EP09.94: The deep dive of different forms of fetal cardiac dysfunction

This study aims to investigate echocardiographic features associated with various forms of fetal cardiac dysfunction (FCD), with a focus on cases lacking structural heart defects. A retrospective analysis was conducted on 6 cases displaying diverse FCD. Utilising a combination of conventional Doppler and advanced fetal speckle tracking, a comprehensive assessment of cardiac function was performed. Fetal speckle tracking was performed in 4 cases. Despite lower CO due to severe bradycardia in CCHB, compensation was more pronounced in the LV than the RV, albeit declining with advanced gestation. In Hb Bart's disease, the heart adapted well to prolonged workload (hypervolemia and increased CO). Compensated LV contractility alongside impaired RV function was observed at 20 weeks, with both ventricles progressively deteriorating. Chorioangioma was characterised by cardiomegaly, hyperdynamic ventricles, and engorged IVC. Serial follow-up revealed holosystolic TR at 32 weeks, yet compensated ventricles persisted, evidenced by increased CO, LV fractional shortening (FS), and TAPSE. Premature ductal constriction indicated acute increased RV afterload, with hypokinetic and dilated RV, and holosystolic TR noted at 34 weeks. Despite worsening MPI, CVP, BPP, and TAPSE at 37 weeks, compensated LVFS persisted, along with the brain sparing phenomenon. Caesarean section was performed at 37 weeks. In RV dilated cardiomyopathy, deteriorating amniotic fluid amount, MPI, BPP, and CVP were noted since 33 weeks. Declined RV contractility, specifically fractional area change and FS of the basal to middle segments, was revealed. Postnatally, digoxin was prescribed. In the case with left-sided chylothorax at 38 weeks, impaired LV contractility surpassed that of the RV. Following chest tapping, ventricular contractility and FS remained unchanged, while end-diastolic dimensions and CVP increased. Caesarean section was followed promptly. A comprehensive assessment integrating conventional Doppler and advanced fetal speckle tracking provided valuable insights into diverse FCD.