Abstract
The functional assessment of the fetal heart has been incorporated into cardiac ultrasound screening as a routine procedure, encompassing fetuses with and without structural heart diseases. It has long been known that various cardiac and extracardiac conditions, such as fetal growth restriction, fetal tumors, twin-to-twin transfusion syndrome, fetal anemia, diaphragmatic hernia, arteriovenous fistula with high cardiac output, and congenital heart diseases (valvular regurgitation and primary myocardial disease), can alter hemodynamic status and fetal cardiac function. Several ultrasound and Doppler echocardiographic parameters of fetal cardiovascular disease have been shown to correlate with perinatal mortality. However, it is still difficult to identify the signs of fetal heart failure and to determine their relationship with prognosis. The aim of this study was to review the main two-dimensional Doppler ultrasound parameters that can be used in the evaluation of fetal cardiac function, with a focus on how to perform that evaluation and on its clinical applicability.
Highlights
Basics of cardiac functionThe heart is composed of four chambers: the right atrium, right ventricle (RV), left atrium, and left ventricle (LV)
A variety of cardiac ultrasound/echocardiographic parameters can be used in order to identify fetal heart failure and predict the risk of adverse perinatal outcomes
The shortening fraction is altered in the late stages of myocardial dysfunction and its determination is impaired by technical limitations in myocardial asymmetry, such as fetal growth restriction and fetuses in women with pregestational diabetes
Summary
The heart is composed of four chambers: the right atrium, right ventricle (RV), left atrium, and left ventricle (LV). Due to the greater technical difficulty in the use of conventional markers of cardiac function, there has been increasing interest in the study of alternative methods, such as determination of the AV blood flow (early/ atrial [E/A] ratio) and the MPI, as well as spectral tissue Doppler, all of which allow evaluation of the contractility and degree of deformity of the fetal heart musculature. The E and A wave velocities increase, the increase in E wave velocity being more pronounced because of the greater capacity of the fetal heart for compliance and relaxation[6,7] This pattern of blood flow through the AV valves manifests as progressive elevation of the E/A ratio through. Hernandez-Andrade et al[9] Van Mieghem et al[23] Meriki et al[22] Cruz-Martínez et al[26] Lobmaier et al[25] Lobmaier et al[25] Peixoto et al[27]
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