Corrigendum to "Behaviour of the Foramen Ovale Flow in Fetuses with Intrauterine Growth Restriction".

[This corrects the article DOI: 10.1155/2018/1496903.].

Behaviour of the Foramen Ovale Flow in Fetuses with Intrauterine Growth Restriction.

Background: Foramen ovale (FO) flow may be altered in IUGR. This study was designed to test this hypothesis. Methods: Forty pregnant women (24-38 weeks) were divided into 3 groups: group I (IUGR), group II (adequate growth and maternal hypertension), and group III (normal controls). Impedance across the FO was assessed by the FO pulsatility index (FOPI): (systolic velocity - presystolic velocity)/mean velocity. Statistical analysis utilized ANOVA, Tukey test, and ROC curves. Results: Mean FOPI in IUGR fetuses (n = 15) was 3.70 ± 0.99 (3.15-4.26); in the group II (n = 12), it was 2.84 ± 0.69 (2.40-3.28), and in the group III (n = 13), it was 2.77 ± 0.44 (2.50-3.04) (p=0.004). FOPI and UtA RI were correlated (r = 0.375, p=0.017), as well as FOPI and UA RI (r = 0.356, p=0.024) and, inversely, FOPI and MCA RI (r = -0.359, p=0.023). Conclusions: The FO flow pulsatility index is increased in fetuses with IUGR, probably as a result of impaired left ventricular diastolic function.

Myocardial velocities, dynamics of the septum primum, and placental dysfunction in fetuses with growth restriction.

INTRODUCTION: Diastolic dysfunction may occur in fetuses with intrauterine growth restriction (IUGR) and may be assessed by myocardial tissue Doppler (MTD). We previously have shown that excursion index of the septum primum (EISP) is reduced in IUGR fetuses over 30 weeks because of a higher left atrial pressure. PATIENTS, SETTING, AND DESIGN: The sample was made up of 14 fetuses with IUGR. MTD examination was carried out with the sample volume placed at the basal lateral wall of the left ventricle (LV), interventricular septum (IVS), and free wall of the right ventricle (RV) to determine E'/A' ratios. EISP was calculated as the ratio between the maximal excursion of the septum primum into the left atrium during diastole and the maximal diastolic diameter of the left atrium. Mitral and tricuspid flows were assessed by the conventional Doppler method. OUTCOME MEASURES: Pearson's correlation test was used to analyze the correlations between the parameters. RESULTS: A positive correlation was observed between UARI and E'/A' ratios for RV (r = 0.63, P = .02), IVS (r = 0.59, P = .03), and LV (r = 0.41, P = .15). There was a negative correlation between EISP and IVS E'/A' ratios (r = -0.58, P = .03), and a positive correlation for LV (r = 0.49, P = .08). At the RV position, a weak negative correlation was observed (r = -0.32, P = .26). CONCLUSIONS: A higher left atrial pressure in fetuses with IUGR, indicated by the lower mobility of the septum primum, is accompanied by higher ratios between early and late diastolic myocardial velocities. Placental dysfunction was correlated to septal E'/A' ratios. Fetal MTD can be a useful method to assess severity of placental dysfunction and fetal distress.

Restrição materna de polifenóis e dinâmica ductal fetal na gestação normal: um ensaio clínico aberto / Maternal restriction of polyphenols and fetal ductal dynamics in normal pregnancy: an open clinical trial

FUNDAMENTOS: Recentemente demonstramos reversão da constrição ductal fetal após redução da ingesta materna de alimentos ricos em polifenóis (ARP), por sua ação inibidora da síntese das prostaglandinas. OBJETIVOS: Testar a hipótese de que fetos normais no 3º trimestre também melhoram a dinâmica ductal após restrição materna de polifenóis. MÉTODOS: Ensaio clínico aberto com 46 fetos com idade gestacional (IG) > 28 semanas submetidos a dois estudos Dopplerecocardiográficos com intervalo de duas semanas, sendo os examinadores cegados para os hábitos alimentares maternos. Um questionário de frequência alimentar validado para esse objetivo foi aplicado e uma dieta com alimentos pobres em polifenóis (< 30 mg/100 mg) foi orientada. Um grupo controle de 26 fetos no 3º trimestre foi submetido ao mesmo protocolo. Utilizou-se o teste-t para amostras independentes. RESULTADOS: A IG média foi 33 ± 2 semanas. A média do consumo materno diário de polifenóis (CMDP) foi 1277 mg, caindo para 126 mg após orientação (p = 0,0001). Ocorreu diminuição significativa nas Velocidades Ductais Sistólica (VSD) e Diastólica (VDD) e na relação dos diâmetros ventriculares (VD/VE), assim como aumento do índice de pulsatilidade (IP) [VSD = 1,2 ± 0,4 m/s (0,7-1,6) para 0,9 ± 0,3 m/s (0,6-1,3) (p = 0,018);VDD = 0,21 ± 0,09 m/s (0,15-0,32) para 0,18 ± 0,06 m/s (0,11-0,25) (p = 0,016); relação VD/VE = 1,3 ± 0,2 (0,9-1,4) para 1,1 ± 0,2 (0,8 - 1,3) (p = 0,004); IP do ducto = 2,2 ± 0,03 (2,0-2,7) para 2,4 ± 0,4 (2,2-2,9) (p = 0,04)]. A IG média dos controles foi de 32 ± 4 semanas, não ocorrendo diferenças significativas no CMDP, nas velocidades ductais, no IP do ducto e na relação VD/VE. CONCLUSÃO: A restrição da ingesta de alimentos ricos em polifenóis no 3º trimestre por duas semanas melhora a dinâmica do fluxo no ducto arterioso fetal e as dimensões do VD.

BACKGROUND:We have recently demonstrated reversal of fetal ductal constriction after dietary maternal restriction of polyphenol-rich foods (PRF), due to its inhibitory action on prostaglandin synthesis. OBJECTIVE: To test the hyphotesis that normal third trimester fetuses also improve ductus arteriosus dynamics after maternal restriction of polyphenols. METHODS: Open clinical trial with 46 fetuses with gestational age (GA) > 28 weeks submitted to 2 Doppler echocardiographic studies with an interval of at least 2 weeks, being the examiners blinded to maternal dietary habits. A validated food frequency questionnaire was applied and a diet based on polyphenol-poor foods (<30mg/100mg) was recommended. A control group of 26 third trimester fetuses was submitted to the same protocol. Statistics used t test for independent samples. RESULTS: Mean GA was 33±2 weeks. Mean daily maternal estimated polyphenol intake (DMPI) was 1277mg, decreasing to 126mg after dietary orientation (p=0.0001). Significant decreases in systolic (SDV) and diastolic (DDV) ductal velocities, and RV/LV diameters ratio, as well as increase in ductal PI were observed [DSV=1.2±0.4m/s (0.7-1.6) to 0.9±0.3m/s (0.6-1.3) (p=0.018); DDV=0.21±0.09m/s (0.15-0.32) to 0.18±0.06m/s (0.11-0.25) (p=0.016); RV/LV ratio =1.3±0.2 (0.9-1.4) to 1.1±0.2 (0.8-1.3) (p=0.004); ductal PI=2.2±0.03 (2.0-2.7) to 2.4±0.4(2.2-2.9) (p=0.04)]. In the control group, with GA of 32±4 weeks, there were no significant differences in DMPI, mean SDV, DDV, PI and RV/LV ratio. CONCLUSION: The oriented restriction of third trimester maternal ingestion of polyphenol-rich foods for a period of 2 weeks or more improve fetal ductus arteriosus flow dynamics and right ventricular dimensions.

Maternal restriction of polyphenols and fetal ductal dynamics in normal pregnancy: an open clinical trial.

BACKGROUND: We have recently demonstrated reversal of fetal ductal constriction after dietary maternal restriction of polyphenol-rich foods (PRF), due to its inhibitory action on prostaglandin synthesis. OBJECTIVE: To test the hyphotesis that normal third trimester fetuses also improve ductus arteriosus dynamics after maternal restriction of polyphenols. METHODS: Open clinical trial with 46 fetuses with gestational age (GA) > 28 weeks submitted to 2 Doppler echocardiographic studies with an interval of at least 2 weeks, being the examiners blinded to maternal dietary habits. A validated food frequency questionnaire was applied and a diet based on polyphenol-poor foods (<30 mg/100 mg) was recommended. A control group of 26 third trimester fetuses was submitted to the same protocol. Statistics used t test for independent samples. RESULTS: Mean GA was 33 ± 2 weeks. Mean daily maternal estimated polyphenol intake (DMPI) was 1277 mg, decreasing to 126 mg after dietary orientation (p=0.0001). Significant decreases in systolic (SDV) and diastolic (DDV) ductal velocities, and RV/LV diameters ratio, as well as increase in ductal PI were observed [DSV = 1.2 ± 0.4 m/s (0.7-1.6) to 0.9 ± 0.3 m/s (0.6-1.3) (p = 0.018); DDV = 0.21 ± 0.09 m/s (0.15-0.32) to 0.18 ± 0.06 m/s (0.11-0.25) (p = 0.016); RV/LV ratio = 1.3 ± 0.2 (0.9-1.4) to 1.1 ± 0.2 (0.8-1.3) (p=0.004); ductal PI = 2.2 ± 0.03 (2.0-2.7) to 2.4 ± 0.4(2.2-2.9) (p = 0.04)]. In the control group, with GA of 32 ± 4 weeks, there were no significant differences in DMPI, mean SDV, DDV, PI and RV/LV ratio. CONCLUSION: The oriented restriction of third trimester maternal ingestion of polyphenol-rich foods for a period of 2 weeks or more improve fetal ductus arteriosus flow dynamics and right ventricular dimensions.

Constrição ductal fetal / Fetal ductal constriction

A constrição do ducto arterioso fetal é uma condição que pode comprometer o bem estar fetal e neonatal, representado pela hipertensão pulmonar persistente do neonato. Seu diagnóstico é através da ecocardiografia-Doppler fetal e a correção de suas causas são fundamentais para uma gestação fisiológica.

The constriction of the fetal ductus arteriosus is a condition that can compromise fetal and neonatal well-being, represented by persistent pulmonary hypertension of the newborn. Its diagnosis by fetal Doppler echocardiography and the correction of underlying causes are fundamental to physiological pregnancy.