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Title: Perinatal changes in fetal cardiac geometry, myocardial performance and ventricular function
Author: Patey, Olga
ISNI:       0000 0004 7427 1380
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2017
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Our findings support the concept that the perinatal period is characterised by profound changes in cardiac geometry, myocardial performance, and ventricular function in normal fetuses and fetuses affected by different pathological conditions such as growth restriction (FGR), gestational diabetes mellitus (GDM), and simple transposition of the great arteries (TGA). The observed changes are most likely explained by cardiac geometrical and functional adaptation in response to significant alterations in volume and resistance load at the end of pregnancy and at birth. Our results provide evidence of significant alteration of perinatal cardiac adaptation in FGR, GDM and TGA fetuses compared to normal controls indicative of cardiac remodelling and myocardial dysfunction as a consequence of the adverse intrauterine environment with evidence of persistence of these alterations in the first days of life. We have proposed possible explanations of different compensatory mechanisms of perinatal cardiac adaptation in pathological pregnancies. Interdependency and interrelationships of cardiac geometry, myocardial deformation and ventricular function in fetal and neonatal assessment have been demonstrated, as has a detrimental impact of pathological intrauterine environment on these parameters. For the first time, unique perinatal left ventricular torsional mechanics have been explored in both normal and pathological fetal groups suggestive of their important role as contributing factors in perinatal cardiac adaptation. We have also shown the association of geometric and functional cardiac indices in normal, FGR and GDM fetuses with the low cerebroplacental ratio, as an index of placental underperfusion, suggesting that a proportion of normal and pathological term fetuses might exhibit signs of cardiac compromise under the condition of hypoxemia at term. Improved knowledge of fetal perinatal adaptation in normal and compromised pregnancies could facilitate the development and delivery of better clinical management and treatment strategies to prevent adverse pregnancy outcome and reduce the long­term risk of cardiovascular pathology in later life.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available