Estimated cardiac output and cardiovascular profile score in fetuses with high cardiac output lesions

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p><jats:italic>High cardiac output lesions are associated with an increased risk of fetal death, largely as a result of cardiac failure and hydrops fetalis. The cardiovascular profile score (<jats:styled-content style="fixed-case">CVPS</jats:styled-content>) has been used to characterize cardiovascular wellbeing, and has been linked to fetal outcomes in other conditions. We aimed to test the hypothesis that elevated combined cardiac output (<jats:styled-content style="fixed-case">CCO</jats:styled-content>) in fetuses with high output lesions may be associated with worsening cardiovascular status, as evidenced by a lower <jats:styled-content style="fixed-case">CVPS</jats:styled-content></jats:italic>.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p><jats:italic>A retrospective review was performed of fetuses with high cardiac output lesions that underwent echocardiography between July 2006 and November 2010. Diagnoses included sacrococcygeal teratoma, placental chorioangioma and vein of Galen aneurysm. Fetal echocardiographic evaluation included assessment of <jats:styled-content style="fixed-case">CVPS</jats:styled-content>, as well as Doppler/two‐dimensional estimation of <jats:styled-content style="fixed-case">CCO</jats:styled-content>, indexed to estimated fetal weight (<jats:styled-content style="fixed-case">CCOi</jats:styled-content>). The relationship between <jats:styled-content style="fixed-case">CCO</jats:styled-content> and <jats:styled-content style="fixed-case">CVPS</jats:styled-content> was assessed</jats:italic>.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p><jats:italic>A total of 35 fetuses were studied: 27 had sacrococcygeal teratoma, seven had chorioangioma and one had vein of Galen aneurysm. There was a significant inverse relationship between mean <jats:styled-content style="fixed-case">logCCOi</jats:styled-content> and <jats:styled-content style="fixed-case">CVPS</jats:styled-content> (r<jats:sup>2</jats:sup> = 0.48, P = 0.008). Of 31 patients with clinical outcome data, 10 experienced either in‐utero demise or intervention; 80% of these fetuses had a <jats:styled-content style="fixed-case">CVPS</jats:styled-content> of < 8</jats:italic>.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p><jats:italic>There is an inverse relationship between <jats:styled-content style="fixed-case">CCO</jats:styled-content> and <jats:styled-content style="fixed-case">CVPS</jats:styled-content> in the fetus with high cardiac output lesions. As a measure of fetal cardiovascular wellbeing in this population, the <jats:styled-content style="fixed-case">CVPS</jats:styled-content> may be a useful tool for stratifying risk and for selection for intervention in these fetuses</jats:italic>.</jats:p></jats:sec>