Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2020; 8(23): 5866-5875
Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.5866
Correlation between ductus venosus spectrum and right ventricular diastolic function in isolated single-umbilical-artery foetus and normal foetus in third trimester
Tian-Gang Li, Fang Nie, Xiao-Yan Xu
Tian-Gang Li, Xiao-Yan Xu, Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou 730050, Gansu Province, China
Fang Nie, Department of Ultrasound Diagnosis, Lanzhou University Second Hospital, Lanzhou 733000, Gansu Province, China
Author contributions: Li TG carried out imaging, participated in image acquisition and analysis, participated in the design of the study and drafted the manuscript; Nie F participated in the design and coordination of the study; Xu XY conceived of the study, participated in its design and coordination and performed the statistical analysis; All authors read and approved the final manuscript.
Institutional review board statement: The study protocol was approved by the Medical Ethics Committee of Gansu Provincial Maternity and Child-Care Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The data and material in the current study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fang Nie, MD, Chief Doctor, Chief Physician, Professor, Department of Ultrasound Diagnosis, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou 733000, Gansu Province, China. fang_nie_1969@126.com
Received: April 18, 2020
Peer-review started: April 18, 2020
First decision: September 14, 2020
Revised: September 23, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: December 6, 2020
Processing time: 229 Days and 20.7 Hours
Abstract
BACKGROUND

Single umbilical artery (SUA) is the most common umbilical cord malformation in prenatal diagnosis. The presence of an SUA can cause blood circulation disorder in the foetus and functional changes of the foetal heart, affecting foetal circulation. The right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester were evaluated using the spectral Doppler of blood flow in the foetal ductus venosus (DV).

AIM

To evaluate the right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester.

METHODS

Colour Doppler was used to measure the spectrum of foetal DV and tricuspid orifice in 34 foetuses with isolated SUA aged 28-39 wk and in age-matched healthy controls. The DV flow velocities and velocity ratios were measured. The early passive/late active (E/A) ratio at the tricuspid orifice and tissue Doppler Tei index of the foetal right ventricular in the two groups were also measured.

RESULTS

During the third trimester, the isolated SUA group showed a lower ‘a’-wave peak velocity in the DV than the control group (P < 0.05). The correlations between the velocity ratios and E/A ratio at the tricuspid orifice in the two groups were analysed, and the correlation between the ventricular late diastolic velocity/ventricular diastolic peak flow velocity and E/A ratios was the best (R2 of the isolated SUA group: 0.520; R2 of the control group: 0.358). The correlations between the velocity ratios and tissue Doppler Tei index of foetal right ventricular in the two groups were analysed, and the correlation between the pulsatility index for veins (PIV) and tissue Doppler Tei index ratios was the best (R2 of the isolated SUA group: 0.865; R2 of the control group: 0.627).

CONCLUSION

In the isolated SUA group, the atrial systolic peak velocity ‘a’ decreased, and this finding might be related to the changes in foetal cardiac functions. The ratio of ventricular late diastolic velocity to ventricular diastolic peak flow velocity was closely related to the E/A ratio at the tricuspid valve and can be used to identify changes in the right ventricular diastolic functions of isolated SUA and healthy foetuses. PIV was closely related to the tissue Doppler Tei index of the foetal right ventricular and can be used to identify the right ventricular overall functions of isolated SUA and healthy foetuses.

Keywords: Isolated single umbilical artery; Ductus venosus; Velocity; Right ventricular diastolic function; Foetus

Core Tip: Single umbilical artery (SUA) is the most common umbilical cord malformation in prenatal diagnosis. The presence of an SUA can cause blood circulation disorder in the foetus and functional changes of the foetal heart, affecting foetal circulation. We used ductus venosus velocity firstly for the evaluation of right ventricular diastolic function in foetuses with isolated SUA and in those with normal cardiac anatomy. This study performed an objective assessment of the occurrence and development of isolated SUA in foetuses, predicted its prognosis and guided clinical work.