Human fetal pulmonary artery velocimetry: repeatability and normal values with emphasis on middle and distal pulmonary vessels

Laudy, J. A. M.; Ridder, Maria A. J. de; Wladimiroff, J. W.

doi:10.1046/j.1469-0705.2000.00134.x

Cited by 45 publications

(45 citation statements)

References 10 publications

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“…Information on normal fetal pulmonary circulation has been obtained in our center. 10,11 As a result, gestation-related changes in pulmonary blood flow velocity waveforms have been reported by us. 10,11 Only sparse data are available on the inverse relationship between Po 2 and downstream impedance in the peripheral pulmonary arteries, established in growth-restricted human fetuses.…”

supporting

confidence: 56%

“…10,11 As a result, gestation-related changes in pulmonary blood flow velocity waveforms have been reported by us. 10,11 Only sparse data are available on the inverse relationship between Po 2 and downstream impedance in the peripheral pulmonary arteries, established in growth-restricted human fetuses. 12 It has been shown in postmortem studies that pulmonary hypoplasia is associated with underdevelopment and structural changes of the pulmonary vascular bed.…”

supporting

confidence: 56%

“…Doppler waveforms (sample volume: 0.1-0.3 cm) were first obtained from the most proximal branch of the pulmonary artery, then in the middle lung region at equal distance from the outer border of the heart and the inner thoracic wall and subsequently in the distal lung region as close as possible to the fetal inner thoracic wall (Fig 1). 10,11 The interrogation angle was always kept below 20 degrees. The highpass filter was set at 100 Hz, and when no end-diastolic or early diastolic reverse flow velocities were present, the filter was set at 70 Hz.…”

Section: Recording Techniquementioning

confidence: 99%

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Prenatal Prediction of Pulmonary Hypoplasia: Clinical, Biometric, and Doppler Velocity Correlates

et al. 2002

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ABSTRACT. Objectives. To determine the value of pulmonary artery Doppler velocimetry relative to fetal biometric indices and clinical correlates in the prenatal prediction of lethal lung hypoplasia (LH) in prolonged (>1 week) oligohydramnios.Methods. Forty-two singleton pregnancies with oligohydramnios associated with premature rupture of membranes ([PROM]; n ‫؍‬ 31) or bilateral renal pathology (n ‫؍‬ 11) were examined using color-coded Doppler ultrasound in a cross-sectional study design. Mean gestational age was 28.0 ؎ 4.3 weeks (range: 20 -36 weeks). Thoracic, cardiac, and abdominal circumference and the largest vertical amniotic fluid pocket were measured. Pulsed Doppler measurements of the arterial pulmonary branches were made at the level of the cardiac 4-chamber view. Diagnosis of LH was based on clinical, radiologic, and pathologic criteria. Clinicians were blinded to the prenatal measurements.Results. The prevalence of lethal LH was 43%. In the PROM subset, combination of onset of PROM at <20 weeks, duration of oligohydramnios at >8 weeks, and degree of oligohydramnios at <1 cm presented the highest clinical prediction rate for lethal LH. For both the total group and the PROM subset, the highest prediction rate for lethal LH was presented by thoracic circumference/ abdominal circumference ratio, peak systolic velocity in the proximal branch, and time-averaged and end-diastolic velocity in the middle branch of the pulmonary artery. In the PROM subset, the combination of all 3 clinical, biometric, and Doppler parameters revealed the most favorable combination to predict lethal LH (positive predictive value: 100%; accuracy: 93%; and sensitivity: 71%).Conclusion. Doppler velocimetry may detect changes in pulmonary artery waveforms in the presence of LH but fails to be the ultimate test for the prenatal prediction of lethal LH. The best prediction can be achieved by combining clinical, biometric, and Doppler parameters. Pediatrics 2002;109:250 -258; human fetus, pulmonary hypoplasia, pulmonary circulation, premature rupture of membranes, oligohydramnios, Doppler velocimetry.

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confidence: 56%

supporting

confidence: 56%

Section: Recording Techniquementioning

confidence: 99%

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Prenatal Prediction of Pulmonary Hypoplasia: Clinical, Biometric, and Doppler Velocity Correlates

et al. 2002

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“…22,23 These studies established that at least 3 levels of bifurcation of pulmonary vessels were imaged in normal fetuses, leading us to consider this simple morphologic criterion for evaluating pulmonary arterial vasculature in fetuses with CDH.…”

Section: Discussionmentioning

confidence: 99%

“…The level of the section was chosen to obtain the largest possible cross-sectional image of the lung. The power Doppler angiogram was considered normal when the 3 distinct segments of the pulmonary vasculature 22,23 were clearly identified, that is, when at least 3 levels of bifurcation of the pulmonary vessels were imaged ( Figure 1A). The pulmonary angiogram was otherwise considered poor ( Figure 1, B and C) or absent ( Figure 1D).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Fetal Pulmonary Vasculature by Power Doppler Imaging in Congenital Diaphragmatic Hernia

Michelet

Aubry

Sayed

et al. 2004

J of Ultrasound Medicine

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Objective. To evaluate the feasibility of prenatal power Doppler imaging of pulmonary arteries in congenital diaphragmatic hernia and to study its potential to predict outcome. Methods. A prospective observational study was conducted. Forty-two cases of congenital diaphragmatic hernia (32 left and 10 right) without associated anomalies were analyzed. Qualitative evaluation of pulmonary vasculature was based on power Doppler imaging performed at 26 to 38 weeks. The pulmonary arteries were studied in the lung contralateral to the hernia. Pulmonary Doppler angiography was considered satisfactory when 3 levels of bifurcation defining 3 distinct segments of the pulmonary arteries were imaged and was otherwise considered poor. We also recorded the gestational age at diagnosis, side of the hernia, abdominal circumference below the third percentile, amniotic fluid volume, lung/thoracic area ratio, left/right ventricle ratio, and, in left-sided hernias, stomach position, and we carried out a multivariate analysis to determine the contribution of each factor to predict neonatal mortality. Results. More than 3 divisions of the fetal pulmonary arteries were imaged in 20 cases; 1 or 2 divisions or none were imaged in 22. Neonatal mortality was significantly greater when fewer than 3 divisions of the pulmonary arteries were imaged (18 [82%] of 22) than when 3 divisions could be identified on power Doppler imaging (5 [25%] of 20; P = .0005). However, the lung/thoracic area ratio was the only factor that remained significantly associated with mortality in the multivariate analysis. Conclusions. An altered pulmonary power Doppler image is associated with neonatal mortality, but estimation of the lung area remains the best predictor of neonatal outcome. Key words: congenital diaphragmatic hernia; lung/head ratio; lung/thorax ratio; power Doppler imaging; prenatal diagnosis; pulmonary hypoplasia; sonography. ongenital diaphragmatic hernia (CDH) diagnosed in utero has a neonatal mortality rate of 50% to 80%, 1-7 death being mainly due to pulmonary hypoplasia. Predicting the neonatal outcome prenatally remains a challenge. Moreover, prenatal staging of CDH is becoming increasingly important as new intrauterine therapeutic interventions emerge, including minimally invasive fetal surgery.8 So far, research on prenatal prediction of pulmonary hypoplasia has focused on using sonography or magnetic resonance imaging to assess the size of the lungs, 7,9-14 the degree of herniation of abdominal organs, 6,15,16 and the consequences of fetal hemodynamic changes on left ventricular size. 17,18 In CDH, however, pulmonary hypoplasia is associated with alterations of the pulmonary vasculature, accounting for potentially lethal postnatal pulmonary hypertension.19

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Prenat. Diagn.

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Human fetal pulmonary artery velocimetry: repeatability and normal values with emphasis on middle and distal pulmonary vessels

Abstract: Alteration in pulmonary vascular resistance may play a role in gestational age-related changes, whereas changes in vessel branching/diameter and in the distance between the heart and more distal arterial pulmonary vessels may cause inter-pulmonary differences.

Cited by 45 publications

References 10 publications

Prenatal Prediction of Pulmonary Hypoplasia: Clinical, Biometric, and Doppler Velocity Correlates

Prenatal Prediction of Pulmonary Hypoplasia: Clinical, Biometric, and Doppler Velocity Correlates

Evaluation of Fetal Pulmonary Vasculature by Power Doppler Imaging in Congenital Diaphragmatic Hernia

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