Blood flow velocity parameters in the ductus venosus in fetuses with congenital heart defects
Yarygina T.A., Gasanova R.M., Shchegolev A.I., Gus A.I., Shmakov R.G.
Objective: To investigate absolute flow velocity parameters in the ductus venosus of fetuses with congenital heart defects (CHD).
Materials and methods: In this cross-sectional study, we assessed the velocities of a-waves, S-waves, D-waves, and time-averaged maximum velocity (TAMX) in the ductus venosus of a total cohort of 171 fetuses with CHD, including 47 fetuses with right heart defects (subgroup 1) and 124 fetuses with other forms of defects (subgroup 2). A comparative analysis of the obtained indicators was conducted across three gestational intervals: 18–21 weeks (x1), 22–29 weeks (x2), and 30–40 weeks (x3) of pregnancy.
Results: The a-wave velocity below the 5th percentile was observed in 18.1%, 21.3%, and 16.9% of cases in the overall cohort and in subgroups 1 and 2, respectively. In the overall group and subgroup 2, there was a significant increase in the a-wave, S-wave, D-wave, and TAMX velocities in each subsequent gestational interval (p<0.001), consistent with the findings in the healthy population. In subgroup 1, there were no significant changes in a-wave velocity between gestational intervals (p>0.05), whereas increases in S-wave, D-wave, and TAMX values were recorded only between the first and third gestational intervals (x1–x3) (p=0.001). No differences were observed between the gestational intervals x1–x2 and x2–x3 (p>0.05). Comparative analysis of a-wave, S-wave, and D-wave velocities and TAMC did not reveal statistically significant differences between the study subgroups (p>0.05).
Conclusion: A decrease in the velocity of oxygenated blood flow to the fetal heart during the atrial contraction phase (a-wave) was observed in 16–21% of fetuses with cardiac pathology, indicating an increased risk of hypoxic complications. The lack of a physiological increase in flow velocities in the ductus venosus among fetuses with right heart defects underscores the need for additional antenatal monitoring in these patients.
Authors' contributions: Yarygina T.A., Shmakov R.G. – conception and design of the study; Yarygina T.A., Gasanova R.M. – drafting of the manuscript; Yarygina T.A., Shchegolev A.I. – data collection and analysis; Gasanova R.M., Shchegolev A.I., Gus A.I., Shmakov R.G. – editing of the manuscript.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: The study was conducted within the framework of the applied scientific topic 123020300017-1.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the A.N. Bakulev NMRC of Cardiovascular Surgery, Ministry of Health of Russia.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Yarygina T.A., Gasanova R.M., Shchegolev A.I., Gus A.I., Shmakov R.G.
Blood flow velocity parameters in the ductus venosus in fetuses with congenital heart defects.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (9): 98-108 (in Russian)
https://dx.doi.org/10.18565/aig.2025.214
Keywords
ductus venosus
Doppler
a-wave
right heart
congenital heart defect
fetal malformations
prenatal diagnosis
References
- Голухова Е.З. Отчет о лечебной и научной работе Национального медицинского исследовательского центра сердечно-сосудистой хирургии им. А.Н. Бакулева Минздрава России за 2024 год. Перспективы дальнейшего развития. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2025; 26 (Cпецвып.): 5-130. [Golukhova E.Z. Report on the clinical and scientific activity of Bakoulev National Medical Research Center for Cardiovascular Surgery for 2024. Development prospects. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2025; 26(Special Issue): 5-130 (in Russian)]. https://dx.doi.org/10.24022/1810-0694-2025-26S
- ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Минздрава России. Методические рекомендации. Резервы для снижения младенческой смертности от врожденных пороков сердца. М.; 2024. 56 с. [A.N. Bakulev National Medical Research Center for Cardiovascular Surgery of the Ministry of Health of Russia. Guidelines. Reserves for reducing infant mortality from congenital heart defects. Moscow; 2024. 56 p. (in Russian)].
- Gimeno L., Brown K., Harron K., Peppa M., Gilbert R., Blackburn R. Trends in survival of children with severe congenital heart defects by gestational age at birth: a population-based study using administrative hospital data for England. Paediatr. Perinat. Epidemiol. 2023; 37(5): 390-400. https://dx.doi.org/10.1111/ppe.12959
- Patel S.R., Michelfelder E. Prenatal diagnosis of congenital heart disease: the crucial role of perinatal and delivery planning. J. Cardiovasc. Dev. Dis. 2024; 11(4): 108. https://dx.doi.org/10.3390/jcdd11040108
- Барышникова И.Ю., Гасанова Р.М. Недоношенный ребенок с врожденным пороком сердца: перинатальные факторы риска развития кардиохирургических осложнений. Детские болезни сердца и сосудов. 2023; 4(20): 235-41. [Baryshnikova I.Yu., Gasanova R.M. Premature baby with congenital heart disease: perinatal risk factors for complications after cardiac surgery. Children’s heart and vascular diseases. 2023; 20(4): 235-41 (in Russian)]. https://dx.doi.org/10.24022/1810-0686-2023-20-4-235-241
- Ярыгина Т.А., Леонова Е.И., Гасанова Р.М., Марзоева О.В., Сыпченко Е.В., Гус А.И. Пренатальное выявление факторов, ассоциированных с нарушением психомоторного развития у детей с врожденными пороками сердца. Детские болезни сердца и сосудов. 2022; 19(4): 285-96. [Yarygina T.A., Leonova E.I., Gasanova R.M., Marzoeva O.V., Sypchenko E.V., Gus A.I. Prenatal identification of factors associated with impaired psychomotor development in children with congenital heart disease. Children’s heart and vascular diseases. 2022; 19(4): 285-96 (in Russian)]. https://dx.doi.org/10.24022/1810-0686-2022-19-3-285-296
- Ярыгина Т.А., Гасанова Р.М., Марзоева О.В., Сыпченко Е.В., Леонова Е.И., Ляпин В.М., Щеголев А.И., Гус А.И. Анализ патоморфологических особенностей строения плаценты в случаях с пренатально диагностированным врожденным пороком сердца у плода. Акушерство и гинекология. 2024; 6: 75-83. [Yarygina T.A., Gasanova R.M., Marzoeva O.V., Sypchenko E.V., Leonova E.I., Lyapin V.M., Shchegolev A.I., Gus A.I. Analysis of pathomorphological characteristics of the placental structure in cases of prenatally diagnosed fetal congenital heart disease. Obstetrics and Gynecology. 2024; (6): 75-83 (in Russian)]. https://dx.doi.org/10.18565/aig.2024.119
- Ярыгина Т.А., Гасанова Р.М., Леонова Е.И., Марзоева О.В., Сыпченко Е.В., Гус А.И. Особенности допплерографических параметров при оценке церебральной гемодинамики у плодов с врожденными пороками сердца. Детские болезни сердца и сосудов. 2022; 19(2): 117-27. [Yarygina T.A., Gasanova R.M., Leonova E.I., Marzoeva O.V., Sypchenko E.V., Gus A.I. Cerebral hemodynamics in fetuses with congenital heart disease. Children’s heart and vascular diseases. 2022; 19(2): 117-27 (in Russian)]. https://dx.doi.org/10.24022/1810-0686-2022-19-2-117-127
- Туманова У.Н., Шувалова М.П., Щеголев А.И. Анализ статистических показателей врожденных аномалий как причины ранней неонатальной смерти в Российской Федерации. Российский вестник перинатологии и педиатрии. 2018; 63(6): 60-7. [Tumanova U.N., Shuvalova M.P., Schegolev A.I. Analysis of statistical indicators of congenital anomalies as causes of early neonatal death in the Russian Federation. Russian Bulletin of Perinatology and Pediatrics. 2018; 63(6): 60-7 (in Russian)]. https://doi.org/10.21508/1027-4065-2018-63-5-60-67
- Щеголев А.И., Туманова У.Н., Фролова О.Г. Региональные особенности мертворождаемости в Российской Федерации. В кн.: Крупнов Н.М., ред. Актуальные вопросы судебно-медицинской экспертизы и экспертной практики в региональных бюро судебно-медицинской экспертизы на современном этапе. Сборник трудов конференции. Рязань: Эмпирикон; 2013: 163-9. [Shchegolev A.I., Tumanova U.N., Frolova O.G. Regional features of stillbirth in the Russian Federation. In: Krupnov N.M., ed. Current issues of forensic medical examination and expert practice in regional bureaus of forensic medical examination at the present stage. Proceedings of the conference. Ryazan: Empiricon; 2013: 163-9 (in Russian)].
- Best K.E., Tennant P.W.G., Rankin J. Survival, by birth weight and gestational age, in individuals with congenital heart disease: a population-based study. J. Am. Heart. Assoc. 2017; 6(7): e005213. https://dx.doi.org/10.1161/JAHA.116.005213
- Moon-Grady A.J., Donofrio M.T., Gelehrter S., Hornberger L., Kreeger J., Lee W. et al. Guidelines and recommendations for performance of the fetal echocardiogram: an update from the American society of echocardiography. J. Am. Soc. Echocardiogr. 2023; 36(7): 679-723. https://dx.doi.org/10.1016/j.echo.2023.04.014
- Haxel C.S., Johnson J.N., Hintz S., Renno M.S., Ruano R., Zyblewski S.C. et al. Care of the fetus with congenital cardiovascular disease: from diagnosis to delivery. Pediatrics. 2022; 150(Suppl 2): e2022056415C. https://dx.doi.org/10.1542/peds.2022-056415C
- Wu J., Ruan Y., Gao X., Wang H., Guan Y., Hao X. et al. The reference ranges for fetal ductus venosus flow velocities and calculated waveform indices and their predictive values for right heart diseases. J. Perinat. Med. 2025; 53(4): 491-502. https://dx.doi.org/10.1515/jpm-2024-0577
- Chemla D., Berthelot E., Assayag P., Attal P., Hervé P. [Pathophysiology of right ventricular hemodynamics]. Rev. Mal. Respir. 2018; 35(10): 1050-62. [Article in French]. https://dx.doi.org/10.1016/j.rmr.2017.10.667
- Ярыгина Т.А., Гасанова Р.М., Марзоева О.В., Сыпченко Е.В., Гус А.И. Все о венозном протоке – в помощь практикующим специалистам. Акушерство и гинекология. 2023; 9: 22-32. [Yarygina T.A., Gasanova R.M., Marzoeva O.V., Sypchenko E.V., Gus A.I. All those practitioners should know about ductus venosus. Obstetrics and Gynecology. 2023; (9): 22-32 (in Russian)]. https://dx.doi.org/10.18565/aig.2023.127
- Ярыгина Т.А., Гус А.И. Задержка (замедление) роста плода: все, что необходимо знать практикующему врачу. Акушерство и гинекология. 2020; 12: 14-24. [Yarygina T.A., Gus A.I. Fetal growth restriction (retardation): everything the practitioner should know. Obstetrics and Gynecology. 2020; (12): 14-24 (in Russian)]. https://dx.doi.org/10.18565/aig.2020.12.14-24
- Министерство здравоохранения Российской Федерации. Клинические рекомендации. Недостаточный рост плода, требующий предоставления медицинской помощи матери (задержка роста плода). М.; 2022. 73 с. [Ministry of Health of the Russian Federation. Clinical guidelines. Insufficient fetal growth requiring the provision of medical care to the mother (fetal growth retardation). Moscow; 2022. 73 p. (in Russian)].
- Министерство здравоохранения Российской Федерации. Клинические рекомендации. Многоплодная беременность. М.; 2021. 58 с. [Ministry of Health of the Russian Federation. Clinical guidelines. Multiple pregnancy. Moscow; 2021. 58 p. (in Russian)].
- Seravalli V., Miller J.L., Block-Abraham D., Baschat A.A. Ductus venosus Doppler in the assessment of fetal cardiovascular health: an updated practical approach. Acta Obstet. Gynecol. Scand. 2016; 95(6): 635-44. https://dx.doi.org/10.1111/aogs.12893
- Berg C., Kremer C., Geipel A., Kohl T., Germer U., Gembruch U. Ductus venosus blood flow alterations in fetuses with obstructive lesions of the right heart. Ultrasound Obstet. Gynecol. 2006; 28(2): 137-42. https://dx.doi.org/10.1002/uog.2810
- Gembruch U., Meise C., Germer U., Berg C., Geipel A. Venous Doppler ultrasound in 146 fetuses with congenital heart disease. Ultrasound Obstet. Gynecol. 2003; 22(4): 345-50. https://dx.doi.org/10.1002/uog.242
- Kahramanoglu O., Eyisoy O.G., Demirci O. Prenatal predictors and early postnatal outcomes in fetuses diagnosed with tricuspid atresia. Diagnostics (Basel). 2024; 14(24): 2855. https://dx.doi.org/10.3390/diagnostics14242855
- Freud L.R., Escobar-Diaz M.C., Kalish B.T., Komarlu R., Puchalski M.D., Jaeggi E.T. et al. Outcomes and predictors of perinatal mortality in fetuses with ebstein anomaly or tricuspid valve dysplasia in the current era: a multicenter study. Circulation. 2015; 132(6): 481-9. https://dx.doi.org/10.1161/CIRCULATIONAHA.115.015839
- Цибизова В.И., Аверкин И.И., Бицадзе В.О., Козленок А.В., Грехов Е.В., Первунина Т.М., Петров К.В., Сапрыкина Д.О., Блинов Д.В. Новая эра в оценке функционального состояния сердца плода. Акушерство, гинекология и репродукция. 2021; 15(2): 208-17. [Tsibizova V.I., Averkin I.I., Bitsadze V.O., Kozlenok A.V., Grekhov E.V., Pervunina T.M., Petrov K.V., Saprykina D.O., Blinov D.V. A new epoch in assessing fetal heart condition. Obstetrics, Gynecology and Reproduction. 2021; 15(2): 208-17 (in Russian)]. https://dx.doi.org/10.17749/2313-7347/ob.gyn.rep.2021.225
- Papageorghiou A.T., Kennedy S.H., Salomon L.J., Ohuma E.O., Cheikh Ismail L., Barros F.C. et al. International standards for early fetal size and pregnancy dating based on ultrasound measurement of crown–rump length in the first trimester of pregnancy. Ultrasound Obstet. Gynecol. 2014: 44(6): 641-8. https://dx.doi.org/10.1002/uog.13448
- Papageorghiou A.T., Ohuma E.O., Altman D.G., Todros T., Cheikh Ismail L., Lambert A. et al. International standards for fetal growth based on serial ultrasound measurements: the fetal growth longitudinal study of the INTERGROWTH–21st project. Lancet. 2014; 384(9946): 869-79. https://dx.doi.org/10.1016/S0140-6736(14)61490-2
- Gómez O., Figueras F., Fernández S., Bennasar M., Martínez J.M., Puerto B. et al. Reference ranges for uterine artery mean pulsatility index at 11-41 weeks of gestation. Ultrasound Obstet. Gynecol. 2008; 32(2): 128-32. https://dx.doi.org/10.1002/uog.5315
- Ciobanu A., Wright A., Syngelaki A., Wright D., Akolekar R., Nicolaides K.H. Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio. Ultrasound Obstet. Gynecol. 2019; 53(4): 465-72. https://dx.doi.org/10.1002/uog.20157
- Srisupundit K., Luewan S., Tongsong T. Prenatal diagnosis of fetal heart failure. Diagnostics (Basel). 2023; 13(4): 779. https://dx.doi.org/10.3390/diagnostics13040779
- Seravalli V., Masini G., Ponziani I., Di Tommaso M., Pasquini L. Ductus venosus Doppler assessment: do the results differ between the sagittal and the transverse approach? J. Matern. Fetal. Neonatal. Med. 2022; 35(25): 9661-6. https://dx.doi.org/10.1080/14767058.2022.2050364
- Sanapo L., Turan O.M., Turan S., Ton J., Atlas M., Baschat A.A. Correlation analysis of ductus venosus velocity indices and fetal cardiac function. Ultrasound Obstet. Gynecol. 2014; 43(5): 515-9. https://dx.doi.org/10.1002/uog.13242
- Fratelli N., Amighetti S., Bhide A., Fichera A., Khalil A., Papageorghiou A.T. et al. Ductus venosus Doppler waveform pattern in fetuses with early growth restriction. Acta Obstet. Gynecol. Scand. 2020; 99(5): 608-14. https://dx.doi.org/10.1111/aogs.13782
Received 12.08.2025
Accepted 26.08.2025
About the Authors
Tamara A. Yarygina, PhD, Head of the Ultrasound Diagnostics Department, Academician V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology, 101000, Russia, Moscow, Pokrovka str., 22a; Researcher at the Perinatal Cardiology Center, A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Ministry of Health of Russia, 121552, Russia, Moscow, Roublyevskoe Shosse, 135; Associated Professor at the Department of Ultrasound Diagnostics of the Faculty of Continuing Medical Education of the Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia, 127015, Russia, Moscow, Pistsovaya str., 10,+7(495)414-78-75, tamarayarygina@gmail.com, https://orcid.org/0000-0001-6140-1930
Rena M. Gasanova, Dr. Med. Sci., Head of the Perinatal Cardiology Center, A.N. Bakulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of Russia, 121552, Russia, Moscow, Roublyevskoe Shosse, 135; Physician of Ultrasound Diagnostics, Department of Ultrasound and Functional Diagnostics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, rmgasanova@bakulev.ru, https://orcid.org/0000-0003-3318-1074
Alexander I. Shchegolev, Dr. Med. Sci., Professor, Head of the 2nd Pathoanatomical Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(495)531-44-44, ashegolev@oparina4.ru,
https://orcid.org/0000-0002-2111-1530
Alexander I. Gus, Dr. Med. Sci., Professor, Chief Researcher at the Department of Ultrasound and Functional Diagnostics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4; Head of the Department of Ultrasound Diagnostics of the Faculty of Continuing Medical Education of the Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia, 127015, Russia, Moscow, Pistsovaya str., 10, a_gus@oparina4.ru, https://orcid.org//0000-0003-1377-3128
Roman G. Shmakov, Dr. Med. Sci., Professor of the Russian Academy of Sciences, Director, Academician V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology, 101000, Russia, Moscow, Pokrovka str., 22a; Head of the Department of Obstetrics and Gynecology, Faculty of Advanced Medical Studies, M.F. Vladimirsky Moscow Regional Research Clinical Institute, mdshmakov@mail.ru https://orcid.org/0000-0002-2206-1002
Corresponding author: Tamara A. Yarygina, tamarayarygina@gmail.com
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