Increased pulsatility in the fetal ductus venosus is not related to altered cardiac strain in high-risk pregnancies

Dahlbäck, Charlotte; Gudmundsson, Sæmundur

doi:10.3109/14767058.2015.1047337

Cited by 7 publications

(6 citation statements)

References 29 publications

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“…Of these, three studies showed an increase in LV‐GLS and RV‐GLS values throughout gestation 38,44,52 , similar to the current study. Other studies reported stable strain values in both ventricles 13,39,40,42,43,48,51,53,54 , increased LV‐GLS values only 37 or increased RV‐GLS values only 36,45,47,49 . The discrepancies among studies can be explained by the differences in ultrasound device and speckle‐tracking software used.…”

Section: Discussionmentioning

confidence: 97%

“…Both studies reported higher strain values compared with our results. To date, 21 studies on fetal GLS and GLSR reference values used a cross-sectional design 11,13,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] . Of these, three studies showed an increase in LV-GLS and RV-GLS values throughout gestation 38,44,52 , similar to the current study.…”

Section: Discussionmentioning

confidence: 99%

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Fetal myocardial deformation measured with two‐dimensional speckle‐tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses

Oostrum

Vet

Clur

et al. 2022

Ultrasound in Obstet & Gyne

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Objectives Two‐dimensional speckle‐tracking echocardiography (2D‐STE) is a promising technique which allows assessment of fetal cardiac function, and can be used in the evaluation of cardiac and non‐cardiac diseases in pregnancy. However, reliable fetal reference values for deformation parameters measured using 2D‐STE are needed before it can be introduced into clinical practice. This study aimed to obtain reference values for fetal global longitudinal strain (GLS) and GLS rate (GLSR) measured using 2D‐STE and compare right and left ventricular values. Methods This was a prospective longitudinal cohort study of uncomplicated pregnancies that underwent echocardiography every 4 weeks from inclusion at 18–21 weeks until delivery to obtain four‐chamber loops of the fetal heart. Left and right ventricular GLS and GLSR were measured using 2D‐STE at each examination. Using Bayesian mixed‐effects models, reference values with lower and upper 5% prediction limits were calculated according to gestational age. Right and left ventricular GLS values according to gestational age were compared using the Wilcoxon signed‐rank test. Results A total of 592 left ventricular and 566 right ventricular GLS and GLSR measurements were obtained from 124 women with uncomplicated pregnancy and non‐anomalous, appropriately grown fetuses. Reference values were obtained for both fetal ventricles according to gestational week. GLS and GLSR values of both ventricles increased (i.e. became less negative) significantly during pregnancy. Right ventricular GLS values were significantly higher (i.e. less negative) than the respective left ventricular values at every gestational week. Conclusions Reference values were obtained for fetal GLS and GLSR measured using 2D‐STE. GLS and GLSR values increased significantly for both ventricles from the second trimester until delivery. GLS values were significantly higher for the right ventricle compared with the left ventricle. Future studies are needed to assess whether the obtained reference values are helpful in clinical practice in the assessment of pregnancy complications, such as fetal growth restriction or cardiac anomaly. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Fetal myocardial deformation measured with two‐dimensional speckle‐tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses

Oostrum

Vet

Clur

et al. 2022

Ultrasound in Obstet & Gyne

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“…In fetuses randomized to be delivered when the DV a‐wave was abnormal, only 44 fetuses were delivered according to this randomization criteria, whereas 155 fetuses were delivered because of abnormal computerized‐CTG (short‐term variation <2.6 bpm) . We might speculate that fetuses randomized to be delivered at the occurrence of an abnormal DV waveform exploited their better shunting ability to protect their brain from hypoxia, whatever the relative role of atrial pressure . As a possible consequence of this mechanism, they fared better at the neurological follow‐up at 2 years of age, perhaps at the cost of a more complicated perinatal period …”

Section: Discussionmentioning

confidence: 99%

“…The a‐wave is then mainly influenced by the changing shape of the DV under hypoxic conditions. In fact, Dahlback and Gudmundsson found no correlation of the mean myocardial velocity, strain, and strain rate of the right and left atria and ventricles with changes in the blood flow velocity waveform patterns of the DV, or pulsations in the umbilical vein in FGR fetuses with abnormal umbilical artery Doppler but without signs of impending hypoxic compromise as heralded by abnormal short‐term variation on computerized cardiotocography (CTG) …”

Section: Experimental Evidence Of Animal and Human Research Under Hypmentioning

confidence: 99%

The controversial role of the ductus venosus in hypoxic human fetuses

Ferrazzi

Lees

Acharya

2019

Acta Obstet Gynecol Scand

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| INTRODUC TI ONIn the last two decades, research on the ductus venosus (DV) has been the subject of large observational and interventional clinical trials, 1-3 as well as many clinical studies focused on human pregnancies affected by fetal growth restriction. 4-7 These studies were based on consistent observations made in animal experiments [8][9][10] and human pregnancies. 5,11,12 The DV is a critical crossroads for the umbilical vein flow to perform complex tasks during gestation to balance fetal brain and body growth. 13 It plays an important role in circulatory adaptation to hypoxia in early severe fetal growth restriction (FGR), but the mechanisms remain controversial. 5,11,12 Both hypoxemia-associated dilation of isthmic region of the DV as well as cardiac dysfunction associated with increased afterload have been implicated as the determinants of abnormal DV Doppler velocity waveforms. Here we consider the evidence underpinning assumptions on the DV waveform in relation to its clinical applicability. | EMB RYOLOGY AND ANATOMYAt 6 weeks of gestation, the embryological development of hepatic circulation endows the human embryo, as well as most other mammals, with a peculiar venous channel, the ductus venosus, that originates at the hepatic venous crossroad (Figure 1). 14 The DV resembles AbstractThe ductus venosus plays a critical role in circulatory adaptation to hypoxia in fetal growth restriction but the mechanisms still remain controversial. Increased shunting of blood through the ductus venosus under hypoxic conditions has been shown in animal and human studies. The hemodynamic laws governing the accelerated flow in

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“…Studies of fetal heart function have not given signs of strain during moderate chronic hypoxia using analysis of speckle tracking of the heart walls or during analysis of waveforms in the hepatic veins or inferior vena cava entering the right atrium which might indicated increased central venous pressure. Fetal heart function has been shown normal even during abnormal blood flow pattern in the ductus venosus [5][6][7][8]. Ductus venosus might thus open without an increase in fetal central venous pressure.…”

Section: Introductionmentioning

confidence: 99%

Ductus venosus opens in high-risk pregnancies without signs of increased central venous pressure

Sekielska -Domanowska,

Iwanicka-Piotrowska,

Dubiel

et al. 2023

Ginekol Pol

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Objectives: It has been belived that changes in diastolic blood velocities in the fetal ductus venosus were due to increased central venous pressure secondary to increased fetal heart strain during hypoxia or heart failure. There have been recent reports of changes in ductus venosus blood velocity without signs of increased fetal heart strain. The aim of this evaluation was to compare blood velocity in the right hepatic vein as a marker of increased central venous pressure in relationship to changes in ductus venosus blood velocity.Material and methods: Fifty pregnancies suspected of fetal growth resitriction were evaluated by Doppler ultrasound. Blood velocity was recorded in the right hepatic vein, ducus venosus and in the umbilical vein. Placental blood flow was also recorded in the uterine and umbilical arteries as well as the fetal middle cerebral artery.Results: Increased umbilical artery pulsatility index was recorded in 19 fetuses and 20 has signes of brain sparing according to recordings in the middle cerebral artery. Abnormal blood velocity in the ductus venosus was recorded in 5 fetuses, none of these fetuses had an abnormal pulsatility in the right hepatic vein. Conclusions:Opening of the ductus venosus is not only related to fetal cardiac strain. This might indicate that the ductus venosus does not primarily open due to increased central venous pressure in moderate fetal hypoxia. Increased fetal cardiac strain might be a late event in the process of chronic fetal hypoxia.

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Increased pulsatility in the fetal ductus venosus is not related to altered cardiac strain in high-risk pregnancies

Cited by 7 publications

References 29 publications

Fetal myocardial deformation measured with two‐dimensional speckle‐tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses

Fetal myocardial deformation measured with two‐dimensional speckle‐tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses

The controversial role of the ductus venosus in hypoxic human fetuses

Ductus venosus opens in high-risk pregnancies without signs of increased central venous pressure

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