Changes in pulmonary venous Doppler parameters in fetal cardiac defects

Giugni

Journal of Fetal Medicine

et al. 2015

Congenital heart disease (CHD) is the leading cause of infant mortality. Nevertheless, routine prenatal ultrasound only detects 30 %-50 % of CHD cases. Therefore, emphasis should be placed on early predictors of CHD that allow physicians to timely refer high-risk patient to specialized fetal echocardiography, in order to maximize chances of improved outcomes. The fetal venous system has been the focus of attention as a marker of heart function. Yet, there exist inconsistent data about the acquisition of pulmonary venous flow in early pregnancy. This study aims to determine the feasibility of fetal pulmonary venous flow acquisition in early pregnancy, and the association between pulmonary vein (A-wave) flow reversal and the presence of CHD. Total of 211 consecutive pregnant women, between 12 and 15 weeks of gestation, underwent routine obstetric ultrasound along with basic fetal echocardiography including fetal pulmonary venous flow assessment. The pulmonary venous flow velocity waveforms were acquired by either Doppler or Doppler plus enhance flow technique based on equipment availability. All the cases were re-evaluated by specialized fetal echocardiography during late pregnancy to identify congenital heart anomalies. The acquisition of fetal pulmonary vein, between 12 and 15 weeks of gestation, was successfully accomplished in 87.7 % of cases. Five out of seven fetuses with end-diastolic (A-wave) pulmonary venous flow reversal were associated with confirmed cardiac anomaly. In this pilot study, pulmonary venous (A-wave) flow reversal was associated with cardiac anomalies in 86.8 % of cases (p = 0.001). This pilot study proposes that Doppler interrogation of fetal pulmonary vein flow during early pregnancy is feasible. Furthermore, the presence of pulmonary vein (A-wave) reversal might represent a marker of major cardiac anomalies. Further investigation is needed to confirm these findings.

“…This mirrors the flow patterns described in late pregnancy by previous studies [7,10,11]. A pulmonary vein A-wave reversal was only described in 0.55 % of normal fetuses.…”

Section: Detection Of Fetal Pulmonary Venous Flow Waveforms During Easupporting

confidence: 88%

Section: End-diastolic (A-wave) Pulmonary Venous Flow Reversal and Cosupporting

confidence: 76%

Section: End-diastolic (A-wave) Pulmonary Venous Flow Reversal and Comentioning

confidence: 85%

Section: Detection Of Fetal Pulmonary Venous Flow Waveforms During Eamentioning

confidence: 97%

See 2 more Smart Citations

Evaluation of Fetal Pulmonary Veins During Early Gestation by Pulsed Doppler Ultrasound: A Feasibility Study

Giugni

Journal of Fetal Medicine

et al. 2015

Journal of Biomechanics

“…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

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.

Methods for prenatal assessment of fetal cardiac function

et al. 2009

Fetal cardiac function is increasingly recognized as a marker of disease severity and prognosis in selected fetal conditions. Magnetic resonance imaging (MRI) has been used in experimental (animal) fetal cardiology but the lack of a noninvasive fetal electrocardiogram (ECG) to trigger image acquisition remains a major limiting factor precluding its application in humans. Fetal medicine specialists are therefore limited to ultrasound to evaluate human fetal cardiac function. In this review, we aim to provide a complete overview of the different ultrasound techniques that can be used for fetal cardiac function assessment and we discuss their (theoretical) strengths and shortcomings. Conventional methods include M-mode assessment of ventricular contractility and Doppler assessment of the precordial veins and cardiac output (CO). More recent techniques such as the measurement of the myocardial performance index (MPI), myocardial motion analysis with tissue Doppler, speckle tracking and three-dimensional (3D) ultrasound techniques are also discussed.