Fetal septum primum excursion (SPE) and septum primum excursion index (SPEI) as sonomarkers of fetal anemia: using hemoglobin Bart's fetuses as a study model

Sirilert, Sirinart; Tongprasert, Fuanglada; Srisupundit, Kasemsri; Luewan, Suchaya; Tongsong, Theera

doi:10.1002/pd.4840

Cited by 5 publications

(8 citation statements)

References 15 publications

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“…It only decreases when cardiac decompensation is in a very advanced stage. Hyperdynamic state: Foetuses with anaemia are in a hyperdynamic state because of high cardiac output and hypervolaemia, as mentioned earlier 18 . The large blood volume crossing the foramen ovale causes the septum primum excursion (SPE) and SPE index (the ratio of SPE to the left atrial diameter) to increase 45 . Sirilert et al 45 .…”

Section: Haemodynamic Changes In Foetal Haemoglobin Bart's Diseasementioning

confidence: 98%

Foetal haemodynamic response to anaemia

et al. 2020

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This study aims to update new knowledge regarding foetal cardiovascular response to anaemia, using foetal haemoglobin Bart's disease as a study model. Original research articles, review articles, and guidelines were narratively reviewed and comprehensively validated. The main foetal cardiovascular changes in response to anaemia are consequences of hypervolaemia and increased cardiac output to meet tissue oxygen requirement. New challenging insights are as follows: (i) the earliest morphological change is an increase in cardiac size and remodelling of the sphericity (an increase in diameter more pronounced than that in long axis) followed by several markers, such as placentomegaly and hepatosplenomegaly. (ii) The earliest functional change is increased peak systolic velocity of the red blood cells because of low viscosity, especially in the middle cerebral artery. (iii) The foetal heart has very high reserve potentials to cope with anaemia: increasing workload without increased central venous pressure and increased myocardial performance without compromising shortening fraction. This hard-working period with good performance lasts long, including most part of the second and third trimester. (iv) At the time cardiomegaly myocardial cellular damage has already occurred, in spite of good cardiac function. (v) Anaemic hydrops foetalis is mainly due to hypervolaemia, hypoalbuminaemia, and high vascular permeability, not heart failure. (vi) Foetal heart failure occurs only when the adaptive mechanism becomes exhausted or long after the development of anaemic hydrops foetalis. Heart failure is a very late result of a longstanding overworked heart. (vii) Ultrasound is highly effective in the detection of foetal response to anaemia. An increase in cardiac size and middle cerebral artery is very helpful in predicting the affected foetuses in pre-hydropic phase. (viii) Theoretically, intrauterine treatment of anaemic hydrops results in satisfactory outcomes as long as cardiac function is normal, but intrauterine intervention should be strongly considered in pre-hydropic phase because myocardial cell damage could have already occurred in this phase or early hydropic phase. Anaemic hydrops foetalis is not primarily caused by heart failure as commonly advocated, but it is rather a consequence of hypervolaemia, hypoalbuminaemia, and high vascular permeability while heart failure is a very late consequence of a longstanding overworked heart. New insights gained from this review may be useful to base clinical practice on which sonographic markers imply significant pathological changes, how ultrasound can be helpful in early detection of anaemic response, when intrauterine transfusion for anaemia due to non-lethal causes should be administered, etc.

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Section: Haemodynamic Changes In Foetal Haemoglobin Bart's Diseasementioning

confidence: 98%

Foetal haemodynamic response to anaemia

et al. 2020

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“…Increased venous blood flow in the DV can be shown as early as 12 to 13 weeks' gestation 49 . Additionally, septum primum excursion (SPE) and the septum primum excursion index (SPEI, the ratio of SPE to the left atrial diameter), indicating the amount of blood flow crossing the foramen ovale, were significantly higher compared with unaffected fetuses and inversely correlated with Hb levels 50 . Sirilert et al 50 evaluated the SPE and SPEI of 180 cardio spatiotemporal image correlation volume data sets of fetuses at risk at 18 to 22 weeks and found that the SPE and SPEI were significantly higher in the affected group (4.1 ± 1.1 versus 3.0 ± 0.8 mm and 0.61 ± 1.1 versus 0.49.1 ± 0.1, respectively).…”

Section: Prehydropic Phasementioning

confidence: 99%

“…Sirilert et al 50 evaluated the SPE and SPEI of 180 cardio spatiotemporal image correlation volume data sets of fetuses at risk at 18 to 22 weeks and found that the SPE and SPEI were significantly higher in the affected group (4.1 ± 1.1 versus 3.0 ± 0.8 mm and 0.61 ± 1.1 versus 0.49.1 ± 0.1, respectively). At a cutoff value of 1.3 MoM, SPE gave sensitivity and specificity of 75.0% and 72.7% 50 …”

Section: Prehydropic Phasementioning

confidence: 99%

“…To be succinct, this review does not describe the measurement techniques for various parameters in detail but refers to the sources available online as follows: measurement of the C/T ratio, 37 placental thickness, 36 liver length, 42 MCA PSV, 17 splenic artery PSV, 60 cardiac preload (DV 23 and IVC 22 ), ventricular SF, 24 Tei index, 25 GSI, 48 SPE, and SPEI 50 …”

Section: Ultrasound Techniques In the Assessment Of Fetal Hb Bart Dismentioning

confidence: 99%

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Ultrasound Features of Fetal Anemia Lessons From Hemoglobin Bart Disease

Thammavong

Luewan

Wanapirak

et al. 2020

J of Ultrasound Medicine

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Insights gained from this review are as follows: (1) Ultrasound is highly effective in early detection of fetal hemoglobin (Hb) Bart disease. (2) The most sensitive parameters in predicting Hb Bart anemia appear to be the cardiac diameter–to–thoracic diameter ratio, middle cerebral artery peak systolic velocity, and placental thickness. (3) Several other ultrasound markers are helpful in increasing specificity, such as hepatosplenomegaly. (4) Hydrops fetalis is not a consequence of heart failure but rather of hypervolemia and high vascular permeability of fetuses, whereas heart failure is a very late consequence of a long‐standing overworked heart. (5) Management guidelines for fetuses at risk of Hb Bart disease are proposed.

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“…ASA in the fetuses should be de ned differently, since an excursion ratio of 25% can be a physiologic movement caused by blood ow crossing the foramen ovale. In fetuses, the cut-off point for diagnosis of excessive excursion is de ned as greater than 1.3 MoM or the excursion ratio of greater than 55% (4) . ASA associated with premature atrial contraction (PAC) has been reported several times (5,6) .…”

Section: Introductionmentioning

confidence: 99%

Fetal Atrial Flutter Associated With Atrial Septal Aneurysm

Tongprasert

Srisupundit

Luewan

et al. 2021

Preprint

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Objective: To provide evidence that fetal atrial flutter (AF) caused by atrial septal aneurysm (ASA) can be completely cured by delivery. Cases: Three fetuses with ASA complicated by AF in late gestation, including hydrops fetalis in one case, were collected and completely followed up. AF in all cases completely disappeared shortly after birth. New insights gained from this study are as follows: 1) PACs or bigeminy associated with ASA can progressively change to AF. 2) AF associated with ASA can cause hydrops fetalis and intrauterine treatment is needed but delivery is definitive treatment. 3) AF associated with ASA completely resolves after birth. Conclusion: This report may have clinical impact because of providing evidence that 1) In case of AF associated with ASA, the prognosis is much better than other causes and delivery should be strongly considered. 2) Fetuses diagnosed with AF should always be looked for the presence of ASA. 3) PAC/bigeminy related to ASA, different from isolated PAC, needs close follow-up for development of SVT and AF. 4) The fetuses remote from term can benefit from intrauterine treatment to avoid hydrops fetalis, and to prolong gestation for maturity and early delivery is recommended once lung maturity is confirmed.

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Fetal septum primum excursion (SPE) and septum primum excursion index (SPEI) as sonomarkers of fetal anemia: using hemoglobin Bart's fetuses as a study model

Cited by 5 publications

References 15 publications

Foetal haemodynamic response to anaemia

Foetal haemodynamic response to anaemia

Ultrasound Features of Fetal Anemia Lessons From Hemoglobin Bart Disease

Fetal Atrial Flutter Associated With Atrial Septal Aneurysm

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