Aortic isthmus shunt dynamics in normal and complicated monochorionic pregnancies

Viola Seravalli; Dana Block-Abraham; Cyrethia McShane; Sarah Millard; Ahmet Baschat; Jena Miller

doi:10.1002/pd.5115

Aortic isthmus shunt dynamics in normal and complicated monochorionic pregnancies

Viola Seravalli, Dana Block-Abraham, Cyrethia McShane, Sarah Millard, Ahmet Baschat, Jena Miller

School of Medicine

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Objective: To study fetal aortic isthmus (AoI) shunt dynamics in monochorionic (MC) twins. Methods: Normal and complicated MC pregnancies were prospectively enrolled. The relationship of isthmus flow index (IFI) with Doppler parameters of umbilical artery (UA), descending aorta, middle cerebral artery, and ductus venosus and with left and right ventricular cardiac output and stroke volume was studied. Results: The IFI was obtained in 180 examinations from 48 pregnancies (24 twin–twin transfusion syndrome, TTTS; 4 selective intrauterine growth restriction, sIUGR; 12 TTTS + sIUGR; and 8 uncomplicated). Median gestational age was 20.9 weeks. AoI diastolic flow was reversed in three cases. UA pulsatility index (PI) and ductus venosus-PI z-scores were negatively correlated with the IFI (r_s −0.40 and −0.26, respectively, p < 0.001). Regression analysis identified only UA-PI as a determinant of the IFI (p < 0.001). The IFI was significantly correlated with left ventricular cardiac output and stroke volume. It did not differ between TTTS donors and recipients. sIUGR fetuses had significantly lower IFI compared with normal-grown counterparts (p < 0.001). Conclusion: In MC gestations, AoI shunting is predominantly determined by placental flow resistance, while cerebral impedance and volume status have no impact. In MC twins, the relationship between AoI flow and outcome deserves further study in the setting of sIUGR.

Original language	English (US)
Pages (from-to)	924-930
Number of pages	7
Journal	Prenatal Diagnosis
Volume	37
Issue number	9
DOIs	https://doi.org/10.1002/pd.5115
State	Published - Sep 2017

ASJC Scopus subject areas

Genetics(clinical)
Obstetrics and Gynecology

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title = "Aortic isthmus shunt dynamics in normal and complicated monochorionic pregnancies",

abstract = "Objective: To study fetal aortic isthmus (AoI) shunt dynamics in monochorionic (MC) twins. Methods: Normal and complicated MC pregnancies were prospectively enrolled. The relationship of isthmus flow index (IFI) with Doppler parameters of umbilical artery (UA), descending aorta, middle cerebral artery, and ductus venosus and with left and right ventricular cardiac output and stroke volume was studied. Results: The IFI was obtained in 180 examinations from 48 pregnancies (24 twin–twin transfusion syndrome, TTTS; 4 selective intrauterine growth restriction, sIUGR; 12 TTTS + sIUGR; and 8 uncomplicated). Median gestational age was 20.9 weeks. AoI diastolic flow was reversed in three cases. UA pulsatility index (PI) and ductus venosus-PI z-scores were negatively correlated with the IFI (rs −0.40 and −0.26, respectively, p < 0.001). Regression analysis identified only UA-PI as a determinant of the IFI (p < 0.001). The IFI was significantly correlated with left ventricular cardiac output and stroke volume. It did not differ between TTTS donors and recipients. sIUGR fetuses had significantly lower IFI compared with normal-grown counterparts (p < 0.001). Conclusion: In MC gestations, AoI shunting is predominantly determined by placental flow resistance, while cerebral impedance and volume status have no impact. In MC twins, the relationship between AoI flow and outcome deserves further study in the setting of sIUGR.",

author = "Viola Seravalli and Dana Block-Abraham and Cyrethia McShane and Sarah Millard and Ahmet Baschat and Jena Miller",

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AU - Seravalli, Viola

AU - Block-Abraham, Dana

AU - McShane, Cyrethia

AU - Millard, Sarah

AU - Baschat, Ahmet

AU - Miller, Jena

PY - 2017/9

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N2 - Objective: To study fetal aortic isthmus (AoI) shunt dynamics in monochorionic (MC) twins. Methods: Normal and complicated MC pregnancies were prospectively enrolled. The relationship of isthmus flow index (IFI) with Doppler parameters of umbilical artery (UA), descending aorta, middle cerebral artery, and ductus venosus and with left and right ventricular cardiac output and stroke volume was studied. Results: The IFI was obtained in 180 examinations from 48 pregnancies (24 twin–twin transfusion syndrome, TTTS; 4 selective intrauterine growth restriction, sIUGR; 12 TTTS + sIUGR; and 8 uncomplicated). Median gestational age was 20.9 weeks. AoI diastolic flow was reversed in three cases. UA pulsatility index (PI) and ductus venosus-PI z-scores were negatively correlated with the IFI (rs −0.40 and −0.26, respectively, p < 0.001). Regression analysis identified only UA-PI as a determinant of the IFI (p < 0.001). The IFI was significantly correlated with left ventricular cardiac output and stroke volume. It did not differ between TTTS donors and recipients. sIUGR fetuses had significantly lower IFI compared with normal-grown counterparts (p < 0.001). Conclusion: In MC gestations, AoI shunting is predominantly determined by placental flow resistance, while cerebral impedance and volume status have no impact. In MC twins, the relationship between AoI flow and outcome deserves further study in the setting of sIUGR.

AB - Objective: To study fetal aortic isthmus (AoI) shunt dynamics in monochorionic (MC) twins. Methods: Normal and complicated MC pregnancies were prospectively enrolled. The relationship of isthmus flow index (IFI) with Doppler parameters of umbilical artery (UA), descending aorta, middle cerebral artery, and ductus venosus and with left and right ventricular cardiac output and stroke volume was studied. Results: The IFI was obtained in 180 examinations from 48 pregnancies (24 twin–twin transfusion syndrome, TTTS; 4 selective intrauterine growth restriction, sIUGR; 12 TTTS + sIUGR; and 8 uncomplicated). Median gestational age was 20.9 weeks. AoI diastolic flow was reversed in three cases. UA pulsatility index (PI) and ductus venosus-PI z-scores were negatively correlated with the IFI (rs −0.40 and −0.26, respectively, p < 0.001). Regression analysis identified only UA-PI as a determinant of the IFI (p < 0.001). The IFI was significantly correlated with left ventricular cardiac output and stroke volume. It did not differ between TTTS donors and recipients. sIUGR fetuses had significantly lower IFI compared with normal-grown counterparts (p < 0.001). Conclusion: In MC gestations, AoI shunting is predominantly determined by placental flow resistance, while cerebral impedance and volume status have no impact. In MC twins, the relationship between AoI flow and outcome deserves further study in the setting of sIUGR.

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Aortic isthmus shunt dynamics in normal and complicated monochorionic pregnancies

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