Maternal Hyperoxygenation in Fetal Left Heart Hypoplasia

Study Overview
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Brief Summary
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Heart disease is the leading cause of infant death related to birth defects. Congenital heart disease in which the left sided structures of the heart (left heart hypoplasia or LHH) are too small are among the most severe, and have some of the highest death and other complication rates.

Detailed Description
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We intend to study a new, non-invasive fetal intervention to help outcomes in children with LHH. We plan to study the effect of giving oxygen to mothers who have fetuses with small left-sided structures. We specifically will evaluate if the fetal left heart valves will grow faster if the mother breathes extra oxygen on a daily basis (at least 8 hours per day). Mothers and fetuses meeting criteria will be offered to enroll in the study. All enrolled mothers will be asked to receive oxygen continuously for the rest of the pregnancy using a non-rebreather mask. At birth, we will compare the fetuses whose mothers received oxygen to historical controls. We specifically will study how fast the left heart valves have grown.

Official Title
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Evaluation of the Use of Supplemental Oxygen to Mothers With Fetal Left Heart Hypoplasia

Conditions
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Left Heart Hypoplasia

Intervention / Treatment
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* Other: Maternal Hyperoxygenation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Group A, C: Fetuses with hypoplastic left sided structures or at risk of coarctation of the aorta and ALL of the following Any mitral annulus, aortic annulus, left ventricular end-diastolic dimension, or aortic diameter z-score less than or equal to 3.0 Right-left ventricular size discrepancy with no other explanation of discrepancy Retrograde blood flow in the aortic arch from the ductus arteriosus Left to right flow across the foramen ovale Group B: Healthy Fetal controls Mothers undergoing screening fetal echo for family history of CHD with a normal echo. Mothers undergoing fetal echocardiography for suspected heart disease with a normal echo Mothers evaluated in the fetal center with normal ultrasound Group D: Fetuses with hypoplastic left sided structures or at risk of coarctation of the aorta and any of the following Any mitral annulus, aortic annulus, left ventricular end-diastolic dimension, or aortic diameter z-score less than or equal to 2.0 Right-left ventricular size discrepancy with no other explanation of discrepancy Continuous Doppler flow in the aortic arch concerning for coarctation Significantly less aortic flow than pulmonary artery flow Severe atrial septal aneurysm with possible obstruction of mitral valve flow Left superior vena cava to coronary sinus with dilated coronary sinus. Retrograde blood flow in the aortic arch from the ductus arteriosus Hypoplastic left heart syndrome (HLHS) and variants of HLHS Total anomalous pulmonary venous return Exclusion criteria: Multiple gestations Persistent arrhythmia Very poor ultrasound images, defined by the inability to reliably measure/evaluate all included cardiac structures (valve annuli, branch pulmonary arteries, PFO, and arch) Major extra cardiac anomalies Aneuploidy Maternal conditions that may alter fetal hemodynamics, including moderate to severe HTN requiring medication in pregnancy, preeclampsia, major or unrepaired maternal congenital heart disease, obstructive sleep apnea, severe asthma (non-responsive to inhaled steroid therapy), restrictive lung disease, severe anemia, maternal chronic renal disease known placentation abnormality (complete placenta previa, accrete, or percreta), and antiphospholipid ab syndrome

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Historical LHH Controls<br>Previous women with a dx of fetal LHH and whose care was continued at Texas Children's Hospital. | |
| Placebo Comparator: Healthy Fetal Controls<br>Healthy mothers with healthy fetuses that will come in monthly for fetal echcos starting at 20 wks. | Other: Maternal Hyperoxygenation<br>* Oxygen is given to mothers at 8L through a non-rebreather mask.<br>* Other names: Oxygen;|
| Experimental: Chonic Maternal Hyperoxygenation w/ LHH<br>Mothers who have a fetus diagnosed with LHH and elect daily maternal hyperoxygenation therapy. | Other: Maternal Hyperoxygenation<br>* Oxygen is given to mothers at 8L through a non-rebreather mask.<br>* Other names: Oxygen;|
| Experimental: Acute Maternal Hyperoxygenation with LHH<br>Mothers who have a fetus diagnosed with LHH and elect acute maternal hyperoxygenation challenge testing. | Other: Maternal Hyperoxygenation<br>* Oxygen is given to mothers at 8L through a non-rebreather mask.<br>* Other names: Oxygen;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Aortic annular dimension | By fetal echo the size of the aortic annulus in mm | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mitral annular dimension | By fetal echo the size of the mitral valve annulus in mm | years |