Influence of intrauterine hemodynamics on the C segment of the aortic arch in the fetus
https://doi.org/10.21508/1027-4065-2021-66-4-45-52
Abstract
Objective. To assess the correlation between the hemodynamic characteristics of the left ventricle and geometric features of the aortic arch in the fetus.
Methods. The study involved 31 fetuses from 29 to 34 weeks of gestation by echocardiography. The scientists assessed the morphogeometric characteristics of the left ventricle andaortic arch. They studied the following parameters: end-diastolic volume ofthe left ventricle (LVEDV), stroke volume of the leftventricle (LVSV), velocity-time integral of the flow through aortic valve (VTI AV), diameter of the aortic valve ring (AV), diameterof the aortic arch segment between brachiocephalic trunk and left carotid artery (dС).
Results. The average gestational age was 31,9±1,4weeks (95% CI: 31,4–32,4 weeks). Average body weight 1899±377 g (95% CI: 1762–2038 g). LVEDV = 1,57±0,64 ml (95% CI: 1,3–1,8). LVSV = 1,3±0,45 ml (95% CI: 1,1–1,4 ml). AV 0,4±0,07 cm (95% CI: 0,39–0,44 cm). C segment of the aorticarc is 0,37±0,07 cm (95% CI: 0,035–0,040 cm). There was direct correlation between the variables used to calculate dC (Pearson correlation coefficient: LVEDV = 0,51; p=0,002; LVSV = 0,46; p=0,005; AV = 0,52, p=0,001). The diameter of the C segment of the aortic arch can be calculated using the following equations: dС= 0,76· LVSV +2,8 (95% CI LVSV 0,2–1,3 95% CI for constant2,1–3,6; Fisher’s criterion 7,6 р=0,01). dС= 0,59· LVEDV +2,8 (95% CI LVEDV 0,2–0,98; 95% CI for constant 2,2–3,5; Fisher’s criterion 10 р=0,004). dС= 0,59·AV+1,3 (95% CI AV 0,22–0,95; 95% CI for constant – 0,23–2,9; Fisher’s criterion 10,7;р=0,003).
Conclusion. 1)hemodynamic characteristics of the left ventricle allow predicting the sizeof the aortic arch in fetuses from 29 to 34 weeks of gestation; 2)morphogeometric characteristics of the aortic arch are determined by the characteristics of the left ventricular stroke volume, end-diastolicvolume of the leftventricleand the sizeof the fibrous ring of the aortic valve.
About the Authors
G. G. HubulavaRussian Federation
Saint-Petersburg
S. P. Marchenko
Russian Federation
Saint-Petersburg
A. B. Naumov
Russian Federation
Saint-Petersburg
U. A. Strupeneva
Russian Federation
Saint-Petersburg
E. S. Kulemin
Russian Federation
Saint-Petersburg
O. V. Nevmerzhitskaya
Russian Federation
Saint-Petersburg
O. Yu. Chupaeva
Russian Federation
Saint-Petersburg
A. A. Seliverstova
Russian Federation
Saint-Petersburg
A. V. Chernomordova
Russian Federation
Saint-Petersburg
M. S. Andreev
Russian Federation
Saint-Petersburg
N. G. Pilyugov
Russian Federation
Saint-Petersburg
E. S. Kavardakova
Russian Federation
Saint-Petersburg
References
1. Brown K.L., Ridout D.A., Hoskote A., Verhulst L., Ricci M., Bull C. Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart 2006; 92(6): 1298–1302. DOI: 10.1136/hrt.2005.078097
2. Wren C., Reinhardt Z., KhawajaK. Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations. Arch Child Fetal Neonatal 2008; 93(1): 33–35. DOI: 10.1136/adc.2007.119032
3. Evers P.D., Ranade D., Lewin M., Arya B. Diagnostic Approach in Fetal Coarctation of the Aorta: A Cost-Utility Analysis. J Am Soc Echocardiogr 2017; 30(6): 589–594. DOI: 10.1016/j.echo.2017.01.019
4. Toole B.J., Schlosser B., McCracken C.E., Stauffer N., Border W.L., Sachdeva R. Importance of Relationship between Ductus and Isthmus in Fetal Diagnosis of Coarctation of Aorta. Echocardiography 2016; 33(5): 771–777. DOI: 10.1111/echo.13140
5. Messing B., Cohen S. M., Valsky D.V., Rosenak D., Hochner-Celnikier D., Savchev S., YagelS. Fetal cardiac ventricle volumetry in the second half of gestation assessed by 4D ultrasound using STIC combined with inversion mode. Ultrasound Obstet Gynecol 2007; 30(2): 141–151. DOI: 10.1002/uog.4036
6. Hornberger L., Sahn D.J., Kleinman C.S., Copel J., Silver-man N.H. Antenatal diagnosis of coarctation of the aorta: a multicenter experience. J Am Coll Cardiol 1994; 23(2): 417–423. DOI: 10.1016/0735-1097(94)90429-4
7. Schmidt K., Silverman N., Hoffman J. Determination of ventricular volumes in human fetal hearts by two-dimensional echocardiography. Am J Cardiol 1995; 76(17): 1313–1316. DOI: 10.1155/2017/4797315
8. Buyens A., Gyselaers W., Coumans A., NasiryS.A., Willekes C., Boshoff D. et al. Difficult prenatal diagnosis: fetal coarctation. Facts Views Vis Obgyn 2012; 4: (4): 230–236
9. Achiron R., Zimand S., Hegesh J., Lipitz S., Zalel Y., Rot-stein Z. Fetal aortic arch measurements between 14 and 38 weeks’ gestation: in-utero ultrasonographic study. Ultrasound Obstet Gynecol 2000; 15(3): 226–230. DOI: 10.1046/j.1469-0705.2000.00068.x
10. Artman M., Mahony L., Teitel D. Neonatal Cardiology (3rd edn). Perinatal Cardiovascular Physiology. McGraw-Hill Education Medica, 2017; 87–120
11. Mor-Avi V., Sugeng L., Weinert L., MacEneaney P., Caiani E.G., Koch R. et al. Fast measurement of left ventricular mass with real- time three-dimensional echocardiography: comparison with magnetic resonance imaging. Circulation 2004; 110(13): 4–5. DOI: 10.1161/01.CIR.0000142670.65971.5F
12. Ushakov F.B., Imbar T., Yagel S. Application of free-hand three-dimensional echocardiography in the evaluation of fetal cardiac ejection fraction: a preliminary study. Ultrasound Obstet Gynecol 2004; 23(6): 546–551. DOI: 10.1002/uog.1059
13. Pasquini L., Mellander M., Seale A., Matsui H., Roughton M., Ho S.Y., Gardiner H.M. Z-scores of the fetal aortic isthmus and duct: an aid to assessing arch hypoplasia. Ultrasound Obstet Gynecol 2007; 29(6): 628–633. DOI: 10.1002/uog.4021
14. Al Akhfash A.A. Almesned A.A., AlHarbi B.F., Al Ghamdi A., Hasson M., Al Habshan F.M. Two-dimensional echocardiographic predictors of coarctation of the aorta. Cardiol Young 2015; 25(1): 87–94. DOI: 10.1017/S1047951113001790
15. Anuwutnavin S. Satou G., Chang R.K., DeVore G.R., Abuel A., Sklansky M. Prenatal Sonographic Predictors of Neonatal Coarctation of the Aorta. J Ultrasound Med 2016; 35: (11): 2353–2364. DOI: 10.7863/ultra.15.06049
16. Ross J. Hurst’s The Heart (9th edn). Assessment of cardiac function and myocardial contractility. London: Mcgraw-Hill, 1998; 731 – 735. DOI: 10.1002/clc.4960231119
17. Khubulava G.G., Marchenko S.P., Starchik D.A., Suvorov V.V., Krivoshhekov E.V., Shihverdiev N.N., Naumov A.B. Geometric and morphological characteristics of the aortic root in norm and in case of aortic valve insufficiency. Khirurgiya 2018; 5: 4–12. DOI: 10.17116/hirurgia201854-12 (in Russ.)
18. Moulaert A.J., Bruins C.C., Oppenheimer-Dekker A. Anomalies of the aortic arch and ventricular septal defects. Circulation 1976; 53(6): 1011–1015. DOI: 10.1161/01.cir.53.6.1011
19. Karl T.R., Sano S., BrawnW., Mee R.B. Repair of hypoplastic or interrupted aortic arch via sternotomy. J Thorac Cardiovasc Surg 1992; 104(3): 688–695
20. Il’inov V.N., Krivoshhekov E.V., Shipulin V.M. Surgical treatment of aortic coarctation in combination with arch hypoplasia. Sibirskii Meditsinskii Zhurnal 2014; 29(3): 80–86. (in Russ.)] DOI: 10.29001/2073-8552-2014-29-3-80-86
21. Il’inov V.N., Jakimova E.V., Ivlev A.J., Kiselev V.O., Gin’ko V.E., Krivoshhekov E.V.et al. O Experience of surgical treatment of aortic arch obstruction in children under conditions of antegrade selective cerebral perfusion. Bjulleten’ NCSSH im A.N. Bakuleva RAMN «Serdechno-sosudistye zabolevanija» 2015; 2(102): 15–20. (in Russ.)
22. Sisli E. Kalin S., Tuncer O.N., Ayik M.F., Alper H., Levent R.E.et al. Comparison Between Nomograms Used to Define Pediatric Aortic Arch Hypoplasia: Retrospective Evaluation Among Patients Less Than 1 Year Old with Coarctation of the Aorta. Pediatr Cardiol 2019; 40(6): 1190–1198. DOI: 10.1007/s00246-019-02130-2
23. Praagh R.V. Normally and Abnormally Related Great Arteries: What Have We Learned? World J Pediatr Congenit Heart Surg 2010; 1(3): 364–385. DOI: 10.1177/2150135110380239
24. Rudolph A.M., Heymann M.A., Spitznas U. Hemodynamic considerations in the development of narrowing of the aorta. Am J Cardiol 1972; 30(5): 514–525. DOI: 10.1016/0002-9149(72)90042-2
25. Rudolph A. Congenital Diseases of the Heart: Clinical- Physiological Considerations (3rd edn). The fetal circulation. San Francisco: Wiley-Blackwell, 2009; 22–67
26. Hubulava G.G., Naumov A.B., Marchenko S.P., Chupaeva O.Ju., Seliverstova A.A., Aleksandrovich J.S. et al. Indicators of blood gas composition in newborns with small cardiac output syndrome after cardiac surgery. Bjulleten’ NCSSH im A.N. Bakuleva RAMN «Serdechno-sosudistye zabolevanija» 2018; 19(5): 676–687. (in Russ.) DOI: 10.24022/1810-0694-2018-19-5-676-687
27. Starchik D.A., Didenko M.V., Marchenko S.P., Hubulava G.G., Pokushalov E.A. Anatomy in cardiovascular medicine: modern technologies in science and education. Patologiya krovoobrashheniya i kardiohirurgiya 2014; 18(4): 139–143. (in Russ.) DOI: 10.21688/1681-3472-2014-4-139-143
28. Marchenko S.P., Nastuev Je.H., Kulikov A.N., Puhova E.N., Shihverdiev N.N. Functional anatomy of the mitral valve in its insufficiency. Patologiya krovoobrashheniya i kardiohirurgiya 2007; 1: 3–6. (in Russ.)
Review
For citations:
Hubulava G.G., Marchenko S.P., Naumov A.B., Strupeneva U.A., Kulemin E.S., Nevmerzhitskaya O.V., Chupaeva O.Yu., Seliverstova A.A., Chernomordova A.V., Andreev M.S., Pilyugov N.G., Kavardakova E.S. Influence of intrauterine hemodynamics on the C segment of the aortic arch in the fetus. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2021;66(4):45-52. (In Russ.) https://doi.org/10.21508/1027-4065-2021-66-4-45-52