• echocardiograms show reduced ejection fraction, stroke volume, cardiac output, and fractional shortening, increased left ventricular end-systolic internal diameter (LVID) and increased end-systolic volume (ESV) indicating systolic dysfunction indicative of inadequate ejection of blood from the heart chambers following each systolic contraction
• systolic dysfunction is progressive as LVID and ESV are increased at 20 weeks compared to 12 weeks
• the ratio of peak mitral inflow velocity during early diastole and mitral annular velocity is altered, indicating increased ventricular filling pressure
• increase in the left-ventricular end-systolic anterior wall thickness at 12 weeks of age
• pulmonary ejection time is reduced at 20 weeks, indicating increased afterload in the right ventricle, however, pulmonary acceleration time (PAT), and PAT/pulmonary ejection time are not altered and mean pulmonary artery pressure is not changed
• however, parameters of diastolic dysfunction, such as isovolumic relaxation time and mitral ratio of the early to late ventricular filling velocities, are not altered