Dynamics of pulmonary venous flow in fetuses with intrauterine growth restriction

Bravo-Valenzuela, Nathalie Jeanne; Zielinsky, Paulo; Huhta, James C.; Acácio, Gregório Lorenzo; Nicoloso, Luiz Henrique Soares; Piccoli, Antônio; Busato, Stefano Boemler; Klein, Caroline

doi:10.1002/pd.4529

Cited by 12 publications

(19 citation statements)

References 26 publications

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“…Prospectively, systemic and umbilical venous Doppler flow abnormalities can predict adverse perinatal outcomes and are considered to be strong predictors of stillbirths in IUGR [27,28]. Similarly to DV flow, the reversed pulmonary vein A-wave reflects fetal hypoxia, but the applicability of pulmonary vein Doppler patterns for predicting outcomes of IUGR remains unknown [29]. In this study, the IUGR fetuses had a higher PVPI with normal DV flow, probably because they were not in late stages of deterioration.…”

Section: Discussionmentioning

confidence: 64%

“…Possible reasons for this correlation are the highly specific IUGR population due to placental dysfunction and the lack of stratification based on placental insufficiency in group 2. The use of pulmonary vein PI in fetuses has been proposed as a good echocardiographic Doppler parameter to assess fetal cardiac dynamics [12,29] since it reflects LA pressure changes and is reproducible [17]. IUGR fetuses showed an increased PVPI, reflecting flow distribution in the left heart with changes in LA pressure, probably due to left ventricular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary Vein Flow Impedance: An Early Predictor of Cardiac Dysfunction in Intrauterine Growth Restriction

Bravo-Valenzuela

Zielinsky²,

Zurita-Peralta³

et al. 2018

Fetal Diagn Ther

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Introduction: In intrauterine growth restriction (IUGR), increased uteroplacental vascular impedance contributes to preferential flow to left ventricle (LV), with consequent alteration of its compliance and increased left atrial (LA) pressure. Pulmonary vein pulsatility index (PVPI) reflects the increased impedance to LA filling and could be used as a cardiac monitoring parameter in IUGR. Material and Methods: A total of 27 IUGR fetuses (group 1), 28 fetuses with appropriate growth for gestational age from hypertensive mothers (group 2), and 28 controls (group 3) were studied. Pulsatility indices (PIs) of pulmonary veins and ductus venosus were calculated by Doppler echocardiography. Obstetric ultrasound was used to assess the PIs of uterine, umbilical, and middle cerebral arteries. Statistical analysis used analysis of variance, post-hoc Tukey, and Pearson’s tests. Results: Mean PVPI was higher in IUGR group (1.27 ± 0.39) when compared to groups 2 (1.02 ± 0.37; p = 0.01) and 3 (0.75 ± 0.12; p < 0.001). In group 2, moderate correlation between PVPI and ductus venosus pulsatility index (DVPI) was found but not between PVPI and cerebroplacental ratio (CPR). Discussion: Higher PVPI in IUGR reflects decreased LV compliance and altered LA dynamics. As LV dysfunction precedes right ventricle, our results suggest that PVPI could be an early echocardiographic parameter of fetal diastolic function in IUGR.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Pulmonary Vein Flow Impedance: An Early Predictor of Cardiac Dysfunction in Intrauterine Growth Restriction

Bravo-Valenzuela

Zielinsky²,

Zurita-Peralta³

et al. 2018

Fetal Diagn Ther

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“…Another clinical application of pulmonary venous Doppler sonography is the investigation of left ventricular diastolic function in fetuses with severe intrauterine growth restriction. In a recent study, it was demonstrated that these fetuses have a significantly higher pulsatility in the pulmonary vein than normal‐weight fetuses . These observations as well and their clinical significance in particular must be verified by further studies including new parameters of cardiac function such as the myocardial performance index and/or tissue Doppler imaging.…”

Section: Discussionmentioning

confidence: 99%

Fetal pulmonary venous blood flow velocities in a normal population and new calculated reference values

et al. 2016

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“…Therefore, the PVPI has been reported as an early marker to evaluate fetal cardiac dysfunction and hemodynamics. It has also been reported that the PVPI is significantly greater in IUGR fetuses than in normal‐weight fetuses; Bravo‐Valenzuela et al showed that the mean PVPI of normal‐weight fetuses was 0.83, whereas the mean PVPI of IUGR fetuses was 1.31 at 31 weeks’ gestation. If placental insufficiency contributes to an increase in the PVPI, a rise in the PVPI can also be expected in placental insufficiency–induced oligohydramnios as well as in IUGR.…”

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confidence: 96%

Does Fetal Pulmonary Venous Flow Impedance Increase in Pregnancies With Placental Insufficiency–Related Oligohydramnios in the Third Trimester?

Cho

2019

J of Ultrasound Medicine

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Objectives-In placental insufficiency, alteration of left heart compliance occurs, with consequent increased placental vascular impedance. Pulmonary vein flow patterns could reflect altered left atrial pressure. Although the fetal pulmonary venous pulsatility index (PVPI) has been reported as an early marker to evaluate fetal cardiac dysfunction, no studies have been focused on its correlation with oligohydramnios. The aim of this study was to determine whether fetal pulmonary venous flow impedance was greater in women with placental insufficiency-related oligohydramnios than in women with adequate amounts of amniotic fluid during the third trimester.Methods-The fetal PVPI and the umbilical arterial systolic-to-diastolic (S/D) ratio were measured by Doppler echocardiography in 130 pregnant women between 28 and 39 gestational weeks. Pregnant women were divided into 2 groups according to the amount of amniotic fluid. The PVPI and umbilical arterial S/D ratio were compared between 19 pregnancies with oligohydramnios and 111 with adequate amniotic fluid.Results-The mean gestational age and estimated fetal weight were not significantly different between the groups. The maternal age was higher in the oligohydramnios group than in the control group (mean AE SD, 36.89 AE 5.88 versus 34.06 AE 4.79 years; P = .023). The mean PVPI was significantly higher in the oligohydramnios group than in the control group (1.13 AE 0.22 versus 0.89 AE 0.31; P < .001). There was no significant difference in umbilical arterial S/D ratio between the groups (P = .142). Conclusions-The PVPI could be used as an early diagnostic marker of fetal deterioration in placental insufficiency-related oligohydramnios.

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Dynamics of pulmonary venous flow in fetuses with intrauterine growth restriction

Abstract: The pulsatility index of pulmonary venous flow in fetuses with growth restriction is higher than in normal fetuses, probably as a result of left atrial dynamics alteration secondary or not to fetal left ventricular diastolic dysfunction. © 2014 John Wiley & Sons, Ltd.

Cited by 12 publications

References 26 publications

Pulmonary Vein Flow Impedance: An Early Predictor of Cardiac Dysfunction in Intrauterine Growth Restriction

Pulmonary Vein Flow Impedance: An Early Predictor of Cardiac Dysfunction in Intrauterine Growth Restriction

Fetal pulmonary venous blood flow velocities in a normal population and new calculated reference values

Does Fetal Pulmonary Venous Flow Impedance Increase in Pregnancies With Placental Insufficiency–Related Oligohydramnios in the Third Trimester?

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