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Wu YC, Chen CH, Lu HT, Lee YL, Chen PY, Wu TY, Tien MH, Wu CH, Huang JYJ, Hsiao CH, Chu WC. Fetal Aortic Blood Flow Velocity and Power Doppler Profiles in the First Trimester: A Comprehensive Study Using High-Definition Flow Imaging. Bioengineering (Basel) 2024; 11:378. [PMID: 38671799 PMCID: PMC11048424 DOI: 10.3390/bioengineering11040378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES This study aimed to establish reference values for fetal aortic isthmus blood flow velocity and associated indices during the first trimester, utilizing a novel ultrasonographic technique known as high-definition flow imaging (HDFI). Additionally, the correlation between Doppler profiles of aortic blood flow and key fetal parameters, including nuchal thickness (NT), crown-rump length (CRL), and fetal heartbeat (FHB), was investigated. METHODS A total of 262 fetuses were included in the analysis between December 2022 and December 2023. Utilizing 2D power Doppler ultrasound images, aortic blood flow parameters were assessed, including aortic peak systolic velocity (PS), aortic end-diastolic velocity (ED), aortic time average maximal velocity (TAMV), and various indices such as aortic systolic velocity/diastolic velocity (S/D), aortic pulsatile index (PI), aortic resistance index (RI), aortic isthmus flow velocity index (IFI), and aortic isthmic systolic index (ISI). Concurrently, fetal FHB, NT, and CRL were evaluated during early trimester Down syndrome screening. RESULTS Significant findings include a positive correlation between gestational age (GA) and PS (PS = 3.75 × (GA) - 15.4, r2 = 0.13, p < 0.01), ED (ED = 0.42 × (GA) - 0.61, r2 = 0.04, p < 0.01), PI (PI = 0.07 × (GA) + 1.03, r2 = 0.04, p < 0.01), and TAMV (TAMV = 1.23 × (GA) - 1.66, r2 = 0.08, p < 0.01). In contrast, aortic ISI demonstrated a significant decrease (ISI = -0.03 × (GA) + 0.57, r2 = 0.05, p < 0.05) with gestational age. No significant correlation was observed for aortic RI (p = 0.33), S/D (p = 0.39), and IFI (p = 0.29) with gestational age. Aortic PS exhibited positive correlations with NT (0.217, p = 0.001) and CRL (0.360, p = 0.000) but a negative correlation with FHB (-0.214, p = 0.001). Aortic PI demonstrated positive correlations with CRL (0.208, p = 0.001) and negative correlations with FHB (-0.176, p = 0.005). Aortic TAMV showed positive correlations with NT (0.233, p = 0.000) and CRL (0.290, p = 0.000) while exhibiting a negative correlation with FHB (-0.141, p = 0.026). Aortic ISI demonstrated negative correlations with NT (-0.128, p = 0.045) and CRL (-0.218, p = 0.001) but a positive correlation with FHB (0.163, p = 0.010). CONCLUSIONS Power Doppler angiography with Doppler ultrasound demonstrates the ability to establish accurate reference values for fetal aortic blood flow during the first trimester of pregnancy. Notably, aortic PS, TAMV, and ISI exhibit significant correlations with NT, CRL, and FHB, with ISI appearing more relevant than IFI, PS, TAMV, and FHB. The utilization of HDFI technology proves advantageous in efficiently detecting the site of the aortic isthmus compared to traditional color Doppler mode in early second trimesters.
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Affiliation(s)
- Yi-Cheng Wu
- Department of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan; (Y.-C.W.); (H.-T.L.)
- Department of Obstetrics and Gynecology, Ton Yen General Hospital, Hsinchu 302048, Taiwan; (M.-H.T.); (C.-H.W.); (J.Y.-J.H.)
- Taiwan IVF Group Center for Reproductive Medicine & Infertility, Hsinchu 302053, Taiwan; (P.-Y.C.); (T.-Y.W.)
| | - Ching-Hsuan Chen
- Department of Obstetrics and Gynecology, Fuyou Branch, Taipei City Hospital, Taipei 100027, Taiwan; (C.-H.C.); (Y.-L.L.)
| | - Hsin-Tzu Lu
- Department of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan; (Y.-C.W.); (H.-T.L.)
| | - Yu-Li Lee
- Department of Obstetrics and Gynecology, Fuyou Branch, Taipei City Hospital, Taipei 100027, Taiwan; (C.-H.C.); (Y.-L.L.)
| | - Pi-Yu Chen
- Taiwan IVF Group Center for Reproductive Medicine & Infertility, Hsinchu 302053, Taiwan; (P.-Y.C.); (T.-Y.W.)
| | - Ting-Yu Wu
- Taiwan IVF Group Center for Reproductive Medicine & Infertility, Hsinchu 302053, Taiwan; (P.-Y.C.); (T.-Y.W.)
| | - Ming-Hsun Tien
- Department of Obstetrics and Gynecology, Ton Yen General Hospital, Hsinchu 302048, Taiwan; (M.-H.T.); (C.-H.W.); (J.Y.-J.H.)
| | - Chiung-Hui Wu
- Department of Obstetrics and Gynecology, Ton Yen General Hospital, Hsinchu 302048, Taiwan; (M.-H.T.); (C.-H.W.); (J.Y.-J.H.)
| | - Jack Yu-Jen Huang
- Department of Obstetrics and Gynecology, Ton Yen General Hospital, Hsinchu 302048, Taiwan; (M.-H.T.); (C.-H.W.); (J.Y.-J.H.)
- Taiwan IVF Group Center for Reproductive Medicine & Infertility, Hsinchu 302053, Taiwan; (P.-Y.C.); (T.-Y.W.)
| | - Ching-Hua Hsiao
- Department of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan; (Y.-C.W.); (H.-T.L.)
- Department of Obstetrics and Gynecology, Fuyou Branch, Taipei City Hospital, Taipei 100027, Taiwan; (C.-H.C.); (Y.-L.L.)
| | - Woei-Chyn Chu
- Department of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan; (Y.-C.W.); (H.-T.L.)
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Alami Laroussi N, Andelfinger G, Bigras JL, Boutin C, Brassard M, Dahdah N, Fournier A, Miró J, Raboisson MJ, van Doesburg N. Cé anvi baille ki baille (C'est l'envie de donner qui donne-It Is the Desire to Give That Gives). CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:1-2. [PMID: 37970102 PMCID: PMC10642114 DOI: 10.1016/j.cjcpc.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2023]
Affiliation(s)
- Nassiba Alami Laroussi
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Gregor Andelfinger
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Jean-Luc Bigras
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Christine Boutin
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Myriam Brassard
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Joaquim Miró
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Marie-Josée Raboisson
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Nicolaas van Doesburg
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
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Chen Z, Zhao H, Zhao Y, Han J, Yang X, Throckmorton A, Wei Z, Ge S, He Y. Retrograde flow in aortic isthmus in normal and fetal heart disease by principal component analysis and computational fluid dynamics. Echocardiography 2022; 39:166-177. [PMID: 35026051 DOI: 10.1111/echo.15256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/04/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Reverse flow Retrograde flow (RF) of blood in the aortic isthmus can be observed in different types of fetal heart disease (FHD), including abnormalities in heart structure and function. This study sought to investigate the relationship between RF and blood flow parameters, and develop a computational fluid dynamics (CFD) model to understand the mechanisms underlying this observation. MATERIAL AND METHODS A total of 281 fetuses (gestational age [GA] 26.6±.3 weeks) with FHD and 2803 normal fetuses (GA: 26.1±.1 weeks) by fetal echocardiography collected from May 2016 to December 2018. Principal component analysis (PCA) was performed to find the relationship and the CFD model reconstructed from 3D/4D spatio-temporal image correlation (STIC) images to simulate hemodynamics. RESULTS There was a significant difference in the percentages of RF between the study (80/201 (39%)) and control (29/2803 (1%)) groups (p < 0.05). The RF occur when the aorta flow rate (left heart) is reduced to 60% by CFD stimulation. Pearson correlation analysis showed significant correlations between flow rate and wall shear stress(WSS) (r = .883, p = 0.047) variables at the AI. CONCLUSION Volumetric flow rate of AO or left heart was the main component of the cause of RF. The hemodynamics of the cardiovascular system have highly complex behavior hinge on the turbulent nature of circulating blood flow.
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Affiliation(s)
- Zhuo Chen
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongkai Zhao
- School of Energy and Power Engineering, Beijing University of Aeronautics and Astronautics, Beijing, China
| | - Ying Zhao
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiancheng Han
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Yang
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Amy Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Zhenglun Wei
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Shuping Ge
- Geisinger Heart and Vascular Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Yihua He
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Mendez A, Codsi E, Gonzalez Barlatay F, Lapointe A, Raboisson MJ. Pulmonary hypertension associated with vein of Galen malformation. Fetal cardiac hemodynamic findings and physiological considerations. J Perinatol 2022; 42:143-148. [PMID: 35022516 DOI: 10.1038/s41372-021-01297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 10/31/2021] [Accepted: 12/07/2021] [Indexed: 11/09/2022]
Abstract
The management of newborns with vein of Galen aneurysmal malformation (VGAM) is clinically challenging for neonatologists and cardiologists. Hemodynamic profiles in four fetuses diagnosed with VGAM who subsequently developed neonatal cardiac failure and pulmonary hypertension were studied using two-dimensional and Doppler echocardiography. All four had an increased cardiothoracic ratio due to right ventricular dilatation on antenatal ultrasound. Doppler studies of the aortic isthmus were abnormal with retrograde flow starting in mid systole and throughout diastole. Left and right ventricular outputs were significantly increased. Net pulmonary flow was highly abnormal with a flow rate almost four times higher than normal. After a short period of clinical stability, all neonates developed cardiac failure and pulmonary hypertension. This article reviews VGAM pathophysiology and the potential relationship between pulmonary hypertension and VGAM, supporting early post-natal treatment of pulmonary hypertension and right ventricular failure.
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Affiliation(s)
- Ana Mendez
- Division of Fetal and Pediatric Cardiology, University of Montreal, Sainte-Justine University Hospital Center, Montreal, QC, Canada.,Pediatric Cardiology Unit, Hospital Virgen del Rocío, Institute of Biomedicine of Seville, Seville, Spain
| | - Elisabeth Codsi
- Division of Obstetrics, University of Montreal, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Francisco Gonzalez Barlatay
- Division of Fetal and Pediatric Cardiology, University of Montreal, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Anie Lapointe
- Division of Neonatology, Department of Paediatrics, Sainte-Justine University Hospital Center, Montréal, QC, Canada
| | - Marie-Josée Raboisson
- Division of Fetal and Pediatric Cardiology, University of Montreal, Sainte-Justine University Hospital Center, Montreal, QC, Canada.
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Choudhary P, Malik A, Batra A. Cerebroplacental ratio and aortic isthmus Doppler in early fetal growth restriction. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:754-761. [PMID: 34101840 DOI: 10.1002/jcu.23028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To assess the utility of cerebroplacental ratio (CPR) and fetal aortic isthmus (AoI) Doppler in the prediction of perinatal outcome in early fetal growth restriction (FGR). METHODS A prospective observational cohort study of 70 early FGR cases was conducted through serial Doppler examinations and findings of the last examination were correlated with perinatal outcome. Doppler blood flow measurements of AoI included end diastolic velocity (EDV), peak systolic velocity (PSV), pulsatility index (PI), resistance index (RI), and isthmic flow index (IFI). RESULTS Significant association of CPR and all Doppler indices of AoI with the overall adverse perinatal outcome was seen. The sensitivity of CPR was moderate (63.64%) but higher than most AoI indices. Most AoI Doppler indices (PI, RI, IFI) had higher specificities (100%). AoI PSV and EDV had higher sensitivities than CPR for the prediction of overall adverse perinatal outcome, with AoI PSV having the highest sensitivity (100%). CONCLUSION CPR shows significant association and moderate sensitivity for prediction of overall adverse perinatal outcome in early FGR; hence recommended in all cases of early FGR. AoI Doppler also appears to have a role in assessment and decision making in FGR in view of high sensitivity and high specificity of AoI indices in the prediction of perinatal outcome. However, larger studies are required to confirm its utility in the management of early FGR.
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Affiliation(s)
- Pratibha Choudhary
- MD Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Amita Malik
- MD Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Achla Batra
- DGO, DNB Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Mappa I, Maqina P, Bitsadze V, Khizroeva J, Makatsarya A, Arduini D, Rizzo G. Cardiac function in fetal growth restriction. Minerva Obstet Gynecol 2021; 73:423-434. [PMID: 33904691 DOI: 10.23736/s2724-606x.21.04787-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Fetal growth restriction (FGR) is defined as the inability of the fetus to reach its growth potential. According to the onset of the disease is defined early (<32 weeks) or late (≥32 weeks). FGR is associated with an increased risk of adverse short- and long-term outcomes, including hypoxemic events and neurodevelopmental delay compared to normally grown fetuses and increased risk of complications in the infanthood and adulthood. The underlying cause of FGR is placental insufficiency leading to chronic fetal hypoxia that affects cardiac hemodynamic with different mechanism in early and late onset growth restriction. In early onset FGR adaptive mechanisms involve the diversion of the cardiac output preferentially in favor of the brain and the heart, while abnormal arterial and venous flow manifest in the case of further worsening of fetal hypoxia. In late FGR the fetal heart shows a remodeling of its shape and function mainly related to a reduction of umbilical vein flow. In this review we discuss the modifications occurring at the level of the fetal cardiac hemodynamic in fetuses with early and late FGR.
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Affiliation(s)
- Ilenia Mappa
- Division of Maternal and Fetal Medicine, Cristo Re Hospital, Tor Vergata University, Rome, Italy
| | - Pavjola Maqina
- Division of Maternal and Fetal Medicine, Cristo Re Hospital, Tor Vergata University, Rome, Italy
| | - Victoria Bitsadze
- Division of Maternal and Fetal Medicine, Cristo Re Hospital, Tor Vergata University, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Jamilya Khizroeva
- Division of Maternal and Fetal Medicine, Cristo Re Hospital, Tor Vergata University, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Alexander Makatsarya
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Domenico Arduini
- Department of Developmental Medicine and Prevention, Tor Vergata University, Rome, Italy
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Cristo Re Hospital, Tor Vergata University, Rome, Italy -
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
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Lehtoranta L, Haapsamo M, Vuolteenaho O, Palo P, Ekholm E, Räsänen J. Fetal cardiovascular hemodynamics in type 1 diabetic pregnancies at near-term gestation. Acta Obstet Gynecol Scand 2020; 100:263-271. [PMID: 32880890 DOI: 10.1111/aogs.13987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/17/2020] [Accepted: 08/13/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Poor glycemic control in maternal type 1 diabetes mellitus during pregnancy can affect fetal cardiac and placental function. However, studies concerning fetal central hemodynamics have revealed conflicting results. We hypothesized that in pregnancies complicated by maternal type 1 diabetes, fetal cardiovascular and placental hemodynamics are comparable to the control fetuses at near-term gestation. In addition, we investigated the relation between newborn serum biomarkers of cardiac function and fetal cardiovascular and placental hemodynamics. Furthermore, we studied whether maternal diabetes is associated with placental inflammation. MATERIAL AND METHODS In this prospective case-control study, fetal central and peripheral hemodynamics were assessed by ultrasonography in 33 women with type 1 diabetes and in 67 controls with singleton pregnancies between 34+2 and 40+2 gestational weeks. Newborn umbilical cord serum was collected to analyze cardiac natriuretic peptides (atrial and B-type natriuretic peptides) and troponin T concentrations. Placental tissue samples were obtained for cytokine analyses. RESULTS Fetal ventricular wall thicknesses were greater and weight-adjusted stroke volumes and cardiac outputs were lower in the type 1 diabetes group than in the control group. Pulsatility in the aortic isthmus and inferior vena cava blood flow velocity waveforms was greater in the type 1 diabetes group fetuses than in the controls. A positive correlation was found between branch pulmonary artery and aortic isthmus pulsatility index values. Umbilical artery pulsatility indices were comparable between the groups. Umbilical cord serum natriuretic peptide and troponin T concentrations were elevated in the type 1 diabetes fetuses. These cardiac biomarkers correlated significantly with cardiovascular hemodynamics. Placental cytokine levels were not different between the groups. CONCLUSIONS In maternal type 1 diabetes pregnancies, fetal cardiovascular hemodynamics is impaired. Maternal type 1 diabetes does not seem to alter placental vascular impedance or induce placental inflammation.
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Affiliation(s)
- Lara Lehtoranta
- Department of Obstetrics and Gynecology, University of Turku, and Turku University Hospital, Turku, Finland.,Institute of Biomedicine, Department of Physiology, University of Oulu, Oulu, Finland.,The Research Center of Applied and Preventive Cardiovascular Medicine (CAPC), University of Turku, Turku, Finland
| | - Mervi Haapsamo
- Institute of Biomedicine, Department of Physiology, University of Oulu, Oulu, Finland.,Satakunta Central Hospital, Pori, Finland
| | - Olli Vuolteenaho
- Institute of Biomedicine, Department of Physiology, University of Oulu, Oulu, Finland
| | - Pertti Palo
- Department of Obstetrics and Gynecology, University of Turku, and Turku University Hospital, Turku, Finland
| | - Eeva Ekholm
- Department of Obstetrics and Gynecology, University of Turku, and Turku University Hospital, Turku, Finland
| | - Juha Räsänen
- Fetal Medicine Center, Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Ferraz MM, Araújo FDV, Carvalho PRND, Sá RAMD. Aortic Isthmus Doppler Velocimetry in Fetuses with Intrauterine Growth Restriction: A Literature Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:289-296. [PMID: 32483809 PMCID: PMC10316834 DOI: 10.1055/s-0040-1710301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Intrauterine growth restriction (IUGR) is associated with poor perinatal prognosis and a higher risk of stillbirth, neonatal death, and cerebral palsy. Its detection and the evaluation of its severity by new Doppler velocimetric parameters, such as aortic isthmus (AoI), are of great relevance for obstetrical practice. The AoI is a vascular segment that represents a point of communication between the right and left fetal circulations. It is considered to be a functional arterial shunt that reflects the relationship between the systemic and cerebral impedances, and has recently been proposed as a tool to detect the status of hemodynamic balance and prognosis of IUGR in fetuses. In the present review, we noticed that in healthy fetuses, the AoI net flow is always antegrade, but in fetuses with IUGR the deterioration of placental function leads to progressive reduction in its flow until it becomes mostly retrograde; this point is associated with a drastic reduction in oxygen delivery to the brain. The more impaired the AoI flow is, the greater is the risk of impairment in the Doppler velocimetry of other vessels; and the alterations of the AoI Doppler seem to precede other indicators of severe hypoxemia. Although there seems to be an association between the presence of retrograde flow in the AoI and the risk of long-term neurologic disability, its role in the prediction of perinatal morbi-mortality remains unclear. The AoI Doppler seems to be a promising tool in the management of fetuses with IUGR, but more studies are needed to investigate its employment in clinical practice.
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Affiliation(s)
- Mariana Martins Ferraz
- Fetal Medicine Post Graduation, Universidade Estácio de Sá, Rio de Janeiro, RJ, Brazil.,Clínica Perinatal, Rio de Janeiro, RJ, Brazil
| | - Flávia do Vale Araújo
- Fetal Medicine Post Graduation, Universidade Estácio de Sá, Rio de Janeiro, RJ, Brazil
| | - Paulo Roberto Nassar de Carvalho
- Fetal Medicine Post Graduation, Universidade Estácio de Sá, Rio de Janeiro, RJ, Brazil.,Fetal Medicine Department, Instituto Fernandes Figueira, Rio de Janeiro, RJ, Brazil.,Clínica Perinatal, Rio de Janeiro, RJ, Brazil
| | - Renato Augusto Moreira de Sá
- Fetal Medicine Department, Instituto Fernandes Figueira, Rio de Janeiro, RJ, Brazil.,Fetal Medicine Department, Instituto Fernandes Figueira, Rio de Janeiro, RJ, Brazil
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Villalaín C, Herraiz I, Quezada MS, Gómez-Arriaga PI, Simón E, Gómez-Montes E, Galindo A. Prognostic value of the aortic isthmus Doppler assessment on late onset fetal growth restriction. J Perinat Med 2019; 47:212-217. [PMID: 30210056 DOI: 10.1515/jpm-2018-0185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/20/2018] [Indexed: 11/15/2022]
Abstract
Background As conflicting results have been reported about the association of reversed flow on the aortic isthmus (AoI) and adverse perinatal results in fetal growth restriction (FGR), we aim to compare perinatal outcomes (including tolerance to labor induction) of late-onset FGR between those with anterograde and reversed AoI flow. Methods This was an observational retrospective cohort study on 148 singleton gestations diagnosed with late-onset FGR (diagnosis ≥32+0 weeks), with an estimated fetal weight (EFW) <10th centile and mild fetal Doppler alteration: umbilical artery (UA) pulsatility index (PI) >95th centile, middle cerebral artery (MCA)-PI <5th centile or cerebral-placental ratio <5th centile. Anterograde AoI flow was present in n=79 and reversed AoI flow in n=69. Delivery was recommended from 37 weeks in both groups. Perinatal results were compared between the groups. Results The global percentage of vaginal delivery of fetuses with anterograde and reversed blood flow was 55.7% vs. 66.7% (P=0.18) and the percentage of cesarean section (C-section) for non-reassuring fetal status was 12.7% vs. 15.9% (P=0.29), respectively. When evaluating those that underwent labor induction, the vaginal delivery rate was 67.9% vs. 77.2% (P=0.17), respectively. There were no significant differences regarding any other perinatal variables and there were no cases of severe morbidity or mortality. Conclusion We observed that the presence of reversed AoI flow does not worsen perinatal outcomes on fetuses with late-onset growth restriction with mild Doppler alterations. Attempt of labor induction is feasible in these fetuses regardless of the direction of AoI flow.
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Affiliation(s)
- Cecilia Villalaín
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Ignacio Herraiz
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain, Tel.: 034-1-3908310
| | - Maria S Quezada
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Paula I Gómez-Arriaga
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Elisa Simón
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Enery Gómez-Montes
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Alberto Galindo
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
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Huhta H, Junno J, Haapsamo M, Erkinaro T, Ohtonen P, Davis LE, Hohimer AR, Acharya G, Rasanen J. Fetal sheep central haemodynamics and cardiac function during occlusion of the ascending aorta. Exp Physiol 2017; 103:58-67. [DOI: 10.1113/ep086500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/31/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Heikki Huhta
- Department of Obstetrics and Gynecology; University of Oulu; Oulu Finland
| | - Juulia Junno
- Department of Obstetrics and Gynecology; University of Oulu; Oulu Finland
| | - Mervi Haapsamo
- Department of Obstetrics and Gynecology; University of Oulu; Oulu Finland
| | - Tiina Erkinaro
- Department of Anesthesiology and Surgery; Oulu University Hospital; Oulu Finland
| | - Pasi Ohtonen
- Division of Operative Care and Medical Research Center Oulu; Oulu University Hospital and University of Oulu; Finland
| | - Lowell E. Davis
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology; Oregon Health & Science University; Portland OR USA
| | - A. Roger Hohimer
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology; Oregon Health & Science University; Portland OR USA
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Science; University of Norway and University Hospital of Northern Norway; Tromsø Norway
- Department of Clinical Science, Intervention and Technology; Karolinska Institute; Stockholm Sweden
| | - Juha Rasanen
- Department of Obstetrics and Gynecology; University of Oulu; Oulu Finland
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology; Oregon Health & Science University; Portland OR USA
- Department of Obstetrics and Gynecology; Helsinki University Hospital; Helsinki Finland
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11
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Seravalli V, Block-Abraham D, McShane C, Millard S, Baschat A, Miller J. Aortic isthmus shunt dynamics in normal and complicated monochorionic pregnancies. Prenat Diagn 2017; 37:924-930. [PMID: 28695721 DOI: 10.1002/pd.5115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To study fetal aortic isthmus (AoI) shunt dynamics in monochorionic (MC) twins. METHODS Normal and complicated MC pregnancies were prospectively enrolled. The relationship of isthmus flow index (IFI) with Doppler parameters of umbilical artery (UA), descending aorta, middle cerebral artery, and ductus venosus and with left and right ventricular cardiac output and stroke volume was studied. RESULTS The IFI was obtained in 180 examinations from 48 pregnancies (24 twin-twin transfusion syndrome, TTTS; 4 selective intrauterine growth restriction, sIUGR; 12 TTTS + sIUGR; and 8 uncomplicated). Median gestational age was 20.9 weeks. AoI diastolic flow was reversed in three cases. UA pulsatility index (PI) and ductus venosus-PI z-scores were negatively correlated with the IFI (rs -0.40 and -0.26, respectively, p < 0.001). Regression analysis identified only UA-PI as a determinant of the IFI (p < 0.001). The IFI was significantly correlated with left ventricular cardiac output and stroke volume. It did not differ between TTTS donors and recipients. sIUGR fetuses had significantly lower IFI compared with normal-grown counterparts (p < 0.001). CONCLUSION In MC gestations, AoI shunting is predominantly determined by placental flow resistance, while cerebral impedance and volume status have no impact. In MC twins, the relationship between AoI flow and outcome deserves further study in the setting of sIUGR. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Viola Seravalli
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dana Block-Abraham
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cyrethia McShane
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Millard
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmet Baschat
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jena Miller
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Relevance of routine Doppler sampling at the two umbilical arteries in the follow-up of dichorionic twin pregnancies with intrauterine growth-restricted fetuses. J Gynecol Obstet Hum Reprod 2017; 46:285-289. [DOI: 10.1016/j.jogoh.2016.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/07/2016] [Accepted: 10/10/2016] [Indexed: 11/22/2022]
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13
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Tynan D, Alphonse J, Henry A, Welsh AW. The Aortic Isthmus: A Significant yet Underexplored Watershed of the Fetal Circulation. Fetal Diagn Ther 2016; 40:81-93. [PMID: 27379710 DOI: 10.1159/000446942] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/11/2016] [Indexed: 11/19/2022]
Abstract
The aortic isthmus (AoI) is a unique fetal watershed with a waveform reflecting its complex haemodynamic physiology. The systolic component represents left and right ventricular systolic ejection, and the diastolic component represents comparative downstream vascular impedance between the brachiocephalic and subdiaphragmatic fetal circulations. Several indices have been devised to quantify different components of the waveform, including the pulsatility index, resistance index, isthmic flow index, and recently the isthmic systolic index. There have been promising preliminary studies applying these indices to both cardiac (congenital) and extracardiac pathologies, including intrauterine growth restriction and twin-twin transfusion syndrome. However, the waveform's multifactorial origin has proven to be challenging, and the difficulty in separating various components of the waveform could explain that AoI evaluation does not have a clear clinical utility. Further research is underway to realise the full potential of this vessel in fetal cardiac and haemodynamically compromised pathological conditions. In this review article we outline the physiological origin of this Doppler waveform, describe in detail the various published indices, summarise the published literature to date, and finally outline potential future research and hopefully clinical applications.
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Affiliation(s)
- Dominique Tynan
- Faculty of Medicine, University of New South Wales, Kensington, N.S.W., Australia
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14
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Gagnon C, Bigras JL, Fouron JC, Dallaire F. Reference Values and Z Scores for Pulsed-Wave Doppler and M-Mode Measurements in Fetal Echocardiography. J Am Soc Echocardiogr 2016; 29:448-460.e9. [DOI: 10.1016/j.echo.2016.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Indexed: 01/13/2023]
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15
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16
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İlhan G, İyibozkurt AC, Kalelioğlu Hİ, İbrahimoğlu L, Zebitay AG, Eken MK, Karasu AFG. Effects of fetal cardiac anomalies on ductus venosus and aortic isthmus doppler profiles. Arch Gynecol Obstet 2015; 293:345-50. [PMID: 26109506 DOI: 10.1007/s00404-015-3796-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To demonstrate the blood flow profiles of fetuses with cardiac anomalies at the level of Ductus venosus (DV) and Aortic isthmus (AI) to evaluate the effects of fetal cardiac anomalies on these profiles, and how these profile changes contribute to cardiac anomaly screening studies as a marker. METHODS DV and AI doppler studies were applied to 64 singleton pregnant women with fetal cardiac anomalies and 74 pregnant women with healthy fetuses. DV-PVIV (peak velocity index for veins) for DV and IFI (isthmic flow index) for AI were used. RESULTS DV doppler studies in fetuses with cardiac anomalies and healthy fetuses did not show statistically significant difference. But the results of the AI doppler studies had statistically significant difference in the fetal cardiac anomaly group with the exception of cases with dilatation and regurgitation. When right-sided heart anomaly and the remaining cases were compared with the control groups, AI doppler results also showed lower IFI values. CONCLUSIONS DV doppler studies in the second or third trimester may not be suitable as a screening test for congenital heart disease, but AI doppler studies might be considered as a supporting parameter. But further studies are needed for routine clinical use.
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Affiliation(s)
- Gülşah İlhan
- Suleymaniye Research and Education Hospital, Istanbul, Turkey.
| | | | | | - Lemi İbrahimoğlu
- İstanbul University İstanbul Medical Faculty, Istanbul, Turkey. lemi.ibrahimoglu.@gmail.com
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17
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Guedes-Martins L, Silva E, Gaio AR, Saraiva J, Soares AI, Afonso J, Macedo F, Almeida H. Fetal-maternal interface impedance parallels local NADPH oxidase related superoxide production. Redox Biol 2015; 5:114-123. [PMID: 25912167 PMCID: PMC4412968 DOI: 10.1016/j.redox.2015.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 12/19/2022] Open
Abstract
Blood flow assessment employing Doppler techniques is a useful procedure in pregnancy evaluation, as it may predict pregnancy disorders coursing with increased uterine vascular impedance, as pre-eclampsia. While the local causes are unknown, emphasis has been put on reactive oxygen species (ROS) excessive production. As NADPH oxidase (NOX) is a ROS generator, it is hypothesized that combining Doppler assessment with NOX activity might provide useful knowledge on placental bed disorders underlying mechanisms. A prospective longitudinal study was performed in 19 normal course, singleton pregnancies. Fetal aortic isthmus (AoI) and maternal uterine arteries (UtA) pulsatility index (PI) were recorded at two time points: 20-22 and 40-41 weeks, just before elective Cesarean section. In addition, placenta and placental bed biopsies were performed immediately after fetal extraction. NOX activity was evaluated using a dihydroethidium-based fluorescence method and associations to PI values were studied with Spearman correlations. A clustering of pregnancies coursing with higher and lower PI values was shown, which correlated strongly with placental bed NOX activity, but less consistently with placental tissue. The study provides evidence favoring that placental bed NOX activity parallels UtA PI enhancement and suggests that an excess in oxidation underlies the development of pregnancy disorders coursing with enhanced UtA impedance.
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Affiliation(s)
- L Guedes-Martins
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Porto, Portugal; Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - E Silva
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Porto, Portugal.
| | - A R Gaio
- Department of Mathematics, Faculty of Sciences, University of Porto, Rua do Campo Alegre, 4169-007 Porto, Portugal; CMUP-Centre of Mathematics of the University of Porto, Rua do Campo Alegre, 4169-007 Porto, Portugal.
| | - J Saraiva
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Porto, Portugal; Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - A I Soares
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Porto, Portugal.
| | - J Afonso
- Department of Pharmacology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
| | - F Macedo
- Department of Cardiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
| | - H Almeida
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Porto, Portugal; Obstetrics-Gynecology, Hospital-CUF Porto, 4100 180 Porto, Portugal.
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Gámez F, Rodríguez MJ, Tenías JM, García J, Pintado P, Martín R, Pérez R, Ortiz-Quintana L, De León-Luis J. Reference ranges for the pulsatility index of the fetal aortic isthmus in singleton and twin pregnancies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:577-584. [PMID: 25792572 DOI: 10.7863/ultra.34.4.577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to estimate reference ranges for the pulsatility index (PI) of the fetal aortic isthmus in uncomplicated singleton and twin pregnancies during the second half of pregnancy. METHODS We conducted a cross-sectional observational study involving 543 healthy fetuses: 361 singleton pregnancies and 182 twin pregnancies between 19 and 36 weeks' gestation. The aortic isthmus PI was measured in 2 sonographic planes: the longitudinal aortic arch view and the 3-vessel and trachea view. We evaluated the reproducibility of aortic isthmus PI measurements between these planes by calculating intraclass correlation coefficients and limits of agreement. Scans were performed by 2 physicians, and intraobserver agreement was also measured. Regression analysis was used to estimate gestational age reference values for the aortic isthmus PI. RESULTS The aortic isthmus PI was significantly correlated with gestational age in singletons and twins during the second half of pregnancy (P < .01). We did not find significant differences between reference ranges in singletons and twins or between the sonographic views. CONCLUSIONS This study offers reference ranges for the aortic isthmus PI during the second half of gestation in singleton and twin pregnancies. Mean aortic isthmus PI values were similar in both types of gestations as well as both sonographic views. The aortic isthmus PI may be reliably obtained from either sonographic view.
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Affiliation(s)
- Francisco Gámez
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain (F.G., P.P., R.M., R.P., L.O.-Q., J.D.L.-L.); and Department of Obstetrics and Gynecology (M.J.R., J.G.) and Research Support Unit (J.M.T.), Hospital la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - María José Rodríguez
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain (F.G., P.P., R.M., R.P., L.O.-Q., J.D.L.-L.); and Department of Obstetrics and Gynecology (M.J.R., J.G.) and Research Support Unit (J.M.T.), Hospital la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - José María Tenías
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain (F.G., P.P., R.M., R.P., L.O.-Q., J.D.L.-L.); and Department of Obstetrics and Gynecology (M.J.R., J.G.) and Research Support Unit (J.M.T.), Hospital la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - Javier García
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain (F.G., P.P., R.M., R.P., L.O.-Q., J.D.L.-L.); and Department of Obstetrics and Gynecology (M.J.R., J.G.) and Research Support Unit (J.M.T.), Hospital la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - Pilar Pintado
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain (F.G., P.P., R.M., R.P., L.O.-Q., J.D.L.-L.); and Department of Obstetrics and Gynecology (M.J.R., J.G.) and Research Support Unit (J.M.T.), Hospital la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - Raquel Martín
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain (F.G., P.P., R.M., R.P., L.O.-Q., J.D.L.-L.); and Department of Obstetrics and Gynecology (M.J.R., J.G.) and Research Support Unit (J.M.T.), Hospital la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - Ricardo Pérez
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain (F.G., P.P., R.M., R.P., L.O.-Q., J.D.L.-L.); and Department of Obstetrics and Gynecology (M.J.R., J.G.) and Research Support Unit (J.M.T.), Hospital la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - Luis Ortiz-Quintana
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain (F.G., P.P., R.M., R.P., L.O.-Q., J.D.L.-L.); and Department of Obstetrics and Gynecology (M.J.R., J.G.) and Research Support Unit (J.M.T.), Hospital la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - Juan De León-Luis
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain (F.G., P.P., R.M., R.P., L.O.-Q., J.D.L.-L.); and Department of Obstetrics and Gynecology (M.J.R., J.G.) and Research Support Unit (J.M.T.), Hospital la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain.
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Doppler assessment of fetal aortic isthmus flow in twin. Obstet Gynecol Sci 2015; 58:17-23. [PMID: 25629014 PMCID: PMC4303748 DOI: 10.5468/ogs.2015.58.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/12/2014] [Accepted: 08/11/2014] [Indexed: 11/15/2022] Open
Abstract
Objective The purpose of this study was to investigate the aortic isthmus (AoI) flow difference between larger fetus and smaller fetus of twin; and to evaluate the predictive value of early diagnosis of hemodynamic change in twin growth. Methods This prospective study on 49 pairs of twin fetuses was performed to obtain AoI blood flow data. Cases with structural or chromosomal abnormalities and co-twin death were excluded. The interval from examination to delivery was within 4 weeks and 3 cases over 4 weeks interval were re-examined. Assessment of fetal AoI Doppler parameters were peak systolic velocity (PSV), end-diastolic velocity, times-averaged maximum velocities, pulsatility index (PI), and resistance index (RI). According to the direction of the diastolic flow in the AoI, antegrade and retrograde flow were made and was used to analyze the perinatal outcomes of each fetus. The predictive value of AoI Doppler parameters in predicting fetal growth was obtained by using ANOVA and logistic regression analysis of quantitative variables in each fetus of twins. Results There were significant differences in the gestational weeks at delivery, birth weight and the incidence of growth discordance over 20% or more between monochorionic twin and dichorionic twin. The AoI PI and RI were significantly higher in smaller fetus than in larger regardless of chorionicity. Retrograde flow was noted in 8 of 98 cases (8.2%) and the only one case was of the larger fetus and the others were smaller fetuses of twin. Significant correlations were found between the AoI PI and birthweight (P=0.018) and between the PSV and growth discordance (P=0.032). In monochorionic twin, linear correlation was shown between the AoI PI and birthweight (P=0.004) and between AoI PI and growth discordance (P=0.031). Also, the meaningful correlation between the PSV and birthweight (P=0.036) was found by using logistic regression analyses. Conclusion On the basis of our observation, AoI PI has revealed their hemodynamic status and this result may improve the understanding of growth patterns in twins.
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Garcia-Canadilla P, Rudenick PA, Crispi F, Cruz-Lemini M, Palau G, Camara O, Gratacos E, Bijens BH. A computational model of the fetal circulation to quantify blood redistribution in intrauterine growth restriction. PLoS Comput Biol 2014; 10:e1003667. [PMID: 24921933 PMCID: PMC4055406 DOI: 10.1371/journal.pcbi.1003667] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/24/2014] [Indexed: 11/18/2022] Open
Abstract
Intrauterine growth restriction (IUGR) due to placental insufficiency is associated with blood flow redistribution in order to maintain delivery of oxygenated blood to the brain. Given that, in the fetus the aortic isthmus (AoI) is a key arterial connection between the cerebral and placental circulations, quantifying AoI blood flow has been proposed to assess this brain sparing effect in clinical practice. While numerous clinical studies have studied this parameter, fundamental understanding of its determinant factors and its quantitative relation with other aspects of haemodynamic remodeling has been limited. Computational models of the cardiovascular circulation have been proposed for exactly this purpose since they allow both for studying the contributions from isolated parameters as well as estimating properties that cannot be directly assessed from clinical measurements. Therefore, a computational model of the fetal circulation was developed, including the key elements related to fetal blood redistribution and using measured cardiac outflow profiles to allow personalization. The model was first calibrated using patient-specific Doppler data from a healthy fetus. Next, in order to understand the contributions of the main parameters determining blood redistribution, AoI and middle cerebral artery (MCA) flow changes were studied by variation of cerebral and peripheral-placental resistances. Finally, to study how this affects an individual fetus, the model was fitted to three IUGR cases with different degrees of severity. In conclusion, the proposed computational model provides a good approximation to assess blood flow changes in the fetal circulation. The results support that while MCA flow is mainly determined by a fall in brain resistance, the AoI is influenced by a balance between increased peripheral-placental and decreased cerebral resistances. Personalizing the model allows for quantifying the balance between cerebral and peripheral-placental remodeling, thus providing potentially novel information to aid clinical follow up. Intrauterine growth restriction (IUGR) is one of the leading causes of perinatal mortality and can be defined as a low birth weight together with signs of chronic hypoxia or malnutrition. It is mostly due to placental insufficiency resulting in a chronic restriction of oxygen and nutrients to the fetus. IUGR leads to cardiac dysfunction in utero which can persist postnatally. Under these altered conditions, IUGR fetuses redistribute their blood in order to maintain delivery of oxygenated blood to the brain, known as brain sparing. Given that, in the fetus the aortic isthmus (AoI) is a key arterial connection between the cerebral and placental circulations, quantifying AoI blood flow has been proposed to assess this brain sparing effect in clinical practice. However, which remodeling or redistribution processes in the cardiovascular systems induce the observed changes in AoI flow in IUGR fetuses is not fully understood. We developed a computational model of the fetal circulation, including the key elements related to fetal blood redistribution. Using measured cardiac outflow profiles to allow personalization, we can recreate and better understand the blood flow changes in individual IUGR fetuses.
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Affiliation(s)
- Patricia Garcia-Canadilla
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
- Physense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain
- * E-mail:
| | - Paula A. Rudenick
- University Hospital and Research Institute Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fatima Crispi
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Monica Cruz-Lemini
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Georgina Palau
- Physense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain
| | - Oscar Camara
- Physense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain
| | - Eduard Gratacos
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Bart H. Bijens
- Physense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain
- ICREA, Barcelona, Spain
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Cruz-Lemini M, Crispi F, Valenzuela-Alcaraz B, Figueras F, Gómez O, Sitges M, Bijnens B, Gratacós E. A fetal cardiovascular score to predict infant hypertension and arterial remodeling in intrauterine growth restriction. Am J Obstet Gynecol 2014; 210:552.e1-552.e22. [PMID: 24368136 DOI: 10.1016/j.ajog.2013.12.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/29/2013] [Accepted: 12/19/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Intrauterine growth restricted (IUGR) fetuses experience cardiovascular remodeling that persists into infancy and has been related to cardiovascular outcomes in adulthood. Hypertension in infancy has been demonstrated to be a strong risk factor for later cardiovascular disease. Close monitoring together with dietary interventions have shown to improve cardiovascular health in hypertensive children; however, not all IUGR infants show increased blood pressure. We evaluated the potential of fetal echocardiography for predicting hypertension and arterial remodeling in 6-month-old IUGR infants. STUDY DESIGN One hundred consecutive IUGR and 100 control fetuses were observed into infancy. Fetal assessment included perinatal Doppler imaging, cardiac morphometry, ejection fraction, cardiac output, isovolumic relaxation time (IVRT), tricuspid annular-plane systolic excursion (TAPSE), and tissue Doppler imaging. Infant hypertension and arterial remodeling were defined as mean blood pressure of >95th percentile together with aortic intima-media thickness of >75th percentile at 6 months of age. Odds ratio were obtained for fetal parameters that were associated with infant outcomes. RESULTS Fetal TAPSE, right sphericity index, IVRT, and cerebroplacental ratio were the strongest predictors for postnatal vascular remodeling. A cardiovascular risk score that was based on fetal TAPSE, cerebroplacental ratio, right sphericity index, and IVRT was highly predictive of infant hypertension and arterial remodeling (area under the curve, 0.87; 95% confidence interval, 0.79-0.93; P < .001). CONCLUSION Fetal echocardiographic parameters identify a high-risk group within the IUGR fetuses who could be targeted for early screening of blood pressure and other cardiovascular risk factors and for promoting healthy diet and physical exercise.
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Affiliation(s)
- Mónica Cruz-Lemini
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain
| | - Fátima Crispi
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain
| | - Brenda Valenzuela-Alcaraz
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain
| | - Francesc Figueras
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain
| | - Olga Gómez
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain
| | - Marta Sitges
- Department of Cardiology, Institut Clínic del Tòrax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Bart Bijnens
- ICREA-Universitat Pompeu Fabra, Barcelona, Spain
| | - Eduard Gratacós
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain.
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Thanasuan S, Phithakwatchara N, Nawapan K. Reference values for fetal aortic isthmus blood flow parameters at 24 to 38 weeks' gestation. Prenat Diagn 2014; 34:241-5. [PMID: 24338633 DOI: 10.1002/pd.4296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 12/03/2013] [Accepted: 12/05/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal of this study is to establish population-specific nomograms of fetal aortic isthmus (AoI) Doppler indices in the period of 24-38 weeks' gestation. METHODS This was a cross-sectional study of 240 Asian singleton pregnant women at 24-38 completed weeks' gestation. Fetal AoI blood flow was evaluated by Doppler study with automatic calculation of pulsatility index, resistance index, peak systolic velocity, end-diastolic velocity, and time-averaged maximum velocity. The relationship of these indices and gestational age was estimated by using regression analysis, and the best predictive models were determined to define mean, 5th, and 95th centile of each gestational age. The reproducibility was expressed by intraclass correlation coefficients and limits of agreement. RESULTS The mean maternal age was 28 ± 5.7 years. A total of 97% of all attempts to obtain AoI Doppler waveforms were successful with high interobserver and intraobserver reproducibility. Pulsatility index and peak systolic velocity significantly correlated with gestational age (P = 0.03 and 0.001, respectively), whereas no significant change of resistance index, end-diastolic velocity, and time-averaged maximum velocity with advancing gestation was observed. CONCLUSION This study offers normative values of fetal AoI Doppler indices, which may be useful in the difficult task of fetal surveillance in growth-restricted fetuses among our population.
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Affiliation(s)
- Sornlada Thanasuan
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Lecarpentier E, Cordier AG, Proulx F, Fouron JC, Gitz L, Grange G, Benachi A, Tsatsaris V. Hemodynamic impact of absent or reverse end-diastolic flow in the two umbilical arteries in growth-restricted fetuses. PLoS One 2013; 8:e81160. [PMID: 24312271 PMCID: PMC3842244 DOI: 10.1371/journal.pone.0081160] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/18/2013] [Indexed: 11/29/2022] Open
Abstract
Objective To determine if bilateral absent or reverse end-diastolic (ARED) flow in the two umbilical arteries (UAs) at the perivesical (PVC) segment represents a more severe degree of hemodynamic compromise than unilateral ARED flow at the PVC segment in singleton pregnancies complicated by intrauterine growth restriction (IUGR). Methods This was a prospective observational study. One hundred nine fetuses with IUGR underwent a total of 225 ultrasound (US) examinations. We measured the pulsatility index (PI) from the two UAs at the PVC segment, UA in the free floating cord (FFC), middle cerebral artery (MCA), ductus venosus (DV) and the aortic isthmus blood flow index (IFI). Three groups were classified according to bilateral positive end-diastolic (PED) flow, unilateral ARED flow or bilateral ARED flow in the UAs at the PVC segment. Results The proportions of US examinations with PED flow, unilateral ARED flow and bilateral ARED flow in the UAs were 54.7%, 20.4%, and 24.9%, respectively. At the last US examination, the IFI z-scores were significantly lower in the bilateral ARED group (-6.28±4.30) compared to the unilateral ARED group (-1.72±3.18, p<0.05) and the bilateral PED group (-0.83±2.36, p<0.05), the DV-PI z-scores were significantly higher in the bilateral ARED group (2.15±3.79) compared to the bilateral PED group (0.64±1.50, p<0.05). Before 32 weeks of gestation, the interval between US examination and delivery was significantly shorter in the bilateral ARED group (8.9 days ±8.2) than the unilateral ARED group (15.9 days ±13.4, p<0.05) and the bilateral PED group (30.3 days±25.7, p<0.05). Conclusion There are significant differences in fetal blood fluxes between left and right UA. Doppler examination at the PVC segment significantly improves the comparability of UA-PI between two successive US examinations and allows a longitudinal and independent hemodynamic investigation of each UA. Examination of a single UA in free floating cord may miss a large fraction of unilateral ARED flow. In singleton IUGR fetuses, a bilateral ARED flow in the UAs at the PVC segment indicates more severe hemodynamic compromise and worse fetal conditions than unilateral ARED flow.
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Affiliation(s)
- Edouard Lecarpentier
- Obstetrics and Gynecology Unit, Maternité Port-Royal, APHP, Paris Descartes University, Paris, France
| | - Anne Gaëlle Cordier
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Sud, Paris, France
| | - Francine Proulx
- Obstetrics and Gynecology Unit, Maternité Port-Royal, APHP, Paris Descartes University, Paris, France
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Sud, Paris, France
| | - Jean Claude Fouron
- Fetal Cardiology Unit, Pediatric Cardiology Service, Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Saint-Justine, University of Montreal, Montreal, Canada
| | - Laurence Gitz
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Sud, Paris, France
| | - Gilles Grange
- Obstetrics and Gynecology Unit, Maternité Port-Royal, APHP, Paris Descartes University, Paris, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Sud, Paris, France
- Premup Foundation (Fondation pour la Prévention de la Prématurité et la Protection du Nouveau-né Prématuré), Paris, France
| | - Vassilis Tsatsaris
- Obstetrics and Gynecology Unit, Maternité Port-Royal, APHP, Paris Descartes University, Paris, France
- Premup Foundation (Fondation pour la Prévention de la Prématurité et la Protection du Nouveau-né Prématuré), Paris, France
- * E-mail:
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Raboisson MJ, Huissoud C, Lapointe A, Hugues N, Bigras JL, Brassard M, Lamoureux J, Fouron JC. Assessment of uterine artery and aortic isthmus Doppler recordings as predictors of necrotizing enterocolitis. Am J Obstet Gynecol 2012; 206:232.e1-6. [PMID: 22189049 DOI: 10.1016/j.ajog.2011.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 09/06/2011] [Accepted: 11/11/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether changes of uterine arteries and aortic isthmus Doppler blood flow recordings could enhance the prediction of necrotizing enterocolitis. STUDY DESIGN Doppler characteristics of the uterine artery, umbilical and middle cerebral arteries, ductus venosus, and aortic isthmus were reviewed in 123 growth-restricted fetuses who were then divided into 2 groups: with and without necrotizing enterocolitis. RESULTS Twelve of 123 newborn infants (9%) expressed necrotizing enterocolitis. This group showed significant association between necrotizing enterocolitis and bilateral notching on the uterine artery (83.3% vs 29.7%; P < .001), uterine artery mean resistance index (83.3% vs 36.9%; P < .002), aortic isthmus diastolic blood flow velocity integrals (Z score: -7.32 vs -3.99; P = .028), and absent or negative "a" wave on the ductus venosus (17% vs 1.8%; P = .021). With the use of logistic regression, uterine bilateral notching could predict necrotizing enterocolitis with a sensitivity of 83.3% and a specificity of 70.3%. CONCLUSION More than any other variable, uterine bilateral notching should be recognized as a strong risk factor for necrotizing enterocolitis.
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Cruz-Lemini M, Crispi F, Van Mieghem T, Pedraza D, Cruz-Martínez R, Acosta-Rojas R, Figueras F, Parra-Cordero M, Deprest J, Gratacós E. Risk of Perinatal Death in Early-Onset Intrauterine Growth Restriction according to Gestational Age and Cardiovascular Doppler Indices: A Multicenter Study. Fetal Diagn Ther 2012; 32:116-22. [DOI: 10.1159/000333001] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 09/12/2011] [Indexed: 11/19/2022]
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Zielinsky P, Frajndlich R, Nicoloso LH, Manica JLL, Piccoli AL, de Morais MR, Bender L, Silva J, Pizzato P, Naujorks A. Aortic isthmus blood flow in fetuses of diabetic mothers. Prenat Diagn 2011; 31:1176-80. [PMID: 22025282 DOI: 10.1002/pd.2859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 08/10/2011] [Accepted: 08/10/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test the hypothesis that the aortic isthmus flow index (IFI) is lower in fetuses of diabetic mothers than in fetuses of nondiabetic mothers. STUDY DESIGN We performed a cross-sectional observational study to assess the IFI in fetuses, with (n = 13) and without (n = 37) myocardial hypertrophy, of mothers with diabetes mellitus and in fetuses of nondiabetic mothers (n = 23). Analysis of variance and Tukey test were used to assess differences among the groups. RESULTS There were no differences in maternal or gestational age among the groups. In fetuses of diabetic mothers, the mean IFI in fetuses with myocardial hypertrophy was 1.19 ± 0.06, and in fetuses without it was 1.18 ± 0.09. The mean IFI in fetuses of nondiabetic mothers was 1.32 ± 0.07 (P < 0.001). CONCLUSIONS The IFI in fetuses of diabetic mothers is lower than in fetuses of nondiabetic mothers, possibly as a result of a decreased left ventricular compliance.
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Affiliation(s)
- Paulo Zielinsky
- Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil.
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Acharya G, Tronnes A, Rasanen J. Aortic isthmus and cardiac monitoring of the growth-restricted fetus. Clin Perinatol 2011; 38:113-25, vi-vii. [PMID: 21353093 DOI: 10.1016/j.clp.2010.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic isthmus acts as an arterial watershed between the cerebral and placental circulations, connecting 2 parallel fetal ventricular pumps. It plays a crucial role in the fetal circulatory dynamics. Information about aortic isthmus blood flow may improve the management of sick fetuses. However, perceived technical difficulties limit the clinical use of aortic isthmus Doppler for fetal hemodynamic monitoring. Changes in aortic isthmus blood flow pattern seem to reflect fetal cardiovascular status accurately and predict perinatal and long-term neurodevelopmental outcome in intrauterine growth restriction. This review evaluates the available scientific information and discusses the role of aortic isthmus in fetal circulation.
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Affiliation(s)
- Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Sykehusveien 38, N-9038 Tromsø, Norway
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Chander L, Sonal G. Colour Doppler in IUGR- Where are we and where do we go? J Obstet Gynaecol India 2010. [DOI: 10.1007/s13224-010-0047-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kennelly MM, Farah N, Turner MJ, Stuart B. Aortic isthmus Doppler velocimetry: role in assessment of preterm fetal growth restriction. Prenat Diagn 2010; 30:395-401. [DOI: 10.1002/pd.2474] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Crispi F, Comas M, Hernández-Andrade E, Eixarch E, Gómez O, Figueras F, Gratacós E. Does pre-eclampsia influence fetal cardiovascular function in early-onset intrauterine growth restriction? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:660-665. [PMID: 19827117 DOI: 10.1002/uog.7450] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Increasing evidence shows that intrauterine growth restriction (IUGR) is associated with fetal cardiac dysfunction. Most studies group IUGR with and without pre-eclampsia (PE) altogether. Our objective was to evaluate whether the association with PE has any impact on cardiac function in IUGR fetuses METHODS Thirty-one normotensive IUGR cases and 31 IUGR cases with pre-eclampsia (PE + IUGR) below 34 weeks of gestation were included. IUGR was defined as a birth weight below the 10(th) centile together with an umbilical artery pulsatility index above 2 SD. Fetal cardiac function was assessed by measuring ductus venosus pulsatility index, modified myocardial performance index, aortic isthmus blood flow, E/A ratios and cardiac output. The presence of fetal cardiac dysfunction was also assessed by measuring cord blood B-type natriuretic peptide (BNP) levels collected at birth. Echocardiographic data were compared with those in 80 term appropriate-for-gestational age (AGA) fetuses from normotensive mothers. Cord blood BNP levels were compared with those in 40 AGA cases that delivered preterm. RESULTS All IUGR cases (with or without PE) showed echocardiographic and biochemical signs of cardiac dysfunction compared with AGA cases. However, no differences were observed between IUGR and PE + IUGR cases either in echocardiographic or in biochemical parameters. IUGR cases with or without PE had similar perinatal results. CONCLUSIONS IUGR fetuses showed echocardiographic and biochemical signs of cardiac dysfunction. Pre-eclampsia per se does not influence cardiac function in IUGR fetuses.
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Affiliation(s)
- F Crispi
- Maternal-Fetal Medicine Department, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Hospital Clinic, Fetal and Perinatal Medicine Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
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Hernandez-Andrade E, Crispi F, Benavides-Serralde JA, Plasencia W, Diesel HF, Eixarch E, Acosta-Rojas R, Figueras F, Nicolaides K, Gratacós E. Contribution of the myocardial performance index and aortic isthmus blood flow index to predicting mortality in preterm growth-restricted fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:430-436. [PMID: 19790100 DOI: 10.1002/uog.7347] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To evaluate the predictive value for perinatal death of the myocardial performance index (MPI) and aortic isthmus flow index (IFI), as isolated parameters and in a combined model including currently used Doppler indices, in preterm growth restricted (IUGR) fetuses. METHODS Umbilical artery, fetal middle cerebral artery (MCA) and ductus venosus (DV) pulsatility indices (PIs) were recorded, along with IFI and MPI, in a cohort of 97 preterm (delivered at between 24 and 34 weeks) IUGR fetuses. Logistic regression analysis was performed to identify those variables that were independently associated with perinatal mortality, and an algorithm to estimate probability of death was constructed including the best combination of parameters. RESULTS With the exception of MCA, all Doppler indices were significantly associated with perinatal death as isolated parameters, but only DV-PI and MPI were found to be independent predictors on multivariate analysis. An algorithm combining DV atrial flow (positive or absent/reversed) and MPI (normal or above 95(th) percentile) had a better predictive accuracy than did any single parameter. The risk for death in IUGR fetuses below 28 weeks' gestation with present atrial flow in the DV and normal MPI was 18%, with either characteristic abnormal it was 70-73%, and with both abnormal it was 97%. The risk for death in IUGR fetuses above 28 weeks with present atrial flow in the DV and normal MPI was 0.1%, with either abnormal it was 6-7%, and with both abnormal it was 45%. CONCLUSIONS MPI is an independent predictor of perinatal death in preterm IUGR fetuses with accuracy similar to that of DV flow. A combination of DV flow with MPI may better stratify the estimated probability of death. IFI does not add to the prediction of perinatal death when used in combination with DV flow.
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Affiliation(s)
- E Hernandez-Andrade
- Maternal-Fetal Medicine Department, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
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Fouron JC, Siles A, Montanari L, Morin L, Ville Y, Mivelaz Y, Proulx F, Bureau N, Bigras JL, Brassard M. Feasibility and reliability of Doppler flow recordings in the fetal aortic isthmus: a multicenter evaluation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:690-693. [PMID: 19479677 DOI: 10.1002/uog.6411] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To evaluate the performance of three different centers with respect to their ability to identify the fetal aortic isthmus (AoI) adequately and place a Doppler sample volume in the AoI correctly, and to address the reproducibility of the isthmic flow index (IFI) calculated from Doppler waveforms recorded in the three centers. METHODS The three collaborating centers sent several ultrasonographic recordings taken at random over a 6-week period to the Saint-Justine Fetal Cardiology Unit (StJ-FCU). A performance quotient ((number of total readings - number of unsatisfactory results)/number of total readings) was calculated for each center by each of three judges, who were experienced fetal cardiologists, to assess the ability of each center to identify the isthmus and to place the Doppler sample volume (DSV) adequately. Intraclass correlation coefficients (ICC) were computed to quantify the variability of IFI measurements ((systolic + diastolic)/systolic flow velocity integrals). RESULTS Fifty-five recordings were available for this study. Concerning isthmus identification, there was 100% agreement between the three judges from StJ-FCU and the performance quotients of Centers A, B and C were: 0.90, 0.95 and 1.00, respectively. For DSV positioning, agreement between the judges varied; for Judge 1 vs. Judge 2, kappa = 0.836 (95% CI, 0.651-1.000); for Judge 1 vs. Judge 3, kappa = 0.773 (95% CI, 0.557-1.000); for Judge 2 vs. Judge 3, kappa = 0.941 (95% CI, 0.805-1.000). The performance quotients of the three centers for DSV positioning were consistently lower than were those for identification of the isthmus, being 0.85, 0.76 and 0.92, respectively. The ICC between the first and second measurements of the IFI by Rater 1 was 0.96 (95% CI, 0.93-0.98, P < 0.001) and that between Raters 1 and 2 was 0.97 (95% CI, 0.95-0.99, P < 0.001). CONCLUSION Adequate imaging of the fetal AoI can be achieved easily by a trained sonographer, while DSV positioning is challenging. The intra- and interrater variability of the IFI are low.
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Affiliation(s)
- J-C Fouron
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Saint-Justine, University of Montreal, Quebec, Canada.
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Acharya G. Technical aspects of aortic isthmus Doppler velocimetry in human fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:628-633. [PMID: 19479680 DOI: 10.1002/uog.6406] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- G Acharya
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tromsø and University Hospital of Northern Norway, Tromsø, Norway.
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Vimpeli T, Huhtala H, Wilsgaard T, Acharya G. Fetal aortic isthmus blood flow and the fraction of cardiac output distributed to the upper body and brain at 11-20 weeks of gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:538-544. [PMID: 19350568 DOI: 10.1002/uog.6354] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To measure serial changes in fetal aortic isthmus (AI) blood flow and estimate the fraction of fetal cardiac output distributed to the upper body, including the brain, at 11-20 weeks of gestation. METHODS Using pulsed-wave Doppler and two-dimensional ultrasound, blood flow velocities and inner diameter of the AI, aortic valve (AV) and pulmonary valve (PV) were measured longitudinally in 143 fetuses and volume blood flows (Q) were calculated for each site using the formula: Q (mL/min) = pix (diameter/2)(2) x velocity time integral x heart rate x 60. The sum of Q(av) and Q(pv) constituted the combined cardiac output (CCO) and the fraction (%) of the upper body (including brain) blood flow was calculated as: (Q(av)-Q(ai))x100/CCO. RESULTS AI blood velocities as well as the vessel diameter increased with advancing gestation, resulting in a significant increase in Q(ai) from 1.9 to 40.5 mL/min during weeks 11 to 20. The AI peak systolic velocity increased from 29 to 63 cm/s, end-diastolic velocity from 1.2 to 5.2 cm/s, and the time-averaged maximum velocity from 11 to 22 cm/s, resulting in a fairly stable pulsatility index (PI) of 2.4-2.6 and resistance index (RI) of 0.91-0.94. On average, 75% of blood ejected by the left ventricle (which represented about 35% of the CCO) passed through the AI to the descending aorta. The fraction of CCO distributed to the upper body, including the brain, was estimated as approximately 13%. CONCLUSION We have established longitudinal reference ranges for fetal AI diameter, blood flow velocities, PI, RI and volume blood flow at 11-20 weeks of gestation. The human fetus appears to direct a relatively small fraction (13%) of its CCO to the upper body, including the brain, during this period of pregnancy.
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Affiliation(s)
- T Vimpeli
- The Central Maternity Unit, City of Tampere, Finland
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Rizzo G, Capponi A, Vendola M, Pietrolucci ME, Arduini D. Use of the 3-vessel view to record Doppler velocity waveforms from the aortic isthmus in normally grown and growth-restricted fetuses: comparison with the long aortic arch view. JOURNAL OF ULTRASOUND IN MEDICINE 2008; 27:1617-22. [PMID: 18946101 DOI: 10.7863/jum.2008.27.11.1617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Aortic isthmus (AoI) velocity waveforms are considered powerful indicators of hemodynamic deterioration in intrauterine growth-restricted (IUGR) fetuses. However, technical difficulties in sampling AoI velocity waveforms from the longitudinal aortic arch (LAA) have limited its clinical application thus far. In this study, we tested the possibility of recording AoI velocity waveforms from the 3-vessel (3V) view of the fetal mediastinum and comparing the agreement of these measurements with recordings from the LAA. METHODS Doppler measurements of the pulsatility index (PI) from the AoI were performed in 70 fetuses (20 IUGR and 50 normally grown) between 20 and 34 weeks' gestation. All measurements were sampled in both the LAA and 3V views by the same investigator. Reliability was evaluated with intraclass correlation coefficients (ICCs), and Bland-Altman plots were generated. The time required to complete the measurements was compared. RESULTS A high degree of reliability was observed between PI values obtained from LAA and 3V views in both IUGR and normally grown fetuses (all fetuses: ICC, 0.976; 95% confidence interval [CI], 0.961-0.985; normally grown: ICC, 0.839; 95% CI, 0.731-0.906; IUGR: ICC, 0.954; 95% CI, 0.886-0.982). However, recordings from the 3V view were significantly less time-consuming than those from the LLA view (mean +/- SD, 30.4 +/- 14.2 versus 52.8 +/- 29.4 seconds; P < .0001) and showed higher intraobserver reproducibility. CONCLUSIONS In IUGR and normally grown fetuses, AoI waveforms can be reliably obtained from the 3V view with higher reproducibility and a shorter recording time.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Fatebenefratelli San Giovanni Calabita Hospital, Rome, Italy.
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Del Río M, Martínez JM, Figueras F, Bennasar M, Olivella A, Palacio M, Coll O, Puerto B, Gratacós E. Doppler assessment of the aortic isthmus and perinatal outcome in preterm fetuses with severe intrauterine growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:41-47. [PMID: 18157796 DOI: 10.1002/uog.5237] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To evaluate the characteristics and association with perinatal outcome of the aortic isthmus (AoI) circulation as assessed by Doppler imaging in preterm growth-restricted fetuses with placental insufficiency. METHODS This was a prospective cross-sectional study. Fifty-one fetuses with intrauterine growth restriction (IUGR) and either an umbilical artery (UA) pulsatility index (PI) > 95(th) centile or a cerebroplacental ratio < 5(th) centile were examined at 24-36 weeks' gestation. AoI impedance indices (PI and resistance index) and absolute velocities (peak systolic (PSV), end-diastolic and time-averaged maximum (TAMXV) velocities), were measured in all cases and compared with reference ranges by gestational age. Furthermore, fetuses were stratified into two groups according to the direction of the diastolic blood flow in the AoI: those with antegrade flow (n = 41) and those with retrograde flow (n = 10). Clinical surveillance was based on gestational age and Doppler assessment of the UA, middle cerebral artery and ductus venosus (DV). Adverse perinatal outcome was defined as stillbirth, neonatal death and severe morbidity (respiratory distress syndrome, bronchopulmonary dysplasia, Grade III/IV intraventricular hemorrhage, necrotizing enterocolitis and a neonatal intensive care unit stay > 14 days). RESULTS Adverse perinatal outcome was significantly associated with an increased AoI-PI (area under the curve 0.77; 95% CI, 0.63-0.92; P < 0.005). A significant correlation (P < 0.001) was found between retrograde blood flow in the AoI and adverse perinatal outcome, the overall perinatal mortality being higher in the retrograde group (70% vs. 4.8%, P < 0.001). In 4/5 (80%) fetuses the reversal of flow in the AoI preceded that in the DV by 24-48 h. AoI-PSV and AoI-TAMXV were < 5(th) centile in 40/51 (78%) and 48/51 (94%) cases, respectively, whereas AoI-PI was > 95(th) centile in 21/51 (41%) cases. CONCLUSIONS Retrograde flow in the AoI in growth-restricted fetuses correlates strongly with adverse perinatal outcome. Absolute velocities in the AoI are decreased in growth-restricted fetuses. The data suggest a potential role for Doppler imaging of the AoI in the clinical surveillance of fetuses with severe IUGR, which should be confirmed in larger prospective studies.
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Affiliation(s)
- M Del Río
- Department of Maternal-Fetal Medicine, ICGON, Hospital Clínic, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain.
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Fouron JC. [Blood flow through the fetal aortic isthmus: a new physiological concept with many clinical implications]. Med Sci (Paris) 2007; 23:950-6. [PMID: 18021706 DOI: 10.1051/medsci/20072311950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
UNLABELLED The new physiological concept: because of the parallel disposition of the fetal ventricles and of their respective arterial outlet, the flow through the aortic isthmus represents the only arterial shunt in the fetal circulation. The low resistance of the placental circulation explains the forward systolic and diastolic flows normally observed through the isthmus. CLINICAL IMPLICATIONS (1) assessment of individual performances of each ventricle : left ventricle causes forward flow while the right ventricle has a retrograde influence; (2) any changes of flow and/or resistances affecting one of the two fetal arterial systems organized in parallel should influence the flow pattern within the isthmus. Examples : peripheral arterio-venous fistula, increase in placental vascular resistance leading to intra-uterine growth restriction, etc. CONCLUSION doppler flow recordings in the fetal aortic isthmus: (1) provides information on the global condition of the fetal cardiocirculatory system; (2) is a good indicator of fetal individual ventricular performance; (3) allows assessment of hemodynamic consequences of abnormalities of the peripheral circulatory systems.
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Affiliation(s)
- Jean-Claude Fouron
- Unité de Cardiologie Foetale, Service de Cardiologie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, Montréal, Québec H3T 1C5, Canada.
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Del Río M, Martínez JM, Figueras F, López M, Palacio M, Gómez O, Coll O, Puerto B. Reference ranges for Doppler parameters of the fetal aortic isthmus during the second half of pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:71-6. [PMID: 16795125 DOI: 10.1002/uog.2827] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To establish reference ranges for blood flow velocity waveforms (FVW) of the fetal aortic isthmus (AoI) during the second and third trimesters of pregnancy. METHODS This was a prospective cross-sectional observational study involving 458 uncomplicated singleton pregnancies between 19 and 37 weeks of gestation. Fetal AoI Doppler parameters were assessed in either the longitudinal aortic arch view or the three vessels and trachea view. Regression analysis was used to determine gestational-age-specific reference ranges and to construct nomograms for the following Doppler parameters: pulsatility index (PI), resistance index (RI) and peak systolic (PSV), end-diastolic (EDV) and time-averaged maximum (TAMXV) velocities. Intra- and interobserver reproducibility were evaluated by calculating intraclass correlation coefficients (ICCs) and limits of agreement. RESULTS Reliable FVW in the AoI were obtained in all cases. Acceptable intra- and interobserver reproducibility was obtained. With advancing gestation, there was a significant increase in PSV, TAMXV and PI, whereas RI and EDV remained constant during the second half of pregnancy. No cases of absent or reversed flow during diastole were detected. CONCLUSION Normal data of the fetal AoI blood FVW throughout the second and third trimesters of pregnancy are provided. The reported Doppler profiles may be of clinical use in the assessment of hemodynamically compromised growth-restricted fetuses.
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Affiliation(s)
- M Del Río
- Department of Obstetrics and Gynecology, ICGON, Hospital Clínic, University of Barcelona, Spain.
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Del Río M, Martínez JM, Figueras F, Bennasar M, Palacio M, Gómez O, Coll O, Puerto B, Cararach V. Doppler assessment of fetal aortic isthmus blood flow in two different sonographic planes during the second half of gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:170-4. [PMID: 16041679 DOI: 10.1002/uog.1955] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To compare the reliability of Doppler blood flow measurements of the fetal aortic isthmus (AoI) according to whether the sampling plane is obtained from the traditional longitudinal aortic arch (LAA) view or the more recently described three vessels and trachea (3VT) view of the fetal upper mediastinum. METHODS Doppler blood flow measurements of pulsatility index (PI), resistance index (RI), peak systolic (PSV), end-diastolic (EDV) and time-averaged maximum (TAMXV) velocities were performed in the AoI of 40 fetuses between 24 and 36 weeks of gestation. All measurements were sampled in two different sonographic planes of the AoI: the LAA view, at a few millimeters beyond the origin of the left subclavian artery, and the 3VT view, just before the V-shaped junction of the aortic and ductal arches. All scans were performed by the same observer. The reliability of Doppler blood flow measurements was assessed by calculating intraclass correlation coefficients (ICCs) and limits of agreement between the two different sonographic sites evaluating the AoI. RESULTS Mean values of PI, RI, PSV, EDV and TAMXV were similar in the LAA and 3VT views. The PI and vascular velocities were reliably measured from both sonographic sites. ICCs for variability of measurements were 0.78, 0.63, 0.63, 0.60 and 0.55 for PI, RI, PSV, EDV and TAMXV, respectively. Limits of agreement revealed minimal disagreement between the two sites of evaluation of the AoI for all measurements. CONCLUSIONS On the basis of our observations, Doppler blood flow measurements across the fetal AoI can be reliably obtained from both the 3VT and the traditional LAA sonographic views. Since the transverse upper thoracic 3VT plane is achievable in most fetal positions, Doppler study of the AoI appears to be easier than expected.
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Affiliation(s)
- M Del Río
- Department of Obstetrics and Gynecology, ICGON, Hospital Clinic, University of Barcelona, Barcelona, Spain.
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Fouron JC, Gosselin J, Raboisson MJ, Lamoureux J, Tison CA, Fouron C, Hudon L. The relationship between an aortic isthmus blood flow velocity index and the postnatal neurodevelopmental status of fetuses with placental circulatory insufficiency. Am J Obstet Gynecol 2005; 192:497-503. [PMID: 15695993 DOI: 10.1016/j.ajog.2004.08.026] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the association between an abnormal aortic isthmus blood flow index and postnatal neurodevelopmental outcome in fetuses with placental circulatory insufficiency. STUDY DESIGN Forty-eight children who were born between 1991 and 1999 were included in this study on the basis of abnormal umbilical artery Doppler velocimetry. Prenatal isthmus blood flow index was obtained by dividing the sum of the systolic and diastolic Doppler blood flow velocity integrals by the systolic blood flow integrals. Neurodevelopmental outcome between 2 and 5 years was classified as optimal, when neurologic assessment and developmental quotient were within normal limits and as nonoptimal when abnormal neurologic findings and/or a nonoptimal developmental quotient was present. Neurodevelopmental outcome was analyzed in relation to isthmus flow index and pulsatility indices in the umbilical artery. RESULTS The mean gestational age at delivery was 33.0 +/- 2 weeks. Nonoptimal neurodevelopmental outcome was found in 60.4% of the children (29/48). An inverse correlation was found between the isthmus blood flow index and postnatal neurodevelopmental outcome. All 13 children with an isthmus blood flow index of <0.5 were in the nonoptimal group. All 19 children with an optimal outcome had an isthmus blood flow index of >0.5, but this was also the case for 16 other children with nonoptimal neurodevelopmental outcome. An isthmus blood flow index cut-off value of 0.70 was associated with the highest overall positive and negative predictive values. The pulsatility index in the umbilical artery did not provide any significant contribution in the explanation of the outcome. CONCLUSION The isthmic blood flow index can help to identify a subgroup of fetuses with placental circulatory insufficiency that might benefit from early delivery.
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Affiliation(s)
- Jean-Claude Fouron
- Fetal Cardiology Unit, Pediatric Cardiology Division, Ste-Justine Hospital, University of Montreal, Montreal, Quebec, Canada.
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Fouron JC. The unrecognized physiological and clinical significance of the fetal aortic isthmus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 22:441-447. [PMID: 14618654 DOI: 10.1002/uog.911] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Current awareness in prenatal diagnosis. Prenat Diagn 2003; 23:611-7. [PMID: 12905995 DOI: 10.1002/pd.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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