Hemodynamic adaptation to suboptimal fetal growth in patients with single ventricle physiology

Echocardiography. 2018 Sep;35(9):1378-1384. doi: 10.1111/echo.14047. Epub 2018 Jun 10.

Abstract

Background: In fetuses with structurally normal heart and suboptimal fetal growth (SFG), umbilical artery vascular resistance increases as measured by umbilical artery pulsatility index (UA-PI). The objective of this study is to compare hemodynamic responses to SFG in fetuses with single ventricle (SV) and controls with structurally normal heart.

Methods: Fetal echocardiograms around 30 weeks of gestation were reviewed. UA-PI and middle cerebral artery pulsatility index (MCA-PI) were calculated. SFG was defined as a birth weight below 25th percentile for gestational age.

Results: Studies from 92 fetuses were reviewed-SV (n = 50) and controls (n = 42). The prevalence of SFG was higher in SV compared to controls (46% vs 21%, P = .02). In patients with normal heart and SFG, UAPI was significantly higher than normal controls (P = .003) suggesting increased placental vascular resistance. In SV with SFG there was no difference in UAPI compared to SV without SFG. There was no difference in MCA-PI between the groups.

Conclusions: The hemodynamic response to SFG in SV varies from fetuses with structurally normal heart. The mechanism of SFG and the placental pathology may be distinct in SV.

Keywords: fetal cardiology; single ventricle; umbilical artery pulsatility index.

Publication types

  • Multicenter Study

MeSH terms

  • Blood Flow Velocity
  • Cohort Studies
  • Echocardiography / methods
  • Female
  • Fetal Growth Retardation / diagnostic imaging*
  • Fetal Heart / abnormalities*
  • Fetal Heart / diagnostic imaging*
  • Heart Ventricles / abnormalities*
  • Heart Ventricles / diagnostic imaging*
  • Hemodynamics / physiology*
  • Humans
  • Infant, Low Birth Weight / physiology
  • Infant, Newborn
  • Male
  • Middle Cerebral Artery / diagnostic imaging
  • Pregnancy
  • Retrospective Studies
  • Ultrasonography, Prenatal / methods
  • Umbilical Arteries / diagnostic imaging