title: Clinical utility of ductus venosus flow in fetuses with right-sided congenital heart disease.
abstract: OBJECTIVE
  Abnormal ductus venosus flow is associated with fetal compromise and can be present in right-sided congenital heart disease. We hypothesized that the ductus venosus flow pattern in fetuses with obstructive right-sided congenital heart disease will have abnormal flow at baseline. Those with nonobstructive disease will have normal flow at baseline. We further hypothesized that abnormal ductus venosus flow will predict fetal compromise.
  
  
  METHODS
  We conducted a retrospective review of fetuses with right-sided congenital heart disease. Ductus venosus measurements included the presence of atrial reversal, velocity time integral, and peak velocity index. Fetuses were separated into those with obstructive (group 1) and nonobstructive (group 2) lesions. Compromise was defined as fetal distress (pericardial effusion, hydrops, or left ventricular dilatation/dysfunction) or death (fetal/neonatal mortality).
  
  
  RESULTS
  Sixty fetuses with right-sided congenital heart disease were identified (mean gestational age ± SD, 24.2 ± 5.4 weeks; group 1, n = 45; group 2, n = 15). Ductus venosus reversal was more often present (49% versus 13%; P = .017), and the peak velocity index was significantly higher (1.39 ± 0.67 versus 0.98 ± 0.33; P= .026) in group 1. In group 1, ductus venosus reversal was more often present (93% versus 32%; P < .001), and the peak velocity index was significantly higher (1.87 ± 0.67 versus 1.12 ± 0.53; P< .001) in compromised fetuses. In this group, a peak velocity index higher than 1.57 predicted compromise with 93% sensitivity and 81% specificity. In group 2, ductus venosus reversal was rarely present (n = 2) and was not found in any fetuses who died.
  
  
  CONCLUSIONS
  Fetuses with obstructive right-sided congenital heart disease have ductus venosus reversal at baseline; an abnormal peak velocity index can be used to predict compromise. Fetuses with nonobstructive disease rarely have ductus venosus reversal; the peak velocity index cannot be used to predict outcomes in this group.
authors.affiliation: Department of Cardiology, Children's National Medical Center, Washington, DC USA.
authors.forename: Bhawna
authors.initials: B
authors.lastname: Arya
authors.affiliation: Department of Cardiology, Children's National Medical Center, Washington, DC USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Krishnan
authors.affiliation: Department of Cardiology, Children's National Medical Center, Washington, DC USA.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Donofrio
mesh_terms: D001783:Blood Flow Velocity; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal
keywords: congenital heart disease; ductus venosus; fetal echocardiography; obstetric ultrasound; outcome