Evaluación ecográfica del ductus venoso fetal y sus aplicaciones Clínicas en la Obstetricia actual
Resumen
El estudio del ductus venoso, un vaso que nace en la el seno portal y lleva sangre ricamente oxigenada desde la placenta al ventrículo izquierdo pasando por el foramen oval, permite la comprensión de la hemodinamia fetal y se cierra luego del inicio de la vida postnatal. Con una típica onda trifásica, siempre anterógrada en condiciones fisiológicas, puede ser evaluado en cualquier momento de la gestación, utilizando la ecografía en dos dimensiones o bien mediante el Doppler color facilita su ubicación anatómica. Numerosos autores han demostrado su utilidad en el cribado de cromosomopatías en el primer trimestre de la gestación y en la actualidad es utilizado como segunda línea luego de la evaluación de la trasnlucencia nucal. Como la morfología de la onda demuestra lo que sucede en el ciclo cardíaco fetal, puede proporcionar información adicional en el estudio de la circulación fetal en aquellas situaciones en que se produce disfunción miocárdica, lo que permite individualizar cardiopatías congénitas cuando la onda de velocidad del flujo es patológica. En la evaluación de gestaciones gemelares monocoriales biamnióticas, permite la identificación precoz de los fetos que tienen mayor riesgo de padecer el Síndrome de Transfusión Feto Fetal, lo que podría permitir un control mas estricto en ellas para aplicar la terapéutica correspondiente. En la evaluación de la sospecha de pérdida del bienestar fetal, este vaso se comporta como un instrumento de vital importancia al identificar las gestaciones de alto riesgo de muerte fetal intrauterina, en especial en los casos de restricción de crecimiento intrauterino severas y lejos del término. Esta revisión, permite conocer los aportes que hace la evaluación ecográfica del ductus venoso en todas las etapas de la gestación.
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Facultad de Ciencias Médicas. Universidad Nacional de Asunción
