Antegrade late diastolic arterial blood flow in the fetus: insight into fetal atrial function

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• 作者：Lisa W. Howley ; MD^a ; Yuka Yamamoto ; MD ; PhD^a ; Sven-Erik Sonesson ; MD ; PhD^c ; Priya Sekar ; MD ; MPH^a ; Venu Jain ; MD ; PhD^b ; Tarek Motan ; MD^b ; Winnie Savard ; RN^a ; Brandie D. Wagner ; PhD^d ; Jean Trines ; RN ; RDCS ; MSc^a ; Lisa K. Hornberger ; MD^a ; ^b ; ^{lisa.hornberger@albertahealthservices.ca}
• 关键词：cardiac output ; fetal echocardiography ; first trimester
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：208
• 期：6
• 页码：490.e1-490.e8
• 全文大小：1401 K

文摘

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Objective

The purpose of this study was to examine the presence and frequency of antegrade late diastolic arterial blood flow (ALDAF) in the fetus and to determine its contribution to cardiac output.

Study Design

We evaluated the presence of ALDAF in 457 fetal and 21 postnatal echocardiograms. The timing of ALDAF to the ventricular systolic Doppler recording (ALDAF-V) was compared with the mechanical atrioventricular interval and, in neonates, the electrical PR interval. Velocity time integrals of ALDAF and the ventricular systolic Doppler signals were measured, and the percent contribution of ALDAF was calculated.

Results

ALDAF was observed in 365 of 457 studies and included all <11 weeks¡¯ gestations. Strong correlation between ALDAF-V, atrioventricular interval, and electrical PR interval suggests that ALDAF coincides with atrial contraction. ALDAF contributed substantially to cardiac output in early gestation with later decline.

Conclusion

ALDAF results from atrial contraction. Increasing gestational age results in less ALDAF, and reduced ALDAF contribution to cardiac output likely due to improved diastolic function.