Fulcro cardíaco de Trainini en el corazón fetal

Alberto  Sosa Olavarría; Arturo  Martí Peña; Artemio  Martínez M; Jorge  Zambrana Camacho; Jesús  Ulloa Virgen; Jesús  Zurita Peralta; Alexander  Alcedo; Gonzalo  Pérez-Canto CH; Esteban  Vázquez; Omar Yassef  Antúnez- Montes; Roberto  Moncayo; Sergio  Belgoff

doi:10.31403/rpgo.v69i2579

Authors

Alberto Sosa Olavarría Universidad de Carabobo
Arturo Martí Peña Médico Cirujano, Especialista en Medicina Materno Fetal y Ultrasonografia Perinatal
Artemio Martínez M Médico Cirujano, Especialista en Ultrasonido, Maestría en Ultrasonido Diagnóstico
Jorge Zambrana Camacho Médico Gineco-Obstetra, Médico Ultrasonografista e Imagenólogo
Jesús Ulloa Virgen Médico Cirujano. Especialista en Obstetricia y Ginecología, Maestría en Ultrasonido Diagnóstico
Jesús Zurita Peralta Médico Gineco-Obstetra, Perinatólogo, Especialista en Cardiología Fetal
Alexander Alcedo Médico Cirujano, Especialista en Obstetricia y Ginecología, Especialista en Medicina Materno Fetal
Gonzalo Pérez-Canto CH Médico Cirujano, Especialista en Obstetricia y Ginecología, Perinatólogo, Ecografista Perinatal
Esteban Vázquez Médico Cirujano, Especialista en Cardiología Pediátrica y Fetal, SAEU
Omar Yassef Antúnez- Montes Medicina de Urgencias y Ultrasonografía, Departamento de Urgencias Hospital General Balbuena, Secretaría de Salud-CDMX
Roberto Moncayo MD, Maestría en Ultrasonido, UNIMESO, Profesor de Ginecología y Obstetricia, Universidad de Quito, Ex-Presidente de FLAUS
Sergio Belgoff Médico Cirujano, Cirujano Infantil, Médico Ultrasonografista

DOI:

https://doi.org/10.31403/rpgo.v69i2579

Keywords:

Fetal heart, Heart fulcrum, Myocardial lever, Biomechanics, Cardiac kinetics, Cardiac bone, Ossa cordis

Abstract

Objective: To demonstrate by dissection of anatomical specimens and prenatal
ultrasonographic images of the fetal heart the presence of the cardiac fulcrum as
a fixation structure supporting the helical myocardial band. Methods: Six hearts
of fetuses between 20-24 weeks of gestational age resulting from spontaneous
abortions were dissected, finding the cardiac fulcrum in the proximity of the aorta
and connections with myocardial fibers. In 50 singleton pregnancies with fetuses
between 18-37 weeks of gestation, fetal cardiac ultrasonography was used to obtain
2D, Doppler, color and three-dimensional modalities, STIC, HD Flow and speckle
tracking, images, fulcrum measurements and its kinetics. Results: With the described
strategy, the presence of the cardiac fulcrum or myocardial lever was identified
and demonstrated, establishing its anatomical characteristics, connections with
myocardial fibers of the cardiac loop and the biometry according to gestational
age. A hypothesis on the biomechanics or kinetics of the fulcrum during the cardiac
cycle is formulated. Conclusions: In order for the heart to fulfill its function as an
aspirating and impelling pump, it must have a support point, a lever or fulcrum, which
constitutes a sort of muscle-tendon unit. This lever presents mixed displacements
during myocardial torsion and detorsion. Its diameters increase progressively as
gestation advances.