Sonographic Assessment of Fetal Cardiac Function: Introduction and Direct Measurement of Cardiac Function

Zusammenfassung

Die nicht invasive Untersuchung fetaler Blutflussmuster mit Doppler-Ultraschall ist das Hauptwerkzeug zur Beurteilung des Kreislaufzustands bedrohter Feten. Sie erfolgt meist durch eine qualitative Untersuchung peripherer Arterien und, in bestimmten klinischen Situationen wie Wachstumsretardierung oder Volumenüberlastung, auch an herznahen Venen oder an Flussmustern im fetalen Herz, um das Stadium der fetalen Kreislauf-Kompensation zu bewerten. Eine echte quantitative Beurteilung der treibenden Kraft des fetalen Kreislaufs, also die direkte Beurteilung des fetalen Herzauswurfs, ist aber weiterhin ein angestrebtes wichtiges Ziel in der Fetalmedizin. Teil 1 dieser Übersicht beschreibt das Konzept der Untersuchung der fetalen Herzfunktion und des „cardiac output“. Teil 2 fasst die Nutzen der fetalen Doppler-Untersuchungen zusammen und gibt eine Übersicht über die anderen Methoden zur direkten und indirekten Messung der fetalen kardialen Funktion einschließlich neuerer klinischer Anwendungen.

Abstract

Noninvasive blood flow measurements based on Doppler ultrasound studies are the main clinical tool for studying the cardiovascular status in fetuses at risk for circulatory compromise. Usually, qualitative analysis of peripheral arteries and, in particular clinical situations such as severe growth restriction or volume overload, also of venous vessels close to the heart or of flow patterns in the heart are being used to gauge the level of compensation in a fetus. Quantitative assessment of the driving force of the fetal circulation, the cardiac output, however, remains an elusive goal in fetal medicine. This article reviews the methods for direct and indirect assessment of cardiac function and explains new clinical applications. Part 1 of this review describes the concept of cardiac function and cardiac output and the techniques that have been used to quantify output. Part 2 summarizes the use of arterial and venous Doppler studies in the fetus and gives a detailed description of indirect measures of cardiac function (like indices derived from the duration of segments of the cardiac cycle) with current examples of their application.

Key words

echocardiography - ultrasound spectral Doppler - ultrasound 3D/ 4D - fetus - obstetrics

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