Ultrasonographic assessment of fetal cardiovascular function in selective intrauterine growth restriction

Abstract

Objective To evaluate the fetal cardiovascular function in selective intrauterine growth restriction(sIUGR) in monochorionic diamniotic (MCDA) twins by using 2D and color Doppler ultrasonography. Methods Twenty-four sIUGR pregnancies and 20 normal MCDA twins pregnancies were enrolled at the First Affiliated Hospital of Sun Yat-Sen University from December 2013 to September 2014, and cardiac structure of fetus and Doppler patterns of the umbilical artery(UA), umbilical vein(UV), pulsatility index of ductus venosus(DV-PI), atrioventricular valve, semilunar valve, tricuspid annulus systolic displacement(TAPSE), fractional shortening of left ventricle short axis (FS) and myocardial performance index (Tei index) of both ventricles were assessed. Results Cardiothoracic ratio, heart rate, DV-PI, FS, TAPSE, Tei index of the left ventricle(0.34±0.03, 0.34±0.04), Tei index of the right ventricle(0.35±0.03, 0.35±0.03) were not significantly different compared with those of the normal MCDA twins(all P>0.05). Cardiothoracic ratio, ventricular wall thickness, isovolumetric relaxation time(IRT), isovolumetric contraction time(ICT), TAPSE and tricuspid regurgitation(TR)in the larger twins of sIUGR were significantly bigger than those in the smaller twins of sIUGR(all P<0.05), Tei index of both ventricles in the larger twin of sIUGR was significantly higher than that in the smaller twins of sIUGR(Tei index of left ventricle: 0.43±0.06 vs 0.35±0.04, Tei index of right ventricle: 0.43±0.06 vs 0.34±0.04, P<0.05), the peak E in early diastolic /the peak A in atrial contraction (E/A), the percentage of inflow during of cardiac cycle length(inflow/CCL) in larger twin of sIUGR were significantly lower than those in smaller twin of sIUGR(all P<0.05). Conclusions There was no difference of cardiac function in normal MCDA twins, at the beginning of the diagnosis of sIUGR, cardiac dysfunction were found in larger twin, follow-up examination are helpful to clinical decision. Key words: Monochorionic diamniotic twins; Selective intrauterine growth restriction; Cardiac function; Echocardiography