Effects of fetal cardiac anomalies on ductus venosus and aortic isthmus doppler profiles

İlhan, Gülşah; İyibozkurt, Ahmet Cem; Kalelioğlu, Halil İbrahim; Ibrahimoglu, L.; Zebitay, Ali Galip; Eken, Meryem; Karasu, Aykut

doi:10.1007/s00404-015-3796-9

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…However, after subgrouping by anomaly, the limited sample size restricted the significance of this finding. The largest subgroups included tetralogy of Fallot (13 fetuses) and muscular VSD (n = 10), for which statistically lower IFI values were seen [61]; the study concluded that AoI Doppler profiles might increase the sensitivity of CHD diagnosis.…”

Section: Aoi In Structural Pathologymentioning

confidence: 99%

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The Aortic Isthmus: A Significant yet Underexplored Watershed of the Fetal Circulation

Tynan

Alphonse

Henry³

et al. 2016

Fetal Diagn Ther

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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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Section: Aoi In Structural Pathologymentioning

confidence: 99%

“…Only one case-control study explored the IFI in CHD [61], finding a statistical difference in the overall sample of 64 fetuses with various types of CHD. However, after subgrouping by anomaly, the limited sample size restricted the significance of this finding.…”

Section: Aoi In Structural Pathologymentioning

confidence: 99%

The Aortic Isthmus: A Significant yet Underexplored Watershed of the Fetal Circulation

Tynan

Alphonse

Henry³

et al. 2016

Fetal Diagn Ther

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“…In fact, competence in Doppler assessment of the DV is achieved only after extensive supervised training [34]. The evaluation of the DV flow can be made in the first [35][36][37][38][39][40] or second and third trimesters of pregnancy [41][42][43][44][45][46][47][48][49] (Figures 2 and 3). The DV can be visualized in a midsagittal longitudinal plane of the fetal trunk or in an oblique transverse plane through the upper abdomen [50].…”

Section: Fetal Ductus Venosus Flow Assessment In Daily Clinical Practicementioning

confidence: 99%

Clinical Significance of Ductus Venosus Waveform as Generated by Pressure- volume Changes in the Fetal Heart

Braga

Moleiro

Guedes-Martins

2019

CCR

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The ductus venosus is a vascular shunt situated within the fetal liver parenchyma, connecting the umbilical vein to the inferior vena cava. This vessel acts as a bypass of the liver microcirculation and plays a critical role in the fetal circulation. The ductus venosus allows oxygenated and nutrient-rich venous blood to flow from the placenta to the myocardium and brain. Increased impedance to flow in the fetal ductus venosus is associated with fetal aneuploidies, cardiac defects and other adverse pregnancy outcomes. This review serves to improve our understanding of the mechanisms that regulate the blood flow redistribution between the fetal liver circulation and fetal heart and the clinical significance of the ductus venosus waveform as generated by pressure-volume changes in the fetal heart.

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“…The left ventricle (LV) perfuses the coronary and brachiocephalic circulations, while the right ventricle (RV) the subdiaphragmatic circulation and placenta 3,4 . Retrograde flow (RF) may occur in the aortic isthmus (AI), the segment between the left subclavian artery and the ductus arteriosus (DA) insertion in the descending aorta 5–10 in fetuses with intra‐uterine growth restriction (IUGR), small for gestational age (SGA), 10–27 and some congenital heart disease (CHD), 28–30 such as transposition of great artery (TGA). However, RF in various fetal heart disease (FHD), including abnormalities in heart structure and function, and its association with flow variables has not been systematically studied 8,21 …”

Section: Introductionmentioning

confidence: 99%

Retrograde flow in aortic isthmus in normal and fetal heart disease by principal component analysis and computational fluid dynamics

Chen

Zhao

et al. 2022

Echocardiography

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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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Effects of fetal cardiac anomalies on ductus venosus and aortic isthmus doppler profiles

Abstract: 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.

Cited by 4 publications

References 22 publications

The Aortic Isthmus: A Significant yet Underexplored Watershed of the Fetal Circulation

The Aortic Isthmus: A Significant yet Underexplored Watershed of the Fetal Circulation

Clinical Significance of Ductus Venosus Waveform as Generated by Pressure- volume Changes in the Fetal Heart

Retrograde flow in aortic isthmus in normal and fetal heart disease by principal component analysis and computational fluid dynamics

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