Venous return and right ventricular diastolic function in ARED flow fetuses.
The absence or reversal of end-diastolic flow in the umbilical artery (UA) is widely accepted as an ominous sign of fetal compromise. However, in these high-risk pregnancies, the significance of sequentially appearing changes of the venous return is poorly established. Doppler blood flow waveforms were longitudinally assessed in the inferior vena cava (IVC), ductus venosus (DV), umbilical vein (UV) and tricuspid valve, along with the UA, middle cerebral artery and descending aorta. Thirty-two serial Doppler studies were performed in six fetuses with intrauterine growth-retardation (IUGR). In the cases of absent or reversed UA endodiastolic flow, changes in the venous return were found following the same sequence: presence of dicrote pulsations in the UV, increase of retrograde flow in the IVC and reduction or inversion of DV velocity during atrial contraction. Transtricuspid flow patterns changed from normal to a restrictive pattern of ventricular filling. There were two intrauterine deaths and one early neonatal death. Our preliminary results suggest that the evaluation of the venous compartment of hemodynamically disturbed preterms fetuses along with right ventricular filling appears to be a useful model for investigating the physiopathology of fetal deterioration and, therefore, may yield indirect discriminatory signs of severe compromise.
Paediatric Cardiology Unit, University Hospital of S. João, Porto, Portugal.
J C
JC
Areias
A
A
Matias
N
N
Montenegro
D000328:Adult; D015150:Echocardiography, Doppler; D005260:Female; D005317:Fetal Growth Retardation; D005318:Fetal Heart / Q000502:physiology*; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology*; D016216:Ultrasonography, Prenatal; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology