Fetal cardiac Doppler indices in fetuses with hemoglobin Bart's disease at 12–14 weeks of gestation

Luewan, Suchaya; Tongprasert, Fuanglada; Srisupundit, Kasemsri; Tongsong, Theera

doi:10.1016/j.ijcard.2015.02.053

Cited by 6 publications

(7 citation statements)

References 12 publications

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“…The MPI in fetal anemia caused by homozygous alpha thalassemia‐1 disease is higher than that in normal fetuses from 12 weeks' gestation and increases continuously from 20 weeks gestation to term . Of the MPI components, ICT is significantly increased in the affected fetuses from the first trimester, but IRT and ET are not .…”

Section: Discussionmentioning

confidence: 92%

“…Likewise, the MPI has been reported to increase in fetuses with anemia as a result of compensatory increased cardiac output to maintain adequate tissue oxygenation causing cardiac dilatation, ischemia and dysfunction . In fetal anemia from homozygous α‐thalassemia‐1 or hemoglobin (Hb) Bart's disease, one of the common causes of hydrops fetalis in Asia, the MPI was found to be higher than that in normal fetuses . Interestingly, ICT was significantly prolonged in anemic fetuses at early gestation, but not IRT, suggesting that the selective measurement of ICT may be a better marker as compared with MPI for fetal cardiac function monitoring.…”

Section: Introductionmentioning

confidence: 99%

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Fetal isovolumetric time intervals as a marker of abnormal cardiac function in fetal anemia from homozygous alpha thalassemia‐1 disease

et al. 2017

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Fetal isovolumetric time intervals as a marker of abnormal cardiac function in fetal anemia from homozygous alpha thalassemia‐1 disease

et al. 2017

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“…Anaemic foetuses can perfectly maintain normal diastolic flow. Additionally, some studies on myocardial performance indicated that isovolumetric relaxation time is unchanged in foetal anaemia, 46,47 suggesting no significant impact on afterload in spite of increased blood volume.…”

Section: Functional Changesmentioning

confidence: 99%

“…In other words, the myocardium works harder but still works well. Luewan et al46 demonstrated that in foetuses with Hb Bart's disease at 12-14 weeks, the median isovolumetric contraction time (ICT) and Tei index were significantly increased compared with those in normal foetuses, whereas other Doppler indices were not significantly different. This finding indicated that foetuses with anaemia have subtle changes in myocardial function from late first trimester, and the earliest sign is prolonged ICT.…”

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confidence: 99%

Foetal haemodynamic response to anaemia

et al. 2020

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This study aims to update new knowledge regarding foetal cardiovascular response to anaemia, using foetal haemoglobin Bart's disease as a study model. Original research articles, review articles, and guidelines were narratively reviewed and comprehensively validated. The main foetal cardiovascular changes in response to anaemia are consequences of hypervolaemia and increased cardiac output to meet tissue oxygen requirement. New challenging insights are as follows: (i) the earliest morphological change is an increase in cardiac size and remodelling of the sphericity (an increase in diameter more pronounced than that in long axis) followed by several markers, such as placentomegaly and hepatosplenomegaly. (ii) The earliest functional change is increased peak systolic velocity of the red blood cells because of low viscosity, especially in the middle cerebral artery. (iii) The foetal heart has very high reserve potentials to cope with anaemia: increasing workload without increased central venous pressure and increased myocardial performance without compromising shortening fraction. This hard-working period with good performance lasts long, including most part of the second and third trimester. (iv) At the time cardiomegaly myocardial cellular damage has already occurred, in spite of good cardiac function. (v) Anaemic hydrops foetalis is mainly due to hypervolaemia, hypoalbuminaemia, and high vascular permeability, not heart failure. (vi) Foetal heart failure occurs only when the adaptive mechanism becomes exhausted or long after the development of anaemic hydrops foetalis. Heart failure is a very late result of a longstanding overworked heart. (vii) Ultrasound is highly effective in the detection of foetal response to anaemia. An increase in cardiac size and middle cerebral artery is very helpful in predicting the affected foetuses in pre-hydropic phase. (viii) Theoretically, intrauterine treatment of anaemic hydrops results in satisfactory outcomes as long as cardiac function is normal, but intrauterine intervention should be strongly considered in pre-hydropic phase because myocardial cell damage could have already occurred in this phase or early hydropic phase. Anaemic hydrops foetalis is not primarily caused by heart failure as commonly advocated, but it is rather a consequence of hypervolaemia, hypoalbuminaemia, and high vascular permeability while heart failure is a very late consequence of a longstanding overworked heart. New insights gained from this review may be useful to base clinical practice on which sonographic markers imply significant pathological changes, how ultrasound can be helpful in early detection of anaemic response, when intrauterine transfusion for anaemia due to non-lethal causes should be administered, etc.

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“…In the late first and early second trimesters of pregnancy (12-15 weeks of gestation), a CTR cut-off value of 0.5 has a 90.7% sensitivity and a 97.2% specificity for Hb Bart's disease [83] . Recent studies on cardiac function have shown that fetuses affected with Hb Bart's disease during the first trimester of pregnancy can show a significantly increased myocardial performance index ( p < 0.001) as well as an increased isovolumetric contraction time ( p = 0.006), whereas the IRT and ejection times (ET) did not change [85] . Both IRT and ET tend to increase in anemic fetuses during the second half of pregnancy [86] .…”

Section: Fetal Cardiac Function In Early Pregnancymentioning

confidence: 99%

Early Evaluation of the Fetal Heart

et al. 2017

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Evaluation of the fetal heart at 11-13 + 6 weeks of gestation is indicated for women with a family history of congenital heart defects (CHD), a previous child with CDH, or an ultrasound finding associated with cardiac anomalies. The accuracy for early detection of CHD is highly related to the experience of the operator. The 4-chamber view and outflow tracts are the most important planes for identification of an abnormal heart, and can be obtained in the majority of fetuses from 11 weeks of gestation onward. Transvaginal ultrasound is the preferred route for fetal cardiac examination prior to 12 weeks of gestation, whereas, after 12 weeks, the fetal heart can be reliably evaluated by transabdominal ultrasound. Cardiac defects, such as ventricular septal defects, tetralogy of Fallot, Ebstein's anomaly, or cardiac tumors, are unlikely to be identified at ≤14 weeks of gestation. Additional ultrasound techniques such as spatiotemporal image correlation and the evaluation of volumes by a fetal-heart expert can improve the detection of congenital heart disease. The evaluation of the fetal cardiac function at 11-13 + 6 weeks of gestation can be useful for early identification of fetuses at risk of anemia due to hemoglobinopathies, such as hemoglobin Bart's disease.

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Fetal cardiac Doppler indices in fetuses with hemoglobin Bart's disease at 12–14 weeks of gestation

Cited by 6 publications

References 12 publications

Fetal isovolumetric time intervals as a marker of abnormal cardiac function in fetal anemia from homozygous alpha thalassemia‐1 disease

Fetal isovolumetric time intervals as a marker of abnormal cardiac function in fetal anemia from homozygous alpha thalassemia‐1 disease

Foetal haemodynamic response to anaemia

Early Evaluation of the Fetal Heart

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