title: Preferential ductus venosus streaming toward the right heart is associated with left heart underdevelopment and aortic arch hypoplasia in human fetuses.
abstract: OBJECTIVE
  Preferential left heart underdevelopment in human fetuses with diaphragmatic hernia is almost uniformly associated with preferential streaming of the ductus venosus toward the right side of the heart. The purpose of our study was to examine whether this flow anomaly might also be present in other fetuses with hypoplasia of left-sided cardiovascular structures.
  
  
  METHODS
  We studied 32 fetuses with left heart hypoplasia as defined by gestational age-related Z-scores by echocardiography. Apart from defining cardiovascular morphology as detailed as possible, particular focus was put on the presence or absence of preferential streaming of the ductus venosus and inferior caval vein toward the right side of the heart.
  
  
  RESULTS
  8 of 32 fetuses with hypoplasia of one or more left-sided cardiovascular structures exhibited preferential streaming of the ductus venosus toward the right side of the heart. In all eight fetuses, this finding was associated with additional cardiovascular anomalies like aortic valve stenosis, ventricular septal defect, left superior caval vein-to-coronary sinus, pulmonary vein stenosis and/or aortic arch hypoplasia.
  
  
  CONCLUSIONS
  As in human fetuses with left diaphragmatic hernia, preferential ductus venosus streaming toward the right side of the heart can be found in a subgroup of fetuses with hypoplasia of left-sided cardiovascular structures.
authors.affiliation: Department of Obstetrics and Prenatal Medicine, University Hospital of Bonn, Bonn, Germany. r.stressig@gmx.de
authors.forename: R
authors.initials: R
authors.lastname: Stressig
authors.forename: R
authors.initials: R
authors.lastname: Axt-Fliedner
authors.forename: U
authors.initials: U
authors.lastname: Gembruch
authors.forename: T
authors.initials: T
authors.lastname: Kohl
mesh_terms: D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D001017:Aortic Coarctation / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006351:Heart Valves / Q000002:abnormalities / Q000000981:diagnostic imaging; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging*; D007231:Infant, Newborn; D010547:Persistent Fetal Circulation Syndrome / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D016216:Ultrasonography, Prenatal; D014682:Vena Cava, Inferior / Q000002:abnormalities* / Q000000981:diagnostic imaging*