Pilot study of chronic maternal hyperoxygenation and effect on aortic and mitral valve annular dimensions in fetuses with left heart hypoplasia

D. A. Lara, S. A. Morris, S. A. Maskatia, M. Challman, M. Nguyen, D. K. Feagin, L. Schoppe, J. Zhang, A. Bhatt, S. K. Sexson-Tejtel, K. N. Lopez, E. J. Lawrence, S. Andreas, Y. Wang, M. A. Belfort, Rodrigo Ruano, N. A. Ayres, C. A. Altman, K. M. Aagaard, J. Becker

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: Acute maternal hyperoxygenation (AMH) results in increased fetal left heart blood flow. Our aim was to perform a pilot study to determine the safety, feasibility and direction and magnitude of effect of chronic maternal hyperoxygenation (CMH) on mitral and aortic valve annular dimensions in fetuses with left heart hypoplasia (LHH) after CMH. Methods: Gravidae with fetal LHH were eligible for inclusion in a prospective evaluation of CMH. LHH was defined as: sum of aortic and mitral valve annuli Z-scores < −4.5, arch flow reversal and left-to-right or bidirectional atrial level shunting without hypoplastic left heart syndrome or severe aortic stenosis. Gravidae with an affected fetus and with ≥ 10% increase in aortic/combined cardiac output flow after 10 min of AMH at 8 L/min 100% fraction of inspired oxygen were offered enrollment. Nine gravidae were enrolled from February 2014 to January 2015. The goal therapy was ≥ 8 h daily CMH from enrollment until delivery. Gravidae who were cared for from July 2012 to October 2014 with fetal LHH and no CMH were identified as historical controls (n = 9). Rates of growth in aortic and mitral annuli over the final trimester were compared between groups using longitudinal regression. Results: There were no significant maternal or fetal complications in the CMH cohort. Mean gestational age at study initiation was 29.6 ± 3.2 weeks for the intervention group and 28.4 ± 1.8 weeks for controls (P = 0.35). Mean relative increase in aortic/combined cardiac output after AMH was 35.3% (range, 18.1–47.9%). Median number of hours per day on CMH therapy was 9.3 (range, 6.5–14.6) and median duration of CMH was 48 (range, 33–84) days. Mean mitral annular growth was 0.19 ± 0.05 mm/week compared with 0.14 ± 0.05 mm/week in CMH vs controls (mean difference 0.05 ± 0.05 mm/week, P = 0.33). Mean aortic annular growth was 0.14 ± 0.03 mm/week compared with 0.13 ± 0.03 mm/week in CMH vs controls (mean difference 0.01 ± 0.03 mm/week, P = 0.75). More than 9 h CMH daily (n = 6) was associated with better growth of the aortic annulus in intervention fetuses (0.16 ± 0.03 vs 0.08 ± 0.02 mm/week, P = 0.014). Conclusions: CMH is both safe and feasible for continued research. In this pilot study, the effect estimates of annular growth, using the studied method of delivery and dose of oxygen, were small.

Original languageEnglish (US)
Pages (from-to)365-372
Number of pages8
JournalUltrasound in Obstetrics and Gynecology
Volume48
Issue number3
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

Fingerprint

Aortic Valve
Mitral Valve
Fetus
Mothers
Fetal Heart
Growth
Maternal Inheritance
Cardiac Output
Hypoplastic Left Heart Syndrome
Oxygen
Aortic Valve Stenosis
Gestational Age

Keywords

  • borderline left heart
  • fetal intervention
  • left heart hypoplasia
  • maternal hyperoxygenation
  • Shone syndrome

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

Cite this

Pilot study of chronic maternal hyperoxygenation and effect on aortic and mitral valve annular dimensions in fetuses with left heart hypoplasia. / Lara, D. A.; Morris, S. A.; Maskatia, S. A.; Challman, M.; Nguyen, M.; Feagin, D. K.; Schoppe, L.; Zhang, J.; Bhatt, A.; Sexson-Tejtel, S. K.; Lopez, K. N.; Lawrence, E. J.; Andreas, S.; Wang, Y.; Belfort, M. A.; Ruano, Rodrigo; Ayres, N. A.; Altman, C. A.; Aagaard, K. M.; Becker, J.

In: Ultrasound in Obstetrics and Gynecology, Vol. 48, No. 3, 01.09.2016, p. 365-372.

Research output: Contribution to journalArticle

Lara, DA, Morris, SA, Maskatia, SA, Challman, M, Nguyen, M, Feagin, DK, Schoppe, L, Zhang, J, Bhatt, A, Sexson-Tejtel, SK, Lopez, KN, Lawrence, EJ, Andreas, S, Wang, Y, Belfort, MA, Ruano, R, Ayres, NA, Altman, CA, Aagaard, KM & Becker, J 2016, 'Pilot study of chronic maternal hyperoxygenation and effect on aortic and mitral valve annular dimensions in fetuses with left heart hypoplasia', Ultrasound in Obstetrics and Gynecology, vol. 48, no. 3, pp. 365-372. https://doi.org/10.1002/uog.15846
Lara, D. A. ; Morris, S. A. ; Maskatia, S. A. ; Challman, M. ; Nguyen, M. ; Feagin, D. K. ; Schoppe, L. ; Zhang, J. ; Bhatt, A. ; Sexson-Tejtel, S. K. ; Lopez, K. N. ; Lawrence, E. J. ; Andreas, S. ; Wang, Y. ; Belfort, M. A. ; Ruano, Rodrigo ; Ayres, N. A. ; Altman, C. A. ; Aagaard, K. M. ; Becker, J. / Pilot study of chronic maternal hyperoxygenation and effect on aortic and mitral valve annular dimensions in fetuses with left heart hypoplasia. In: Ultrasound in Obstetrics and Gynecology. 2016 ; Vol. 48, No. 3. pp. 365-372.
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abstract = "Objective: Acute maternal hyperoxygenation (AMH) results in increased fetal left heart blood flow. Our aim was to perform a pilot study to determine the safety, feasibility and direction and magnitude of effect of chronic maternal hyperoxygenation (CMH) on mitral and aortic valve annular dimensions in fetuses with left heart hypoplasia (LHH) after CMH. Methods: Gravidae with fetal LHH were eligible for inclusion in a prospective evaluation of CMH. LHH was defined as: sum of aortic and mitral valve annuli Z-scores < −4.5, arch flow reversal and left-to-right or bidirectional atrial level shunting without hypoplastic left heart syndrome or severe aortic stenosis. Gravidae with an affected fetus and with ≥ 10{\%} increase in aortic/combined cardiac output flow after 10 min of AMH at 8 L/min 100{\%} fraction of inspired oxygen were offered enrollment. Nine gravidae were enrolled from February 2014 to January 2015. The goal therapy was ≥ 8 h daily CMH from enrollment until delivery. Gravidae who were cared for from July 2012 to October 2014 with fetal LHH and no CMH were identified as historical controls (n = 9). Rates of growth in aortic and mitral annuli over the final trimester were compared between groups using longitudinal regression. Results: There were no significant maternal or fetal complications in the CMH cohort. Mean gestational age at study initiation was 29.6 ± 3.2 weeks for the intervention group and 28.4 ± 1.8 weeks for controls (P = 0.35). Mean relative increase in aortic/combined cardiac output after AMH was 35.3{\%} (range, 18.1–47.9{\%}). Median number of hours per day on CMH therapy was 9.3 (range, 6.5–14.6) and median duration of CMH was 48 (range, 33–84) days. Mean mitral annular growth was 0.19 ± 0.05 mm/week compared with 0.14 ± 0.05 mm/week in CMH vs controls (mean difference 0.05 ± 0.05 mm/week, P = 0.33). Mean aortic annular growth was 0.14 ± 0.03 mm/week compared with 0.13 ± 0.03 mm/week in CMH vs controls (mean difference 0.01 ± 0.03 mm/week, P = 0.75). More than 9 h CMH daily (n = 6) was associated with better growth of the aortic annulus in intervention fetuses (0.16 ± 0.03 vs 0.08 ± 0.02 mm/week, P = 0.014). Conclusions: CMH is both safe and feasible for continued research. In this pilot study, the effect estimates of annular growth, using the studied method of delivery and dose of oxygen, were small.",
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author = "Lara, {D. A.} and Morris, {S. A.} and Maskatia, {S. A.} and M. Challman and M. Nguyen and Feagin, {D. K.} and L. Schoppe and J. Zhang and A. Bhatt and Sexson-Tejtel, {S. K.} and Lopez, {K. N.} and Lawrence, {E. J.} and S. Andreas and Y. Wang and Belfort, {M. A.} and Rodrigo Ruano and Ayres, {N. A.} and Altman, {C. A.} and Aagaard, {K. M.} and J. Becker",
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TY - JOUR

T1 - Pilot study of chronic maternal hyperoxygenation and effect on aortic and mitral valve annular dimensions in fetuses with left heart hypoplasia

AU - Lara, D. A.

AU - Morris, S. A.

AU - Maskatia, S. A.

AU - Challman, M.

AU - Nguyen, M.

AU - Feagin, D. K.

AU - Schoppe, L.

AU - Zhang, J.

AU - Bhatt, A.

AU - Sexson-Tejtel, S. K.

AU - Lopez, K. N.

AU - Lawrence, E. J.

AU - Andreas, S.

AU - Wang, Y.

AU - Belfort, M. A.

AU - Ruano, Rodrigo

AU - Ayres, N. A.

AU - Altman, C. A.

AU - Aagaard, K. M.

AU - Becker, J.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Objective: Acute maternal hyperoxygenation (AMH) results in increased fetal left heart blood flow. Our aim was to perform a pilot study to determine the safety, feasibility and direction and magnitude of effect of chronic maternal hyperoxygenation (CMH) on mitral and aortic valve annular dimensions in fetuses with left heart hypoplasia (LHH) after CMH. Methods: Gravidae with fetal LHH were eligible for inclusion in a prospective evaluation of CMH. LHH was defined as: sum of aortic and mitral valve annuli Z-scores < −4.5, arch flow reversal and left-to-right or bidirectional atrial level shunting without hypoplastic left heart syndrome or severe aortic stenosis. Gravidae with an affected fetus and with ≥ 10% increase in aortic/combined cardiac output flow after 10 min of AMH at 8 L/min 100% fraction of inspired oxygen were offered enrollment. Nine gravidae were enrolled from February 2014 to January 2015. The goal therapy was ≥ 8 h daily CMH from enrollment until delivery. Gravidae who were cared for from July 2012 to October 2014 with fetal LHH and no CMH were identified as historical controls (n = 9). Rates of growth in aortic and mitral annuli over the final trimester were compared between groups using longitudinal regression. Results: There were no significant maternal or fetal complications in the CMH cohort. Mean gestational age at study initiation was 29.6 ± 3.2 weeks for the intervention group and 28.4 ± 1.8 weeks for controls (P = 0.35). Mean relative increase in aortic/combined cardiac output after AMH was 35.3% (range, 18.1–47.9%). Median number of hours per day on CMH therapy was 9.3 (range, 6.5–14.6) and median duration of CMH was 48 (range, 33–84) days. Mean mitral annular growth was 0.19 ± 0.05 mm/week compared with 0.14 ± 0.05 mm/week in CMH vs controls (mean difference 0.05 ± 0.05 mm/week, P = 0.33). Mean aortic annular growth was 0.14 ± 0.03 mm/week compared with 0.13 ± 0.03 mm/week in CMH vs controls (mean difference 0.01 ± 0.03 mm/week, P = 0.75). More than 9 h CMH daily (n = 6) was associated with better growth of the aortic annulus in intervention fetuses (0.16 ± 0.03 vs 0.08 ± 0.02 mm/week, P = 0.014). Conclusions: CMH is both safe and feasible for continued research. In this pilot study, the effect estimates of annular growth, using the studied method of delivery and dose of oxygen, were small.

AB - Objective: Acute maternal hyperoxygenation (AMH) results in increased fetal left heart blood flow. Our aim was to perform a pilot study to determine the safety, feasibility and direction and magnitude of effect of chronic maternal hyperoxygenation (CMH) on mitral and aortic valve annular dimensions in fetuses with left heart hypoplasia (LHH) after CMH. Methods: Gravidae with fetal LHH were eligible for inclusion in a prospective evaluation of CMH. LHH was defined as: sum of aortic and mitral valve annuli Z-scores < −4.5, arch flow reversal and left-to-right or bidirectional atrial level shunting without hypoplastic left heart syndrome or severe aortic stenosis. Gravidae with an affected fetus and with ≥ 10% increase in aortic/combined cardiac output flow after 10 min of AMH at 8 L/min 100% fraction of inspired oxygen were offered enrollment. Nine gravidae were enrolled from February 2014 to January 2015. The goal therapy was ≥ 8 h daily CMH from enrollment until delivery. Gravidae who were cared for from July 2012 to October 2014 with fetal LHH and no CMH were identified as historical controls (n = 9). Rates of growth in aortic and mitral annuli over the final trimester were compared between groups using longitudinal regression. Results: There were no significant maternal or fetal complications in the CMH cohort. Mean gestational age at study initiation was 29.6 ± 3.2 weeks for the intervention group and 28.4 ± 1.8 weeks for controls (P = 0.35). Mean relative increase in aortic/combined cardiac output after AMH was 35.3% (range, 18.1–47.9%). Median number of hours per day on CMH therapy was 9.3 (range, 6.5–14.6) and median duration of CMH was 48 (range, 33–84) days. Mean mitral annular growth was 0.19 ± 0.05 mm/week compared with 0.14 ± 0.05 mm/week in CMH vs controls (mean difference 0.05 ± 0.05 mm/week, P = 0.33). Mean aortic annular growth was 0.14 ± 0.03 mm/week compared with 0.13 ± 0.03 mm/week in CMH vs controls (mean difference 0.01 ± 0.03 mm/week, P = 0.75). More than 9 h CMH daily (n = 6) was associated with better growth of the aortic annulus in intervention fetuses (0.16 ± 0.03 vs 0.08 ± 0.02 mm/week, P = 0.014). Conclusions: CMH is both safe and feasible for continued research. In this pilot study, the effect estimates of annular growth, using the studied method of delivery and dose of oxygen, were small.

KW - borderline left heart

KW - fetal intervention

KW - left heart hypoplasia

KW - maternal hyperoxygenation

KW - Shone syndrome

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