Assessment of Fetal Compromise by Doppler Ultrasound Investigation of the Fetal Circulation

Hecher, Kurt; Campbell, Stuart; Doyle, Pat; Harrington, Kevin; Nicolaides, Kypros H.

doi:10.1161/01.cir.91.1.129

Cited by 416 publications

(294 citation statements)

References 31 publications

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“…13 In the normal flow group, the appearance of a brain-sparing flow with hyperperfusion of the brain was detected in combination with de novo pulsations in the Galena vein. In central veins, a pulsatile flow is a normal finding due to retrograde pressure waves transmitted from atrial contractions 23 . Cheema et al 21 discussed the etiology of Galena vein pulsations, or rather the absence of pulsations during normal conditions, since Galena vein pulsations would normally be expected.…”

Section: Methodsmentioning

confidence: 99%

Restrained cerebral hyperperfusion in response to superimposed acute hypoxemia in growth-restricted human fetuses with established brain-sparing blood flow

Olofsson

2006

Early Human Development

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Section: Methodsmentioning

confidence: 99%

Restrained cerebral hyperperfusion in response to superimposed acute hypoxemia in growth-restricted human fetuses with established brain-sparing blood flow

Olofsson

2006

Early Human Development

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“…Recent advances in high-resolution ultrasound (Bonnet et al, 1999;Brackley et al, 2000;Cohen, 2001;Denkhaus et al, 1979;Hamar et al, 2006;Hecher et al, 1995;Tworetzky et al, 2001) and fetal cardiac MRI (Coakley, 2001;Fogel, 2006;Fogel et al, 2005;Hubbard et al, 1999;Liu et al, 2001) have demonstrated that aortic arch hemodynamics (Lenz et al, 2006) and great vessel anatomy (Axt-Fliedner et al, 2006;Hubbard et al, 1999) correlate with the prognosis of patients with complex CHD, However, fetal cardiac imaging modalities have practical limitations. Fetal echocardiography is often not a true 4D modality, has limited field-of-view, and is constrained by acoustic maternal and fetal windows.…”

Section: Discussionmentioning

confidence: 99%

In vitro hemodynamic investigation of the embryonic aortic arch at late gestation

Pekkan

Dasi

Nourparvar

et al. 2008

Journal of Biomechanics

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This study focuses on the dynamic flow through the fetal aortic arch driven by the concurrent action of right and left ventricles. We created a parametric pulsatile computational fluid dynamics (CFD) model of the fetal aortic junction with physiologic vessel geometries. To gain a better biophysical understanding an in vitro experimental fetal flow loop for flow visualization was constructed for identical CFD conditions. CFD and in vitro experimental results were comparable.Swirling flow during the acceleration phase of the cardiac cycle and unidirectional flow following mid-deceleration phase were observed in pulmonary arteries (PA), head-neck vessels, and descending aorta. Right-to-left (oxygenated) blood flowed through the ductus arteriosus (DA) posterior relative to the antegrade left ventricular outflow tract (LVOT) stream and resembled jet flow. LVOT and right ventricular outflow tract flow mixing had not completed until ~3.5 descending aorta diameters downstream of the DA insertion into the aortic arch. Normal arch model flow patterns were then compared to flow patterns of four common congenital heart malformations that include aortic arch anomalies. Weak oscillatory reversing flow through the DA junction was observed only for the Tetralogy of Fallot configuration. Pulmonary Atresia and Hypoplastic Left Heart Syndrome configurations demonstrated complex, abnormal flow patterns in the PAs and head-neck vessels. Aortic Coarctation resulted in large scale recirculating flow in the aortic arch proximal to the DA. Intravascular flow patterns spatially correlated with abnormal vascular structures consistent with the paradigm that abnormal intravascular flow patterns associated with congenital heart disease influence vascular growth and function.

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“…16 Doppler investigation of regional fetal circulation can provide information regarding fetal well-being and has been evaluated in a number of conditions including intrauterine growth retardation and preeclampsia, where the particular focus has been on relative changes in cerebral and umbilical blood flow resistances. 9,17,18 A beneficial, autoregulatory brain sparing effect from a decrease in middle cerebral arterial resistance improves oxygen delivery to the brain in the presence of increased umbilical artery resistance. This effect is likely due to two potential mechanisms: 'forced centralization' from elevated placental resistance; and a decrement in cerebral arterial resistance.…”

Section: Discussionmentioning

confidence: 99%

The cerebroplacental Doppler ratio predicts postnatal outcome in fetuses with congenital heart block

et al. 2008

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Objective: Autoimmune-mediated congenital complete heart block (CCHB) is associated with significant perinatal morbidity and mortality, and prenatal monitoring of these fetuses is a significant challenge. The cerebroplacental Doppler ratio (CPR), defined as the ratio of the middle cerebral artery pulsatility index (MCA-PI) to the umbilical artery pulsatility index (UA-PI), is predictive of perinatal outcome in growth-restricted fetuses. This study tests the hypothesis that the CPR would be useful in monitoring fetal well-being in fetuses with CCHB.Study Design: We reviewed data on all patients diagnosed prenatally with autoimmune-mediated CCHB at our institution over the past 2 years. The fetal echocardiograms from each patient were analyzed for: CPR, UA-PI, MCA-PI, cardiothoracic ratio, degree of tricuspid regurgitation, ventricular function and presence of effusions. We compared hemodynamic data from the fetal echocardiogram before delivery in patients who required urgent pacemaker placement postnatally to those patients that did not require an urgent pacemaker.Result: Five patients with autoimmune-mediated CCHB were identified, and two patients required urgent pacemaker placement. The CPR before delivery was significantly lower in the patients who required urgent pacemaker placement (0.97±0.06 versus 1.45±0.03; P ¼ 0.003), but there was no difference in other fetal echocardiographic markers between groups. Both patients requiring urgent pacemaker placement had a CPR less than 1.08. Conclusion:The CPR is predictive of postnatal outcome in fetuses with CCHB and is useful in prenatal monitoring of these patients.

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Assessment of Fetal Compromise by Doppler Ultrasound Investigation of the Fetal Circulation

Cited by 416 publications

References 31 publications

Restrained cerebral hyperperfusion in response to superimposed acute hypoxemia in growth-restricted human fetuses with established brain-sparing blood flow

Restrained cerebral hyperperfusion in response to superimposed acute hypoxemia in growth-restricted human fetuses with established brain-sparing blood flow

In vitro hemodynamic investigation of the embryonic aortic arch at late gestation

The cerebroplacental Doppler ratio predicts postnatal outcome in fetuses with congenital heart block

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