Aortic isthmus shunt dynamics in normal and complicated monochorionic pregnancies

作者：Seravalli Viola^*; Block Abraham Dana; McShane Cyrethia; Millard Sarah; Baschat Ahmet; Miller Jena

来源：Prenatal Diagnosis, 2017, 37(9): 924-930.

DOI：10.1002/pd.5115

ObjectiveTo study fetal aortic isthmus (AoI) shunt dynamics in monochorionic (MC) twins.
MethodsNormal and complicated MC pregnancies were prospectively enrolled. The relationship of isthmus flow index (IFI) with Doppler parameters of umbilical artery (UA), descending aorta, middle cerebral artery, and ductus venosus and with left and right ventricular cardiac output and stroke volume was studied.
ResultsThe IFI was obtained in 180 examinations from 48 pregnancies (24 twin-twin transfusion syndrome, TTTS; 4 selective intrauterine growth restriction, sIUGR; 12 TTTS+sIUGR; and 8 uncomplicated). Median gestational age was 20.9weeks. AoI diastolic flow was reversed in three cases. UA pulsatility index (PI) and ductus venosus-PI z-scores were negatively correlated with the IFI (r(s) -0.40 and -0.26, respectively, p<0.001). Regression analysis identified only UA-PI as a determinant of the IFI (p<0.001). The IFI was significantly correlated with left ventricular cardiac output and stroke volume. It did not differ between TTTS donors and recipients. sIUGR fetuses had significantly lower IFI compared with normal-grown counterparts (p<0.001).
ConclusionIn MC gestations, AoI shunting is predominantly determined by placental flow resistance, while cerebral impedance and volume status have no impact. In MC twins, the relationship between AoI flow and outcome deserves further study in the setting of sIUGR.

• 出版日期2017-9