Ductus arteriosus and fetal echocardiography: Implications for practice

Alvarez, Silvia; McBrien, Angela

doi:10.1016/j.siny.2018.03.001

Cited by 17 publications

(13 citation statements)

References 61 publications

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“…In severe POO with ventricular septal defect, the origin, course and size of AD are abnormal, and flow is usually retrograde [39]. In pulmonary atresia with ventricular septal defect for example, the AD often arises with an acute angle from the undersurface of the AA and in TOF may be absent or arise from a subclavian artery [40][41][42].…”

Section: Discussionmentioning

confidence: 99%

The multiform sonographic spectrum of arterial duct in right aortic arch

Chiappa

Ridolfi

Cordisco³

2021

Int J Cardiovasc Imaging

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To study the different characteristics of arterial duct (AD) in a series of prenatally detected right aortic arch (RAA). Out of 832 congenital heart diseases (CHD) referred to a tertiary center, 98 cases had RAA. Based on anatomical landmarks we identified 7 types of AD: type 1 left-sided, transverse; type 2 left-sided, vertical; type 3 from the underside of aortic arch (AA), vertical; type 4 right-sided, mirror-image “V”, transverse; type 5 right-sided, “H” shaped, transverse; type 6 bilateral; type 7 absent or unidentifiable. For each type of AD the incidence of associated major CHD was calculated and chi-square test was applied to verify the null hypothesis with significance level of p < 0.05. Type 1 occurred in 43% of cases including 4 with CHD and no cases with pulmonary outflow obstruction (POO). Symptoms of vascular ring were present in 41% of survivors. Type 2, 3 and 7 AD were associated with tetralogy of Fallot (TOF) or equivalents. No type 5 AD with CHD had POO and 3 isolated cases had asymptomatic hypoplasia of left pulmonary artery (LPA). Two type 6 AD had disconnection of LPA. Type 1 occurred more often as an isolated finding (p < 0.001), whereas types 2 (p = 0.0026), 3 (p = 0.0045), 4 (p = 0.0325) and 7 (p = 0.0001) were frequently associated with major CHD. In RAA, type 1 (U-shaped) is usually an isolated finding (p < 0.001) which includes all symptomatic vascular rings. POO is always present when the AD is vertical or absent but not when it lies on a transverse plane. Bilateral AD is rare and brings the risk of functionary loss of left lung if not identified.

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Section: Discussionmentioning

confidence: 99%

The multiform sonographic spectrum of arterial duct in right aortic arch

Chiappa

Ridolfi

Cordisco³

2021

Int J Cardiovasc Imaging

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“…It is interesting that the ductal anomaly (closure/contraction) shows a signi cantly higher V TR , when compared with pulmonary valve atresia/stenosis. As the ductus imports more than 90 percent of the blood ow from the pulmonary artery into the descending aorta, it reduces both the volume and pressure load of the right heart [18]. Obstruction of the ductus is an accurate process which undoubtedly leads to a sharp rise in right ventricular pressure.…”

Section: Discussionmentioning

confidence: 99%

Strategies for Diagnosis of Fetal right atrium dilation: Based on fetal cardiac anatomy and hemodynamics

Wang

Zhao

Zhang³

2020

Preprint

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Background: Fetal right atrium (RA) dilation is frequently detected in routine screenings while it remains a challenge to clarify the reasons. This study aimed to analyze the cardiac anatomy and hemodynamics of fetal RA dilation and the changes of hemodynamic indexes. Methods: In the retrospective study, 420 fetuses with RA dilation were included, which were classified into the physiological group (n=202), volume overload group (n=142), and the pressure overload group (n=76). The ratio of right atrium to left atrium (RA/LA) were measured at four-chamber view. Peak velocity of tricuspid regurgitation (VTR) was recorded in each case, if existed. Results: The RA/LA ratio in the volume overload group is significantly higher than both the pressure overload group and the physiological group (both P=0.000) throughout the pregnancy while no difference presents between the pressure overload group and the physiological group (P=0.694 for 19-31 GW, and P=0.974 for 32-36 GW, respectively). The VTR in the pressure overload group (3.29±0.58 m/s) is significantly higher than both the volume overload group (1.85±0.45 m/s, P=0.000) and the physiological group (0.88±0.45 m/s, P=0.000). The volume overload group shows a significantly higher VTR than the physiological group (P=0.000). In the volume overload group, the ductal contraction/closure shows a significantly higher VTR than that in the pulmonary valve stenosis/atresia (3.98±0.41 m/s vs. 3.03±0.38 m/s, P=0.000).Conclusions: A strategy proposed herein is useful to clarify the reasons for RA dilatation by systematically assessing fetal hemodynamics, which may facilitate the sonographers to make an accurate diagnosis of CHD.

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“…It constitutes more than 80% of the blood flow source of the descending aorta. Therefore, premature contraction of the arterial catheter significantly aggravates the pressure load of the right heart ( Alvarez & McBrien, 2018 ; Enzensberger et al, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of oval foramen restriction and premature contraction of the arterial catheter on right heart function of fetuses and infants

Liu

Cao

et al. 2023

PeerJ

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Objective The effect of fetal oval foramen restriction and premature contraction of the arterial catheter for the right heart function of fetuses and infants was studied by evaluating the right and left ventricular (RV/LV) ratios, the tricuspid annular plane systolic excursion (TAPSE) value, and the Tei index of right heart function parameters. Methods This study was approved by the Ethics Committee of First Affiliated Hospital of Hebei North University (K20190116). We collected 257 fetuses between March 2020 and December 2021. Among these, 98 fetuses that did not have any heart abnormalities were assigned to group A, 91 fetuses with restriction of the left and right atrial channels were assigned to group B, and 68 fetuses with premature contraction of the arterial catheter were assigned to group C. The ventricular transverse diameter, the right heart TAPSE value and the Tei index of fetuses in late pregnancy and 90 days after birth were measured in the three groups, and the diagnostic value of each index for the right heart function injury was evaluated. P < 0.05 indicates significant. Results The P-value of the TAPSE value and Tei index of infants in BC and AC groups and postnatal infants were less than 0.05, which was significant. In the BC group, the RV/LV ratio of fetuses was compared when P > 0.05, which was not significant; however, P < 0.05 after birth was considered significant. For fetuses and postnatal infants in the BC group, the RV/LV ratio was negatively associated with the TAPSE value. However, it was positively associated with the Tei index; Diagnostic test results. To predict impaired right heart function after birth, TAPSE had low diagnostic value, RV/LV and Tei index had high diagnostic value. Conclusions Oval foramen restriction and premature contraction of the arterial catheter may affect the right heart function after birth and be related to the degree of the right heart enlargement. Although TAPSE prediction of the fetal and postnatal right heart function is limited, the RV/LV ratio and the Tei index can be used to predict impaired right heart function after birth.

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Ductus arteriosus and fetal echocardiography: Implications for practice

Cited by 17 publications

References 61 publications

The multiform sonographic spectrum of arterial duct in right aortic arch

The multiform sonographic spectrum of arterial duct in right aortic arch

Strategies for Diagnosis of Fetal right atrium dilation: Based on fetal cardiac anatomy and hemodynamics

Effect of oval foramen restriction and premature contraction of the arterial catheter on right heart function of fetuses and infants

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