DOPPLER-ECHOCARDIOGRAPHIC EVALUATION OF VENTRICULAR DIASTOLIC FILLINGIN FETUSES WITH DUCTAL CONSTRICTION

To assess ventricular diastolic filling in fetuses with constriction o f ductus arteriosus, 43 fetuses of pregnant women receiving indomethac in (100 to 150 mg/day) were examined with Doppler echocardiography. Du ctal constriction occurred in 21 fetuses, defined as maximal systolic velocity >140 cm/s and diastolic flow velocity >30 cm/s. The variables measured to assess diastolic function were peak velocity during early diastole (peak E wave), peak velocity during atrial contraction (peak A wave), and the velocity ratio (peak E/A ratio); these were compared to maximal ductal flow velocity during systole and diastole. The mitr al peak E wave, peak A wave, and peak E/A ratio in fetuses with ductal constriction showed no significant difference from those in fetuses w ithout ductal constriction. In fetuses with ductal constriction, the t ricuspid A wave increased significantly without changes in the peak E wave (57 +/- 9 vs 50 +/- 6 cm/s, p <0.01) and the peak E/A ratio was s ignificantly lower than in fetuses without ductal constriction (0.57 /- 0.10 vs 0.65 +/- 0.08, p <0.05). In 9 fetuses with ductal constrict ion, we compared the Doppler tricuspid E wave, A wave, and E/A ratio d uring indomethacin administration with those after withdrawal of the d rug for a mean of 24 hours. Both systolic and diastolic ductal flow ve locities in the fetuses returned to normal range after discontinuation of indomethacin. The tricuspid peak A wave decreased (59 +/- 9 vs 50 +/- 11 cm/s) and the E/A ratio increased significantly (0.56 +/- 0.07 vs 0.69 +/- 0.07) (both p <0.01) without any significant change in pea k E wove after discontinuation of indomethacin. This study suggests th at ductal constriction influences Doppler patterns of right ventricula r diastolic filling. These changes could be related to the increased a fterload presented to the right ventricle which might affect diastolic function. (C) 1997 by Excerpta Medica, Inc.