title: The fetal cardiovascular response to increased placental vascular impedance to flow determined with 4-dimensional ultrasound using spatiotemporal image correlation and virtual organ computer-aided analysis.
abstract: OBJECTIVE
  We sought to determine if increased placental vascular impedance to flow is associated with changes in fetal cardiac function using spatiotemporal image correlation and virtual organ computer-aided analysis.
  
  
  METHODS
  A cross-sectional study was performed in fetuses with umbilical artery pulsatility index >95th percentile (abnormal [ABN]). Ventricular volume (end-systole, end-diastole), stroke volume, cardiac output (CO), adjusted CO, and ejection fraction were compared to those of 184 normal fetuses.
  
  
  RESULTS
  A total of 34 fetuses were evaluated at a median gestational age of 28.3 (range, 20.6-36.9) weeks. Mean ventricular volumes were lower for ABN than normal cases (end-systole, end-diastole) with a proportionally greater decrease for left ventricular volume (vs right). Mean left and right stroke volume, CO, and adjusted CO were lower for ABN (vs normal) cases. Right ventricular volume, stroke volume, CO, and adjusted CO exceeded the left in ABN fetuses. Mean ejection fraction was greater for ABN than normal cases. Median left ejection fraction was greater (vs right) in ABN fetuses.
  
  
  CONCLUSIONS
  Increased placental vascular impedance to flow is associated with changes in fetal cardiac function.
authors.affiliation: Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Hamill
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.forename: Sonia
authors.initials: S
authors.lastname: Hassan
authors.forename: Wesley
authors.initials: W
authors.lastname: Lee
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Myers
authors.forename: Pooja
authors.initials: P
authors.lastname: Mittal
authors.forename: Juan Pedro
authors.initials: JP
authors.lastname: Kusanovic
authors.forename: Mamtha
authors.initials: M
authors.lastname: Balasubramaniam
authors.forename: Tinnakorn
authors.initials: T
authors.lastname: Chaiworapongsa
authors.forename: Edi
authors.initials: E
authors.lastname: Vaisbuch
authors.forename: Jimmy
authors.initials: J
authors.lastname: Espinoza
authors.forename: Francesca
authors.initials: F
authors.lastname: Gotsch
authors.forename: Luis F
authors.initials: LF
authors.lastname: Goncalves
authors.forename: Shali
authors.initials: S
authors.lastname: Mazaki-Tovi
authors.forename: Offer
authors.initials: O
authors.lastname: Erez
authors.forename: Edgar
authors.initials: E
authors.lastname: Hernandez-Andrade
authors.forename: Lami
authors.initials: L
authors.lastname: Yeo
mesh_terms: D002302:Cardiac Output / Q000502:physiology*; D003430:Cross-Sectional Studies; D019561:Echocardiography, Four-Dimensional / Q000379:methods; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D010927:Placental Insufficiency / Q000503:physiopathology*; D011247:Pregnancy; D013318:Stroke Volume / Q000502:physiology*; D016216:Ultrasonography, Prenatal / Q000379:methods*; D016276:Ventricular Function / Q000502:physiology*