Echocardiographic assessment of ventricular filling pressure during the second and third trimesters of gestation

Aims To confirm changes in the atrioventricular diastolic flow velocities ( peak E, peak A, E/A ratio) with gestational age and to define whether these changes genuinely reflect variations in filling pressure in the fetal hear t. Methods Fifty normal Pregnancies were studied between the 13th and the 37th weeks of gestation. The fetal flow velocity patterns were evaluated by pul sed-wave (PW) Doppler and the annular velocities of the atrioventricular va lves by PW-Doppler tissue imaging (DTI). Results All indexes evaluated (atrioventricular peak flow and annular veloc ities) correlated significantly with gestational age. This correlation was stronger for the early diastolic indexes (tricuspid E and E-A, 0.69 and 0.7 8; mitral E and E-A, 0.62 and 0.77, respectively) and weaker for the end-di astolic indexes (tricuspid A and A(A), 0.46 and 0.37; mitral A and A(A), 0. 45 and 0.39, respectively). Neither mitral nor tricuspid E/E-a ratio change d significantly with gestational age. Conclusions The lack of correlation between the Doppler-assessed ventricula r filling pressures and gestational age suggests absence of significant cha nges of ventricular compliance during the second and third trimesters of pr egnancy and a progressive enhancement of active relaxation and/or changes i n loading conditions.