic cardiovascular structures in most fetuses. However, in some cases, the effect of HO was neutralized or impaired by the presence of ventricular septal defects as well as obstructions to ventricular filling or emptying. Chronic intermittent materno-fetal HO near term may be associated with improvements of hypoplastic cardiovascular dimensions in fetuses with a spectrum of cardiac malformations. This effect may facilitate postnatal treatment and improve prognosis in suitable cases. Keywords Coarctation - Congenital heart disease - Fetal cardiac intervention - Fetus - Hypoplastic left heart complex - Hyperoxygenation - Left heart hypoplasia - Right heart hypoplasia This manuscript is cordially dedicated to Ulrich Gembruch, Director of the Department of Obstetrics and Prenatal Medicine, University of Bonn.