Longitudinal study of aortic isthmus Doppler in appropriately grown and small‐for‐gestational‐age fetuses with normal and abnormal umbilical artery Doppler

Farah, Nadine; Hogan, Jennifer; Reilly, Amanda; Turner, Michael J.; Stuart, Bernard

doi:10.1002/uog.9076

Cited by 18 publications

(22 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The direction of systolic AoI blood flow is thus determined by the comparative LV and RV stroke volumes along with the downstream vascular impedances [1]. In diastole, when the two semilunar valves are closed, the direction of AoI blood flow is determined purely by the balance of downstream vascular impedance in the brachiocephalic and placental and subdiaphragmatic circulation [15]. The AoI waveform can therefore be seen as the product of a complex interaction between (a) LV and RV ejection and (b) brachiocephalic plus placental and subdiaphragmatic vascular impedance.…”

Section: Physiologymentioning

confidence: 99%

“…In normal fetuses antegrade flow is present in the first half of pregnancy in both systole and diastole of the AoI waveform due to low placental vascular impedance. The gradual deceleration of the systolic upstroke with a brief reversal of flow may be due to increasing RV dominance, coupled with the rise in placental impedance that occurs with gestation [1,14,15]. However, a large cross-sectional study (458 fetuses) found no correlation between AoI PI and umbilical artery (UA) PI, suggesting rather that they could be considered independent factors for fetal surveillance [11].…”

Section: Physiologymentioning

confidence: 99%

“…Five studies have also published mean PI values in a control group of uncomplicated singleton fetuses [5,6,15,16,19]. In all studies PI values were obtained using both the 3VT and the LAA view, with three of the studies differentiating PI results from each view.…”

Section: Quantification Of the Aoimentioning

confidence: 99%

“…Alterations in the diastolic component of the AoI therefore reflect comparative impedance of the cerebral and peripheral vascular beds. To date most studies involving AoI Doppler have focused on diastole, attempting to assist in the timing of delivery of IUGR fetuses (table 4) [6,8,15,17,19,26,31,38,39,40,41,42,43,44,45,46,47,48,49,50,51]. Reversed diastolic AoI flow suggests significant fetal hypoxic deterioration, usually occurring after the UA, MCA, and CPR Doppler parameters become abnormal, but preceding DV Doppler abnormalities by an average of 1 week [6,17,31,39,40,44].…”

Section: Aoi In Extracardiac Functional Pathologymentioning

confidence: 99%

See 3 more Smart Citations

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

Tynan

Alphonse

Henry³

et al. 2016

Fetal Diagn Ther

View full text Add to dashboard Cite

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.

show abstract

Section: Physiologymentioning

confidence: 99%

Section: Physiologymentioning

confidence: 99%

Section: Quantification Of the Aoimentioning

confidence: 99%

Section: Aoi In Extracardiac Functional Pathologymentioning

confidence: 99%

See 2 more Smart Citations

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

Tynan

Alphonse

Henry³

et al. 2016

Fetal Diagn Ther

View full text Add to dashboard Cite

show abstract

“…To date, several modalities have been commonly used to diagnose and monitor the deterioration of the affected fetuses . Myocardial performance index (MPI) or Tei index is a method of the Doppler echocardiography used to evaluate cardiac ventricular systolic and diastolic functions .…”

Section: Introductionmentioning

confidence: 99%

Fetal cardiac function measured by myocardial performance index of small‐for‐gestational age fetuses

Chawengsettakul

Russameecharoen

Wanitpongpan

2014

J of Obstet and Gynaecol

View full text Add to dashboard Cite

Aim: The aim of this study was to demonstrate the changes of right and left myocardial performance indices (MPI) in small-for-gestational age (SGA) fetuses during 28-40 weeks of gestation. Material and Methods: Singleton pregnant women during 28-40 weeks of gestation were enrolled. Estimated fetal weight was used to classify the subjects into appropriate-for-gestational age (AGA) and SGA groups. The Doppler indices of umbilical and middle cerebral arteries, including amniotic fluid index, were used to distinguish constitutional SGA (both normal Doppler indices and amniotic fluid index) from intrauterine growth restriction (IUGR) fetuses (abnormal Doppler indices and/or oligohydramnios). MPI was obtained and compared between the groups. Inter-and intra-observer variations were also assessed. Results: Fifty women had AGA fetuses whereas another 50 cases had SGA fetuses (41 constitutional SGA and nine IUGR). Right MPI in AGA fetuses was constant whereas left MPI was slightly increased. The MPI of SGA fetuses were significantly greater than those of AGA fetuses starting from 30 weeks gestation until delivery (P < 0.01 and <0.05 in right and left side, respectively). Subgroup analysis demonstrated right and left MPI of IUGR fetuses increased with advancing gestation and were significantly greater than those of constitutional SGA and AGA fetuses, which appeared to be similar. The reproducibility of the test was high. Conclusions: In SGA fetuses, the MPI of right and left ventricles was significantly increased with advancing gestation compared to AGA cases.

show abstract

Fetal Aortic Isthmus and Descending Aorta

Maršál¹,

Hernández‐Andrade²

2023

Doppler Ultrasound in Obstetrics and Gynecology

View full text Add to dashboard Cite

Longitudinal study of aortic isthmus Doppler in appropriately grown and small‐for‐gestational‐age fetuses with normal and abnormal umbilical artery Doppler

Abstract: Objective To establish reference ranges using longitudinal data for aortic isthmus (AoI)

Cited by 18 publications

References 27 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

Fetal cardiac function measured by myocardial performance index of small‐for‐gestational age fetuses

Fetal Aortic Isthmus and Descending Aorta

Contact Info

Product

Resources

About