Fetal anemia is associated with a hyperdynamic circulation and cardiac remodeling. Rapid intrauterine transfusion (IUT) of blood with high hematocrit and viscosity into the umbilical vein used to treat this condition can temporarily further affect fetal heart function. The aim of this study was to evaluate the short-term changes in fetal myocardial function caused by IUT using automated analysis of cine-loops of the fetal heart obtained by color tissue Doppler imaging (cTDI). Fetal echocardiography was performed before and after IUT. cTDI recordings were obtained in a four-chamber view and regions of interest were placed at the atrioventricular plane in the left ventricular (LV), right ventricular (RV) and septal walls. Myocardial velocities were analyzed by an automated analysis software to obtain peak myocardial velocities during atrial contraction (Am), ventricular ejection (Sm), rapid ventricular filling (Em) and Em/Am ratio was calculated. Myocardial velocities were converted to z-scores using published reference ranges. Delta z-scores (after minus before IUT) were calculated. Correlations were assessed between variables and hemoglobin before IUT. Thirty-two fetuses underwent 70 IUTs. Fourteen were first time transfusions. In the LV and septal walls, all myocardial velocities were significantly increased compared to normal values, whereas in the RV only Sm was increased before IUT (z-scores 0.26–0.52). In first time IUTs, there was a negative correlation between LV Em (rho = − 0.61, p = 0.036) and LV Em/Am (rho = − 0.82, p = 0.001) z-scores and hemoglobin before IUT. The peak myocardial velocities that were increased before IUT decreased, whereas LV Em/Am increased significantly after IUT. This study showed that peak myocardial velocities assessed by cTDI are increased in fetuses before IUT reflecting the physiology of hyperdynamic circulation. In these fetuses, the fetal heart is able to adapt and efficiently handle the volume load caused by IUT by altering its myocardial function.

中文翻译：

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通过彩色组织多普勒记录的自动分析评估宫内输血时的胎儿心脏功能。

胎儿贫血与高动力循环和心脏重塑有关。将具有高血细胞比容和粘度的血液快速宫内输血 (IUT) 进入用于治疗这种疾病的脐静脉会暂时进一步影响胎儿心脏功能。本研究的目的是使用彩色组织多普勒成像 (cTDI) 获得的胎儿心脏电影循环的自动分析来评估 IUT 引起的胎儿心肌功能的短期变化。在 IUT 之前和之后进行了胎儿超声心动图检查。cTDI 记录是在四腔视图中获得的，感兴趣的区域被放置在左心室 (LV)、右心室 (RV) 和间隔壁的房室平面上。通过自动分析软件分析心肌速度以获得心房收缩 (Am)、心室射血 (Sm)、快速心室充盈 (Em) 和 Em/Am 比值期间的峰值心肌速度。使用公开的参考范围将心肌速度转换为 z 值。计算 Delta z 分数（在 IUT 之前减去之后）。在 IUT 之前评估变量和血红蛋白之间的相关性。32 个胎儿接受了 70 个 IUT。十四是第一次输血。在 LV 和间隔壁中，与正常值相比，所有心肌速度都显着增加，而在 RV 中，在 IUT 之前仅 Sm 增加（z 分数 0.26-0.52）。在第一次 IUT 中，LV Em (rho = − 0.61, p = 0.036) 和 LV Em/Am (rho = − 0.82, p = 0) 之间存在负相关。001) 在 IUT 之前的 z 分数和血红蛋白。IUT 前增加的峰值心肌速度降低，而 IUT 后 LV Em/Am 显着增加。该研究表明，在 IUT 之前，胎儿通过 cTDI 评估的峰值心肌速度增加，反映了高动力循环的生理学。在这些胎儿中，胎心能够通过改变其心肌功能来适应和有效处理由 IUT 引起的容量负荷。