Fetal cardiac function between 11 and 35 weeks' gestation and nuchal translucency thickness

Authors

  • S. A. B. Clur,

    Corresponding author
    1. Department of Paediatric Cardiology of the Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
    2. The Centre for Congenital Heart Anomalies Amsterdam-Leiden, The Netherlands
    • Department of Paediatric Cardiology, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, PO Box 2244, 1100 DD, Amsterdam, The Netherlands
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  • K. Oude Rengerink,

    1. Department of Obstetrics and Gynaecology, Fetal Medicine Unit, Academic Medical Centre, Amsterdam, The Netherlands
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  • B. W. J. Mol,

    1. Department of Obstetrics and Gynaecology, Fetal Medicine Unit, Academic Medical Centre, Amsterdam, The Netherlands
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  • J. Ottenkamp,

    1. Department of Paediatric Cardiology of the Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
    2. The Centre for Congenital Heart Anomalies Amsterdam-Leiden, The Netherlands
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  • C. M. Bilardo

    1. Department of Obstetrics and Gynaecology, Fetal Medicine Unit, Academic Medical Centre, Amsterdam, The Netherlands
    2. Department of Obstetrics and Gynecology, University Medical Centre Groningen, Groningen, The Netherlands
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Errata

This article is corrected by:

  1. Errata: Erratum Volume 38, Issue 4, 486, Article first published online: 20 September 2011

Abstract

Objectives

The pathophysiological background of an increased nuchal translucency (NT) is still poorly understood. Cardiac dysfunction has been proposed as a cause. The aim of this study was to determine if, in fetuses with normal hearts, the NT thickness is related to cardiac function throughout gestation.

Methods

The NT was measured in 191 karyotypically/phenotypically normal fetuses with structurally normal hearts and was increased (≥ 95th centile) in 104. All fetuses had been referred for fetal echocardiography and were prospectively included between October 1 2003 and April 1 2009. Three-hundred and ten echocardiograms were performed between 11 and 35 weeks' gestation. The E- and A-wave velocity, E/A velocity ratio, E/time velocity integral (TVI) ratio over the atrioventricular (AV) valves, myocardial performance index, acceleration time (AT) and peak velocity over the semilunar valves, stroke volume (SV) and cardiac output (CO) as well as the ductus venosus pulsatility index for veins at 11–14 weeks' gestation (DV-PIV), were measured. A multilevel analysis was performed using the NT multiples of the median (MoM) as a continuous variable.

Results

AV-E- and A-wave velocities, E/A velocity ratios, semilunar valve peak velocity, SV, CO and aortic valve (AoV) AT increased significantly with advancing gestation. At 11–14 weeks' gestation, the AoV-AT, tricuspid valve (TV)-E/A, TV-E/TVI ratios and DV-PIV increased, and the pulmonary valve (PV) AT decreased, with increasing NT-MoMs. After midgestation, the PV-AT increased and the AoV-AT, TV-E/A and TV-E/TVI ratios decreased with increasing NT-MoMs.

Conclusions

NT thickness is related to right ventricular diastolic function and semilunar valve AT. Our findings suggest improved first-trimester, but later reduced, right ventricular relaxation and discordant ventricular afterload in fetuses with an increased NT. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

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