Hello Dave,

Can you help with my below dilema?

I am confused regarding the E/A ratio changes with IUGR or other anomalies. Some sources talk about a reversal in the E to A ratio as being abnormal in these conditions such as in Julie Drose's book:
From Julia Drose's Book
A true in utero reversal of the E and A points may result from abnormalities that affect the myocardium, such as intrauterine growth restriction.

Also Rima Bader, Lisa Hornberger and Jim Huhta's book- The Perinatal Cardiology Handbook show a diastolic function chart which says that the E/A ratio is normal at <1 and abnormal at >1.

However, an article from Seminars in Perinatology by Bahtiyar and Copel state: Earlier in pregnancy, IUGR fetuses have similar E/A ratios to AGA fetuses. However the E/A ratio does not increase later in pregnancy and is significantly lower than in AGA fetuses.

These sources contradict each other. Can you help me understand please?

Thank you in advance!
Jill
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Cardiac Changes in the Intrauterine Growth-Restricted Fetus
Mert Ozan Bahtiyar, MD,* and Joshua A. Copel, MD*,†

In AGA fetuses, the E/A ratio increases progressively during pregnancy in both mitral valve and tricuspid valve waveforms, approaching 1 at term. Earlier in pregnancy, IUGR fetuses have similar E/A ratios to AGA fetuses. However the E/A ratio does not increase later in pregnancy and is significantly lower than in AGA fetuses. The progressive rise in the E/A ratio in normal fetuses is thought to reflect a gradual drop in the stiffness of the ventricles and therefore less reliance on atrial contraction for adequate ventricular filling. The lack of this change in IUGR fetuses could be due to delayed maturation of ventricular myocardium, or some other form of diastolic dysfunction.

Dave, the baby delivered and it was a coarctation! The original findings of a small Ao on the 3VV, a slight right sided enlargement and a mild MR was at 20 weeks. Do you know of any earlier cases in the literature?

Our MFM's woud like to train in lasers for TTTS and other interventional techniques. Had a great case lately of TTTS! Changed from normal to high grade in 2 weeks! It's a beautiful day here- on a lake in MN. Working on a lecture for the SDMS this fall all day however- ugh! Do you do Tei index? I am having trouble finding any info on what the normal values are. Devore sent me his ppt on it but no normal values. Do you know specifics on it?

Always interested! Good luck in your training.