Preferential Ductus Venosus Streaming Toward the Right Heart Is Associated with Left Heart Underdevelopment and Aortic Arch Hypoplasia in Human Fetuses

Abstract

Purpose: Preferential left heart underdevelopment in human fetuses with diaphragmatic hernia is almost uniformly associated with preferential streaming of the ductus venosus toward the right side of the heart. The purpose of our study was to examine whether this flow anomaly might also be present in other fetuses with hypoplasia of left-sided cardiovascular structures.

Materials and Methods: We studied 32 fetuses with left heart hypoplasia as defined by gestational age-related Z-scores by echocardiography. Apart from defining cardiovascular morphology as detailed as possible, particular focus was put on the presence or absence of preferential streaming of the ductus venosus and inferior caval vein toward the right side of the heart.

Results: 8 of 32 fetuses with hypoplasia of one or more left-sided cardiovascular structures exhibited preferential streaming of the ductus venosus toward the right side of the heart. In all eight fetuses, this finding was associated with additional cardiovascular anomalies like aortic valve stenosis, ventricular septal defect, left superior caval vein-to-coronary sinus, pulmonary vein stenosis and/or aortic arch hypoplasia.

Conclusion: As in human fetuses with left diaphragmatic hernia, preferential ductus venosus streaming toward the right side of the heart can be found in a subgroup of fetuses with hypoplasia of left-sided cardiovascular structures.

Zusammenfassung

Ziel: Eine Linksherzhypoplasie bei Ungeborenen mit Zwerchfellhernie ist meistens mit einem bevorzugten Streaming des Ductus venosus zur rechten Herzseite assoziiert. Ziel dieser Studie war zu untersuchen, ob sich diese Flussanomalie auch bei anderen Ungeborenen mit unterentwickelten Linksherzstrukturen finden würde.

Patienten und Methoden: Wir untersuchten 32 Ungeborene mit Linksherzhypoplasie, definiert anhand gestationsalterbezogener Z-Scores, mittels Echokardiografie. Neben der Beurteilung der kardialen Morphologie wurde besonderer Wert auf die Erfassung eines bevorzugten Streamings des Ductus venosus zur rechten Herzseite gelegt.

Ergebnisse: 8 der 32 Ungeborenen mit Hypoplasie einer oder mehrerer linksseitiger kardiovaskulärer Strukturen zeigten ein bevorzugtes Streaming des Ductus venosus zur rechten Herzseite. Bei diesen 8 Feten fanden sich des Weiteren assoziierte Anomalien, wie Aortenklappenstenose, Ventrikelseptumdefekt, links persistierende obere Hohlvene zum Koronarsinus und/oder eine Aortenbogenhypoplasie.

Schlussfolgerung: Bei einer Untergruppe humaner Feten mit unterentwickeltem linken Herzen und Aortenbogen findet sich ein bevorzugtes Ductus venosus Streaming zur rechten Herzseite. Dieses Flussphänomen könnte durch eine verminderte Vorfüllung der linken Herzseite zu dieser Morphologie beitragen.

Key words

cardiac - echocardiography - ultrasound color Doppler - ultrasound Doppler - fetus

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