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Reference Ranges for Pulsed-Wave Doppler of the Fetal Cardiac Inflow and Outflow Tracts from 13 to 36 Weeks’ Gestation

Research output: Contribution to journalArticlepeer-review

Vita Zidere, Trisha V. Vigneswaran, Argyro Syngelaki, Marietta Charakida, Lindsey D. Allan, Kypros H. Nicolaides, John M. Simpson, Ranjit Akolekar

Original languageEnglish
Pages (from-to)1007-1016.e10
JournalJournal of The American Society of Echocardiography
Volume34
Issue number9
DOIs
Accepted/In press2021
PublishedSep 2021

Bibliographical note

Funding Information: We wish to acknowledge the input of the late Dr. Ian C. Huggon, who supervised and performed many of the echocardiographic examinations and helped drive the standards of fetal echocardiography within the unit. Publisher Copyright: © 2021 American Society of Echocardiography Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

Background: Doppler assessment of ventricular filling and outflow tract velocities is an integral part of fetal echocardiography, to assess diastolic function, systolic function, and outflow tract obstruction. There is a paucity of prospective data from a large sample of normal fetuses in the published literature. The authors report reference ranges for pulsed-wave Doppler flow of the mitral valve, tricuspid valve, aortic valve, and pulmonary valve, as well as heart rate, in a large number of fetuses prospectively examined at a single tertiary fetal cardiology center. Methods: The study population comprised 7,885 fetuses at 13 to 36 weeks’ gestation with no detectable abnormalities from pregnancies resulting in normal live births. Prospective pulsed-wave Doppler blood flow measurements were taken of the mitral, tricuspid, aortic, and pulmonary valves. The fetal heart rate was recorded at the time of each assessment. Regression analysis, with polynomial terms to assess for linear and nonlinear contributors, was used to establish the relationship between each measurement and gestational age. Results: The measurement for each cardiac Doppler measurement was expressed as a Z score (difference between observed and expected values divided by the fitted SD corrected for gestational age) and percentile. Analysis included calculation of gestation-specific SDs. Regression equations are provided for the cardiac inflow and outflow tracts. Conclusions: This study establishes reference ranges for fetal cardiac Doppler measurements and heart rate between 13 to 36 weeks’ gestation that may be useful in clinical practice.

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