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DeVore GR, Klas B, Satou G, Sklansky M. Measuring the Area of the Interventricular Septum in the 4-Chamber View: A New Technique to Evaluate the Fetus at Risk for Septal Hypertrophy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2939-2953. [PMID: 35305032 DOI: 10.1002/jum.15980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES One of the problems for the clinician who desires to measure the interventricular septum (IVS) in a high-risk fetus is to know where to make the measurement. The purpose of this study was to use speckle-tracking analysis to measure the IVS area, 24-segment widths, and length at end-diastole (ED) and end-systole (ES) in normal fetuses. METHODS From the 4-chamber view, speckle-tracking analysis was performed at ED and ES on the IVS in 200 normal fetuses. The following were computed and regressed against gestational age (GA) and fetal biometric (FB) measurements: area, length, and the 24-segment transverse widths from the apex to the crux. The 24-segment width/length ratio was also measured. The speckle-tracking measurements of the ED area and length were compared using a point-to-point measurement tool available on all ultrasound machines. RESULTS The ED and ES areas, lengths, and 24-segment widths increased with GA and FB. The ED and ES areas were virtually identical. The 24-segment width/length ratio decreased from the apex to the crux of the septum. There was no significant difference in the measurement of the ED area and the length between speckle-tracking and the point-to-point measurements. CONCLUSIONS Measurement of the area and length of the IVS are simple to obtain and provide a new diagnostic tool to evaluate the fetus at risk for IVS hypertrophy which may be observed in fetuses of mothers with pregestational and gestational diabetes.
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Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, Pasadena, CA, USA
| | | | - Gary Satou
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Şenol G, Aslan Çetin B, Esin D, Tobaş Selçuki NF, Tayyar A, Turhan U, Bütün Z, Yüksel MA. Evaluation of right side foetal myocardial performance index in pregestational and gestational diabetes mellitus. J OBSTET GYNAECOL 2021; 42:91-96. [PMID: 33938355 DOI: 10.1080/01443615.2021.1882971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of our study is to investigate the myocardial performance index (MPI) of the right side of the foetal heart in pregestational and gestational diabetes mellitus and to compare it with non-diabetic pregnancies. This prospective cross-sectional study was conducted between August 2018 and March 2019 at Kanuni Sultan Suleyman Research and Training Hospital. Women with pregestational or gestational diabetes mellitus at 24-34 weeks of gestation were included in the study and non-diabetic pregnant women were included as the control group. MPI of the right side of the foetal heart were evaluated and compared between the groups. A total of 65 pregestational or gestational diabetic patients and 65 non-diabetic patients were included in the study. Isovolumetric contraction time and isovolumetric relaxation time values were significantly longer in the diabetic group (p < .001). Ejection time values were significantly shorter in the diabetic group (p < .001). MPI values were significantly higher in the diabetic group than the non-diabetic group (p < .001). In conclusion, MPI of the right side of the foetal heart is significantly higher in pregestational and gestational diabetes than in the non-diabetic group.IMPACT STATEMENTWhat is already known on this subject? Gestational diabetes mellitus causes foetal cardiomyopathy and foetal diastolic dysfunction. Myocardial performance index (MPI) is a non-invasive, Doppler-derived myocardial performance assessment that is independent of both heart rate and ventricular anatomy.What do the results of this study add? MPI of the right side of the foetal heart was significantly higher in pregestational and gestational diabetes than in the non-diabetic group. There was no difference in right ventricular MPI between pregestational and gestational groups in diabetic pregnancies, and between insulin using and not insulin using groups.What are the implications of these findings for clinical practice and/or further research? Our study results are promising. MPI of the right side of the foetal heart is significantly higher in pregestational and gestational diabetes than in the non-diabetic group. Prospective cohort studies evaluating serial MPI and evaluating by postpartum foetal echocardiography are needed to evaluate possible adverse effects of diabetes on foetal cardiac functions.
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Affiliation(s)
- Gökalp Şenol
- Department of Perinatology, Osmangazi University, Eskişehir, Turkey
| | - Berna Aslan Çetin
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Didem Esin
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Nura Fitnat Tobaş Selçuki
- Department of Obstetrics and Gynecology, Şişli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Ahmet Tayyar
- Department of Perinatology, Medipol University, Istanbul, Turkey
| | - Uğur Turhan
- Department of Perinatology, Samsun Research and Training Hospital, Samsun, Turkey
| | - Zafer Bütün
- Department of Perinatology, Osmangazi University, Eskişehir, Turkey
| | - Mehmet Aytaç Yüksel
- Department of Obstetrics and Gynecology, Beykent University, Istanbul, Turkey
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Depla AL, De Wit L, Steenhuis TJ, Slieker MG, Voormolen DN, Scheffer PG, De Heus R, Van Rijn BB, Bekker MN. Effect of maternal diabetes on fetal heart function on echocardiography: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:539-550. [PMID: 32730637 PMCID: PMC8048940 DOI: 10.1002/uog.22163] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/20/2020] [Accepted: 07/22/2020] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Maternal diabetes in pregnancy is associated with structural anomalies of the fetal heart, as well as hypertrophy and functional impairment. This systematic review and meta-analysis aimed to estimate the effect of maternal diabetes on fetal cardiac function as measured by prenatal echocardiography. METHODS We performed a search of the EMBASE, PubMed and The Cochrane Library databases, from inception to 4 July 2019, for studies evaluating fetal cardiac function using echocardiography in pregnancies affected by diabetes compared with uncomplicated pregnancies. Outcome measures were cardiac hypertrophy and diastolic, systolic and overall cardiac function as assessed by various ultrasound parameters. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Data on interventricular septal (IVS) thickness, myocardial performance index (MPI) and E/A ratio were pooled for the meta-analysis using random-effects models. For pregnancies with diabetes, results were reported overall and according to whether diabetes was pregestational (PDM) or gestational (GDM). Results were also stratified according to the trimester in which fetal cardiac assessment was performed. RESULTS Thirty-nine studies were included, comprising data for 2276 controls and 1925 women with pregnancy affected by diabetes mellitus (DM). Of these, 1120 had GDM, 671 had PDM and in 134 cases diabetes type was not specified. Fetal cardiac hypertrophy was more prevalent in diabetic pregnancies than in non-diabetic controls in 21/26 studies, and impaired diastolic function was observed in diabetic pregnancies in 22/28 studies. The association between DM and systolic function was inconsistent, with 10/25 studies reporting no difference between cases and controls, although more recent studies measuring cardiac deformation, i.e. strain, did show decreased systolic function in diabetic pregnancies. Of the studies measuring overall fetal cardiac function, the majority (14/21) found significant impairment in diabetic pregnancies. Results were similar when stratified according to GDM or PDM. These effects were already present in the first trimester, but were most profound in the third trimester. Meta-analysis of studies performed in the third trimester showed, compared with controls, increased IVS thickness in both PDM (mean difference, 0.75 mm (95% CI, 0.56-0.94 mm)) and GDM (mean difference, 0.65 mm (95% CI, 0.39-0.91 mm)) pregnancies, decreased E/A ratio in PDM pregnancies (mean difference, -0.09 (95% CI, -0.15 to -0.03)), no difference in E/A ratio in GDM pregnancies (mean difference, -0.01 (95% CI, -0.02 to 0.01)) and no difference in MPI in either PDM (mean difference, 0.04 (95% CI, -0.01 to 0.09)) or GDM (mean difference, 0.03 (95% CI, -0.01 to 0.06)) pregnancies. CONCLUSIONS The findings of this review show that maternal diabetes is associated with fetal cardiac hypertrophy, diastolic dysfunction and overall impaired myocardial performance on prenatal ultrasound, irrespective of whether diabetes is pregestational or gestational. Further studies are needed to demonstrate the relationship with long-term outcomes. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A. L. Depla
- Department of Obstetrics and Gynaecology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - L. De Wit
- Department of Obstetrics and Gynaecology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - T. J. Steenhuis
- Department of Pediatric Cardiology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - M. G. Slieker
- Department of Pediatric Cardiology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - D. N. Voormolen
- Department of Obstetrics and Gynaecology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - P. G. Scheffer
- Department of Obstetrics and Gynaecology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - R. De Heus
- Department of Obstetrics and Gynaecology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - B. B. Van Rijn
- Department of Obstetrics and Fetal Medicine, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - M. N. Bekker
- Department of Obstetrics and Gynaecology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
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Sepúlveda-Martínez A, García-Otero L, Soveral I, Guirado L, Valenzuela-Alcaraz B, Torres X, Rodriguez-Lopez M, Gratacos E, Gómez O, Crispi F. Comparison of 2D versus M-mode echocardiography for assessing fetal myocardial wall thickness. J Matern Fetal Neonatal Med 2018; 32:2319-2327. [DOI: 10.1080/14767058.2018.1432041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Alvaro Sepúlveda-Martínez
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
- Fetal Medicine Unit, Department of Obstetrics and Gynecology Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Laura García-Otero
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Iris Soveral
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Laura Guirado
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Brenda Valenzuela-Alcaraz
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Ximena Torres
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Mérida Rodriguez-Lopez
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
- Pontificia Universidad Javeriana, Seccional Cali, Cali, Colombia
| | - Eduard Gratacos
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Olga Gómez
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Fàtima Crispi
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
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Wang X, Lian Y, Wang X, Tian M. Study of Regional Left Ventricular Longitudinal Function in Fetuses with Gestational Diabetes Mellitus by Velocity Vector Imaging. Echocardiography 2016; 33:1228-33. [PMID: 27460645 DOI: 10.1111/echo.13238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Xiaoyan Wang
- Department of Ultrasound; Heping Hospital Affiliated to Changzhi Medical College; Changzhi Shanxi China
| | - Yajun Lian
- Internal Medicine-Cardiovascular Department; Heping Hospital Affiliated to Changzhi Medical College; Changzhi Shanxi China
| | - Xiaofang Wang
- Department of Ultrasound; Heping Hospital Affiliated to Changzhi Medical College; Changzhi Shanxi China
| | - Min Tian
- Department of Ultrasound; Heping Hospital Affiliated to Changzhi Medical College; Changzhi Shanxi China
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6
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Vaksmann G. [The heart and maternal or fetal diabetes]. Arch Pediatr 2015; 22:129-30. [PMID: 26112555 DOI: 10.1016/s0929-693x(15)30064-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G Vaksmann
- INTERCARD, Hôpital privé de La Louvière, 69 rue de La Louvière, 59000 Lille, France.
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Rolo LC, Santana EFM, da Silva PH, Costa FDS, Nardozza LMM, Tonni G, Moron AF, Araujo Júnior E. Fetal cardiac interventricular septum: volume assessment by 3D/4D ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL). J Matern Fetal Neonatal Med 2014; 28:1388-93. [PMID: 25134922 DOI: 10.3109/14767058.2014.955005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine reference values for fetal interventricular septum (IVS) volume by 3D/4D ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL). METHODS A prospective cross-sectional study was conducted on 200 consecutive normal low-risk pregnant women at a gestational age ranging from 18w0d to 33w6d. The volume data sets of the fetal heart were acquired by applying STIC to a four-chamber plane. IVS volume was calculated offline using VOCAL with rotation of 30° (six planes). To assess the correlation of fetal IVS volume as a function of gestational age (GA), Pearson's correlation coefficient (r) and polynomial regression models with adjustments through the coefficient of determination (R(2)) were calculated. The intra-class coefficient (ICC) was used to evaluate intra- and inter-observer reproducibility. RESULTS A good correlation between GA and fetal IVS volume (r = 0.827) was observed. The mean fetal IVS volume ranged from 0.13 ± 0.03 cm(3) (0.08-0.18 cm(3)) at 18wd0 of gestation to 1.33 ± 0.37 cm(3) (0.41-1.98 cm(3)) at 33w6d. The best correlation between fetal IVS volume and GA was exponential: fetal IVS volume = 0.11e(0.139×GA) (R(2 )= 0.785). A good intra- and inter-observer reliability were observed, with ICC = 0.999 and 0.991, respectively. CONCLUSIONS Reference values for fetal IVS volume using STIC and VOCAL by 3D/4D ultrasound between 18w0d and 33w6d of gestation were determined and showed to be reliable and concordant.
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Affiliation(s)
- Liliam Cristine Rolo
- a Fetal Cardiology Unit, Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo , SP , Brazil
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Assessment of cardiac functions in fetuses of gestational diabetic mothers. Pediatr Cardiol 2014; 35:30-7. [PMID: 23780554 DOI: 10.1007/s00246-013-0734-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
Abstract
We investigated cardiac function in 67 fetuses of gestational diabetic mothers (FGDMs) and 122 fetuses of healthy mothers between 24 and 36 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. Fetal echocardiograms were performed at 24, 28, 32, and 36 weeks of gestation. Glycated hemoglobin (HbA1c) levels were obtained from all pregnant women at 24 weeks of gestation. The mean age of diabetic pregnant women was significantly greater than that of controls. Serum HbA1c values of both groups were within normal limits, but they were significantly greater in the diabetic group (p = 0.003). The increase in peak aortic and pulmonary artery velocities were greater in FGDM (p < 0.001). No pathological interventricular septal (IVS) hypertrophy was observed. There was a significant increase in IVS thickness in FGDM compared with controls, which was more prominent at the end of the third trimester (p < 0.001). During the course of pregnancy, mitral E-wave (p < 0.001), A-wave (p = 0.007), tricuspid E-wave (p < 0.001) and A-wave (p = 0.002) velocities were greater in FGDM. The increases in mitral E/A and tricuspid E/A ratios were lower in FGDM with advancing gestation. The E a-wave (p = 0.02), A a-wave (p = 0.04), and S a-wave (p < 0.001) velocities of the right-ventricular (RV) free wall and the E a (p = 0.02) and A a (p = 0.01) velocities of the left-ventricle (LV) posterior wall were greater in FGDM during the course of pregnancy. The E a/A a ratio of the RV posterior wall was greater in FGDM with advancing gestation (p < 0.03). LV and RV E/E a ratios were similar in both groups. The LV myocardial performance index measured by pulsed-wave Doppler was greater in FGDM (p < 0.001). We detected diastolic dysfunction in FGDM. The data suggest that gestational diabetes mellitus may impair ventricular diastolic functions without causing pathological fetal myocardial hypertrophy. We detected subclinical diastolic dysfunction using both pulsed-wave and tissue Doppler imaging in FGDM.
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Nardozza LMM, Rolo LC, Araujo Júnior E, Hatanaka AR, Rocha LA, Simioni C, Ruano R, Moron AF. Reference range for fetal interventricular septum area by means of four-dimensional ultrasonography using spatiotemporal image correlation. Fetal Diagn Ther 2013; 33:110-5. [PMID: 23295684 DOI: 10.1159/000345650] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 10/30/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine reference range for fetal interventricular septum area by means of 3-dimensional ultrasonography (3DUS) using the spatiotemporal image correlation (STIC) method. METHODS A prospective, cross-sectional study was conducted on 328 normal pregnant women between the 18th and 33rd gestational weeks. To obtain the interventricular septum area, a virtual plane was used, with the green line (region of interest) adjacent to the external margin of the septum, which was manually delimited. To evaluate the correlation of the septum area with the gestational age, different regression modes were evaluated. The intraclass correlation coefficient was used to evaluate the interobserver reproducibility. RESULTS The interventricular septum area showed correlation with the gestational age (r = 0.81). The mean increased from 0.47 ± 0.10 cm² in the 18th week to 2.42 ± 1.13 cm² in the 33rd week of gestation. The mathematical equation that best represented this correlation was provided by linear regression: interventricular septum area = 0.0511 × gestational age (R² = 0.095). The interobserver reproducibility was good, with bias of 0.01 cm², precision of 0.07 cm² and absolute limits of agreement of -0.14 and +0.15 cm². CONCLUSIONS Reference range for fetal interventricular septum area were determined by means of 3DUS using STIC in the rendering mode and were shown to be reproducible.
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Zielinsky P, Frajndlich R, Nicoloso LH, Manica JLL, Piccoli AL, de Morais MR, Bender L, Silva J, Pizzato P, Naujorks A. Aortic isthmus blood flow in fetuses of diabetic mothers. Prenat Diagn 2011; 31:1176-80. [PMID: 22025282 DOI: 10.1002/pd.2859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 08/10/2011] [Accepted: 08/10/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test the hypothesis that the aortic isthmus flow index (IFI) is lower in fetuses of diabetic mothers than in fetuses of nondiabetic mothers. STUDY DESIGN We performed a cross-sectional observational study to assess the IFI in fetuses, with (n = 13) and without (n = 37) myocardial hypertrophy, of mothers with diabetes mellitus and in fetuses of nondiabetic mothers (n = 23). Analysis of variance and Tukey test were used to assess differences among the groups. RESULTS There were no differences in maternal or gestational age among the groups. In fetuses of diabetic mothers, the mean IFI in fetuses with myocardial hypertrophy was 1.19 ± 0.06, and in fetuses without it was 1.18 ± 0.09. The mean IFI in fetuses of nondiabetic mothers was 1.32 ± 0.07 (P < 0.001). CONCLUSIONS The IFI in fetuses of diabetic mothers is lower than in fetuses of nondiabetic mothers, possibly as a result of a decreased left ventricular compliance.
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Affiliation(s)
- Paulo Zielinsky
- Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil.
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Turan S, Turan OM, Miller J, Harman C, Reece EA, Baschat AA. Decreased fetal cardiac performance in the first trimester correlates with hyperglycemia in pregestational maternal diabetes. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:325-331. [PMID: 21538641 DOI: 10.1002/uog.9035] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/14/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE In-vitro animal studies suggest that high glucose levels impair fetal cardiac function early in gestation. We aimed to study whether evidence of first-trimester myocardial dysfunction can be detected in fetuses of women with pregestational diabetes mellitus. METHODS Women with diabetes mellitus underwent fetal echocardiography at 11-14 weeks' gestational age. In fetuses with normal anatomy, the cardiac preload, diastolic function, global myocardial performance and placental afterload were studied by Doppler of the ductus venosus (DV), mitral and tricuspid early/atrial (E/A) ratios, left and right ventricular myocardial performance index (MPI) and umbilical artery (UA) Doppler, respectively. Cases were matched for gestational age and UA and DV Doppler with controls that had no diabetes mellitus. RESULTS Sixty-three singleton diabetic pregnancies were matched with 63 controls. Mean gestational age at enrollment was 12.6 (range, 11.1-13.6) weeks. Diabetic mothers had moderate to poor glycemic control (median (range) glycosylated hemoglobin A1 (HbA1c), 7.5 (5.1-12.7)%, and the HbA1c level was ≥ 7% in 37 (59%)). Fetuses of diabetic mothers exhibited worse measures of diastolic dysfunction: the isovolumetric relaxation time (IRT) was significantly prolonged (left ventricle: 36.9 ± 7.4 ms vs. 45.8 ± 6.8 ms; right ventricle: 35.6 ± 8 ms vs. 46.4 ± 7.3 ms, P < 0.0001 for both). The mitral E/A ratio was lower in diabetics (0.55 ± 0.06 vs. 0.51 ± 0.08, P = 0.03), and the global myocardial performance was lower in both ventricles (left ventricle MPI: 0.5 ± 0.08; right ventricle MPI: 0.52 ± 0.08, P = 0.03 and P < 0.0001, respectively). This lower global myocardial performance was caused by a prolonged myocardial relaxation time, which was most marked in diabetics with an HbA1c of ≥ 7% (P < 0.001 vs. controls for both ventricles). There were no significant correlations between cardiac Doppler parameters and DV, UA indices and fetal heart rate (P > 0.05 for all). CONCLUSIONS Fetuses of poorly controlled diabetic mothers demonstrate significant differences in first-trimester diastolic myocardial function compared with non-diabetic controls. The decrease in myocardial performance is more marked with increasing HbA1c and appears to be independent of preload and afterload. The ability to document these cardiac functional changes this early in pregnancy opens potential new avenues to understand the consequences of maternal glycemic status.
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Affiliation(s)
- S Turan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, School of Medicine, Baltimore, MD, USA.
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Köşüş A, Köşüş N, Turhan NÖ. Assessment of cardiomyopathy in fetuses of women with false positive oral glucose loading test. Eur J Obstet Gynecol Reprod Biol 2010; 154:37-9. [PMID: 20855145 DOI: 10.1016/j.ejogrb.2010.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 07/28/2010] [Accepted: 08/25/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate fetal asymmetric septal hypertrophy in women with a false positive oral glucose loading test (OGL). STUDY DESIGN OGL was applied to 79 pregnant women at gestational age between 24 and 28 weeks. The first study group consisted of patients with a normal OGL. Cases having glucose levels above 130 mg/dL after 50 g OGL but a normal 100g oral glucose tolerance test (OGTT) formed a second group. M-mode echocardiography was then performed. Fetal septal and left ventricular posterior wall (LVPW) thicknesses in Group 1 and Group 2 were compared. RESULTS Mean septal and LVPW thickness was slightly higher in the second group but there was no statistically significant difference between the two groups. CONCLUSIONS Although statistically not significant, there is some increase in septal and ventricular wall thickness in cases with high OGL but normal OGTT. The study also provides evidence of the absence of prominent septal and ventricular thickening in these cases with minimal glucose intolerance.
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Affiliation(s)
- Aydin Köşüş
- Dept of ObGyn, Fatih University, Faculty of Medicine, Ankara, Turkey
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Claudio Gutierrez J, Prater MR, Hrubec TC, Smith BJ, Freeman LE, Holladay SD. Heart changes in 17-day-old fetuses of diabetic ICR (Institute of Cancer Research) mothers: improvement with maternal immune stimulation. Congenit Anom (Kyoto) 2009; 49:1-7. [PMID: 19243410 DOI: 10.1111/j.1741-4520.2008.00213.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Maternal diabetes mellitus is associated with increased fetal teratogenesis, including cardiovascular defects. Non-specific maternal immune stimulation with Freund's complete adjuvant (FCA) or interferon gamma (IFNgamma) has been associated with protection against birth malformations. Using a diabetic mouse model, late-gestation fetal heart and great vessel morphology were analyzed. Four groups of mice were used: non-diabetic females as a control group, hyperglycemic females induced by streptozotocin as a diabetic group, and diabetic females injected either with FCA or IFNgamma. At day 17 of gestation, females were euthanized and one fetus was arbitrarily selected per litter for fixation and sectioning. Treatment-induced changes in cardiac development were assessed from digital images of serial sections taken at standardized levels in the thorax. One-way parametric and non-parametric ANOVA and ordinal logistic regression were performed to compare the difference among groups (P<0.05). Maternal hyperglycemia altered morphology of the late-gestation fetal mouse heart by causing ventricular chamber dilation, sectional myocardial reduction, and an increase in transversal aortic area. FCA protected the fetal heart from cavitary dilation in diabetic mothers. FCA and IFNgamma protected the fetal heart against reduction of myocardial area, and ascending thoracic aorta dilation. Consequences of late gestation heart chamber dilation and myocardial reduction are not yet known. Maternal immune stimulation partially protected against these developmental defects by mechanisms that remain unclear.
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Affiliation(s)
- Juan Claudio Gutierrez
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
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Russell NE, Foley M, Kinsley BT, Firth RG, Coffey M, McAuliffe FM. Effect of pregestational diabetes mellitus on fetal cardiac function and structure. Am J Obstet Gynecol 2008; 199:312.e1-7. [PMID: 18771996 DOI: 10.1016/j.ajog.2008.07.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 05/06/2008] [Accepted: 07/07/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Fetuses of diabetic pregnancy experience cardiomyopathy, the intracardiac cause of which is understood poorly. The aim of this study was to assess the interrelation between cardiac functional and structural changes in fetuses of mothers with pregestational diabetes mellitus. STUDY DESIGN Twenty-six mothers with pregestational diabetes mellitus were recruited prospectively to have a fetal echocardiogram at 13, 20, and 36 weeks of gestation to assess cardiac function and structure. For comparison, 30 healthy control subjects were recruited at each gestational age. RESULTS In the first trimester, there was evidence of poorer fetal cardiac diastolic function among the diabetic cohort (lower left early/atrial ratio, longer isovolumetric relaxation time and higher left myocardial performance index; P < .05). In the third trimester, the fetal interventricular septum and the right ventricular free wall were thicker in the diabetic cohort (P < .05). CONCLUSION In fetuses of pregestational diabetic pregnancy, sonographic evidence of altered cardiac function is evident before ultrasound evidence of cardiac structural changes. This suggests that altered cardiac function may precede cardiac structural changes in fetuses of pregestational diabetic pregnancy.
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Affiliation(s)
- Noirin E Russell
- Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland
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Gutierrez JC, Hrubec TC, Prater MR, Smith BJ, Freeman LE, Holladay SD. Aortic and ventricular dilation and myocardial reduction in gestation day 17 ICR mouse fetuses of diabetic mothers. ACTA ACUST UNITED AC 2007; 79:459-64. [PMID: 17335049 DOI: 10.1002/bdra.20357] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Maternal diabetes mellitus is associated with increased fetal teratogenesis, including cardiovascular defects. Information regarding cardiovascular changes in late-gestation fetal mice, related to maternal hyperglycemia, is not present in the literature. METHODS Late-gestation fetal heart and great vessel morphology were analyzed in fetuses from control and diabetic mice. Female ICR mice were injected with streptozocin (200 mg/kg IP) prior to mating to induce diabetes (n = 8). Nonhyperglycemic females were used as controls (n = 8). At day 17 of gestation, females were euthanized and one fetus was arbitrarily selected per litter to analyze the heart and great vessels. Six additional fetuses from different litters, showing external malformations (spina bifida and/or exencephaly), were also evaluated from the diabetic group. Fetal thoraxes were processed using routine histopathologic techniques, and 7-mum transversal sections were stained with hematoxylin-eosin. Digital images of sections were made and analyzed using NIH Image J software to compare regional cardiac development. Student's t tests for means were performed to determine differences between groups (p < .05). RESULTS Maternal hyperglycemia caused a dilation of late-gestation fetal ventricular chambers, a reduction of total ventricular myocardial area, and an increase in transversal ascending thoracic aortic area. Three of six fetuses that displayed external malformations showed an overt cardiac defect, beyond the ventricular and myocardial changes. CONCLUSIONS Maternal hyperglycemia altered morphology of the late-gestation fetal mouse heart. Postnatal persistence or consequences of late-gestation heart chamber dilation and myocardial reduction are not yet known.
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MESH Headings
- Animals
- Aorta, Thoracic/embryology
- Aorta, Thoracic/pathology
- Cardiomyopathy, Hypertrophic/etiology
- Cardiomyopathy, Hypertrophic/pathology
- Diabetes Mellitus, Experimental/complications
- Diabetes Mellitus, Type 1/complications
- Dilatation, Pathologic
- Female
- Gestational Age
- Heart Defects, Congenital/etiology
- Heart Defects, Congenital/pathology
- Heart Rate, Fetal
- Heart Ventricles/embryology
- Heart Ventricles/pathology
- Hyperglycemia/complications
- Male
- Mice
- Mice, Inbred ICR
- Pregnancy
- Pregnancy in Diabetics
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Affiliation(s)
- J Claudio Gutierrez
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute & State University, Blacksburg, Virginia, USA.
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Mirghani H, Zayed R, Thomas L, Agarwal M. Gestational diabetes mellitus: fetal liver length measurements between 21and 24 weeks' gestation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:34-7. [PMID: 17152075 DOI: 10.1002/jcu.20294] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To evaluate sonographic measurements of the fetal liver, fetal abdominal fat layer, interventricular septum, and Wharton's jelly area between 21 and 24 weeks' gestation in women with gestational diabetes mellitus (GDM). METHODS A total of 123 consecutive healthy pregnant women underwent sonographic examination at 21-24 weeks' gestational age. The measurements included fetal biometry, detailed anomaly scan, and fetal body composition measurements (subcutaneous fat, liver size, cardiac muscle thickness, and Wharton's jelly area). GDM was confirmed by way of a 75-g oral glucose tolerance test using World Health Organization criteria within 1 week of the examination. RESULTS Nineteen (15.4%) women were diagnosed with GDM, while 104 (84.6%) women were without GDM. The mean fetal liver length was 36 mm (95% CI 32-37) in women with GDM and 31 mm (95% CI 30-33) in women without GDM (p < 0.01). Liver enlargement was related to maternal fasting glucose levels and not 2-hour postprandial levels. There was no significant difference in the fetal biometric and other fetal body measurements between the 2 groups. CONCLUSIONS The findings of this study suggest that midtrimester fetal liver length appears to be longer in GDM than in normal pregnancies. However, the fetal abdominal fat layer, interventricular septum, and Wharton's jelly were not affected. Nevertheless, further, larger randomized studies are required to confirm these findings.
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Affiliation(s)
- Hisham Mirghani
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, United Arab Emirate University, United Arab Emirates
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Abstract
Maternal diabetes mellitus significantly affects the fetal heart and fetal-placental circulation in both structure and function. The influence of pre-conceptional diabetes begins during embryonic development in the first trimester, with altered cardiac morphogenesis and placental development. It continues to have an influence on the fetal circulation through the second and third trimesters and into the perinatal and neonatal period.
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Langer O. Ultrasound biometry evolves in the management of diabetes in pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:585-95. [PMID: 16254874 DOI: 10.1002/uog.2615] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Lampl M, Jeanty P. Exposure to maternal diabetes is associated with altered fetal growth patterns: A hypothesis regarding metabolic allocation to growth under hyperglycemic-hypoxemic conditions. Am J Hum Biol 2004; 16:237-63. [PMID: 15101051 DOI: 10.1002/ajhb.20015] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The prevalence of diabetes is rising worldwide, including women who grew poorly in early life, presenting intergenerational health problems for their offspring. It is well documented that fetuses exposed to maternal diabetes during pregnancy experience both macrosomia and poor growth outcomes in birth size. Less is known about the in utero growth patterns that precede these risk factor expressions. Fetal growth patterns and the effects of clinical class and glycemic control were investigated in 37 diabetic pregnant women and their fetuses and compared to 29 nondiabetic, nonsmoking maternal/fetal pairs who were participants in a biweekly longitudinal ultrasound study with measurements of the head, limb, and trunk dimensions. White clinical class of the diabetic women was recorded (A2-FR) and glycosylated hemoglobin levels taken at the time of measurement assessed glycemic control (median 6.9%, interquartile range 5.6-9.2%). No significant difference in fetal weight was found by exposure. The exposed sample had greater abdominal circumferences from 21 weeks (P < or = 0.05) and shorter legs, but greater upper arm and thigh circumferences accompanied increasing glycemia in the second trimester. In the third trimester, exposed fetuses had a smaller slope for the occipital frontal diameter (P = 0.00) and were brachycephalic. They experienced a proximal/distal growth gradient in limb proportionality with higher humerus / femur ratios (P = 0.04) and arms relatively long by comparison with legs (P = 0.02). HbA1c levels above 7.5% accompanied shorter femur length for thigh circumference after 30 gestational weeks of age. Significant effects of diabetic clinical class and glycemic control were identified in growth rate timing. These growth patterns suggest that hypoxemic and hyperglycemic signals cross-talk with their target receptors in a developmentally regulated, hierarchical sequence. The increase in fetal fat often documented with diabetic pregnancy may reflect altered growth at the level of cell differentiation and proximate mechanisms controlling body composition. These data suggest that the maternal-fetal interchange circuit, designed to share and capture resources on the fetal side, may not have had a long evolutionary history of overabundance as a selective force, and modern health problems drive postnatal sequelae that become exacerbated by increasing longevity.
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Affiliation(s)
- Michelle Lampl
- Department of Anthropology, Emory University, Atlanta, Georgia 30324, USA.
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Bethune M, Bell R. Evaluation of the measurement of the fetal fat layer, interventricular septum and abdominal circumference percentile in the prediction of macrosomia in pregnancies affected by gestational diabetes. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 22:586-590. [PMID: 14689530 DOI: 10.1002/uog.885] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate the measurement of the fetal abdominal fat layer (FFL), cardiac interventricular septum (IVS) and abdominal circumference (AC) percentile in the early third trimester as predictors of macrosomia at birth in the fetuses of women with gestational diabetes. METHODS Ninety patients attending the hospital's special diabetic clinic were recruited prospectively. FFL and IVS were measured in addition to the routine biometry in the early third trimester. AC was measured routinely and AC percentile was determined from established antenatal charts. These measurements were then assessed as predictors of macrosomia. RESULTS A fetal fat layer of >/=5 mm was the most useful predictor of macrosomia at term as assessed using the likelihood ratio. An AC >/=90th percentile, however, had a better sensitivity. CONCLUSION The usefulness of routine FFL measurement in the early third trimester in the management of diabetic pregnancies is worthy of further evaluation.
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Affiliation(s)
- M Bethune
- Ultrasound Department, Royal Women's Hospital, Melbourne, Australia.
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Firpo C, Zielinsky P. Behavior of septum primum mobility in third-trimester fetuses with myocardial hypertrophy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 21:445-450. [PMID: 12768554 DOI: 10.1002/uog.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES The mobility of the septum primum (SP) in the fetus is a diastolic phenomenon and could be related to left atrial pressure. We studied the linear displacement of the SP in the left atrium in fetuses of diabetic mothers (FDM) with and without septal hypertrophy (SH) and in normal fetuses of normoglycemic mothers. In this study we set out to test the hypothesis that the linear displacement of the SP flap valve is less marked in fetuses with SH than in those without SH. METHODS The ratio between the linear displacement of the flap valve and the left atrial diameter (excursion index (EI)) was compared in ten FDM with SH, eight FDM with normal septal thickness and eight normal fetuses of non-diabetic mothers. Atrioventricular flow velocities were also compared in the three groups. RESULTS Comparison of the three groups showed that in FDM with SH, the mean EI was 0.36 +/- 0.09, in FDM without SH it was 0.51 +/- 0.09 (P = 0.001) and in the control fetuses it was 0.49 +/- 0.12 (P = 0.03). There was a significant negative correlation between septal thickness and EI in FDM with SH. There was no correlation between septal thickness and atrioventricular flow velocities. CONCLUSION Mobility of the SP in FDM with SH is reduced and there is an inverse correlation between the linear displacement of the SP and septal thickness. These findings may be related to changes in left ventricular diastolic function secondary to myocardial hypertrophy.
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Affiliation(s)
- C Firpo
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, Brazil.
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