Seravalli Viola, Miller Jena L, Block-Abraham Dana, Baschat Ahmet A
The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA.
Acta Obstet Gynecol Scand. 2016 Jun;95(6):635-44. doi: 10.1111/aogs.12893. Epub 2016 Mar 28.
The ductus venosus has a central role in the distribution of highly oxygenated umbilical venous blood to the heart. Its waveform is related to the pressure-volume changes in the cardiac atria and it is therefore important in the monitoring of any fetal condition that may affect forward cardiac function. The cardiovascular parameters that can influence forward cardiac function include afterload, myocardial performance and preload. Decreased forward flow during atrial systole (a-wave) is the most sensitive and ubiquitous finding when any of these parameters is affected. In contrast, decreased forward velocities during end-systolic relaxation (v-wave) are more specifically related to myocardial performance. The ductus venosus pulsatility index alone does not accurately reflect cardiac function, and in cases of suspected fetal cardiac dysfunction, echocardiography is required to identify the underlying mechanism. The role of ductus venosus Doppler in the assessment of fetal growth restriction, supraventricular tachycardia, fetal hydrops, complicated monochorionic twins and congenital heart disease is discussed with these considerations in mind.
静脉导管在将高氧合的脐静脉血输送至心脏的过程中起核心作用。其波形与心脏心房的压力-容积变化相关，因此在监测任何可能影响心脏前向功能的胎儿状况时很重要。可影响心脏前向功能的心血管参数包括后负荷、心肌性能和前负荷。当这些参数中的任何一个受到影响时，心房收缩期（a波）正向血流减少是最敏感且最常见的表现。相比之下，收缩末期舒张期（v波）正向血流速度降低更具体地与心肌性能相关。仅静脉导管搏动指数不能准确反映心脏功能，在怀疑胎儿心脏功能障碍的情况下，需要超声心动图来确定潜在机制。基于这些考虑，讨论了静脉导管多普勒在评估胎儿生长受限、室上性心动过速、胎儿水肿、复杂性单绒毛膜双胎及先天性心脏病中的作用。
