Open AccessDuctus venosus Doppler in the assessment of fetal cardiovascular health: an updated practical approach
Author(s) -
Seravalli Viola,
Miller Jena L.,
BlockAbraham Dana,
Baschat Ahmet A.
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.12893
Subject(s) - ductus venosus , medicine , cardiology , preload , cardiac cycle , afterload , cardiac function curve , systole , hydrops fetalis , blood flow , fetus , ventricle , blood pressure , hemodynamics , diastole , pregnancy , heart failure , genetics , biology
The ductus venosus has a central role in the distribution of highly oxygenated umbilical venous blood to the heart. Its waveform is related to the pressure‐volume changes in the cardiac atria and it is therefore important in the monitoring of any fetal condition that may affect forward cardiac function. The cardiovascular parameters that can influence forward cardiac function include afterload, myocardial performance and preload. Decreased forward flow during atrial systole (a‐wave) is the most sensitive and ubiquitous finding when any of these parameters is affected. In contrast, decreased forward velocities during end‐systolic relaxation (v‐wave) are more specifically related to myocardial performance. The ductus venosus pulsatility index alone does not accurately reflect cardiac function, and in cases of suspected fetal cardiac dysfunction, echocardiography is required to identify the underlying mechanism. The role of ductus venosus Doppler in the assessment of fetal growth restriction, supraventricular tachycardia, fetal hydrops, complicated monochorionic twins and congenital heart disease is discussed with these considerations in mind.