Alterations in Ventricular Filling in Small-for-Gestational-Age Fetuses

Abstract

Objective: This study was designed to evaluate if fetal diastolic cardiac function is compromised in small-for-gestational-age (SGA) fetuses with documented fetal well-being at the biophysical profile. Study Design: We have compared indices of diastolic cardiac flow in singleton SGA fetuses with forward diastolic flow in the umbilical artery at Doppler velocimetry and documented fetal well-being (n = 10) with those of appropriate-for-gestational-age (AGA) controls with documented fetal well-being matched for gestational age at ultrasound (n = 20). Results: At the mitral valve, velocity time integral (VTI) (0.059 ± 0.011 vs. 0.069 ± 0.011 m, p = 0.04), peak velocity of the A wave (0.426 ± 0.043 vs. 0.498 ± 0.087 m/s, p = 0.005), and acceleration time of the E wave (0.046 ± 0.004 vs. 0.053 ± 0.007 s, p = 0.008) were significantly different between SGA and AGA fetuses. At the right atrioventricular valve, only VTI was significantly different between SGA and AGA fetuses (0.065 ± 0.014 vs. 0.078 ± 0.011, p = 0.03). Conclusions: These findings suggest that SGA fetuses have significantly lower left and right ventricular diastolic filling compared with AGA fetuses without significant changes in diastolic function.

Effects of chronic hypoxia on cardiac function measured by pressure-volume catheter in fetal chickens

“…Indices of depressed cardiac function in this study parallel previously reported consequences of developmental hypoxia or intrauterine growth restriction in the sheep and human heart (6,22,29), suggesting that placental and maternal factors are not primarily responsible for cardiovascular adaptations to this stress. We found that developmental hypoxia decreased ⌬P/ ⌬t Max and increased , similar to findings from prior studies of the isolated, Langendorff-perfused fetal chicken heart at 90% of incubation (day 19; 38), and isolated muscle bundles from the 95% incubation (day 20) hypoxia-incubated chicken heart (48).…”

Dynamics of the septum primum in fetuses with intrauterine growth restriction

“…9,21 These data support the hypothesis that in these fetuses, the EI is a more sensitive parameter for the evaluation of diastolic function than Doppler analysis of AV valves.…”

“…Flow velocities through the atrioventricular (AV) valves are altered in IUGR fetuses, as a result of diastolic function. Miyague et al 9 showed that the ventricular filling is altered in fetuses with inappropriate intrauterine growth. Tsyvian et al 10 demonstrated an increase of the ventricular isovolumic relaxation time in fetuses with IUGR due to placental insufficiency.…”

Cardiac remodelling in a baboon model of intrauterine growth restriction mimics accelerated ageing

“…Likewise, our findings of diastolic dysfunction suggest the previously reported diastolic disturbance and impaired ventricular filling in IUGR human neonates and small for gestational age human fetuses persist into adulthood (Miyague et al . ; Fouzas et al . ).…”