Analysis of ventricular shape by echocardiography in normal fetuses, newborns, and infants

Qualitative and quantitative changes in left ventricular shapes were analyzed in 14 normal fetuses, 29 normal newborns, and 12 normal infants. Qualitative observations demonstrated that most fetuses and newborns with dominant right ventricles had flattened or even indented interventricular septae, which changed left ventricular shape into an ellipse. In contrast, left ventricular shapes in infants were round, similar to shapes described in older children and adults. When changes in shape or septal distortions were gross, interobserver agreement was 100%; when changes were less altered from a circular shape, interobserver agreement was 78%. To avoid subjective misinterpretations, quantitative analyses were performed, including M mode echocardiographic comparisons of right ventricular/left ventricular dimensions and left ventricular cavity anterior-posterior/lateral diameters, as well as Fourier analysis of digitized tracings of the entire left ventricular shape. The right ventricular/left ventricular ratio, determined by M mode echocardiography, showed significant differences between fetuses (1.07 ± 0.07) and newborns (0.62 ± 0.12) (p < .001). Infants had a significantly lower right ventricular/left ventricular ratio (0.45 ± 0.01) when compared with newborns (p < .01). Ratios of left ventricular antero-posterior/lateral diastolic diameters were significantly lower (p < .001) in newborns (0.66 ± 0.08) when compared with those of infants (0.82 ± 0.10). All diameters tended to increase (toward roundness) with systole and with aging. Fourier analysis allowed evaluation of the entire left ventricle, including that portion of the septum that qualitatively appeared most indented and could not be analyzed by either of the above techniques. Shape factor derived from idealized shapes ranging from a circle to an indented ellipse allowed comparison with digitized left ventricular tracings. This technique allowed accurate quantitation of the observed changes in shape. Fetuses had the highest diastolic shape factor (7.47 ± 0.92), whereas infants' shape factors were lowest (2.12 ± 0.41). A tendency toward roundness and loss of distortion occurred with aging. Systolic shape factor was lower with aging in each group studied. The Fourier technique used in this study allows evaluation of an arbitrarily large number of components of a shape, and thus a complete description of that shape is permitted. Comparisons of right ventricular/left ventricular diastolic dimensions and left ventricular anterior-posterior/lateral comparisons are subsets of this technique, which allow evaluation of only two points (circular component-first harmonic) or four points (elliptical component-second harmonic) of an overall shape. Left ventricular geometric changes were similar to shapes seen in various pathologic conditions of right ventricular pressure or volume overload. Accordingly, quantitation of left ventricular shape in normal subjects is necessary before comparison can be made with abnormal subjects. The Fourier method used in this study helps to achieve an enhanced understanding of right and left ventricular interdependence in normal fetuses, newborns, and infants. Through this information, comparison can be made with observations in patients with congenital heart disease.