Open AccessVentricular outputs, central blood flow distribution and flow pattern through the aortic isthmus of fetuses with simple transposition of the great arteries
Author(s) -
Blanc Julie,
Fouron JeanClaude,
Sonesson SvenErik,
Raboisson MarieJosée,
Huggon Ian,
Gendron Roxanne,
Berger Annie,
Brisebois Sophie
Publication year - 2016
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12892
Subject(s) - medicine , great arteries , cardiology , ductus arteriosus , ventricle , fetus , aortic valve , gestational age , blood flow , cardiac output , anatomy , hemodynamics , pregnancy , biology , genetics
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 ( Q DA ) was evaluated using the same technique. Flow through the lungs ( Q LUNGS ) was calculated by subtracting net Q DA from flow in main pulmonary artery [ net Q DA = Q DA minus retrograde ductus arteriosus ( DA ) diastolic flow]. Relative performance of each ventricle expressed as percentage of combined cardiac output was also indirectly assessed by the aortic isthmus systolic index ( ISI ) (nadir of incisura/peak systolic of the Doppler waveforms in the isthmus); the relation between ISI and Q LUNGS was investigated. Results Fifty‐one fetuses with TGA were compared with 74 normal controls matched for gestational age. TGA fetuses had higher Q LV at T2 (58.6 ± 9.4% vs. 43.4 ± 5.0%, p < 0.001) and T3 (53.7 ± 8.9% vs. 43.9 ± 5.7%, p < 0.001). Q LUNGS was higher in fetuses with TGA , in the second (50.4 ± 16.3% vs. 39.0 ± 16.8%, p = 0.007) and third trimesters of gestation (52.8 ± 22.0% vs. 37.1 ± 16.3%, p = 0.005). No difference was found between ISI values from normal and TGA groups. A significant inverse correlation was observed between ISI and Q LUNGS ( r = −0.55, p = 0.006). Conclusions Central distribution of combined cardiac output of fetuses with simple TGA is characterized by a greater Q LUNGS leading to a dominant LV . In prenatal TGA , changes in Q LUNGS could be monitored by measuring ISI . The clinical importance of this last observation deserves further investigations.