Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-26T14:02:57.908Z Has data issue: false hasContentIssue false
  • English
  • Français

Serial echocardiographic Doppler evaluation of diastolic function in the normal human fetus

Published online by Cambridge University Press:  19 August 2008

Howard S. Weber
Howard S. Weber*
Affiliation:
From the Section of Pediatrics (Cardiology), Pennsylvania State University Childrens Hospital, The Milton S. Hershey Medical Center, Hershey
*
Dr. Howard S. Weber, Section of Pediatrics (Cardiology), The Pennsylvania State University Childrens Hospital, P.O. Box 850, Hershey, PA. 17033, United States of America. Tel. (717) 531 -8638; Fax. (717) 531 -8985.
Get access Rights & Permissions [Opens in a new window]

Abstract

The assessment of diastolic function in the developing fetus is difficult because of constantly changing conditions of loading. Previous reports suggesting improved ventricular compliance with fetal development are limited by the Doppler indices utilized. Using load-dependent and independent variables, we examined and compared serially right and left ventricular diastolic function in 11 normal fetuses (44 echocardiographic studies) at 22±1.0 weeks; 30±1.0 weeks; 36±1.0 weeks of gestation and 64±25 hours postnatally. Load-dependent indices included early to late time velocity integral ratios and percentage of early filling to total diastolic filling. The load-independent index was the peak filling rate normalized to the total time velocity integral. Both right and left ventricular time velocity integral ratios were similar initially, and shifted from late to early diastole with increasing gestational age (greater ratios). The shift in left ventricular ratios was greater, and increased earlier in fetal development. The right ventricular normalized peak filling rate decreased with increasing gestational age, while the left ventricular normalized peak filling rate remained constant, but was greater than the right ventricular rate postnatally. Both right and left ventricular filling shifts from late “active” to early “passive” diastole during fetal development. Left ventricular ratios are greater and increase earlier in fetal development, likely influenced by changes in preload. The right and left ventricular normalized peak filling rates were similar prenatally, indicating similar diastolic filling properties, but disparate postnatally, consistent with improved left ventricular relaxation immediately preceding or at the time of onset of transitional circulation.

Keywords

Fetal echocardiographydiastolic functionDoppler
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 6 , Issue 1 , January 1996 , pp. 32 - 36
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Reed, KL, Sahn, DJ, Scagnelli, S, Anderson, CF, Shenker, L. Doppler echocardiographic studies of diastolic function in the human fetal heart: changes during gestation. J Am Coll Cardiol 1986: 8: 391–395.CrossRefGoogle ScholarPubMed
2. Van der Mooren, K, Barendregt, LG, WladimirofF, JW. Fetal atrioventricular and outflow tract flow velocity waveforms during normal second half of pregnancy. Am J Obstet Gynecol 1991; 165: 668–674.CrossRefGoogle ScholarPubMed
3. Kenny, JF, Plapert, T, Doubilet, P, Saltzman, DH, Carrier, M, Zollars, L, Leatherman, GF, St John Sutton, MG. Changes in intracardiac blood flow velocities and right and left ventricular stroke volumes with gestational age in the normal human fetus: a prospective Doppler echocardiographic study. Circulation 1986; 6: 1208–1216.CrossRefGoogle Scholar
4. Carcellar, AM, Fouron, JC. Determinants of the Doppler flow velocity profile through the mitral valve of the fetus. Br Heart J 1993; 70: 457–460.CrossRefGoogle Scholar
5. Kitabatake, A, Inoue, M, Asao, M. Transmitral blood flow reflecting diastolic behavior of the left ventricle in health and disease-a study by pulsed Doppler technique. Jpn Circ J 1982; 46: 92–102.CrossRefGoogle ScholarPubMed
6. Gardin, JM, Dabestani, A, Rohan, MK. Noninvasive studies of ventricular filling with Doppler echocardiography: effects of aging on early and late diastolic transmitral flow. J Am Coll Cardiol 1984; 3: 613. [Abstract]Google Scholar
7. Miki, S, Murakami, T, Iwase, T, Tomita, T, Nakamura, Y, Kawai, C. Doppler echocardiographic transmitral peak early velocity does not directly reflect hemodynamic changes in humans: Importance of normalization to mitral stroke volume. J Am Coll Cardiol 1991; 17: 1507–1516.CrossRefGoogle Scholar
8. Carceller-Blanchard, AM, Fouron, JC. Determinants of the Doppler flow velocity profile through the mitral valve of the human fetus. Br Heart J 1993; 70: 457–460.CrossRefGoogle ScholarPubMed
9. Vermilion, RP, Snider, R, Bengur, AR, Meliones, JN. Long term assessment of right ventricular diastolic filling in patients with pulmonic valve stenosis successfully treated in childhood. Am J Cardiol 1991; 68: 648–652.CrossRefGoogle ScholarPubMed
10. Stoddard, MF, Pearson, AC, Kern, MJ, Ratcliff, J, Mrosek, DG, Labovitz, AJ. Left ventricular diastolic function: comparison of pulsed Doppler echocardiographic and hemodynamic indexes in subjects with and without coronary artery disease. J Am Coll Cardiol 1989; 13: 327–336.CrossRefGoogle ScholarPubMed
11. Dexereux, RB. Left ventricular diastolic dysfunction: early diastolic relaxation and late diastolic compliance. J Am Coll Cardiol 1989; 13: 337–339.CrossRefGoogle Scholar
12. Thomas, JD, Weyman, AE. Echocardiographic Doppler evaluation of left ventricular diastolic function: physics and physiology. Circulation 1991; 84: 977–990.CrossRefGoogle ScholarPubMed
13. Bowman, LK, Lee, FA, Jaffe, CC, Mattera, J, Wackers, FJ, Zaret, BL. Peak filling rate normalized to mitral stroke volume: a new Doppler echocardiographic filling index validated by radionu-clide angiographic techniques. J Am Coll Cardiol 1988; 12: 937–943.CrossRefGoogle ScholarPubMed
14. Riggs, TW, Rodriquez, R, Snider, AR, Batton, D, Pollock, J, Sharp, EJ. Doppler echocardiographic evaluation of right and left ventricular diastolic function in normal neonates. J Am Coll Cardiol 1989; 13: 700–705.CrossRefGoogle ScholarPubMed