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Fetal aortic isthmus

Aparna Kulkarni, Patricia Garcia-Cañadilla, Abdullah Khan, Jose Miguel Lorenzo, Karen Beckerman, Brenda Valenzuela-Alcaraz, Monica Cruz-Lemini, Olga Gomez, Eduard Gratacos, Fatima Crispi, Bart Bijnens
AIMS: Myocardial structural and functional abnormalities are known to occur in fetuses of mothers with diabetes mellitus (FMDM). The main aim of this investigation was to explore the cardiovascular circulatory patterns in FMDM using a validated lumped computational model of the cardiovascular system. METHODS: This was a multi-institutional study involving FMDM compared to fetuses of maternal controls (FC). Fetal echocardiographic Doppler data from left and right ventricular outflow tracts, aortic isthmus, middle cerebral and umbilical arteries were fitted into a validated fetal circulation computational model to estimate patient-specific placental and vascular properties...
March 2018: Placenta
Hiroshi Kawamura, Noboru Inamura, Yuka Inoue, Yukiko Kawazu, Futoshi Kayatani, Nobuaki Mitsuda
PURPOSE: To validate the relationship between retrograde blood flow in the aortic isthmus (AoI-R) by color Doppler in fetal echocardiography and postnatal coarctation of the aorta (CoA) diagnosed as isthmus narrowing. METHODS: This was a retrospective study of 22 cases of prenatally suspected simple CoA or CoA with small ventricular septum defect based on fetal echocardiography performed by pediatric cardiologists in our hospital. Gestational age at the first detection of AoI-R and the optimal cut-off value for the prediction of postnatal CoA were mainly evaluated according to the postnatal diagnosis of CoA...
November 23, 2017: Journal of Medical Ultrasonics
Heikki Huhta, Juulia Junno, Mervi Haapsamo, Tiina Erkinaro, Pasi Ohtonen, Lowell E Davis, A Roger Hohimer, Ganesh Acharya, Juha Rasanen
What is the central question of this study? The fetal aortic isthmus has an important physiological role, allowing communication between the left and right ventricular outputs, which are arranged in parallel. Can the aortic isthmus provide unrestrictive communication between the left and right ventricular circulations during occlusion of the ascending aorta? What is the main finding and its importance? During occlusion of the ascending aorta, fetal carotid artery perfusion pressure fell significantly, showing that the aortic isthmus failed to redirect blood flow and pressure from the ductus arteriosus to the aortic arch...
January 1, 2018: Experimental Physiology
France Leduc, Amélie Delabaere, Roxanne Gendron, Florent Fuchs, Sandrine Wavrant, Marie-Josée Raboisson, Jean-Claude Fouron, François Audibert
INTRODUCTION: The objective was to assess the prognostic value of the systolic flow through the aortic isthmus in monochorionic pregnancies complicated by twin-twin transfusion syndrome (TTTS) treated by placental laser ablation. MATERIAL AND METHODS: Fetal echocardiography and outcome data of 105 cases of TTTS treated by laser photocoagulation of placental anastomoses were reviewed. Hemodynamic parameters were collected before and after treatment. The isthmic systolic index (ISI) was calculated as the peak systolic velocity/systolic nadir ratio...
September 16, 2017: Fetal Diagnosis and Therapy
Zhuo Chen, Yue Zhou, Jingying Wang, Xiaowei Liu, Shuping Ge, Yihua He
OBJECTIVES: We sought to develop a hemodynamic model of aortic and ductal arches using computational fluid dynamics (CFD) and 3D/4D spatio-temporal image correlation (STIC) fetal echocardiography and to investigate the hemodynamics of coarctation of aorta (CoA) in human fetuses using this approach. METHODS: We obtained 3D/4D STIC fetal echocardiographic images of the aortic and ductal arches (DA) in five normal fetuses. Based on these images, we simulated the hemodynamics in the two arches using CFD...
December 2017: Echocardiography
Viola Seravalli, Dana Block-Abraham, Cyrethia McShane, Sarah Millard, Ahmet Baschat, Jena Miller
OBJECTIVE: To study fetal aortic isthmus (AoI) shunt dynamics in monochorionic (MC) twins. METHODS: Normal and complicated MC pregnancies were prospectively enrolled. The relationship of isthmus flow index (IFI) with Doppler parameters of umbilical artery (UA), descending aorta, middle cerebral artery, and ductus venosus and with left and right ventricular cardiac output and stroke volume was studied. RESULTS: The IFI was obtained in 180 examinations from 48 pregnancies (24 twin-twin transfusion syndrome, TTTS; 4 selective intrauterine growth restriction, sIUGR; 12 TTTS + sIUGR; and 8 uncomplicated)...
September 2017: Prenatal Diagnosis
Shi Zeng, Jiawei Zhou, Qinghai Peng, Wen Deng, Ming Zang, Tao Wang, Qichang Zhou
BACKGROUND: We aimed to assess differences in myocardial deformation in fetuses at risk for coarctation (CoA) and the effects of maternal hyperoxygenation on deformation. METHODS: Fetal echocardiography and velocity vector imaging were performed prospectively and serially in 48 fetuses with a small aortic isthmus and 48 gestation age-matched normal fetuses. Fetuses with a small aortic isthmus were randomly divided into two groups: one group with and the other group without maternal supplemental oxygen administration...
October 2017: Journal of the American Society of Echocardiography
Lauren Tague, Mary T Donofrio, Amanda Fulgium, Robert McCarter, Catherine Limperopoulos, David N Schidlow
OBJECTIVES: Fetal echocardiography provides detailed information about cardiac structure and function in utero. Limited information is available regarding normal findings late in pregnancy. We therefore sought to identify and describe common cardiac findings in late gestation. METHODS: Fetuses with structurally normal hearts were identified in mid gestation within a subset of pregnant women in a prospective study. The atrioventricular valves, right and left atria, aortic isthmus and ductus arteriosus dimensions and flow abnormalities, aneurysm of the septum primum, and presence and grade of tricuspid regurgitation were assessed throughout pregnancy...
December 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Shi Zeng, Jiawei Zhou, Qinghai Peng, Wen Deng, Ming Zhang, Yili Zhao, Tao Wang, Qichang Zhou
The aim was to investigate the impact of maternal hyperoxygenation (HO) on cardiac dimensions in fetuses with isolated Coarctation (CoA). Fetal echocardiography was performed serially in 48 fetuses with CoA and gestation age matched normal fetues. The Z-scores for the mitral valve (MV), tricuspid valve (TV), aortic valve (AV), ascending aorta (AAo), isthmus, pulmonary valve (PV), main pulmonary artery (MPA), and descending aorta (DAo) were measured and compared among normal fetuses, CoA fetuses with oxygen and CoA fetuses with air...
December 16, 2016: Scientific Reports
Jean-Claude Fouron, Ariane McNeal-Davidson, Sylvia Abadir, Anne Fournier, Jean-Luc Bigras, Christine Boutin, Myriam Brassard, Marie-Josée Raboisson, Nicolaas van Doesburg, Annie Berger, Sophie Brisebois, Roxanne Gendron
OBJECTIVES: Since postnatal identification of accelerated idioventricular rhythm (AIVR) is essentially based on specific electrocardiographic patterns, its prenatal diagnosis is challenging and its genuine incidence undetermined. Therefore the objectives of this study are: 1) To evaluate the performance of specific ultrasonographic approaches in intrauterine identification of cardiocirculatory events linked to electrocardiographic signs of AIVR, including its left or right ventricular origin, and 2) To assess the prenatal prognosis of the arrhythmia...
December 10, 2016: Ultrasound in Obstetrics & Gynecology
Xiaoyan Gu, Yihua He, Ye Zhang, Lin Sun, Ying Zhao, Jiancheng Han, Xiaowei Liu
OBJECTIVE: Global racial variability in human development can lead to differences in size of fetal cardiac structures during gestation. Our objective is to establish normal reference ranges of fetal cardiac dimensions between 20 and 34 weeks from fetal echocardiograms recorded at a single center in China. METHODS: A prospective cross-sectional study was undertaken on single pregnancies with normal fetuses of varying gestational ages (GAs). A total of 4396 normal fetuses were divided into 15 groups from 20 to 34 weeks according to the GA...
February 1, 2017: Journal of Perinatal Medicine
D Paladini, B Deloison, A Rossi, G E Chalouhi, C Gandolfo, P Sonigo, S Buratti, A E Millischer, G Tuo, Y Ville, A Pistorio, A Cama, L J Salomon
OBJECTIVE: Vein of Galen aneurysmal malformation (VGAM) is a rare fetal anomaly, the neurological outcome of which can be good with appropriate perinatal management. However, most fetal series are too small to allow reliable statistical assessment of potential prognostic indicators. Our aim was to assess, in a two-center series of 49 cases, the prognostic value of several prenatal variables, in order to identify possible prenatal indicators of poor outcome, in terms of mortality and cerebral disability...
August 2017: Ultrasound in Obstetrics & Gynecology
Dominique Tynan, Jennifer Alphonse, Amanda Henry, Alec W Welsh
The aortic isthmus (AoI) is a unique fetal watershed with a waveform reflecting its complex haemodynamic physiology. The systolic component represents left and right ventricular systolic ejection, and the diastolic component represents comparative downstream vascular impedance between the brachiocephalic and subdiaphragmatic fetal circulations. Several indices have been devised to quantify different components of the waveform, including the pulsatility index, resistance index, isthmic flow index, and recently the isthmic systolic index...
2016: Fetal Diagnosis and Therapy
Xiaowei Liu, Yihua He, Zhiyun Tian, Jack Rychik
Ventricular size discrepancy may be due to a persistent left superior vena cava (PLSVC) in utero. We sought to investigate for differences in cardiac structure measures and hemodynamics between fetuses with isolated PLSVC connected to the coronary sinus (CS) and normal. Fetuses diagnosed with isolated PLSVC in the second and third trimester were enrolled. We defined two groups: group 1, twenty-five fetuses in the second trimester (22-27 W + 6d); group 2, twenty-two fetuses in the third trimester (28-39 W + 6d)...
August 2016: Pediatric Cardiology
Julie Blanc, Jean-Claude Fouron, Sven-Erik Sonesson, Marie-Josée Raboisson, Ian Huggon, Roxanne Gendron, Annie Berger, Sophie Brisebois
INTRODUCTION: Our objective was to determine the impact of simple transposition of the great arteries (TGA) on fetal left ventricular (LV) and right ventricular (RV) performances and central circulatory dynamics including the aortic isthmus. MATERIAL AND METHODS: Ventricular stroke volumes were calculated as the product of the cross-sectional area of the corresponding semi-lunar valve and the flow velocity integral through these valves. Volume flow in ductus arteriosus (QDA ) was evaluated using the same technique...
2016: Acta Obstetricia et Gynecologica Scandinavica
Patricia Garcia-Canadilla, Fatima Crispi, Monica Cruz-Lemini, Brenda Valenzuela-Alcaraz, Paula A Rudenick, Eduard Gratacos, Bart H Bijnens
OBJECTIVE: The aortic isthmus (AoI) blood flow has a characteristic shape with a small end-systolic notch observed during the third trimester of pregnancy. However, what causes the appearance of this notch is not fully understood. We used a lumped model of the fetal circulation to study the possible factors causing the end-systolic notch and the changes of AoI flow through gestation. METHODS: A validation of the model was performed by fitting patient-specific data from two normal fetuses...
2017: Fetal Diagnosis and Therapy
Amy-Lee Gunter, Zahra Keshavarz-Motamed, Rocco Portaro, Lyes Kadem, Hoi Dick Ng
The initial stages of fetal development require that blood oxygenation occur through the placenta rather than the non functioning lungs. As a result the fetal circulatory system develops a temporary shunt between the aorta and pulmonary artery, known as the ductus arteriosis (DA). This study utilizes CFD techniques to analyze the flow behavior in the aortic isthmus neighboring the DA. The geometry used to represent these structures is equivalent to that of a 25 week old fetus. The effect of aortic and pulmonary pressure pulse wave delay is examined for producing flow disturbances in the fetal circulatory system...
August 2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
R Arias-Ortega, J C Echeverría, M Guzmán-Huerta, L Camargo-Marín, M J Gaitán-González, H Borboa-Olivares, E Portilla-Islas, S Camal-Ugarte, C Vargas-García, M R Ortiz, R González-Camarena
BACKGROUND: The autonomic behavior of growth-restricted fetuses at different evolving hemodynamic stages has not been fully elicited. AIM: To analyze the respiratory sinus arrhythmia (RSA) of growth-restricted fetuses that despite this severe condition show normal Doppler hemodynamics. SUBJECTS: 10 growth-restricted fetuses (FGR group) with normal arterial pulsatility indices (umbilical, uterine, middle cerebral, ductus venosus and aortic isthmus), and 10 healthy fetuses (Control group), 32-37weeks of gestation...
February 2016: Early Human Development
Claudiu Mărginean, Cristina Oana Mărginean, Iolanda Muntean, Rodica Togănel, Septimiu Voidăzan, Liliana Gozar
AIM: To analyze the role of ventricular disproportion, aortic, and ductal isthmus ultrasound measurements for the diagnosis of fetal aortic coarctation (AoCo) and to evaluate the prediction of a needed neonatal surgical intervention in the presence of a diagnosis of AoCo. MATERIAL AND METHODS: We performed a prospective study on 41 fetuses (pregnancy age- 32 to 39 weeks, median 36 weeks) evaluated for left ventricle (LV) < right ventricle (RV) disproportion. Four fetuses were lost from evidence and five fetuses with complex cardiac malformations were excluded...
December 2015: Medical Ultrasonography
Joseph J Smolich, Kelly R Kenna, Jonathan P Mynard
Arterial reservoir ("windkessel") function, whereby a part of left ventricular (LV) output is stored in elastic arteries during systole and discharged in diastole, is a well-established physiological phenomenon. However, its role in rapid reversal (to left-to-right) and a systolic-to-diastolic shift of shunting across the ductus arteriosus after birth is unknown. To address this question, ductal and aortic isthmus flows were measured with high-fidelity transit-time probes in six anesthetized preterm fetal lambs before and after cord clamping and subsequent early mechanical ventilation and for 30 min postbirth...
February 15, 2016: Journal of Applied Physiology
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