title: Ductus venosus Doppler in the assessment of fetal cardiovascular health: an updated practical approach.
abstract: The ductus venosus has a central role in the distribution of highly oxygenated umbilical venous blood to the heart. Its waveform is related to the pressure-volume changes in the cardiac atria and it is therefore important in the monitoring of any fetal condition that may affect forward cardiac function. The cardiovascular parameters that can influence forward cardiac function include afterload, myocardial performance and preload. Decreased forward flow during atrial systole (a-wave) is the most sensitive and ubiquitous finding when any of these parameters is affected. In contrast, decreased forward velocities during end-systolic relaxation (v-wave) are more specifically related to myocardial performance. The ductus venosus pulsatility index alone does not accurately reflect cardiac function, and in cases of suspected fetal cardiac dysfunction, echocardiography is required to identify the underlying mechanism. The role of ductus venosus Doppler in the assessment of fetal growth restriction, supraventricular tachycardia, fetal hydrops, complicated monochorionic twins and congenital heart disease is discussed with these considerations in mind.
authors.affiliation: The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Viola
authors.initials: V
authors.lastname: Seravalli
authors.affiliation: The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Jena L
authors.initials: JL
authors.lastname: Miller
authors.affiliation: The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Block-Abraham
authors.affiliation: The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Ahmet A
authors.initials: AA
authors.lastname: Baschat
mesh_terms: D001783:Blood Flow Velocity; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology; D005318:Fetal Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D018617:Ultrasonography, Doppler, Pulsed; D016216:Ultrasonography, Prenatal
keywords: Fetal monitoring; ductus venosus; fetal physiology; prenatal diagnosis; ultrasound