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BACKGROUND In the current literature, there is a tendency to describe normal values of echocardiographic measurements by means of the Z-score. In fetal cardiology, these Z-score equations are still being established. Measurement of myocardial thickness is an important assessment, especially in fetuses of diabetic mothers, because of the risk of developing myocardial hypertrophy secondary to elevated maternal blood glucose levels. OBJECTIVE To determine the percentiles and to develop the Z-score equations of right and left ventricular lateral walls and interventricular septum measurements using two-dimensional echocardiography in normal fetuses between 24 and 34 weeks of gestation. METHODS This is a prospective cross-sectional study that was performed in single fetuses with normal heart from nondiabetic pregnant women. Measurements of the lateral walls of the right and left ventricles and the interventricular septum were made. RESULTS Eight hundred and seventy three pregnant women were included. We determined the percentiles of the measurements for each gestational age. The Z-score equation was developed for each of the measurements: right ventricular lateral wall measurement [RVLW = x-(-1 + 0.109 * GA)/0.4], left ventricle lateral wall measurement [LVLW = x-(-1.366 + 0.12 * GA)/0.43], and interventricular septum, both at the four-chamber view [IVS4ch = (x-(-1.113 + 0.107 * GA)/0.4] and at the left ventricular outflow tract plane [IVSLVOT = (x-(-0.581 + 0.084 * GA)/0.35]. CONCLUSION The present study allowed the demonstration of the percentiles and the Z-score equations for each of the measurements studied.

OBJECTIVES To test the hypotheses that estimated mean pulmonary arterial pressure (MPAP) decreases and pulmonary vascular maturation, assessed by the ratio of pulmonary arterial flow acceleration time to ejection time (AT/ET ratio), increases after reversal of fetal ductus arteriosus constriction by reducing maternal intake of the causal agent (prostaglandin inhibitors, such as polyphenol-rich foods or non-steroidal anti-inflammatory drugs), and that these effects are independent of gestational age, which are inferences not yet demonstrated in the clinical setting. METHODS This was a prospective cohort study comparing Doppler echocardiographic ductal flow dynamics, MPAP and pulmonary arterial flow AT/ET ratio in third-trimester fetuses (≥ 28 weeks' gestation) with ductus arteriosus constriction, at the time of diagnosis and after 2 weeks of reduced maternal intake of prostaglandin inhibitors either by suspending the use of pharmacological agents with potential for prostaglandin inhibition or by restricting the consumption of polyphenol-rich foods. MPAP was estimated using the Dabestani equation (MPAP = 90 - (0.62 × AT)), and pulmonary vascular maturity was assessed using the AT/ET ratio, according to reported validation studies. Student's t-test was used for comparison of variables at diagnosis with those after reversal of ductal constriction. Change in MPAP and pulmonary AT/ET ratio between the two assessments was compared with the expected change in the same gestational period in normal fetuses based on reference curves of MPAP and pulmonary AT/ET ratio constructed in normal fetuses from healthy pregnant women at 19-37 weeks' gestation, encompassing the same gestational age range as the study group (28-37 weeks). RESULTS Seventy pregnancies with fetal ductus arteriosus constriction were included in the study. After 2 weeks of reduced maternal intake of prostaglandin inhibitors, normalization of mean systolic (change from 1.86 ± 0.34 m/s at diagnosis to 1.38 ± 0.41 m/s; P

Made available in DSpace on 2019-09-12T16:56:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2019 Introduction: In intrauterine growth restriction (IUGR), increased uteroplacental vascular impedance contributes to preferential flow to left ventricle (LV), with consequent alteration of its compliance and increased left atrial (LA) pressure. Pulmonary vein pulsatility index (PVPI) reflects the increased impedance to LA filling and could be used as a cardiac monitoring parameter in IUGR. Material and Methods: A total of 27 IUGR fetuses (group 1), 28 fetuses with appropriate growth for gestational age from hypertensive mothers (group 2), and 28 controls (group 3) were studied. Pulsatility indices (PIs) of pulmonary veins and ductus venosus were calculated by Doppler echocardiography. Obstetric ultrasound was used to assess the PIs of uterine, umbilical, and middle cerebral arteries. Statistical analysis used analysis of variance, post-hoc Tukey, and Pearson's tests. Results: Mean PVPI was higher in IUGR group (1.27 +/- 0.39) when compared to groups 2 (1.02 +/- 0.37; p = 0.01) and 3 (0.75 +/- 0.12; p < 0.001). In group 2, moderate correlation between PVPI and ductus venosus pulsatility index (DVPI) was found but not between PVPI and cerebroplacental ratio (CPR). Discussion: Higher PVPI in IUGR reflects decreased LV compliance and altered LA dynamics. As LV dysfunction precedes right ventricle, our results suggest that PVPI could be an early echocardiographic parameter of fetal diastolic function in IUGR. (c) 2018 S. Karger AG, Basel [Bravo-Valenzuela, Nathalie J. M.; Zielinsky, Paulo; Zurita-Peralta, Jesus; Nicoloso, Luiz Henrique; Piccoli, Antonio, Jr.; Van der Sand, Luiza Ferreira; Sulis, Natassia Miranda; Ritter, Camila Carvalho] Inst Cardiol, Fetal Cardiol Unit, Av Princesa Isabel 370, BR-620001 Porto Alegre 90, RS, Brazil [Bravo-Valenzuela, Nathalie J. M.] Universidade de Taubaté (Unitau), Fetal Med

Background. Foramen ovale (FO) flow may be altered in IUGR. This study was designed to test this hypothesis. Methods. Forty pregnant women (24–38 weeks) were divided into 3 groups: group I (IUGR), group II (adequate growth and maternal hypertension), and group III (normal controls). Impedance across the FO was assessed by the FO pulsatility index (FOPI): (systolic velocity − presystolic velocity)/mean velocity. Statistical analysis utilized ANOVA, Tukey test, and ROC curves. Results. Mean FOPI in IUGR fetuses (n = 15) was 3.70 ± 0.99 (3.15–4.26); in the group II (n = 12), it was 2.84 ± 0.69 (2.40–3.28), and in the group III (n = 13), it was 2.77 ± 0.44 (2.50–3.04) (p=0.004). FOPI and UtA RI were correlated (r = 0.375, p=0.017), as well as FOPI and UA RI (r = 0.356, p=0.024) and, inversely, FOPI and MCA RI (r = −0.359, p=0.023). Conclusions. The FO flow pulsatility index is increased in fetuses with IUGR, probably as a result of impaired left ventricular diastolic function.

Objective To test the hypothesis that the pulmonary vein pulsatility index (PVPI) is higher in fetuses with growth restriction (IUGR) than in normal fetuses. Methods Twenty-two fetuses with IUGR and twenty-one (21) fetuses with appropriate growth for gestational age from healthy mothers were studied. PVPI was calculated by Doppler echocardiography [maximal velocity (systolic or diastolic peak) − pre-systolic peak / mean velocity]. Obstetric ultrasound was used to assess fetal biometry and Doppler to assess the uterine, umbilical and middle cerebral arteries PI. Statistical analysis used t test and Pearson's correlation. Results Mean gestational age was 31.5 +/− 2.1 weeks in the control group and 31.4 +/− 3.1 weeks in IUGR (P = 0.91). The PI of uterine and umbilical arteries were higher in IUGR than in controls (P

OBJECTIVE Anti-inflammatory substances that inhibit the synthesis of prostaglandins, such as non-steroidal anti-inflammatory drugs (NSAIDs) and polyphenol-rich foods, can cause constriction of the fetal ductus arteriosus. This study aimed to test the hypothesis that reversal of fetal ductal constriction after maternal restriction of polyphenol-rich foods, in the third trimester of pregnancy, is accompanied by increased plasma levels of prostaglandin E2 (PGE2). METHODS This was a controlled clinical trial of women with singleton pregnancy ≥ 28 weeks undergoing fetal echocardiography. The intervention group included pregnancies with diagnosis of fetal ductal constriction and not exposed to NSAIDs. The control group consisted of third-trimester normal pregnancies. Both groups answered a food frequency questionnaire to assess the amount of total polyphenols in their diet, underwent Doppler echocardiographic examination and had blood samples collected for analysis of plasma levels of PGE2. Intervention group participants received dietary guidance to restrict the intake of polyphenol-rich foods. The assessments were repeated after 2 weeks in both groups. RESULTS Forty normal pregnancies were assessed in the control group and 35 with fetal ductal constriction in the intervention group. Mean maternal age (26.6 years) and mean body mass index (30.12 kg/m2 ) were similar between the two groups. Intragroup analysis showed that dietary guidance reduced the median consumption of polyphenols (from 1234.82 to 21.03 mg/day, P

Anti-inflammatory property of polyphenols and their effect on the metabolism of prostaglandins is not established in healthy humans. This study aimed to evaluate the effect of polyphenol supplementation in plasma levels of prostaglandin E2 and other markers of inflammation and oxidative stress in women using contraceptives. In this randomized double-blind clinical trial, women aged 25-35 years were selected. Participants received capsules containing polyphenols or placebo, to be consumed for fifteen days. From 40 women randomized, 28 completed the study. Control group showed a significant increase in the levels of PGE2 (p=0.01) while the polyphenols group showed no change in these levels (p=0.79). There was an increase in hs-CRP (p

Objective Because we have previously demonstrated the relation between polyphenol-rich foods (PRF) consumption and ductus arteriosus constriction, in this work, pregnant sheep were submitted to oral PRF intake for 14days to understand how this process occurs. Fetal Doppler echocardiography, oxidative and inflammatory biomarkers and total polyphenol excretion were evaluated. Results The high polyphenol intake induced ductus arteriosus constriction by 71.6% increase in systolic (P=0.001) and 57.8% in diastolic velocities (P=0.002), and 18.9% decrease in pulsatility index (P=0.033), along with 1.7-fold increase in total polyphenol excretion, 2.3-fold decrease in inflammatory mediator nitric oxide and following redox status changes (mean±standard deviation): higher protein carbonyls (1.09±0.09 and 1.49±0.31), catalase (0.69±0.39 and 1.44±0.33) and glutathione peroxidase (37.23±11.19 and 62.96±15.03) in addition to lower lipid damage (17.22±2.05 and 12.53±2.11) and nonprotein thiols (0.11±0.04 and 0.04±0.01) found before and after treatment, respectively. Ductal parameters correlated to NOx, catalase, glutathione peroxidase and protein carbonyl. Conclusion Our results highlight the need to reduce maternal PRF intake in late pregnancy to prevent fetal duct constriction through NO-mediated vasoconstrictive action of polyphenols. © 2014 John Wiley & Sons, Ltd.

Introduction Diastolic dysfunction may occur in fetuses with intrauterine growth restriction (IUGR) and may be assessed by myocardial tissue Doppler (MTD). We previously have shown that excursion index of the septum primum (EISP) is reduced in IUGR fetuses over 30 weeks because of a higher left atrial pressure. Patients, Setting, and Design The sample was made up of 14 fetuses with IUGR. MTD examination was carried out with the sample volume placed at the basal lateral wall of the left ventricle (LV), interventricular septum (IVS), and free wall of the right ventricle (RV) to determine E′/A′ ratios. EISP was calculated as the ratio between the maximal excursion of the septum primum into the left atrium during diastole and the maximal diastolic diameter of the left atrium. Mitral and tricuspid flows were assessed by the conventional Doppler method. Outcome Measures Pearson's correlation test was used to analyze the correlations between the parameters. Results A positive correlation was observed between UARI and E′/A′ ratios for RV (r = 0.63, P = .02), IVS (r = 0.59, P = .03), and LV (r = 0.41, P = .15). There was a negative correlation between EISP and IVS E′/A′ ratios (r = −0.58, P = .03), and a positive correlation for LV (r = 0.49, P = .08). At the RV position, a weak negative correlation was observed (r = −0.32, P = .26). Conclusions A higher left atrial pressure in fetuses with IUGR, indicated by the lower mobility of the septum primum, is accompanied by higher ratios between early and late diastolic myocardial velocities. Placental dysfunction was correlated to septal E′/A′ ratios. Fetal MTD can be a useful method to assess severity of placental dysfunction and fetal distress.

FUNDAMENTOS: Recentemente demonstramos reversao da constricao ductal fetal apos reducao da ingesta materna de alimentos ricos em polifenois (ARP), por sua acao inibidora da sintese das prostaglandinas. OBJETIVOS: Testar a hipotese de que fetos normais no 3o trimestre tambem melhoram a dinâmica ductal apos restricao materna de polifenois. METODOS: Ensaio clinico aberto com 46 fetos com idade gestacional (IG) > 28 semanas submetidos a dois estudos Dopplerecocardiograficos com intervalo de duas semanas, sendo os examinadores cegados para os habitos alimentares maternos. Um questionario de frequencia alimentar validado para esse objetivo foi aplicado e uma dieta com alimentos pobres em polifenois (< 30 mg/100 mg) foi orientada. Um grupo controle de 26 fetos no 3o trimestre foi submetido ao mesmo protocolo. Utilizou-se o teste-t para amostras independentes. RESULTADOS: A IG media foi 33 ± 2 semanas. A media do consumo materno diario de polifenois (CMDP) foi 1277 mg, caindo para 126 mg apos orientacao (p = 0,0001). Ocorreu diminuicao significativa nas Velocidades Ductais Sistolica (VSD) e Diastolica (VDD) e na relacao dos diâmetros ventriculares (VD/VE), assim como aumento do indice de pulsatilidade (IP) [VSD = 1,2 ± 0,4 m/s (0,7-1,6) para 0,9 ± 0,3 m/s (0,6-1,3) (p = 0,018);VDD = 0,21 ± 0,09 m/s (0,15-0,32) para 0,18 ± 0,06 m/s (0,11-0,25) (p = 0,016); relacao VD/VE = 1,3 ± 0,2 (0,9-1,4) para 1,1 ± 0,2 (0,8 - 1,3) (p = 0,004); IP do ducto = 2,2 ± 0,03 (2,0-2,7) para 2,4 ± 0,4 (2,2-2,9) (p = 0,04)]. A IG media dos controles foi de 32 ± 4 semanas, nao ocorrendo diferencas significativas no CMDP, nas velocidades ductais, no IP do ducto e na relacao VD/VE. CONCLUSAO: A restricao da ingesta de alimentos ricos em polifenois no 3o trimestre por duas semanas melhora a dinâmica do fluxo no ducto arterioso fetal e as dimensoes do VD.

Objectives The aim of this study was to test the hypothesis that experimental maternal intake of green tea in late pregnancy causes fetal ductus arteriosus constriction, probably because of prostaglandin inhibition. Methods and Results Twelve fetal lambs (pregnancy > 120 days) were assessed before and after maternal administration of green tea (n = 8) or water (n = 4; controls) as the only source of liquid. After 1 week, echocardiography showed signs of constriction of the ductus arteriosus in all fetuses from mothers ingesting green tea, with increase in mean systolic velocity(from 0.70 ± 0.19 m/s to 0.92 ± 0.15 m/s, 31.4%, p = 0.001) and mean diastolic velocity (0.19 ± 0.05 m/s to 0.31 ± 0.01 m/s, 63.1%, p

To test the hypothesis that maternal restriction of polyphenol-rich foods (PRF), which, like non-steroidal anti-inflammatory drugs (NSAID), inhibit prostaglandin synthesis in the third trimester, reverse fetal ductal constriction (DC).An open clinical trial of 51 third trimester fetuses with DC with no history of NSAID intake was designed. All mothers were submitted to a food frequency questionnaire and were oriented to withdrawl PRF, being reassessed after 3 weeks. Doppler parameters were assessed before and after discontinuation of these substances. A control group of 26 third trimester normal fetuses, with no ductus arteriosus (DA) constriction, in which no dietary intervention was offered, was reviewed after 3 weeks. Student's t-test and Wilcoxon's test were used.Mean gestational age was 32±3 weeks (28 to 37 weeks). After discontinuation of PRF (≥3 weeks), 48/51 fetuses (96%) showed complete reversal of DC, with decrease in mean ductal systolic velocity (1.74±0.20 m s(-1) to 1.31±0.34 m s(-1), P0.001), mean diastolic velocity (0.33±0.09 m s(-1) to 0.21±0.07 m s(-1), P0.001) and mean right to left ventricular dimension ratio (1.37±0.26 to 1.12±0.17, P0.001) and increase in mean ductal pulsatility index (PI) (1.98±0.36 to 2.46±0.23, P0.001). Median daily maternal consumption of PRF was 286 mg per day and decreased after orientation to 0 mg per day, P0.001. In the control group, with GA of 32±4 w (29-37 w), there was no significant differences in median daily maternal consumption of PRF, mean ductal systolic velocitiy, diastolic velocity, PI and right ventricular to left ventricular diameter ratio (RV/LV) ratio.Reduction of maternal PRF intake during pregnancy, especially in the third trimester, is followed by complete reversal of DC (wide open DA), which may influence maternal dietary habits in late pregnancy.

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

Foramen ovale (FO) flow may be altered in IUGR. This study was designed to test this hypothesis.Forty pregnant women (24-38 weeks) were divided into 3 groups: group I (IUGR), group II (adequate growth and maternal hypertension), and group III (normal controls). Impedance across the FO was assessed by the FO pulsatility index (FOPI): (systolic velocity - presystolic velocity)/mean velocity. Statistical analysis utilized ANOVA, Tukey test, and ROC curves.Mean FOPI in IUGR fetuses (The FO flow pulsatility index is increased in fetuses with IUGR, probably as a result of impaired left ventricular diastolic function.

ObjectiveTo test the hypothesis that, in diabetic pregnancies, left atrial shortening fraction (LASF) is decreased in fetuses with myocardial hypertrophy, compared to those without hypertrophy and to fetuses of non-diabetic mothers. MethodsFetal echocardiography was performed in women with pre-existing or gestational diabetes and in non-diabetic controls between 25 weeks’ gestation and term. LASF was calculated using the formula: (end-systolic diameter – end-diastolic diameter)/end-systolic diameter, and data were compared between diabetic women with and without fetal myocardial hypertrophy and controls. ResultsThe study population comprised 53 diabetic women and 45 controls. Out of the 53 fetuses of diabetic women, 14 had myocardial hypertrophy and 39 had normal septal thickness. Gestational age at the time of examination did not differ significantly between the control group and the two diabetic subgroups (P=0.57). Fetuses with myocardial hypertrophy presented a mean (±SD)LASFof0.32±0.11, those without myocardial hypertrophy 0.46±0.12, and those of normal mothers 0.53±0.09 (P

ObjectiveTo identify the presence of ventricular diastolic dysfunction by tissue Doppler in fetuses of diabetic mothers, with or without septal hypertrophy, in comparison to fetuses of nondiabetic mothers.MethodsA contemporary transverse study in fetuses with a gestational age between 25 weeks to term, studying diastolic function by assessment using tissue Doppler and pulsed wave Doppler of the atrioventricular diastolic flow. The mothers of the fetuses all had previous or gestational diabetes, and were referred to the Fetal Cardiology Unit of the Institute of Cardiology in Porto Alegre, Brazil. We analysed variance with the Student-Neumann-Keuls post hoc test. An alfa of 0.05 was considered significant for statistical analysis.ResultsThe mean myocardial velocities of the E′and A′ waves at the mural mitral annulus, in fetuses of diabetic mothers with myocardial hypertrophy, were, respectively, 7.00 plus or minus 1.6 centimetres per second, and 10.24 plus or minus 3.3 centimetres per second. In the fetuses of diabetic mothers group without myocardial hypertrophy, the comparable values were 7.19 plus or minus 2.4 centimetres per second and 10.77 plus or minus 3.77 centimetres per second, respectively. In the control group, they were 4.81 plus or minus 0.85 centimetres per second and 8.01 plus or minus 2.2 centimetres per second. The difference between the velocities in fetuses of diabetic mothers and in fetal normal mothers was statistically significant (p less than 0.05). Statistically significant differences were also observed in E′ and A′ diastolic waves at the aortic mitral annulus, as well as for the tricuspid annulus when tissue Doppler assessment was carried out in the same sample. The mean ratio between the E and E′ of mitral and tricuspid waves in the control fetuses of normal mothers was significantly higher than in fetuses of diabetic mothers.ConclusionPulsed tissue Doppler, when used in fetuses of diabetic mothers and compared with fetuses of nondiabetic mothers, shows evidence of impaired diastolic function, independently of the presence of myocardial hypertrophy.

Alternative methods to assess ventricular diastolic function in the fetus are proposed. Fetal myocardial hypertrophy in maternal diabetes was used as a model of decreased left ventricular compliance (LVC), and fetal respiratory movements as a model of increased LVC. Comparison of three groups of fetuses showed that, in 10 fetuses of diabetic mothers (FDM) with septal hypertrophy (SH), the mean excursion index of the septum primum (EISP) (ratio between the linear excursion of the flap valve and the left atrial diameter) was 0.36 +/- 0.09, in 8 FDM without SH it was 0.51 +/- 0.09 (P=0.001), and in the 8 normal control fetuses (NCF) it was 0.49 +/- 0.12 (P=0.003). In another study, 28 fetuses in apnea had a mean EISP of 0.39 +/- 0.05 which increased to 0.57 +/- 0.07 during respiration (P0.001). These two studies showed that the mobility of the septum primum was reduced when LVC was decreased and was increased when LVC was enhanced. Mean pulmonary vein pulsatility was higher in 14 FDM (1.83 +/- 1.21) than in 26 NCF (1.02 +/- 0.31; P=0.02). In the same fetuses, mean left atrial shortening was decreased (0.40 +/- 0.11) in relation to NCF (0.51 +/- 0.09; P=0.011). These results suggest that FDM may have a higher preload than normal controls, probably as a result of increased myocardial mass and LV hypertrophy. Prenatal assessment of LV diastolic function by fetal echocardiography should include analysis of septum primum mobility, pulmonary vein pulsatility, and left atrial shortening.

Objective Because fetal respiratory movements increase left ventricular compliance, we hypothesized that the left atrial shortening fraction increases during fetal respiratory motions. Methods A group of 26 normal fetuses with gestational ages between 28 and 38weeks were assessed in a prospective cross-sectional study. Left atrial telesystolic and presystolic diameters were measured during apnea and after five consecutive respiratory movements. Left atrial shortening fraction was obtained by the ratio: [maximal left atrium diameter (telesystolic)– minimal left atrium diameter (presystolic)]/maximal left atrium diameter (telesystolic). The mean of three measurements were considered. Two-tailed Student’st-test was used. Results Mean gestational age was (mean SD) 30.7 2.8weeks. Mean left atrial telesystolic diameter in apnea was 10.6 0.7mm and during respiratory movements it was 10.5 1.1mm (p=0.98). Presystolic left atrial diameter was 5.2 0.1mm in apnea and 4.4 1.3mm during respiratory movements (p

Objective To test the hypothesis that there are differences in the level of maternal–fetal attachment before and after fetal echocardiography in the presence or absence of cardiac abnormalities. Study design Cohort study in which the mothers responded to a validated Maternal–Fetal Attachment Scale. The study compared a group of pregnant women with diagnosis of fetal heart disease (FHD) with a group without this diagnosis (“no fetal heart disease” – NFHD). Results 197 pregnant women were included, 96 FHD and 101 NFHD. Maternal–fetal attachment at the initial and final periods showed no significant baseline differences between groups (p = 0.081). At the final period, migration from medium to high level of attachment was significantly higher in FHD (p = 0.017). Transition from medium to high levels comparing the initial and final periods was more pronounced in FHD (p = 0.009). Conclusion Diagnosis of fetal heart disease increases the level of maternal–fetal attachment.

Fetal ductus arteriosus constriction is a clinical disorder that occurs as a result of inhibition of the prostaglandin synthesis pathway, and has long been associated to maternal intake of nonsteroidal anitiinflammatory drugs in late pregnancy. As a consequence of an increased right ventricular pressure, with tricuspid regurgitation and heart failure, there is a risk for the development of neonatal pulmonary artery hypertension. This artcile reviews the basic knowledge of the mechanisms involved in this important disorder. Clinical and experimental evidence that maternal consumption of polyphenol-rich substances, such as herbal teas, orange and grape juice, chocolate, and others, may interfere with fetal ductus arteriosus dynamics are discussed. Preventive measures to avoid fetal ductal constriction in the third trimester of pregnancy are discussed, including the possible need to change maternal dietary orientation, aiming to limit ingestion of foods with high concentrations of polyphenol-rich substances.

Objective. To test the hypothesis that fetal pulmonary venous flow pulsatility index is lower during fetal respiratory movements than in apnea. Design. Case control. Settings/Patients. Twenty-two normal fetuses of mothers without systemic disease were examined in apnea (controls) and in the presence of fetal respiratory movements (cases). Fetuses were examined by prenatal Doppler echocardiography with color flow mapping. The pulsatility index of the pulmonary vein was obtained by placing the pulsed Doppler sample volume over the right upper or left lower pulmonary vein, and calculating the ratio (maximum velocity [systolic or diastolic]–presystolic velocity/mean velocity). Results. Mean gestational age was 28.9 ± 2.9 weeks. During fetal apnea, mean systolic, diastolic, and presystolic velocities were, respectively, 0.35 ± 0.08 m/s, 0.26 ± 0.07 m/s, and 0.09 ± 0.03 m/s. In the presence of fetal respiratory movements, mean systolic, diastolic, and presystolic velocities were, respectively, 0.33 ± 0.1 m/s, 0.28 ± 0.08 m/s, and 0.11 ± 0.04 m/s. Pulsatility index pulmonary vein in apnea was 1.25 ± 0.23 (1.69 to 0.82), and during fetal respiratory movements it was 0.97 ± 0.2 (1.53 to 0.61). Conclusion. We showed a significant reduction in impedance of pulmonary venous flow, represented by pulmonary vein pulsatility index, during fetal respiratory movements, reflecting modifications of the left atrial dynamics and enhancement of left ventricular compliance.

Objective: To test the hypothesis that maternal consumption of polyphenol-rich foods during third trimester interferes with fetal ductal dynamics by inhibition of prostaglandin synthesis. Study Design: In a prospective analysis, Doppler ductal velocities and right-to-left ventricular dimensions ratio of 102 fetuses exposed to polyphenol-rich foods (daily estimated maternal consumption >75th percentile, or 1089 mg) were compared with 41 unexposed fetuses (flavonoid ingestion

Purpose. To test the hypothesis that the linear displacement of the septum primum (SP) is lower in fetuses with intrauterine growth restriction (IUGR) than in fetuses with appropriate growth for gestational age (AGA). Methods. In a cross-sectional study, the ratio between the SP displacement and left atrial diameter (excursion index [EI]) was compared in 27 fetuses with IUGR (group 1), 24 fetuses with AGA of hypertensive mothers (group 2), and 35 controls (group 3). Flow through the atrioventricular (AV) valves and the umbilical artery resistance index (RI) were also compared. Results. Irrespective of gestational age, mean EI in group 1 (0.41 ± 0.07) was significantly lower than in group 2 (0.48 ± 0.07; p < 0.001) and than in group 3 (0.50 ± 0.06; p < 0.001), with no significant differences between groups 2 and 3. In fetuses over 30 weeks of gestation of group 1, EI was lower (0.38 ± 0.05) than in group 2 (0.49 ± 0.07) and group 3 (0.51 ± 0.06; p < 0.001). There was significant inverse correlation between EI and RI (r = 0.46; p < 0.01) and no correlation between EI and AV flow velocities. Conclusions. SP mobility is reduced in fetuses over 30 weeks with IUGR compared with AGA fetuses. These findings may depend on alterations of left ventricular diastolic function and are correlated to the degree of placental insufficiency. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009

To compare a group of fetuses whose mothers had acute or recent toxoplasmosis with a group of fetuses whose mothers had no systemic disease, analyzing the presence of changes in endocardial refringence.This study assessed 91 fetuses of mothers diagnosed with acute or recent toxoplasmosis, detected by seroconversion or the presence of elevated IgM and IgG titers, confirmed through the IgM-capture ELISA. They were compared with a control group comprising 182 fetuses selected from a low-risk population participating in a prenatal screening program for heart diseases.No significant difference was observed between the mean gestational (29.2+/-4.6 weeks; 29.2+/-4.6 weeks) and maternal (25.7+/-6.7 years; 26+/-5.4 years) ages in the 2 groups. Areas of endocardial hyperechogenicity were observed in 69 fetuses whose mothers had toxoplasmosis (75.8%) and in only 6 fetuses of the control group (3.3%) (P0.001). In 52 patients of the group studied (75.4%), endocardial hyperrefringence was diffuse, and, in 17 (24.3%), it was focal. In the control group, focal distribution was observed in 5 fetuses (83.3%).The prenatal echocardiographic image of focal or diffuse endocardial hyperrefringence is more prevalent in pregnancies with maternal toxoplasmosis than in the healthy ones, and an association between fetal endocardial hyperechogenicity and maternal disease exists.

OBJETIVO: Testar a hipótese de que a fração de encurtamento atrial esquerda seja menor nos fetos de mães diabéticas do que em fetos de mães sem doenças sistêmicas. MÉTODOS: Foram examinados, por ecocardiografia, 42 fetos de mães com diabetes prévio ou gestacional e 39 fetos normais de mães sem doença sistêmica (controles), com idades gestacionais a partir da 25ª semana até o termo. A fração de encurtamento atrial esquerda foi obtida pelo quociente diâmetro máximo do átrio esquerdo (AE) - diâmetro mínimo AE/diâmetro máximo AE. Os dados foram comparados pelo teste t de Student, com um alfa crítico de 0,05. RESULTADOS: Os filhos de mães diabéticas apresentaram fração de encurtamento atrial esquerda média de 0,39 ± 0,15 e os fetos do grupo controle de 0,51 ± 0,11. Esta diferença foi significativa, com p < 0,001. CONCLUSÃO: A dinâmica atrial esquerda, com diminuição do seu encurtamento global, está acentuada nos filhos de mães diabéticas. Especulamos que este parâmetro possa ser útil na avaliação da função diastólica ventricular esquerda fetal. OBJECTIVE: To test the hypothesis that left atrial shortening fraction is lower in fetuses of diabetic mothers than in fetuses of mothers with no systemic disease. METHODS: Forty-two fetuses of mothers with previous diabetes or gestational diabetes and 39 healthy fetuses of mothers with no systemic disease (controls) underwent echocardiographic examination. Their gestational ages ranged from 25 weeks to term. The left atrial shortening fraction was obtained with the following formula: (left atrial maximum diameter - left atrial minimum diameter)/left atrial maximum diameter. Data were compared using the Student t test, with an alpha level of 0.05. RESULTS: Mean left atrial shortening fractions in fetuses of diabetic mothers and in those in the control group were 0.39±0.15 and 0.51±0.11, respectively. This difference was significant with P < 0.001. CONCLUSION: Left atrial dynamics, with a reduction in global left atrial shortening, is increased in fetuses of diabetic mothers. We speculate that this parameter may be useful in assessing fetal left ventricular diastolic function.

OBJETIVO: Estudar, comparativamente, um grupo de fetos de mães com toxoplasmose aguda ou recente e um grupo sem doença sistêmica, analisando-se a presença de alterações da refringência endocárdica. MÉTODOS: Avaliados 91 fetos cujas mães tinham diagnóstico de toxoplasmose aguda ou recente, detectados por soroconversão ou presença de títulos elevados de IgM e IgG, confirmados através do teste de captura e comparados com um grupo controle constituído de 182 fetos, selecionados a partir de uma população de baixo risco, participante de um programa de rastreamento de cardiopatias pré-natais. RESULTADOS: Não houve diferença significativa entre as idades médias gestacionais (29,2±4,6 semanas; 29,2±4,6 semanas) e maternas (25,7±6,7 anos; 26±5,4 anos) nos dois grupos. Áreas de hiperecogenicidade endocárdica observadas em 69 fetos com toxoplasmose materna (75,8%) e em apenas 6 fetos do grupo controle (3,3%) (p

OBJECTIVE: To verify the hypothesis that the pulmonary vein pulsatility index is higher in fetuses of diabetic mothers than it is in normal fetuses of nondiabetic mothers. METHODS: Twenty-four fetuses of mothers with either gestational or previous diabetes (cases), and 25 normal fetuses of mothers without systemic disease (control) were examined. Fetuses were examined through prenatal Doppler and color flow mapping. The pulmonary vein pulsatility index was obtained by placing the pulsed Doppler sample volume over the right superior pulmonary vein and applying the formula (systolic velocity - presystolic velocity)/mean velocity. RESULTS: The mean gestational age of the study fetuses was 30.3±2.7 weeks, and gestational age of the controls was 29±3.3 weeks, with no significant difference in gestational age between groups (p=0.14). Fetuses of diabetic mothers had a mean pulmonary vein pulsatility index of 1.6±1, and those of the control group had an index of 0.86±0.27. CONCLUSION: Fetuses of diabetic mothers had pulmonary vein pulsatility indexes (parameter easily obtained through Doppler echocardiography that may be related to fetal diastolic function) higher than those in fetuses of mothers with normal glycemia.

Maternal consumption of polyphenol-rich foods interferes with fetal ductus arteriosus flow in humans and its restriction reverses ductal constriction. We aimed to assess experimentally the interrelations of ductal dynamics, oxidative damage and polyphenol excretion after a high polyphenol intake in

Myocardial performance is diminished in persistent SVT and will lead to hydrops fetalis (HDF). This study sought to determine which methods of fetal echocardiography are best for evaluating treatment and outcome in these fetuses. Methods: Ten infants with HDF due to SVT were included in this study. No fetus has structural heart disease. Serial cardiovascular function was estimated from CC/TC ratio, left ventricular shortening fraction, tricuspid E and A velocities and E/A ratio, mitral E, A velocities and E/A ratio and Doppler flow patterns in the free loop of the umbilical cord, MCA, ductus arteriosus and ductus venosus (DV) as well as maximal velocities and time velocity integrals into the ascending aorta and main pulmonary artery. The Tei index was calculated as the sum of the isovolumetric contraction time (ICT) and the isovolumetric relaxation time (IRT) divided by the ejection time using the ‘‘clicks’’ method. These parameters were compared to age matched normal fetuses from our data base. Changes in the gross measurements of third space effusions were considered demonstrable of improvement of fetal cardiovascular status. Results: The most sensitive indicator of change in fetal function was the Tei index followed by CC/TC ratio. Tei index is the first cardiovascular parameter which gets normalised in these fetuses responding to the treatment. There was no significant change over time with E/A ratios, LV shortening fraction or peripheral arterial Doppler values. DV A wave reversal normalized with cessation of SVT with normal PI values. DV size went from greater than the 95% to normal with cessation of SVT. Conclusions: The Tei index easily performed from 14 weeks through term. It is a useful and likely the most sensitive method of evaluating global myocardial performance in followup of fetuses with HDF especially due to SVT.

Objectives: We have already demonstrated that maternal consumption of beverages with high polyphenol compounds causes fetal ductal constriction, as a result of COX-2 and prostaglandin inhibition. This study tested the hypothesis that in normal pregnancies maternal ingestion of polyphenol-rich common beverages (MIPRB) interferes with fetal ductal flow velocities and with the size of the right ventricle. Methods: A prospective analysis of 140 third-trimester fetuses from normal mothers was carried out, determining systolic and diastolic ductal flow velocities (DFV) and right to left ventricular dimension ratio. Mean gestational age was 28.4 ± 3.1 weeks (range, 23–38 weeks). A questionnaire was applied about MIPRB during pregnancy (herbal teas, mate tea and grape derivatives). Results: The group of 100 fetuses whose mothers declared to have used herbal teas or grape juice derivatives showed higher mean systolic (0.96 ± 0.23 m/s) and diastolic (0.17 ± 0.05 m/s) DFV, as well as higher mean RV/LV ratio (1.23 ± 0.23) than the group of 40 fetuses whose mothers had not utilized these substances (mean systolic velocity: 0.61 ± 0.18 m/s, P 0.85 m/s (P 0.15 m/s (P 1.1 (P < 0.001, relative risk = 27.6; 95% CI, 3.96–192.01), independently of gestational age. Conclusions: Ductal flow velocities are higher and right ventricular to left ventricular dimension ratios are larger in fetuses exposed to maternal ingestion of polyphenol-rich substances than in those not exposed. It seems clear that the ductal flow response to consumption of polyphenols during pregnancy is not a categorical parameter, but rather a continuous dose-dependent variable.