Prenatal Identification of Restrictive and Non-restrictive Ventricular Septal Defects Based on End-Systolic Flow Patterns in the Fetal Aortic Isthmus
Autor: | Nagib Dahdah, A. Berger, Julie Thomas-Chabaneix, Sophie Brisebois, Jean-Claude Fouron |
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Rok vydání: | 2019 |
Předmět: |
Heart Septal Defects
Ventricular medicine.medical_specialty Heart malformation Aorta Thoracic 030204 cardiovascular system & hematology Asymptomatic Ultrasonography Prenatal 03 medical and health sciences 0302 clinical medicine Pregnancy Internal medicine Medicine Humans Retrospective Studies Fetus business.industry Retrospective cohort study Ultrasonography Doppler Vascular surgery 3. Good health Cardiac surgery Cross-Sectional Studies 030228 respiratory system Echocardiography Pediatrics Perinatology and Child Health Cardiology Gestation Aortic isthmus Female medicine.symptom Cardiology and Cardiovascular Medicine business Blood Flow Velocity |
Zdroj: | Pediatric cardiology. 41(2) |
ISSN: | 1432-1971 |
Popis: | Fetuses with large ventricular septal defects (VSDs) must be closely monitored during the perinatal period. Intrauterine assessment of size of septal defects with bidimensional echocardiography are unreliable. The objective of the present study is to document the contribution of flow pattern analysis in the fetal aortic isthmus for prenatal identification of large non-restrictive VSDs requiring immediate postnatal attention. We conducted a cross-sectional retrospective study of Doppler recordings from patients referred to our Fetal Cardiology Unit and diagnosed with one or multiple VSDs from January 2006 to November 2015. Three groups were defined: (1) large non-restrictive VSDs (n = 11) with postnatal cardiac failure (2) small restrictive VSDs (n = 28) asymptomatic, and (3) absence of cardiac abnormality (n = 66). The Isthmic end-Systolic Index (ISI) was computed to quantify aortic isthmus flow and compared between the three groups. Fetuses with restrictive VSD and control group showed similar ISI: stable at 0.20 ± 0.01 up to 27 weeks of gestation and dropping later due to the fall of end-systolic velocities in the aortic isthmus. By 35 weeks, a brief end-systolic retrograde flow was present, associated with a further fall of ISI down to −0.26 ± 0.05. In contrast, ISI of fetuses with large non-restrictive VSDs were unchanged throughout gestation (0.18 ± 0.06), becoming significantly higher during the last weeks of gestation compared to the two other groups (p |
Databáze: | OpenAIRE |
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