Demonstration of fetal coronary blood flow by Doppler ultrasound in relation to arterial and venous flow velocity waveforms and perinatal outcome - The 'heart-sparing effect'

A. A. Baschat, U. Gembruch, I. Reiss, L. Gortner, K. Diedrich

Research output: Contribution to journalArticlepeer-review

Abstract

This longitudinal observational study evaluates the stage at which coronary flow can be visualized by color-coded and pulsed wave Doppler sonography in fetuses with normal cardiac anatomy. Fetal biometry, echocardiography and Doppler examination of the umbilical and middle cerebral arteries, ductus venosus, inferior vena cava and umbilical vein were performed in 109 cases. Fetuses were divided into five groups based on the Doppler examination of the umbilical artery, birth weight and the ability to visualize coronary blood flow. Coronary blood flow was identified in six of 55 fetuses with normal growth who had normal Doppler studies and perinatal outcome. In these, visualization of coronary blood flow was possible after 31 weeks' gestation at a median gestational age of 37 weeks. Coronary blood flow was also visualized in ten of 54 fetuses with severe intrauterine growth retardation and highly pathological flow velocity waveforms in all vessels soon after a significant increase of venous indices in the inferior vena cava and ductus venosus. In these cases, coronary blood flow was identified at a significantly earlier gestational age (median 27 weeks). These fetuses had a poor perinatal outcome (average birth weight less than 3rd centile, mortality rate 50%, significantly lower umbilical artery blood pH and Apgar scores after 1 and 5 min). Intrauterine fetal death occurred in five fetuses after a median of 3.5 days following visualization of coronary blood flow. Median coronary peak blood flow velocities in the right coronary artery were higher in intrauterine growth-retarded than appropriate-for-gestational-age fetuses.

Original languageEnglish (US)
Pages (from-to)162-172
Number of pages11
JournalUltrasound in Obstetrics and Gynecology
Volume9
Issue number3
DOIs
StatePublished - 1997
Externally publishedYes

Keywords

  • Atrioventricular valve regurgitation
  • Coronary artery flow velocity waveform
  • Doppler sonography
  • Fetal coronary blood flow
  • Fetal heart
  • Fetal hypoxia
  • Fetal surveillance
  • Fetus
  • Intrauterine growth retardation
  • Prenatal medicine
  • Ultrasound
  • Uteroplacental insufficiency

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

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