Authors
1 Radiology Department, Medicine Faculty, Tehran University of Medical Sciences, Tehran, Iran
2 Maternal, Fetal & Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Introduction: Many different Doppler-derived techniques have been proposed for overall assessment of cardiovascular well-being. In this report, 3 cases of high output cardiac failure were presented with the aim of evaluating the effect of fetal weight on fetal combined cardiac output (CCO).
Patients Information: The first and second cases were referred to Yas Hospital for the management of fetal anemia at 31and 29 weeks of gestation, respectively, and the third case had a large solid and vascular sacrococcygeal teratoma at 17 weeks. The fetal weight in the first case was less than 10 percentile, in the second case was in normal limit, and in the third one was above 90 percentile. Left ventricle, right ventricle, CCO, and weight-indexed CCO were assessed for both fetuses and all were above normal limit, indicating high output cardiac failure. Right to left cardiac output ratio also increased obviously.
Conclusion: The fetal growth restriction overestimates the weight-indexed CCO and the weight above 90 percentile underestimates it. In these conditions, CCO seems more precise in demonstrating the true burden on fetal heart in comparison with weight-indexed CCO.
Keywords
- Crispi F, Gratacós E. Fetal cardiac function: Technical considerations and potential research and clinical applications. Fetal Diagn Ther. 2012;32(1-2):47-64. [DOI:10.1159/000338003] [PMID]
- Tutschek B, Schmidt KG. Techniques for assessing cardiac output and fetal cardiac function. Semin Fetal Neonatal Med. 2011;16(1):13-21. [DOI:10.1016/j.siny.2010.09.005] [PMID]
- Vimpeli T, Huhtala H, Wilsgaard T, Acharya G. Fetal cardiac output and its distribution to the placenta at 11-20 weeks of gestation. Ultrasound Obstet Gynecol. 2009;33(3):265-71. [DOI:10.1002/uog.6247] [PMID]
- 4 Davey B, Szwast A, Rychik J. Diagnosis and management of heart failure in the fetus. Minerva Pediatr. 2012;64(5):471-92.
- Schmidt KG, Silverman NH, Harison MR, Callen PW. High-output cardiac failure in fetuses with large sacrococcygeal teratoma: Diagnosis by echocardiography and Doppler ultrasound. J Pediatr. 1989;114(6):1023-8. [DOI:10.1016/S0022-3476(89)80456-1]
- Moradi B, Tahmasebpour AR, Kazemi MA, Sharifian H, Rokni-Yazdi H. Prenatal diagnosis of concurrent facial and cerebral vascular malformation which caused congestive heart failure. Middle East Fertil Soc J. 2017;22(4):343-6. [DOI:10.1016/j.mefs.2017.04.006]
- Kiserud T, Ebbing C, Kessler J, Rasmussen S. Fetal cardiac output, distribution to the placenta and impact of placental compromise. Ultrasound Obstet Gynecol. 2006;28(2):126-36. [DOI:10.1002/uog.2832] [PMID]
- Mielke G, Benda N. Cardiac output and central distribution of blood flow in the human fetus. Circulation. 2001;103(12):1662-8. [DOI:10.1161/01.CIR.103.12.1662] [PMID]
- De Smedt MC, Visser GH, Meijboom EJ. Fetal cardiac output estimated by Doppler echocardiography during mid- and late gestation. Am J Cardiol. 1987;60(4):338-42. [DOI:10.1016/0002-9149(87)90238-4]
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