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Aortic isthmus shunt dynamics in normal and complicated monochorionic pregnancies
Author(s) -
Seravalli Viola,
BlockAbraham Dana,
McShane Cyrethia,
Millard Sarah,
Baschat Ahmet,
Miller Jena
Publication year - 2017
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.5115
Subject(s) - ductus venosus , medicine , cardiology , intrauterine growth restriction , gestational age , descending aorta , monochorionic twins , umbilical artery , middle cerebral artery , hemodynamics , fetus , ductus arteriosus , shunt (medical) , stroke volume , shunting , aorta , pregnancy , ischemia , ejection fraction , heart failure , biology , genetics
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). Median gestational age was 20.9 weeks. AoI diastolic flow was reversed in three cases. UA pulsatility index (PI) and ductus venosus‐PI z ‐scores were negatively correlated with the IFI ( r s −0.40 and −0.26, respectively, p < 0.001). Regression analysis identified only UA‐PI as a determinant of the IFI ( p < 0.001). The IFI was significantly correlated with left ventricular cardiac output and stroke volume. It did not differ between TTTS donors and recipients. sIUGR fetuses had significantly lower IFI compared with normal‐grown counterparts ( p < 0.001). Conclusion In MC gestations, AoI shunting is predominantly determined by placental flow resistance, while cerebral impedance and volume status have no impact. In MC twins, the relationship between AoI flow and outcome deserves further study in the setting of sIUGR. © 2017 John Wiley & Sons, Ltd.