Nonlinear analysis of heart rate variability to assess the reaction of ewe fetuses undergoing fetal cardiac surgery

Costantino Del Gaudio, Adriano Carotti, Mauro Grigioni, Umberto Morbiducci

Research output: Contribution to journalArticlepeer-review


Fetal cardiac surgery (FCS) represents a challenging issue for the in utero treatment of congenital heart defects. However, FCS has still not gained the sufficient reliability for clinical practice due to an incompletely elucidated fetal stress response. For example, blood sampling can contribute to its onset, leading to fetoplacental unit dysfunction, one of the main causes of failure of the surgical procedure. In order to address this issue, the role of the autonomic control system during an experimental procedure of cardiac bypass on ewe fetuses was investigated by means of recurrence quantification analysis (RQA), a well-recognized method for the analysis of nonlinear systems. RQA was applied to time series extracted from fetal arterial pressure recordings before and after the cardiac bypass established by means of an extracorporeal circuit, including an axial blood pump, and taking advantage of the capability of the placenta to work as a natural oxygenator. Statistically significant correlations were found among RQA-based metrics and fetal blood gas data, suggesting the possibility to infer the clinical status of the fetus starting from its hemodynamic signals. This study shows the relevance of RQA as a complementary tool for the monitoring of the fetal status during cardiac bypass.

Original languageEnglish
Pages (from-to)376-384
Number of pages9
JournalInternational Journal of Artificial Organs
Issue number5
Publication statusPublished - 2012


  • Fetal cardiac surgery
  • Fetal sheep
  • Fetoplacental unit dysfunction
  • Heart rate variability
  • Recurrence quantification analysis

ASJC Scopus subject areas

  • Biomaterials
  • Biomedical Engineering
  • Bioengineering
  • Medicine (miscellaneous)


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