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Published on: June 29, 2013
Venous Doppler ultrasound in 146 fetuses with congenital heart disease
U Gembruch1, C Meise, U Germer
1Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany. ulrich.gembruch@ukb.uni-bonn.de
Insights
Isolated congenital heart disease (CHD) does not significantly alter fetal venous Doppler waveforms, making it unreliable for screening. Venous Doppler is more useful for monitoring cardiac function in fetuses with known cardiac malformations.
Area of Science:
- Fetal medicine
- Cardiology
- Medical imaging
Background:
- Congenital heart disease (CHD) is a common birth defect.
- Fetal venous Doppler studies assess blood flow in fetal vessels.
- The utility of venous Doppler in isolated CHD requires further investigation.
Purpose of the Study:
- To evaluate the impact of isolated CHD on fetal venous Doppler waveforms.
- To determine if venous Doppler can serve as a screening tool for isolated CHD.
- To explore the predictive value of venous Doppler for fetal outcomes in isolated CHD.
Main Methods:
- Doppler flow velocimetry of the inferior vena cava and ductus venosus was performed in 146 fetuses with CHD.
- Fetuses were categorized into isolated CHD, isolated CHD with non-immune hydrops fetalis, and non-isolated CHD groups.
- Comparison was made with a control group of 109 healthy fetuses; measurements were converted to Z-scores.
Main Results:
- No significant difference in venous Doppler parameters was found between fetuses with isolated CHD and controls.
- Significant differences were observed in non-isolated CHD cases compared to controls.
- Isolated right heart malformations showed altered ductus venosus flow, but not inferior vena cava flow.
Conclusions:
- Venous Doppler studies of the ductus venosus and inferior vena cava are not reliable for screening isolated CHD in mid-second- and third-trimester fetuses.
- Venous Doppler did not predict fetal outcomes in isolated CHD cases.
- Abnormal venous Doppler findings are primarily linked to myocardial dysfunction or severe right heart obstruction, aiding in cardiac function monitoring.
Objective:
To assess the influence of isolated congenital heart disease (CHD) on fetal venous Doppler blood flow velocity waveforms.
Methods:
Doppler flow velocimetry was performed in the inferior vena cava and ductus venosus in 146 consecutive fetuses with antenatally diagnosed CHD. Gestational age ranged between 19 and 39 weeks. Fetuses with isolated CHD without non-immune hydrops fetalis (NIHF) (Group A, n = 89) were separated from seven fetuses showing isolated CHD with NIHF (Group B) and 50 cases complicated by chromosomal or other extracardiac malformations, intrauterine growth restriction or non-cardiogenic NIHF (Group C). The control group comprised 109 healthy fetuses of uncomplicated pregnancies. Individual peak velocity index for veins (PVIV) measurements were converted into their Z-scores (delta values) for statistical analysis.
Results:
There was no statistical difference between fetuses with isolated CHD (Group A) and controls, for the delta PVIV of neither the ductus venosus nor the inferior vena cava. Statistical analysis revealed significant differences between non-isolated CHD fetuses (Group C) and controls for both vessels. However, in a separate analysis of isolated right heart malformations compared with the remaining isolated heart malformations (Groups A and B), a significant difference was observed for the ductus venosus, but not the inferior vena cava. There was an overall survival of 62%. In Group A, 58% of fetuses survived despite increased PVIV and 22% of fetuses with normal venous Doppler had an adverse outcome. All fetuses with cardiogenic NIHF (Group B) died.
Conclusion:
Doppler studies of the ductus venosus and inferior vena cava in fetuses with isolated CHD do not present sufficient alterations to be a reliable marker for screening purposes for CHD in mid-second- and third-trimester fetuses. Furthermore, venous Doppler did not predict fetal outcome in cases of isolated CHD. Abnormal venous Doppler results were mainly attributable to myocardial dysfunction and also to severe right heart obstruction even in the absence of congestive heart failure. Therefore, venous Doppler studies are clinically helpful in indirectly monitoring cardiac function in fetuses with cardiac malformations.
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