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Objectives: Blood‐flow pattern is an essential factor in cardiovascular development. Recently, blood speckle‐tracking echocardiography (BST) based on high‐frame‐rate ultrasound has emerged as a promising technique for the assessment of blood‐flow patterns and properties. The objectives of this study were to determine the feasibility of BST in the fetus and to assess intracardiac blood‐flow patterns of fetuses with a congenital heart defect (CHD) using this technique. Methods: This was a prospective study consisting of 35 normal fetuses, 35 fetuses with left‐sided obstructive lesion (LSOL) and 35 fetuses with right‐sided obstructive lesion (RSOL). BST images of fetal intracardiac regions of interest (ROIs), including the left ventricle (LV), right ventricle (RV), ascending aorta (AAo), aortic arch (AA), descending aorta (DAo) and pulmonary artery (PA), were obtained and analyzed. The feasibility of BST was assessed, and blood‐flow pattern and number of vortices in the ROIs were recorded. Results: The median gestational age of the fetuses was 24.7 weeks (range, 19.6–34.3 weeks). BST was feasible in 81.6% of cases, and the cut‐off value of depth for an adequate BST image was ≤ 7.9 cm. There were no differences in the presence of vortex/turbulent blood flow in the LV or RV among the three groups. Vortex/turbulent blood flow in the AAo was detected in 0% (0/35), 14.3% (5/35) and 57.1% (20/35) of cases in the control, LSOL and RSOL groups, respectively. The respective values were 5.7% (2/35), 14.3% (5/35) and 51.4% (18/35) for the AA; 0% (0/35), 48.6% (17/35) and 0% (0/35) for the DAo; and 0% (0/35), 40.0% (14/35) and 51.4% (18/35) for the PA. With the exception of the DAo in the RSOL group, vortex/turbulent flow in the great artery ROIs was significantly more common in the LSOL and RSOL groups than in controls (P < 0.01). In the LSOL group, the number of vortices in the AAo, AA, DAo and PA was significantly greater compared with that in controls (P < 0.01). In the RSOL group, the number of vortices in the LV, AAo, AA and PA was significantly greater compared with that in controls (P < 0.01). Conclusions: Fetuses with CHD were more likely to exhibit vortex/turbulent blood flow and increased number of vortices in the great arteries compared with healthy controls. Further research is needed to determine the biomechanical effect of blood‐flow patterns, especially vortex flow, on fetal cardiovascular structure and function. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Re: Correspondence on 'Fetal myocardial deformation measured with two-dimensional speckle-tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses' I read with interest the Reply by de Vet I et al i . to my previous correspondence regarding the Original Paper by van Oostrum I et al i .[[1], [3]]. Our LV-GLS values were comparable to the values of Li I et al i . between 20 and 27 weeks, and our RV-GLS values were comparable to the values of Erickson I et al i .'[[5]]. [Extracted from the article]

4 DeVore GR, Satou G, Sklansky M. Comparing the Non-Quiver and Quiver Techniques for Identification of the Endocardial Borders Used for Speckle-Tracking Analysis of the Ventricles of the Fetal Heart. In this paper, we obtained reliable reference values for fetal global longitudinal strain (GLS) and strain rate (GLSR) using the 2D Cardiac Performance 1.2 software program by TOMTEC Imaging Systems GmbH (Munich, Germany). We thank Dr DeVore for his interest in our paper[1]. [Extracted from the article]

Linked article: This Correspondence comments on van Oostrum et al.. Click here to view the article. [ABSTRACT FROM AUTHOR]

Objectives: Two‐dimensional speckle‐tracking echocardiography (2D‐STE) is a promising technique which allows assessment of fetal cardiac function, and can be used in the evaluation of cardiac and non‐cardiac diseases in pregnancy. However, reliable fetal reference values for deformation parameters measured using 2D‐STE are needed before it can be introduced into clinical practice. This study aimed to obtain reference values for fetal global longitudinal strain (GLS) and GLS rate (GLSR) measured using 2D‐STE and compare right and left ventricular values. Methods: This was a prospective longitudinal cohort study of uncomplicated pregnancies that underwent echocardiography every 4 weeks from inclusion at 18–21 weeks until delivery to obtain four‐chamber loops of the fetal heart. Left and right ventricular GLS and GLSR were measured using 2D‐STE at each examination. Using Bayesian mixed‐effects models, reference values with lower and upper 5% prediction limits were calculated according to gestational age. Right and left ventricular GLS values according to gestational age were compared using the Wilcoxon signed‐rank test. Results: A total of 592 left ventricular and 566 right ventricular GLS and GLSR measurements were obtained from 124 women with uncomplicated pregnancy and non‐anomalous, appropriately grown fetuses. Reference values were obtained for both fetal ventricles according to gestational week. GLS and GLSR values of both ventricles increased (i.e. became less negative) significantly during pregnancy. Right ventricular GLS values were significantly higher (i.e. less negative) than the respective left ventricular values at every gestational week. Conclusions: Reference values were obtained for fetal GLS and GLSR measured using 2D‐STE. GLS and GLSR values increased significantly for both ventricles from the second trimester until delivery. GLS values were significantly higher for the right ventricle compared with the left ventricle. Future studies are needed to assess whether the obtained reference values are helpful in clinical practice in the assessment of pregnancy complications, such as fetal growth restriction or cardiac anomaly. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Although Erickson I et al i .[6] and Li I et al i .[7] also used the TOMTEC software, they used a different ultrasound device (Vivid E9 ultrasound system; GE Healthcare, Horten, Norway) compared with the one used in our study (Epiq W7 ultrasound system; Philips Healthcare, Eindhoven, The Netherlands)[3]. DeVore I et al i .[10] and Wang I et al i .[13] used a Voluson E10 ultrasound system (GE Healthcare, Zipf, Austria) and TOMTEC software, Germanakis I et al i .[14] used an Acuson Sequoia ultrasound system and Syngo Velocity Vector Imaging software (Siemens Healthineers, Mountain View, CA, USA) and we used an Epiq W7 ultrasound system and TOMTEC software[3]. We read with interest the comment by DeVore about our previous Reply[1] to his Correspondence[2] regarding our Original Paper[3]. [Extracted from the article]

To analyse the impact of intrauterine aortic valvuloplasty in fetuses with critical aortic stenosis (AS) on global longitudinal peak systolic strain (GLPSS) of the left ventricle (LV) using two-dimensional Speckle Tracking (2D STE). Conclusions Intrauterine aortic valvuloplasty in fetuses with critical AS seeks to improve fetal LV function in order to prevent progression from aortic stenosis (AS) to hypoplastic left heart syndrome (HLHS). OC17.06: Two-dimensional speckle-tracking echocardiography in fetuses with critical aortic stenosis before and after intrauterine aortic valvuloplasty. [Extracted from the article]