Association Between Fetal Myocardial Alterations and Congenital Heart Disease Based on Post‐Mortem Myocardial MRI

ABSTRACT Background Congenital heart disease (CHD) results from abnormal heart development during fetal development, leading to life‐threatening complications. This study aimed to evaluate the feasibility of applying myocardial parametric mapping in post‐mortem magnetic resonance imaging and to examine differences in the left ventricular myocardium between fetuses with CHD and controls. Methods This prospective case–control study was conducted on 14 deceased fetuses with CHD (CHD group) and 24 fetuses without CHD (control group). Fetuses with CHD were further stratified into the cyanotic ( n = 9) and non‐cyanotic ( n = 5) CHD groups. T1, T2, and proton density relaxation times of the left ventricular myocardium were calculated and compared using multiple‐dynamic multiple‐echo post‐mortem magnetic resonance imaging technology. Results The myocardial T2 relaxation time was significantly different between the groups ( p = 0.033), with no difference in T1 or proton density relaxation times between the groups. A one‐way analysis of variance with Tukey's test showed that the mean cyanotic CHD group showed a longer myocardial T2 relaxation time than the control group (98.000 ± 13.143 vs. 83.542 ± 9.491 ms, p = 0.003). Additionally, the correlation coefficient in the CHD group was significantly different between the myocardial T2 relaxation time and peak systolic velocity of pulmonary artery on a fetal echocardiogram ( r 2 = 0.681, p = 0.010). Conclusions These results suggest that using myocardial alterations in the T2 relaxation time may provide a accurate early warning for myocardial injury and enable noninvasive recognition of cardiac involvement in fetuses with CHD.