Beurteilung der fetalen kardialen Funktion – etablierte und neue Methoden

 

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Zusammenfassung

Zahlreiche maternale (Diabetes, Präeklampsie) und fetale Auffälligkeiten (uteroplazentare Dysfunktion, Hydrops, Infektionen, Vitien) können beim Feten zu einer Beeinträchtigung der Herzfunktion führen. Hierzu zählen eine Erhöhung der Vor- oder Nachlast, Herzkompression, Myokardschaden, Hypoxie und Hyperglykämie. Neben bereits etablierten Methoden wie M-Mode, Farb- und konventionellem Spektraldoppler sind u. a. auch neuere Techniken wie Gewebedoppler und Speckle Tracking zur Überwachung der kardialen Funktion verfügbar. Einige dieser Messtechniken haben bis dato allerdings noch keinen Einzug gehalten in die klinischen Routineuntersuchungen, da entweder eine Validierung noch aussteht und/oder die Methode noch zu zeitaufwändig ist. Andere Techniken befinden sich aktuell erst in der Erprobungsphase und sind daher zunächst Gegenstand rein wissenschaftlicher Untersuchungen. Neuheiten wie das Speckle Tracking, die ihren Ursprung in der Erwachsenenkardiologie haben, sind derzeit aufgrund der geringeren Herzgröße, der höheren Herzfrequenz, den fetalen und maternalen Bewegungsartefakten sowie zuletzt auch bedingt durch eine fehlende fetale EKG-Ableitung nur eingeschränkt aussagekräftig und sollten daher kritisch eingesetzt werden.

Abstract

Numerous maternal (diabetes, preeclampsia) and fetal pathologies (uteroplacental dysfunction, hydrops, infection, congenital heart disease) can lead to cardiac dysfunction in the fetus. This includes increase of pre- and afterload, compression of the heart, myocardial damage, hypoxia and hyperglycemia. Beside already established methods like m-mode and pulse-waved Doppler, new promising technologies like tissue Doppler and speckle tracking are available for monitoring fetal cardiac function. Some of these new techniques have not been part of clinical routine yet because no validation has been performed so far and/or the technique is too time-consuming. Other technologies are currently being tested and only part of research projects. Innovations like speckle tracking that have its seeds in adult cardiology, are still limited because of the smallness of the fetal heart, the higher heart rate, fetal and maternal moving artefacts and finally because of a missing fetal ECG signal. Therefore their application should be performed critically.

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