Mesenteric venous/arterial index in gastroschisis cases: a new prognostic tool

• Autores: Sosa Olavarría, Alberto, Larrazábal, Natasha, Martínez de Mora, Ydimar, Ledezma del Corral, Juan, Morillo Jr., Jiver, Morillo Ochoa, Jiver
• Formato: artículo
• Fecha de Publicación: 2019
• Institución: Sociedad Peruana de Obstetricia y Ginecología
• Repositorio: Revista SPOG - Revista Peruana de Ginecología y Obstetricia
• Lenguaje: español
• OAI Identifier: oai:ojs.spog:article/2203
• Enlace del recurso: http://www.spog.org.pe/web/revista/index.php/RPGO/article/view/2203
• Nivel de acceso: acceso abierto

Objective: To evaluate the flow of the superior mesenteric artery and vein both by Doppler flowmetry and simultaneously, in normal controls and in cases of gastroschisis, as additional prognostic criteria. Methods: The venous/arterial index was determined by Doppler flowmetry; reference values for the superior mesenteric vessels were obtained from a group of 60 healthy fetuses of 30 to 34 weeks and 15 cases of gastroschisis. The flow rate wave (FRW) was obtained simultaneously from both the superior mesenteric artery and vein with an angle of insonation less than 60°; the vein velocity was divided by the systolic peak of the artery and the percentage index was calculated based on the velocity of both vessels. The equipment used was a Mylab™Twice from Esaote with a 3.5 MHz convex probe. Results: The superior mesenteric venous/arterial index value in the control group was 26% ± 6 (2SD). In 12 cases of gastroschisis, the index remained within the reference values, with favorable prognosis for primary reduction (9 with Svelitza technique and 3 with immediate neonatal primary reduction). In three cases, the venous/arterial index was below 20% (1%, 14% and 16% respectively), with unfavorable results; the worst case, where no venous flow was detected, required wide resection, presented short bowel syndrome and died at 6 months. Conclusions: The perfusion index of the eviscerated bowel, studied by the percentage between vein velocity and maximum mesenteric artery velocity, could have prognostic value for the flow conditions of afferent and efferent intestinal loops in gastroschisis.