Prenatal Identification of Restrictive and Non-restrictive Ventricular Septal Defects Based on End-Systolic Flow Patterns in the Fetal Aortic Isthmus

  • Jean-Claude FouronEmail author
  • Julie Thomas-Chabaneix
  • Sophie Brisebois
  • Annie Berger
  • Nagib Dahdah
Original Article


Fetuses with large ventricular septal defects (VSDs) must be closely monitored during the perinatal period. Intrauterine assessment of size of septal defects with bidimensional echocardiography are unreliable. The objective of the present study is to document the contribution of flow pattern analysis in the fetal aortic isthmus for prenatal identification of large non-restrictive VSDs requiring immediate postnatal attention. We conducted a cross-sectional retrospective study of Doppler recordings from patients referred to our Fetal Cardiology Unit and diagnosed with one or multiple VSDs from January 2006 to November 2015. Three groups were defined: (1) large non-restrictive VSDs (n = 11) with postnatal cardiac failure (2) small restrictive VSDs (n = 28) asymptomatic, and (3) absence of cardiac abnormality (n = 66). The Isthmic end-Systolic Index (ISI) was computed to quantify aortic isthmus flow and compared between the three groups. Fetuses with restrictive VSD and control group showed similar ISI: stable at 0.20 ± 0.01 up to 27 weeks of gestation and dropping later due to the fall of end-systolic velocities in the aortic isthmus. By 35 weeks, a brief end-systolic retrograde flow was present, associated with a further fall of ISI down to −0.26 ± 0.05. In contrast, ISI of fetuses with large non-restrictive VSDs were unchanged throughout gestation (0.18 ± 0.06), becoming significantly higher during the last weeks of gestation compared to the two other groups (p < 0.001). In fetuses with VSDs, the ISI measurement from the aortic isthmus Doppler flow during the second half of gestation is a reliable predictor of a large non-restrictive defect with risk of major postnatal clinical impact.


Fetal heart defect Ventricular septal defect Aortic isthmus Isthmic Systolic Index (ISI) Prediction Risk stratification 



The authors are grateful to Stéphanie Bilodeau and Danielle Buch, medical writers, for critical revision and editing of the manuscript.


This investigation was supported (in part) by a research Grant (Grant # MOP-97986) from the Canadian Institutes of Health Research.

Compliance with Ethical Standards

Conflict of interest

Dr. Jean-Claude Fouron declares that he has no conflict of interest. Dr. Julie Chabaneix Thomas declares that she has no conflict of interest. Dr. Nagib Dahdah declares that he has no conflict of interest. Ms. Sophie Brisebois declares that she has no conflict of interest. Ms. Annie Berger declares that she has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jean-Claude Fouron
    • 1
    • 4
    Email author
  • Julie Thomas-Chabaneix
    • 1
    • 2
  • Sophie Brisebois
    • 1
  • Annie Berger
    • 1
  • Nagib Dahdah
    • 3
  1. 1.Fetal Cardiology Unit, Pediatric Cardiology DivisionCHU Sainte Justine, University of MontrealMontrealCanada
  2. 2.Cardiac Catheterization Laboratory, Pediatric Cardiology DivisionCHU Sainte Justine, University of MontrealMontrealCanada
  3. 3.Pediatric and Congenital Cardiology Unit, Bordeaux University HospitalPessacFrance
  4. 4.Fetal Cardiology Unit, Pediatric Cardiology DivisionCHU Sainte-JustineMontrealCanada

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