Assessment of right and left ventricular function in terms of force development with gestational age in the normal human fetus.

OBJECTIVE To assess right and left ventricular systolic function in normal human fetuses by cross sectional Doppler echocardiography to calculate the force developed by myocardial shortening. DESIGN Cross sectional echocardiographic images of the aorta and pulmonary arteries were obtained prospectively in order to measure great vessel diameters and calculate their cross sectional areas. Doppler velocity signals were recorded from the proximal aorta and the proximal pulmonary artery and digitised to obtain peak velocity, acceleration time, flow velocity time integral during acceleration, and the flow velocity time integral for the whole of ejection. Right and left ventricular force development was estimated by Newton's equation in which force is defined as the product of mass and acceleration. PATIENTS 58 normal human fetuses at a gestational age of from 20 to 42 weeks. RESULTS The cross sectional area of the pulmonary artery was 20% greater than that of the aorta. Aortic acceleration time was longer than that in the pulmonary artery, and peak blood flow velocity in the aorta was consistently greater than that in the pulmonary artery. Right ventricular stroke volume was significantly greater than left ventricular stroke volume. The force developed by the right and left ventricles was, however, similar throughout the gestational period studied, increasing tenfold from 20 weeks' gestation to term (r = 0.74, p less than 0.0001; r = 0.75, p less than 0.0001) respectively. CONCLUSION The development of right and left ventricular force in the human fetus is similar in spite of the greater volume handled by the right ventricle. This index of ventricular performance does not require calculation of ventricular volume and because it varies independently of ventricular geometry and heart rate it should prove useful in assessing cardiac function in the normal human fetus and in fetuses with ventricular dysfunction.