Comparison of prenatal and postnatal cardiac function assessed by echocardiography using pulsed wave Doppler, Tissue Doppler and speckle tracking (strain and strain rate) between foetuses/neonates with a structural heart disease, with an fetal growth restriction (FGR) and healthy fetuses/neonates

Currently, fetal echocardiography mainly focusses on the detection of
structural heart disease. New echocardiographic techniques also permit detailed
assessment of the myocardial contraction and relaxation, permitting early
detection of subtle changes in heart function. Structural heart disease and
fetal growth restriction are often accompanied by changes in myocardial
function. These changes already start during early intrauterine life. They can
influence clinical course and outcome during fetal adaptation to hypoxic
intrauterine conditions, during transition from fetal to neonatal circulation
and during early neonatal life in both growth restricted infants and infants
with heart disease. With improved survival of these infants, it becomes clear
that these changes in cardiac function, subtle in early life, often progress or
induce remodelling affecting long term cardiovascular outcome. Expanding the
ultrasonic examination of the heart by adding measurements related to fetal
cardiac function would increase knowledge about the physiology and
pathophysiology of cardiac adaptation during fetal and early neonatal life in
healthy infants as well in infants with fetal growth restriction and/or a
structural heart disease.
Early detection of dysfunction could lead to targeted preventive strategies to
improve short term and long term cardiovascular outcomes in these vulnerable
children.

Early changes before overt cardiac dysfunction can be observed by analysing
myocardial deformation during contraction and relaxation with ultrasonic
techniques such as (blood) speckle-tracking (focussing on myocardial strain and
strain rate) and Tissue Doppler. These techniques are validated in the adult
and pediatric populations but remain experimental in fetuses. The fetal heart
is much smaller, beats faster and is more difficult to assess through the
maternal abdomen. Besides that, the circulation and balance between left and
right ventricle is fundamentally different in a fetus. This brings challenges
in technical feasibility as well as in clinical interpretation of differences.
Recent technical innovations permit to overcome the former and gain experience
with the latter.

Along with 2-D, 3-D and pulsed waved Doppler assessments, inclusion of these
techniques could be of additional value in the assessment of the fetal heart.

Comparison of prenatal and postnatal cardiac function assessed by
echocardiography using 2-D, 3-D, pulsed wave Doppler, Tissue Doppler and
(blood) speckle tracking (focussing on strain and strain rate) between
fetuses/neonates with structural heart disease, fetuses/neonates with fetal
growth restriction (FGR) and healthy fetuses/neonates, both prenatally and
postnatally.

A longitudinal prospective cohort study, conducted at the Department of
Obstetrics and Gynaecology (Division of Fetal Medicine) and the Department of
Paediatrics (Division of Paediatric Cardiology and Division of Neonatology) of
the Erasmus Medical Centre Rotterdam.

Burden associated with participation exists for the group with healthy fetuses
of two (additional) prenatal investigations and one (additional) postnatal
investigation. For the group with fetuses with a structural heart disease the
burden exists of one (additional) prenatal investigation and for the group of
fetuses with a growth restriction, the burden exists of one (additional)
postnatal investigation. All investigations have an estimated time of 15-30
minutes. Ultrasound can be safely used in pregnancy (Doppler ultrasound can be
safely used from 11 weeks in pregnancy). There is no risk associated with
participation for mother and fetus. There is no individual benefit for
participants.