Spectral Doppler, tissue Doppler, and speckle-tracking echocardiography for the evaluation of fetal cardiac function: an update

Alberto Borges Peixoto, Nathalie Jeanne Bravo-Valenzuela, Luciane Alves Rocha, Edward Araujo Júnior, Alberto Borges Peixoto, Nathalie Jeanne Bravo-Valenzuela, Luciane Alves Rocha, Edward Araujo Júnior

Abstract

The functional assessment of the fetal heart has been incorporated into cardiac ultrasound screening as a routine procedure, encompassing fetuses with and without structural heart diseases. It has long been known that various cardiac and extracardiac conditions, such as fetal growth restriction, fetal tumors, twin-to-twin transfusion syndrome, fetal anemia, diaphragmatic hernia, arteriovenous fistula with high cardiac output, and congenital heart diseases (valvular regurgitation and primary myocardial disease), can alter hemodynamic status and fetal cardiac function. Several ultrasound and Doppler echocardiographic parameters of fetal cardiovascular disease have been shown to correlate with perinatal mortality. However, it is still difficult to identify the signs of fetal heart failure and to determine their relationship with prognosis. The aim of this study was to review the main two-dimensional Doppler ultrasound parameters that can be used in the evaluation of fetal cardiac function, with a focus on how to perform that evaluation and on its clinical applicability.

Keywords: Echocardiography, Doppler; Echocardiography/methods; Fetal heart; Ultrasonography, Doppler.

Figures

Figure 1
Figure 1
Spectral Doppler imaging showing the E and A waves through the fetal heart mitral valve.
Figure 2
Figure 2
MPI measured by aperture clicks in the Doppler velocity spectrum.
Figure 3
Figure 3
Reference speckle (acoustic point) for measuring the modified MPI using the opening and closing clicks of the fetal heart mitral and aortic valves. A: ICT measured from the beginning of the mitral valve closure click to the beginning of the aortic valve opening click. B: IRT measured from the beginning of the aortic valve closure click and beginning of the mitral valve opening click. C: ET measured from the beginning of the aortic valve (opening click) to the beginning of the aortic valve (closing click).
Figure 4
Figure 4
Peak velocity obtained by spectral tissue Doppler in the right annulus of the fetal heart.
Figure 5
Figure 5
Measurement of peak velocities and RV tissue MPI′ by the assessment of tissue ICT′, tissue IRT′, and tissue ET′.

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