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Wagner P, Eberle K, Sonek J, Berg C, Gembruch U, Hoopmann M, Prodan N, Kagan KO. First-trimester ductus venosus velocity ratio as a marker of major cardiac defects. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:663-668. [PMID: 30125415 DOI: 10.1002/uog.20099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/29/2018] [Accepted: 08/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To examine ductus venosus (DV) flow in fetuses with and those without a cardiac defect and to evaluate different phases of DV flow in addition to the standard assessment of DV pulsatility index for veins (PIV) and the a-wave. METHODS This was a retrospective study of singleton pregnancies that underwent first-trimester ultrasound screening, which included DV flow assessment, at the University of Tübingen (between 2010 and 2017) or the University of Cologne (between 2013 and 2016). The study population comprised normal fetuses and fetuses with major cardiac defects at a ratio of 10:1. For each fetus, the following parameters of the DV waveform were evaluated: qualitative assessment of the a-wave, PIV measurement and ratios of flow velocities during the S-wave (S) or D-wave (D) and the a-wave (a) or v-wave (v). Reproducibility of DV-PIV and DV flow ratios was evaluated in 30 fetuses in which the DV flow was assessed twice. RESULTS Our study population included 480 anatomically normal fetuses and 48 with a cardiac defect. Median fetal nuchal translucency (NT) in the normal and in the affected group was 1.9 mm and 2.6 mm, respectively. In five (1.0%) of the normal and 18 (37.5%) of the affected cases, fetal NT thickness was above the 99th centile. In the normal group, the DV a-wave was reversed in 15 (3.1%) cases and the DV-PIV was above the 95th centile in 25 (5.2%). In the cases with cardiac defects, the a-wave was reversed and the DV-PIV measurement was above the 95th centile in 26 (54.2%). The reproducibility of measurement of the ratios of DV flow velocities was similar to that of the DV-PIV. Most cardiac defects were associated with an abnormal a/S or a/D ratio. If the cut-off for these two ratios was set at the 5th centile of the normal distribution, the detection rate of fetal cardiac anomalies would be 62.5%. This compares favorably with the DV-PIV, which detects 26 (54.2%) of the affected fetuses for the same threshold. CONCLUSION In the first trimester, the a/S ratio has the potential to detect approximately 60% of congenital cardiac defects for a false-positive rate of 5%. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- P Wagner
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - K Eberle
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - J Sonek
- Fetal Medicine Foundation USA, Dayton, OH, USA
- Division of Maternal Fetal Medicine, Wright State University, Dayton, OH, USA
| | - C Berg
- Department of Obstetrics and Gynaecology, University of Cologne, Cologne, Germany
- Department of Obstetrics and Gynaecology, University of Bonn, Bonn, Germany
| | - U Gembruch
- Department of Obstetrics and Gynaecology, University of Bonn, Bonn, Germany
| | - M Hoopmann
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - N Prodan
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - K O Kagan
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
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Burger NB, Haak MC, Kok E, de Groot CJM, Shou W, Scambler PJ, Lee Y, Cho E, Christoffels VM, Bekker MN. Cardiac defects, nuchal edema and abnormal lymphatic development are not associated with morphological changes in the ductus venosus. Early Hum Dev 2016; 101:39-48. [PMID: 27405055 DOI: 10.1016/j.earlhumdev.2016.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 05/20/2016] [Accepted: 05/26/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND In human fetuses with cardiac defects and increased nuchal translucency, abnormal ductus venosus flow velocity waveforms are observed. It is unknown whether abnormal ductus venosus flow velocity waveforms in fetuses with increased nuchal translucency are a reflection of altered cardiac function or are caused by local morphological alterations in the ductus venosus. AIM The aim of this study was to investigate if the observed increased nuchal translucency, cardiac defects and abnormal lymphatic development in the examined mouse models are associated with local changes in ductus venosus morphology. STUDY DESIGN Mouse embryos with anomalous lymphatic development and nuchal edema (Ccbe1(-/-) embryos), mouse embryos with cardiac defects and nuchal edema (Fkbp12(-/-), Tbx1(-/-), Chd7(fl/fl);Mesp1Cre, Jarid2(-/-NE+) embryos) and mouse embryos with cardiac defects without nuchal edema (Tbx2(-/-), Fgf10(-/-), Jarid2(-/-NE-) embryos) were examined. Embryos were analyzed from embryonic day (E) 11.5 to 15.5 using markers for endothelium, smooth muscle actin, nerve tissue and elastic fibers. RESULTS All mutant and wild-type mouse embryos showed similar, positive endothelial and smooth muscle cell expression in the ductus venosus at E11.5-15.5. Nerve marker and elastic fiber expression were not identified in the ductus venosus in all investigated mutant and wild-type embryos. Local morphology and expression of the used markers were similar in the ductus venosus in all examined mutant and wild-type embryos. CONCLUSIONS Cardiac defects, nuchal edema and abnormal lymphatic development are not associated with morphological changes in the ductus venosus. Ductus venosus flow velocity waveforms most probably reflect intracardiac pressure.
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Affiliation(s)
- Nicole B Burger
- Department of Obstetrics and Gynecology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
| | - Monique C Haak
- Department of Obstetrics, Leiden University Medical Center, Albinusdreef 2 2333 ZA Leiden, the Netherlands.
| | - Evelien Kok
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, Meibergdreef 9 1105 AZ Amsterdam, the Netherlands.
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
| | - Weinian Shou
- Riley Heart Research Center, Herman B Wells Center for Pediatric Research, Division of Pediatric Cardiology, Indiana University School of Medicine, 705 Riley Hospital Dr. Indianapolis, Indiana, USA.
| | - Peter J Scambler
- Department of Molecular Medicine, University College London, Institute of Child Health, Gower Street, London, WC1E 6BT, United Kingdom.
| | - Youngsook Lee
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison, 1111 Highland Ave. Madison, Wisconsin, USA.
| | - Eunjin Cho
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison, 1111 Highland Ave. Madison, Wisconsin, USA.
| | - Vincent M Christoffels
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, Meibergdreef 9 1105 AZ Amsterdam, the Netherlands.
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
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Burger NB, Matias A, Kok E, de Groot CJM, Christoffels VM, Bekker MN, Haak MC. Absence of an anatomical origin for altered ductus venosus flow velocity waveforms in first-trimester human fetuses with increased nuchal translucency. Prenat Diagn 2016; 36:537-44. [PMID: 27060369 DOI: 10.1002/pd.4820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/19/2016] [Accepted: 03/24/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To perform a morphological evaluation of the ductus venosus, heart and jugular lymphatic sac (JLS) in first-trimester human fetuses with normal and abnormal ductus venosus flow velocity waveforms (DV-FVWs) and normal and increased nuchal translucency (NT). METHOD Postmortem examination was performed on fetuses with increased NT or structural malformations with previous NT and DV-FVW measurements. Ductus venosus morphology was examined using markers for endothelium, smooth muscle actin (SMA), nerves and elastic fibers. Fetal hearts were studied by microscopy. The nuchal region was analyzed using markers for lymphatic vessels, endothelium, SMA and nerves. RESULTS Two trisomy 21 and two trisomy 18 fetuses with increased NT and abnormal DV-FVWs were analyzed. As a control, one euploid anencephalic fetus with normal NT, cardiac anatomy and DV-FVWs was examined. Similar endothelial and SMA expression was observed in the ductus venosus in all fetuses. Nerve and elastic fiber expression were not detected. Three trisomic fetuses showed cardiac defects, one trisomic fetus demonstrated normal cardiac anatomy. The JLS was abnormally enlarged or contained red blood cells in all trisomic fetuses. The control fetus showed a normal JLS. CONCLUSION Abnormal DV-FVWs are not justified by alterations in ductus venosus morphology. DV-FVWs most probably reflect intracardiac pressure. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nicole B Burger
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexandra Matias
- Department of Obstetrics and Gynecology, University Hospital Sao João, Porto, Portugal
| | - Evelien Kok
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Vincent M Christoffels
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique C Haak
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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Burger NB, Bekker MN, Kok E, De Groot CJM, Martin JF, Shou W, Scambler PJ, Lee Y, Christoffels VM, Haak MC. Increased nuchal translucency origins from abnormal lymphatic development and is independent of the presence of a cardiac defect. Prenat Diagn 2015; 35:1278-86. [DOI: 10.1002/pd.4687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/27/2015] [Accepted: 08/31/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Nicole B. Burger
- Department of Obstetrics and Gynecology; VU University Medical Center; Amsterdam The Netherlands
| | - Mireille N. Bekker
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Evelien Kok
- Department of Anatomy, Embryology and Physiology; Academic Medical Center; Amsterdam The Netherlands
| | | | - James F. Martin
- Department of Molecular Physiology and Biophysics; Baylor College of Medicine; Houston TX USA
| | - Weinian Shou
- Riley Heart Research Center, Division of Pediatric Cardiology; Indiana University School of Medicine; Indianapolis IN USA
| | - Peter J. Scambler
- Department of Molecular Medicine; UCL Institute of Child Health; London United Kingdom
| | - Youngsook Lee
- Department of Cell and Regenerative Biology; University of Wisconsin-Madison; Madison WI USA
| | - Vincent M. Christoffels
- Department of Anatomy, Embryology and Physiology; Academic Medical Center; Amsterdam The Netherlands
| | - Monique C. Haak
- Department of Obstetrics; Leiden University Medical Center; Leiden The Netherlands
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Burger NB, Bekker MN, de Groot CJM, Christoffels VM, Haak MC. Why increased nuchal translucency is associated with congenital heart disease: a systematic review on genetic mechanisms. Prenat Diagn 2015; 35:517-28. [DOI: 10.1002/pd.4586] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/09/2014] [Accepted: 02/21/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Nicole B. Burger
- Department of Obstetrics and Gynaecology; VU University Medical Center; Amsterdam The Netherlands
| | - Mireille N. Bekker
- Department of Obstetrics and Gynaecology; Radboud University Medical Center; Nijmegen The Netherlands
| | | | - Vincent M. Christoffels
- Department of Anatomy, Embryology & Physiology; Academic Medical Center; Amsterdam The Netherlands
| | - Monique C. Haak
- Department of Obstetrics; Leiden University Medical Center; Leiden The Netherlands
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Burger NB, Haak MC, De Bakker BS, Al Shaibani Z, De Groot CJM, Christoffels VM, Bekker MN. Systematic analysis of the development of the ductus venosus in wild type mouse and human embryos. Early Hum Dev 2013; 89:1067-73. [PMID: 23978399 DOI: 10.1016/j.earlhumdev.2013.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 07/28/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Doppler flow velocities of the ductus venosus are increasingly used to assess fetal increased nuchal translucency, growth-restriction and monochorionic twins, and might contribute to screening for cardiac defects. It is disputed whether a sphincter at the ductus venosus inlet actively regulates blood flow. AIMS This study aims to define the morphogenesis of the developing mouse and human ductus venosus and to address the existence of a sphincter. STUDY DESIGN The presence of endothelium, smooth muscle, elastic fibers and nerves in the ductus venosus of E10.5-15.5 mouse embryos and in three corresponding human embryos (CS16, CS19 and CS23) was examined using immunohistochemistry. Three-dimensional reconstructions of the ductus venosus of E11.5-15.5 mouse and CS14-23 human embryos were generated and examined. RESULTS The ductus venosus lumen was narrowed from ventral-caudal to dorsal-cranial in E13.5-15.5 mouse and CS16-23 human embryos. Mouse embryos showed positive endothelial Pecam1 expression from E11.5-15.5 and smooth muscle actin staining in the ventral-caudal part of the ductus venosus from E12.5-15.5. At all developmental stages, elastic fiber and nerve marker expression was not detected in the ductus venosus (Fig. 2). In human embryos endothelial Pecam1 and smooth muscle actin expression was found in the ductus venosus from CS16 and CS19 onwards. Elastic fiber and nerve marker expression was not detected in all stages (Fig. 4). Morphogenesis and staining results of the ductus venosus were similar in both species. CONCLUSIONS The ductus venosus lacks a sphincter at its inlet as no accumulation of smooth muscle cells, elastic fibers or nerve innervation was found in mouse embryos from E11.5-15.5 and in human embryos from CS14-23.
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Affiliation(s)
- Nicole B Burger
- Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
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Papatheodorou SI, Evangelou E, Makrydimas G, Ioannidis JPA. First-trimester ductus venosus screening for cardiac defects: a meta-analysis. BJOG 2011; 118:1438-45. [DOI: 10.1111/j.1471-0528.2011.03029.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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