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Sukenik-Halevy R, Katz A, Regev RH, Markovitch O, Sharony R, Ganor Paz Y, Biron-Shental T. The yield of the prenatal work-up in intrauterine growth restriction and the spectrum of fetal abnormalities detected postnatally. J Matern Fetal Neonatal Med 2017; 32:753-759. [DOI: 10.1080/14767058.2017.1391776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Rivka Sukenik-Halevy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Genetics Institute, Meir Medical Center, Kfar Saba, Israel
| | - Adi Katz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rivka H. Regev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
| | - Ofer Markovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ultrasound Unit, Meir Medical Center, Kfar Saba, Israel
| | - Reuven Sharony
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Genetics Institute, Meir Medical Center, Kfar Saba, Israel
| | - Yael Ganor Paz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
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52
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Chu C, Yan Y, Ren Y, Li X, Gui Y. Prenatal diagnosis of congenital heart diseases by fetal echocardiography in second trimester: a Chinese multicenter study. Acta Obstet Gynecol Scand 2017; 96:454-463. [PMID: 28029179 DOI: 10.1111/aogs.13085] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Chen Chu
- Heart Center; Children's Hospital of Fudan University; Shanghai China
| | - Yingliu Yan
- Ultrasound Department; Obstetrics and Gynecology Hospital; Fudan University; Shanghai China
| | - Yunyun Ren
- Ultrasound Department; Obstetrics and Gynecology Hospital; Fudan University; Shanghai China
| | - Xiaotian Li
- Department of Obstetrics, Obstetrics and Gynecology Hospital; Fudan University; Shanghai China
| | - Yonghao Gui
- Heart Center; Children's Hospital of Fudan University; Shanghai China
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53
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Scott T, Jones J, Swan H. Assessment of the Fetal Heart During Routine Obstetrical Screening, a Standardized Method. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479316661506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Assessment of the fetal heart during routine obstetrical screening remains a challenge for sonographers and physicians. Reliance on still images and nonstandard methods of acquiring images and assessing the fetal heart contribute to the relatively low rate of identification of congenital heart disease (CHD). A standardized assessment of the fetal heart using two cine-loop sweeps has been shown to address some of these challenges. Image acquisition using two cine-loop sweeps combined with a standardized five-step assessment is proposed to address the limitations of the nonstandard approach in place at most screening centers today.
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Affiliation(s)
- Ted Scott
- Society of Diagnostic Medical Screening Member, Hamilton, Canada
| | | | - Hans Swan
- Charles Sturt University, Wagga Wagga, Australia
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van Velzen CL, Türkeri F, Pajkrt E, Clur SA, Rijlaarsdam ME, Bax CJ, Hruda J, de Groot CJ, Blom NA, Haak MC. Pregnancy complications in singleton pregnancies with isolated fetal heart defects. Acta Obstet Gynecol Scand 2016; 95:1273-1280. [DOI: 10.1111/aogs.12955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/27/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Christine L. van Velzen
- Department of Obstetrics and Gynecology; VU University Medical Center; Amsterdam the Netherlands
| | - Freya Türkeri
- Department of Obstetrics and Gynecology; VU University Medical Center; Amsterdam the Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology; Academic Medical Center; Amsterdam the Netherlands
| | - Sally-Ann Clur
- Department of Pediatric Cardiology; Emma Children's Hospital; Academic Medical Center; Amsterdam the Netherlands
| | - Marry E.B. Rijlaarsdam
- Department of Pediatric Cardiology; Leiden University Medical Center; Leiden the Netherlands
| | - Caroline J. Bax
- Department of Obstetrics and Gynecology; VU University Medical Center; Amsterdam the Netherlands
| | - Jaroslav Hruda
- Department of Pediatric Cardiology; VU University Medical Center; Amsterdam the Netherlands
| | | | - Nico A. Blom
- Department of Pediatric Cardiology; Emma Children's Hospital; Academic Medical Center; Amsterdam the Netherlands
- Department of Pediatric Cardiology; Leiden University Medical Center; Leiden the Netherlands
| | - Monique C. Haak
- Department of Obstetrics and Gynecology; Leiden University Medical Center; Leiden the Netherlands
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55
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Sklansky MS, DeVore GR. Reply. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1832-1833. [PMID: 27462132 DOI: 10.7863/ultra.16.05011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Mark S Sklansky
- Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California USA
| | - Greggory R DeVore
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California USA
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56
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Abstract
Compared with the assessment of most fetal anatomic structures, the assessment of the fetal heart during routine obstetric screening represents a diagnostic challenge for sonographers and interpreting physicians. This is due to a number of factors: the structural complexity of the heart, the rate at which it moves, the position of the fetus relative to the transducer, and variations in assessment protocols used by sonographers and physicians. The fetal heart is a relatively small and complex structure, as seen in an early second-trimester sonogram. In some forms of congenital heart disease, the abnormality may be detectable within only a relatively small fraction of the heart volume. Congenital heart disease represents a range of structural defects, a number of which have specific sonographic features that can be identified during routine assessment. Many approaches have been proposed to improve the assessment of the fetal heart, including specific still images, color Doppler, 3D imaging techniques, and cineloops.
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Affiliation(s)
- Ted Scott
- Society of Diagnostic Medical Screening Member, Hamilton, Canada
| | | | - Hans Swan
- Charles Sturt University, Wagga Wagga, Australia
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57
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Eckersley L, Sadler L, Parry E, Finucane K, Gentles TL. Timing of diagnosis affects mortality in critical congenital heart disease. Arch Dis Child 2016; 101:516-520. [PMID: 26130379 DOI: 10.1136/archdischild-2014-307691] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 06/10/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Screening for critical congenital heart disease (CHD) with prenatal ultrasound or postnatal pulse oximetry has the potential to improve outcome. To guide screening recommendations, this study aimed to identify the proportion and outcome of major CHD diagnosed before (early) or after (late) postnatal discharge prior to the introduction of postnatal oximetry screening. DESIGN A retrospective, population-based review of all major CHD in New Zealand from 2006 to 2010. The timing of diagnosis relative to discharge and to intervention in critical and non-critical cases with intention to treat was determined, as was the relationship of diagnostic timing to mortality at 1 year of age. RESULTS Late diagnosis occurred in 20% of critical and 51% of non-critical cases. Mortality occurred in 18% of critical vs 8% of non-critical cases. Mortality was lower with an early diagnosis of critical CHD (early diagnosis 16% vs late diagnosis 27%, p=0.04). Isolated critical CHD benefited most from early diagnosis (mortality, early diagnosis 12% vs late diagnosis 29%, p=0.002). Early diagnosis occurred in >90% critical complex CHD and hypoplastic left heart syndrome, 85% d-transposition of the great arteries (d-TGA) and 53% critical left ventricular outflow tract obstruction (LVOTO). Deaths in d-TGA and LVOTO primarily occurred prior to intervention and for d-TGA most often when birth was distant from the cardiac centre. CONCLUSIONS Excess mortality occurs following late diagnosis of critical CHD, and for d-TGA even with early diagnosis if intervention is not immediately available. Antenatal detection retains an important role in reducing mortality related to critical CHD.
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Affiliation(s)
- Luke Eckersley
- Greenlane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand
| | - Lynn Sadler
- Department of Obstetrics & Gynaecology, National Women's Hospital, Auckland, New Zealand
| | - Emma Parry
- New Zealand Maternal Fetal Medicine Network, National Women's Hospital, Auckland, New Zealand
| | - Kirsten Finucane
- Greenlane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand
| | - Thomas L Gentles
- Greenlane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand
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58
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Abstract
Advances in ultrasound technology and specialized training have allowed clinicians to diagnose congenital heart disease in utero and counsel families on perinatal outcomes and management strategies, including fetal cardiac interventions and fetal surgery. This article gives a detailed approach to fetal cardiac assessment and provides the reader with accompanying figures and video clips to illustrate unique views and sweeps invaluable to diagnosing congenital heart disease. We demonstrate that using a sequential segmental approach to evaluate cardiac anatomy enables one to decipher the most complex forms of congenital heart disease. Also provided is a review of fetal cardiac intervention and surgery from the fetal cardiologist's perspective.
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Affiliation(s)
- Ericka S McLaughlin
- Children's Healthcare of Atlanta, The McGill Building, 2835 Brandywine Road, Suite 300, Atlanta, GA 30341, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Brian A Schlosser
- Children's Healthcare of Atlanta, The McGill Building, 2835 Brandywine Road, Suite 300, Atlanta, GA 30341, USA
| | - William L Border
- Children's Healthcare of Atlanta, The McGill Building, 2835 Brandywine Road, Suite 300, Atlanta, GA 30341, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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59
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Nayak K, Chandra G S N, Shetty R, Narayan PK. Evaluation of fetal echocardiography as a routine antenatal screening tool for detection of congenital heart disease. Cardiovasc Diagn Ther 2016; 6:44-9. [PMID: 26885491 DOI: 10.3978/j.issn.2223-3652.2015.12.01] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Fetal echocardiography plays a pivotal role in identifying the congenital heart defects (CHDs) in utero. Though foetal echocardiography is mostly reserved for high risk pregnant women, its role as a routine prenatal screening tool still needs to be defined. Performing foetal echocardiography based on only these indications can lead to a significant numbers of CHD cases going undetected who will be deprived of further management leading to increased early neonatal mortalities. The aim of this study is to assess the incidence of CHDs by fetal echocardiography in an unselected population of pregnant women in comparison with pregnant women with conventional high risk factors for CHD. METHODS This study enrolled consecutive pregnant women who attended antenatal clinic between 2008 and 2012 in a tertiary care hospital. These pregnant women were categorized into two groups: high risk group included pregnant women with traditional risk factors for CHD as laid down by Pediatric Council of the American Society of Echocardiography and low risk group. Detailed fetal 2 D echocardiography was done. RESULTS A total of 1,280 pregnant women were included in study. The 118 women were categorized as the high risk group while remaining 1,162 were included in the low risk group. Twenty six cases of CHDs were detected based on abnormal foetal echocardiography (20.3 per 1,000). Two of the 26 cases of CHD occurred in high risk group whereas the remaining 24 occurred in low risk pregnancy. The difference in the incidence of CHDs between the two groups was not significant statistically (P=0.76). CONCLUSIONS Our study shows no difference in incidence of CHDs between pregnancies associated with high risk factors compared to low risk pregnancies. So we advocate foetal echocardiography should be included as a part of routine antenatal screening and all pregnant women irrespective of risk factors for CHDs.
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Affiliation(s)
- Krishnananda Nayak
- 1 SOAHS, Manipal University, Manipal, Karnataka, India ; 2 Department of Cardiology, Kasturba Medical College, Manipal University, Manipal, India ; 3 Kasturba Medical College, Manipal University, Manipal, India ; 4 Department Of Obstetrics And Gynecology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Naveen Chandra G S
- 1 SOAHS, Manipal University, Manipal, Karnataka, India ; 2 Department of Cardiology, Kasturba Medical College, Manipal University, Manipal, India ; 3 Kasturba Medical College, Manipal University, Manipal, India ; 4 Department Of Obstetrics And Gynecology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Ranjan Shetty
- 1 SOAHS, Manipal University, Manipal, Karnataka, India ; 2 Department of Cardiology, Kasturba Medical College, Manipal University, Manipal, India ; 3 Kasturba Medical College, Manipal University, Manipal, India ; 4 Department Of Obstetrics And Gynecology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Pratap Kumar Narayan
- 1 SOAHS, Manipal University, Manipal, Karnataka, India ; 2 Department of Cardiology, Kasturba Medical College, Manipal University, Manipal, India ; 3 Kasturba Medical College, Manipal University, Manipal, India ; 4 Department Of Obstetrics And Gynecology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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60
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Mogra R. Simplifying ultrasound assessment of the fetal heart: Incorporating the complete Three Vessel View into routine screening. Australas J Ultrasound Med 2015; 16:168-175. [PMID: 28191193 PMCID: PMC5030054 DOI: 10.1002/j.2205-0140.2013.tb00243.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: As our experience and ultrasound resolution have improved significantly in last 30 years it is possible to detect most of the major cardiac abnormalities prenatally with high degree of accuracy. Method: Current screening techniques have poor detection rate for congenital heart diseases (CHD) and nearly half of the major cardiac abnormalities mainly of Great Arteries goes unrecognised. A high detection rate for major CHDs can be achieved in a screening setting by improving techniques of routine screening in the low risk population. Conclusion: This article summarises the alternative strategies to examine the outflow tracts and Great Arteries, its correct interpretation and examples of abnormal views.
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Affiliation(s)
- Ritu Mogra
- RPA Women and Babies Royal Prince Alfred Hospital Sydney Ultrasound for Women Sydney New South Wales Australia
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61
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Araujo Júnior E, Novoa Y. Novoa VA, Barros FSB, Rocha LA, Peixoto AB, Martins WP, Nardozza LMM, Moron AF. Reference values for the volumes of foetal heart atrial wall by three-dimensional ultrasound using STIC and VOCAL methods between 20w0d and 33w6d weeks of gestation. J Matern Fetal Neonatal Med 2015; 29:3076-83. [DOI: 10.3109/14767058.2015.1118454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine – Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil and
| | - Victoria Arruga Novoa Y. Novoa
- Department of Obstetrics, Paulista School of Medicine – Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil and
| | - Fernanda Silveira Bello Barros
- Department of Obstetrics, Paulista School of Medicine – Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil and
| | - Luciane Alves Rocha
- Department of Obstetrics, Paulista School of Medicine – Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil and
| | - Alberto Borges Peixoto
- Department of Obstetrics, Paulista School of Medicine – Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil and
| | - Wellington P. Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo (DGO-FMRP-USP), Ribeirão Preto-SP, Brazil
| | | | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine – Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil and
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Adekola H, Soto E, Dai J, Lam-Rachlin J, Gill N, Leon-Peters J, Puder K, Abramowicz JS. Optimal visualization of the fetal four-chamber and outflow tract views with transabdominal ultrasound in the morbidly obese: Are we there yet? JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:548-555. [PMID: 26419498 DOI: 10.1002/jcu.22307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/27/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND To compare optimal visualization of the four-chamber and outflow-tract views of the fetal heart on sonographic examination between morbidly obese (body mass index [BMI] ≥ 40 kg/m(2) ) and nonobese (BMI < 25 kg/m(2) ) pregnant women. METHODS In this retrospective cohort study, we included records and images from 509 pregnant women who had first undergone sonographic examination between 18 and 36 weeks' fetal gestational age. RESULTS Compared with the nonobese women, morbidly obese women had lower optimal visualization of the four-chamber and outflow-tract heart views: four-chamber view, morbidly obese, 83/186 (44.6%), versus nonobese, 283/323 (87.6%), and outflow-tract view, morbidly obese, 80/186 (43%) versus nonobese, 258/290 (89%); p < 0.0001 for each comparison. Similar outcomes were observed when the results from each subcategory of morbidly obese women (ie, BMI 40-49.9, 50-59.9, and ≥60 kg/m(2) ) were compared with that from nonobese women; p < 0.0001 for each comparison. These outcomes remained the same regardless of whether this comparison was made among those who had their examination before or at 19 weeks' or more gestational age. Among the morbidly obese women, there was no difference in optimal visualization of the four-chamber or outflow-tract views regardless of whether the examination was performed at <23 weeks' or at ≥23 weeks' gestational age: four-chamber view <23 weeks, 44.8% (78/174), versus four-chamber view ≥23 weeks, 41.7% (5/12); p = 0.8, and outflow-tract view <23 weeks, 43.1% (75/174), versus outflow-tract view ≥23 weeks, 41.7% (5/12); p = 0.9. After controlling for maternal age and race, the odds of visualizing the four-chamber and outflow-tract views in the morbidly obese were reduced compared with those in their nonobese counterparts: odds ratio (OR) for four-chamber, 0.13; 95% confidence interval (CI), 0.08-0.21, and OR for outflow-tract, 0.11; 95% CI, 0.07-0.17. CONCLUSIONS Optimal visualization of the fetal four-chamber and outflow-tract views was achieved in less than 50% of morbidly obese women, compared with almost 90% in nonobese women.
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Affiliation(s)
- Henry Adekola
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, 48201
| | - Eleazar Soto
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, TX, 77030
| | - Jing Dai
- C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, 48201
| | - Jennifer Lam-Rachlin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, 48201
| | - Navleen Gill
- Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, 48201
| | - Jocelyn Leon-Peters
- Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, 48201
| | - Karoline Puder
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, 48201
| | - Jacques S Abramowicz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, 48201
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Outcomes of infants with prenatally diagnosed congenital heart disease delivered in a tertiary-care pediatric cardiac facility. Indian Pediatr 2015; 52:852-6. [DOI: 10.1007/s13312-015-0731-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hill GD, Block JR, Tanem JB, Frommelt MA. Disparities in the prenatal detection of critical congenital heart disease. Prenat Diagn 2015; 35:859-63. [PMID: 25989740 PMCID: PMC4558244 DOI: 10.1002/pd.4622] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Prenatal diagnosis of critical congenital heart disease, which requires surgical or catheter intervention in the first 30 days of life, allows for delivery at a specialized center and can reduce preoperative morbidity and mortality. We sought to identify the risk factors for a missed prenatal diagnosis of critical congenital heart disease. METHODS Patients presenting to the Children's Hospital of Wisconsin with critical congenital heart disease from 2007 to 2013 were included. Those with a prenatal diagnosis were compared with those with a postnatal diagnosis. RESULTS The cohort included 535 patients with prenatal diagnosis made in 326 (61%). The prenatal diagnostic rate improved from 44% in 2007 to 69% in 2013. Independent factors associated with a postnatal diagnosis were a lesion that required a view other than a four chamber view to make the diagnosis (p < 0.0001), absence of another organ system anomaly (p < 0.0001), and living in a higher poverty (p = 0.02) or lower population density communities (p = 0.002). CONCLUSIONS While the prenatal diagnostic rate for critical congenital heart disease is improving, those living in impoverished or rural communities are at highest risk of not having a diagnosis made prenatally. Interventions to improve prenatal detection of congenital heart disease should target these vulnerable areas.
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Affiliation(s)
- G D Hill
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J R Block
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J B Tanem
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M A Frommelt
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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65
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Novaes JY, Zamith MM, Araujo Júnior E, de Sá Barreto EQ, Barros FSB, Moron AF. Screening of Congenital Heart Diseases by Three-Dimensional Ultrasound Using Spatiotemporal Image Correlation: Influence of Professional Experience. Echocardiography 2015; 33:99-104. [DOI: 10.1111/echo.13002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Juliana Y. Novaes
- Department of Obstetrics; Paulista School of Medicine; Federal University of São Paulo (EPM-UNIFESP); São Paulo SP Brazil
| | - Marina M. Zamith
- Discipline of Cardiology; Paulista School of Medicine; Federal University of São Paulo (EPM-UNIFESP); São Paulo SP Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics; Paulista School of Medicine; Federal University of São Paulo (EPM-UNIFESP); São Paulo SP Brazil
| | - Enoch Q. de Sá Barreto
- Department of Obstetrics; Paulista School of Medicine; Federal University of São Paulo (EPM-UNIFESP); São Paulo SP Brazil
| | - Fernanda S. B. Barros
- Department of Obstetrics; Paulista School of Medicine; Federal University of São Paulo (EPM-UNIFESP); São Paulo SP Brazil
| | - Antonio F. Moron
- Department of Obstetrics; Paulista School of Medicine; Federal University of São Paulo (EPM-UNIFESP); São Paulo SP Brazil
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66
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Liu X, Liu G, Wang P, Huang Y, Liu E, Li D, Ren S, Pan L, Li N, Yang X, Yu Z, Hu G. Prevalence of congenital heart disease and its related risk indicators among 90,796 Chinese infants aged less than 6 months in Tianjin. Int J Epidemiol 2015; 44:884-93. [PMID: 26071138 DOI: 10.1093/ije/dyv107] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Congenital heart disease (CHD) represents one of the most prevalent congenital malformations. However, few studies use whole-population screening by colour Doppler ultrasonic diagnostic system to identify CHD among live infants. We estimate the prevalence of CHD and its major risk indicators among infants aged less than 6 months in urban Tianjin, China. METHODS A colour Doppler ultrasonic diagnostic system was used as the screening tool for the diagnosis of CHD. A total of 90,796 infants aged less than 6 months, living in the nine urban districts of Tianjin, China, participated in the CHD screening programme between July 2009 and June 2011. RESULTS A total of 1817 children were identified as having CHD. The overall prevalence of congenital heart disease was 16.4 per 1000 live births among 47,697 boys, 24.1 per 1000 live births among 43,099 girls, and 20.0 per 1,000 live births among 90,796 boys and girls combined. Atrial septal defect was the most common heart lesion of CHD, with the prevalence of 10.6 per 1000 live births. Several maternal antenatal factors, such as older age, pregnant infections, pregnancy-induced hypertension, gestational diabetes, family history of CHD, and lower education level, and several child factors, such as early screening age, lower birthweight and short gestational age, were associated with an increased risk of CHD. CONCLUSIONS The prevalence of CHD of live infants in Tianjin was found to be relatively high by using a colour Doppler ultrasonic diagnostic system to screen CHD. Several maternal factors were associated with CHD risk.
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Affiliation(s)
| | - Gongshu Liu
- Tianjin Women's and Children's Health Center, and
| | - Ping Wang
- Tianjin Women's and Children's Health Center, and
| | | | - Enqing Liu
- Tianjin Women's and Children's Health Center, and
| | - Dongbei Li
- TEDA International Cardiovascular Hospital
| | | | - Lei Pan
- Tianjin Women's and Children's Health Center, and
| | - Nan Li
- Tianjin Women's and Children's Health Center, and Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Xilin Yang
- Tianjin Medical University, Tianjin, China
| | - Zhijie Yu
- Dalhousie University, Halifax, NS, Canada and
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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Bahtiyar MO, Copel JA. Screening for congenital heart disease during anatomical survey ultrasonography. Obstet Gynecol Clin North Am 2015; 42:209-23. [PMID: 26002162 DOI: 10.1016/j.ogc.2015.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Congenital heart disease (CHD) is among the most common congenital abnormalities. The prevalence of CHD ranges between 0.6% and 1.2% of live births. Despite its high prevalence, CHD is also among the most commonly missed abnormalities during prenatal ultrasound examination. A simple yet systematic approach to fetal heart examination, regular feedback, and implementation of training programs could improve detection rates and, in turn, neonatal outcome.
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Affiliation(s)
- Mert Ozan Bahtiyar
- Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Science, Yale Fetal Cardiovascular Center, Yale Fetal Care Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Joshua A Copel
- Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Science, Yale Fetal Cardiovascular Center, Yale Fetal Care Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA; Department of Pediatrics, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
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van Velzen CL, Clur SA, Rijlaarsdam MEB, Bax CJ, Pajkrt E, Heymans MW, Bekker MN, Hruda J, de Groot CJM, Blom NA, Haak MC. Prenatal detection of congenital heart disease--results of a national screening programme. BJOG 2015; 123:400-7. [PMID: 25625301 DOI: 10.1111/1471-0528.13274] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Congenital heart disease (CHD) is the most common congenital malformation and causes major morbidity and mortality. Prenatal detection improves the neonatal condition before surgery, resulting in less morbidity and mortality. In the Netherlands a national prenatal screening programme was introduced in 2007. This study evaluates the effects of this screening programme. DESIGN Geographical cohort study. SETTING Large referral region of three tertiary care centres. POPULATION Fetuses and infants diagnosed with severe CHD born between 1 January 2002 and 1 January 2012. METHODS Cases were divided into two groups: before and after the introduction of screening. MAIN OUTCOME MEASURES Detection rates were calculated. RESULTS The prenatal detection rate (n = 1912) increased with 23.9% (95% confidence interval [95% CI] 19.5-28.3) from 35.8 to 59.7% after the introduction of screening and of isolated CHD with 21.4% (95% CI 16.0-26.8) from 22.8 to 44.2%. The highest detection rates were found in the hypoplastic left heart syndrome, other univentricular defects and complex defects with atrial isomerism (>93%). Since the introduction of screening, the 'late' referrals (after 24 weeks of gestation) decreased by 24.3% (95% CI 19.3-29.3). CONCLUSIONS This is the largest cohort study to investigate the prenatal detection rate of severe CHD in an unselected population. A nationally organised screening has resulted in a remarkably high detection rate of CHD (59.7%) compared with earlier literature.
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Affiliation(s)
- C L van Velzen
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - S A Clur
- Department of Pediatric Cardiology, Academic Medical Centre, Emma Children's Hospital, Amsterdam, the Netherlands
| | - M E B Rijlaarsdam
- Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - C J Bax
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - M W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - M N Bekker
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J Hruda
- Department of Paediatric Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - C J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - N A Blom
- Department of Pediatric Cardiology, Academic Medical Centre, Emma Children's Hospital, Amsterdam, the Netherlands.,Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M C Haak
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
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Sarkola T, Ojala TH, Ulander VM, Jaeggi E, Pitkänen OM. Screening for congenital heart defects by transabdominal ultrasound - role of early gestational screening and importance of operator training. Acta Obstet Gynecol Scand 2015; 94:231-5. [DOI: 10.1111/aogs.12572] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 12/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Taisto Sarkola
- Children's Hospital; Helsinki University Central Hospital; Helsinki Finland
| | - Tiina H. Ojala
- Children's Hospital; Helsinki University Central Hospital; Helsinki Finland
| | - Veli-Matti Ulander
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
| | - Edgar Jaeggi
- Labatt Family Heart Centre; Hospital for Sick Children; University of Toronto; Toronto Ontario Canada
| | - Olli M. Pitkänen
- Children's Hospital; Helsinki University Central Hospital; Helsinki Finland
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Araujo Júnior E, Darahem Tedesco G, Carvalho Carrilho M, Borges Peixoto A, Costa Carvalho FH. 4D Fetal Echocardiography in Clinical Practice. ACTA ACUST UNITED AC 2015. [DOI: 10.5005/jp-journals-10009-1425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Spatiotemporal image correlation (STIC) is a technique that acquires the fetal cardiac volumes, and then analyzes it offline in both multiplanar and rendered modes, using both static and moving images from a four-dimensional (4D) cine sequence simulating a full cardiac cycle. Spatiotemporal image correlation makes it possible to evaluate cardiac structures and their vascular connections, is less operator dependent, and allows cardiac volumes to be sent to specialists in tertiary centers for examination. Spatiotemporal image correlation can be combined with other software techniques, such as virtual organ computer-aided analysis (VOCAL) and automatic volume calculation (SonoAVC), to calculate cardiac function parameters. It can also be used in association with Omniview® in order to obtain standard echocardiographic planes using simple targets arterial rendering (STAR) and four-chamber view and swing technique (FAST). Recently, fetal intelligent navigation echocardiography (FINE), acquired from 3D STIC volumes, has made it possible to automatically obtain nine standard echocardiographic planes. In this article, we review the chief applications of 4D echocardiography using STIC technique in clinical practice.
How to cite this article
Araujo Júnior E, Tedesco GD, Carrilho MC, Peixoto AB, Carvalho FHC. 4D Fetal Echocardiography in Clinical Practice. Donald School J Ultrasound Obstet Gynecol 2015;9(4): 382-396.
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Araujo Júnior E, Rocha LAD, Nardozza LMM. Sonocubic fine: new three-dimensional ultrasound software to the screening of congenital heart diseases. Braz J Cardiovasc Surg 2014; 29:426-31. [PMID: 25372918 PMCID: PMC4409063 DOI: 10.5935/1678-9741.20140040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 03/11/2014] [Indexed: 12/05/2022] Open
Abstract
Congenital heart disease is the most common fetal congenital malformations; however,
the prenatal rate detection still is low. The two-dimensional echocardiography is the
"gold standard" exam to screening and diagnosis of congenital heart disease during
the prenatal; however, this exam is operator-depending and it is realized only in
high risk pregnancies. Spatio-temporal image correlation is a three-dimensional
ultrasound software that analyses the fetal heart and your connections in the
multiplanar and rendering modes; however, spatio-temporal image correlation too is
operator-depending and time-consuming. We presenting a new three-dimensional software
named Sonocubic fine to the screening of congenital heart disease. This software
applies intelligent navigation technology to spatio-temporal image correlation volume
datasets to automatically generate nine fetal echocardiography standard views. Thus,
this new software tends to be less operator-depending and time-consuming.
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Abstract
PURPOSE OF REVIEW Fetal cardiology is a rapidly evolving field. Imaging technology continues to advance as do approaches to in-utero interventions and care of the critically ill neonate, with even greater demand for improvement in prenatal diagnosis of congenital heart disease (CHD) and arrhythmias. RECENT FINDINGS Reviewing the advances in prenatal diagnosis of CHD in such a rapidly developing field is a broad topic. Therefore, we have chosen to focus this review of recent literature on challenges in prenatal detection of CHD, challenges in prenatal counseling, advances in fetal arrhythmia diagnosis, and potential benefits to patients with CHD who are identified prenatally. SUMMARY As methods and tools to diagnose and manage CHD and arrhythmias in utero continue to improve, future generations will hopefully see a reduction in both prenatal and neonatal morbidity and mortality. Prenatal diagnosis can and should be used to optimize location and timing of delivery and postnatal interventions.
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Araujo Júnior E, Nardozza LMM, Moron AF. Three-dimensional ultrasound STIC-HDlive rendering: new technique to assessing of fetal heart. Braz J Cardiovasc Surg 2014; 28:v-vii. [PMID: 24598969 PMCID: PMC4389437 DOI: 10.5935/1678-9741.20130070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Liu H, Zhou J, Feng QL, Gu HT, Wan G, Zhang HM, Xie YJ, Li XS. Fetal echocardiography for congenital heart disease diagnosis: a meta-analysis, power analysis and missing data analysis. Eur J Prev Cardiol 2014; 22:1531-47. [DOI: 10.1177/2047487314551547] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/26/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Hong Liu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, PR China
- Collaborative Group of Congenital Heart Disease, Department of Pediatric Cardiology, Jiangsu Women’s and Children’s Health of Nanjing Medical University, PR China
- Research Institute of Heart, Lung and Blood Vessel Diseases, Jiangsu Provincial Academy of Clinical Medicine, PR China
| | - Jie Zhou
- Study Group of Echocardiography, Department of Sonographic Diagnostic Medicine, First Affiliated Hospital of Nanjing Medical University, PR China
| | - Qiao-Ling Feng
- Key Laboratory of Diagnostic Medicine of Education Ministry, Institute of Laboratory Medicine, Chongqing Medical University, PR China
| | - Hai-Tao Gu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, PR China
- Collaborative Group of Congenital Heart Disease, Department of Pediatric Cardiology, Jiangsu Women’s and Children’s Health of Nanjing Medical University, PR China
- Research Institute of Heart, Lung and Blood Vessel Diseases, Jiangsu Provincial Academy of Clinical Medicine, PR China
| | - Gang Wan
- Department of Radiology, General Clinical Center for Radiation Oncology, Affiliated Cancer Hospital of Guangxi Medical University, PR China
| | - Huo-Ming Zhang
- Institute of Fluid Measurement and Simulation, Department of Mechanics, College of Metrology & Measurement Engineering, China Jiliang University, PR China
| | - Yong-Jun Xie
- National Experimental Center for Medical Simulation of China, Laboratory of Anthropotomy & Histo-Embryology, School of Basic Medical Sciences, Chengdu Medical College, PR China
| | - Xiao-Song Li
- Department of Health Statistics, National Center for Chinese Clinical Trial Register, School of Public Health, Sichuan University Western China School of Medicine, PR China
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Rocha LA, Rolo LC, Barros FSB, Nardozza LMM, Moron AF, Araujo Júnior E. Assessment of Quality of Fetal Heart Views by 3D/4D Ultrasonography Using Spatio-Temporal Image Correlation in the Second and Third Trimesters of Pregnancy. Echocardiography 2014; 32:1015-21. [PMID: 25231765 DOI: 10.1111/echo.12743] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To assess the quality of fetal heart views by three-dimensional/four-dimensional (3D/4D) ultrasonography using spatio-temporal image correlation (STIC) in the second and third trimester of pregnancy. METHODS This prospective and cross-sectional study was conducted at a single referral service for the screening of congenital heart diseases (CHDs), with pregnant women at 20-30 weeks' gestation with a normal fetal heart. 3D/4D STIC were obtained from the fetal heart screening in the following views: four-chamber (4C), left and right ventricular outflow tracts (LVOT and RVOT), 3 vessels and trachea (3VT), aortic arch (AA), and ductal arch (DA). We categorized the images as satisfactory or unsatisfactory and performed McNemar's test to evaluate the differences between the two-dimensional (2D) echocardiography and 3D/4D STIC techniques. The inter-observer concordance was obtained by kappa coefficient. RESULTS The rate of satisfactory fetal heart views using 3D/4D STIC was 54% by using 4 planes (4C, RVOT, LVOT, and 3VT) and 14% by using 6 planes (4C, RVOT, LVOT, 3VT, AA, and DA). In contrast, 100% of the 2D echocardiography images were satisfactory (McNemar's test, P < 0.001). We observed moderate inter-observer concordance to both 4- and 6 planes (κ = 0.56 and 0.43, respectively). CONCLUSION The quality of the main fetal heart views by 3D/4D STIC still present some limitations compared with the 2D echocardiography.
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Affiliation(s)
- Luciane Alves Rocha
- Fetal Cardiology Unit, Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Liliam Cristine Rolo
- Fetal Cardiology Unit, Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | - Antonio Fernandes Moron
- Fetal Cardiology Unit, Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- Fetal Cardiology Unit, Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Pinto NM, Nelson R, Puchalski M, Metz TD, Smith KJ. Cost-effectiveness of prenatal screening strategies for congenital heart disease. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:50-7. [PMID: 24357432 PMCID: PMC5278773 DOI: 10.1002/uog.13287] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/22/2013] [Accepted: 12/05/2013] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The economic implications of strategies to improve prenatal screening for congenital heart disease (CHD) in low-risk mothers have not been explored. The aim was to perform a cost-effectiveness analysis of different screening methods. METHODS We constructed a decision analytic model of CHD prenatal screening strategies (four-chamber screen (4C), 4C + outflow, nuchal translucency (NT) or fetal echocardiography) populated with probabilities from the literature. The model included whether initial screens were interpreted by a maternal-fetal medicine (MFM) specialist and different referral strategies if they were read by a non-MFM specialist. The primary outcome was the incremental cost per defect detected. Costs were obtained from Medicare National Fee estimates. A probabilistic sensitivity analysis was undertaken on model variables commensurate with their degree of uncertainty. RESULTS In base-case analysis, 4C + outflow referred to an MFM specialist was the least costly strategy per defect detected. The 4C screen and the NT screen were dominated by other strategies (i.e. were more costly and less effective). Fetal echocardiography was the most effective, but most costly. On simulation of 10 000 low-risk pregnancies, 4C + outflow screen referred to an MFM specialist remained the least costly per defect detected. For an additional $580 per defect detected, referral to cardiology after a 4C + outflow was the most cost-effective for the majority of iterations, increasing CHD detection by 13 percentage points. CONCLUSIONS The addition of examination of the outflow tracts to second-trimester ultrasound increases detection of CHD in the most cost-effective manner. Strategies to improve outflow-tract imaging and to refer with the most efficiency may be the best way to improve detection at a population level.
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Affiliation(s)
- N M Pinto
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Araujo Júnior E, Rolo LC, Rocha LA, Nardozza LMM, Moron AF. The value of 3D and 4D assessments of the fetal heart. Int J Womens Health 2014; 6:501-7. [PMID: 24868174 PMCID: PMC4032184 DOI: 10.2147/ijwh.s47074] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The objective of this review was to demonstrate the main tools of three- and four-dimensional ultrasonography, using the spatiotemporal image correlation software and its respective applications for assessing the fetal heart and its vascular connections, along with its potential contribution towards screening for congenital heart diseases. Today, conventional, two-dimensional, echocardiography continues to be the gold standard for diagnosing congenital heart diseases. However, recent studies have demonstrated that spatiotemporal image correlation offers some advantages that boost two-dimensional accuracy in detecting congenital heart diseases, given that the fetal heart assessment can be completed in the absence of the patient (offline) and be discussed by different examiners. Additionally, data volumes can be sent for analysis in reference centers via internet links. Spatiotemporal image correlation also enables direct measurement of heart structures in rendering mode, such as the interventricular septum and the annulus of the atrioventricular valves. Furthermore, it enables assessment of cardiac function when used in association with the virtual organ computer-aided analysis software, thus making it possible to calculate the total systolic function, ejection fraction, and cardiac output.
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Affiliation(s)
- Edward Araujo Júnior
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Liliam Cristine Rolo
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Luciane Alves Rocha
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, Cuneo BF, Huhta JC, Jonas RA, Krishnan A, Lacey S, Lee W, Michelfelder EC, Rempel GR, Silverman NH, Spray TL, Strasburger JF, Tworetzky W, Rychik J. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129:2183-242. [PMID: 24763516 DOI: 10.1161/01.cir.0000437597.44550.5d] [Citation(s) in RCA: 719] [Impact Index Per Article: 71.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. METHODS AND RESULTS A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin-twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. CONCLUSIONS Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.
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Prenatal ultrasound screening of congenital heart disease in the general population: general concepts, guidelines, differential diagnoses. Ultrasound Q 2014; 29:111-24. [PMID: 23644810 DOI: 10.1097/ruq.0b013e3182915867] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Congenital heart diseases (CHDs) carry a high prevalence rate in the general population (0.8%-1%). Most fetal CHDs occur in patients without any risk factors. The prenatal recognition of CHD has major impacts on the pregnancy and its outcome. The aforementioned data justify prenatal ultrasound (US) screening of CHD in the general low-risk population. As demonstrated in the literature, the application of an extended basic US cardiac examination improves the detection of CHD, in particular the conotruncal anomalies. The stepwise method suggested for fetal heart US screening during the mid-second trimester sonogram is based on 4 routine axial views of heart and great vessels: (1) a transverse view of the superior abdomen, (2) a 4-chamber view, (3) a 3-vessel view, and (4) a transverse view of the aortic arch. This protocol can be obtained rapidly because these scans are easy to perform. Despite the fact that the sequential segmental approach universally used in the postnatal diagnosis of CHD is not specifically addressed here, the detected anomalies can be categorized according to these views, and a short differential diagnosis proposed. Abnormal cardiac and/or vascular landmarks shown on these key scans should lead to a referral in the fetal cardiac center for a more precise evaluation, as well as for counseling.
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Assessment of the fetal heart at 12-14 weeks of pregnancy using B-mode, color Doppler, and spatiotemporal image correlation via abdominal and vaginal ultrasonography. Pediatr Cardiol 2013; 34:1577-82. [PMID: 23479309 DOI: 10.1007/s00246-013-0686-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 02/25/2013] [Indexed: 10/27/2022]
Abstract
This study aimed to evaluate the effect that combining multiple ultrasonographic imaging methods has on the proportion of tests with a satisfactory fetal heart assessment at 12-14 weeks of pregnancy using B-mode, color Doppler, and spatiotemporal image correlation software (STIC) via both the abdominal and vaginal routes. This cross-sectional prospective study involved healthy pregnant women at 12-14 weeks of pregnancy with a crown-rump length (CRL) of 84 mm or shorter. The following four cardiac views were assessed: four-chamber, left and right ventricular outflow tract, and aortic arch views. The same examiner sought to identify these four views using B-mode, color Doppler, and STIC via both the vaginal and abdominal routes. The study determined the proportion of cases and the respective 95 % confidence intervals (CIs) in which all four views were identified. The presence of significant differences in comparisons between methods was analyzed using McNemar's test. Although 57 pregnant women at 12-14 weeks of pregnancy agreed to participate in the study, 4 were not included because they presented with a CRL longer than 84 mm. Thus, 53 pregnant women were thoroughly assessed and included in the analysis. The combination of B-mode, color Doppler, and STIC via both the abdominal and vaginal routes enabled the highest proportion of identification of the four views (90.6 %; 95 % CI, 79.8-95.9 %). The lowest proportions were observed when B-mode was used alone via both the vaginal route (30.2 %; 95 % CI, 19.5-43.5 %) and the abdominal route (37.7 %; 95 % CI, 25.9-51.2 %). The abdominal route showed results slightly better than those of the vaginal route with all the methods, but the differences were not statistically significant. In the vast majority of the cases, the fetal hearts were properly assessed at 12-14 weeks of pregnancy when several methods were combined using both the abdominal and vaginal routes. However, only one-third of them would have had adequate heart assessment if the B-mode via either the abdominal or the vaginal route had been used alone.
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Zhu S, Cao L, Zhu J, Kong L, Jin J, Qian L, Zhu C, Hu X, Li M, Guo X, Han S, Yu Z. Identification of maternal serum microRNAs as novel non-invasive biomarkers for prenatal detection of fetal congenital heart defects. Clin Chim Acta 2013; 424:66-72. [DOI: 10.1016/j.cca.2013.05.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
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Li Y, Hua Y, Fang J, Wang C, Qiao L, Wan C, Mu D, Zhou K. Performance of different scan protocols of fetal echocardiography in the diagnosis of fetal congenital heart disease: a systematic review and meta-analysis. PLoS One 2013; 8:e65484. [PMID: 23750263 PMCID: PMC3672155 DOI: 10.1371/journal.pone.0065484] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 04/26/2013] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The rapid progress in fetal echocardiography has lead to early detection of congenital heart diseases. Increasing evidences have shown that prenatal diagnosis could be life saving in certain cases. However, there is no agreement on which protocol is most adaptive diagnostic one. Thus, we use meta-analysis to conduct a pooled performance test on 5 diagnostic protocols. METHODS We searched PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials and WHO clinical trails registry center to identify relevant studies up to August, 2012. We performed meta-analysis in a fixed/random-effect model using Meta-disc 1.4. We used STATA 11.0 to estimate the publication bias and SPSS 17.0 to evaluate variance. RESULTS We use results from 81 studies in 63 articles to analyze the pooled accuracy. The overall performance of pooled sensitivities of spatiotemporal image correlation (STIC), extend cardiac echography examination (ECEE) and 4 chambers view + outflow tract view + 3 vessels and trachea view (4 CV+OTV+3 VTV) were around 0.90, which was significant higher than that of 4 chambers view + outflow tract view or 3 vessels and trachea view (4 CV+OTV/3 VTV) and 4 chambers view (4 CV). Unfortunately the pooled specificity of STIC was 0.92, which was significant lower than that of other 4 protocols which reached at 1.00. The area under the summary receiver operating characteristic curves value of STIC, ECEE, 4 CV+OTV+3 VTV, 4 CV+OTV/3 VTV and 4 CV were 0.9700, 0.9971, 0.9983, 0.9929 and 0.9928 respectively. CONCLUSION These results suggest a great diagnostic potential for fetal echocardiography detection as a reliable method of fetal congenital heart disease. But at least 3 sections view (4 CV, OTV and 3 VTV) should be included in scan protocol, while the STIC can be used to provide more information for local details of defects, and can not be used to make a definite diagnosis alone with its low specificity.
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Affiliation(s)
- Yifei Li
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jie Fang
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Wang
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Lina Qiao
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chaomin Wan
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dezhi Mu
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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83
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Ishii Y, Inamura N, Kawazu Y, Kayatani F, Arakawa H. 'I-shaped' sign in the upper mediastinum: a novel potential marker for antenatal diagnosis of d-transposition of the great arteries. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:667-671. [PMID: 23023957 DOI: 10.1002/uog.12312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/17/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To investigate the 'I-shaped' sign as a novel echocardiographic marker for antenatal diagnosis of d-transposition of the great arteries (dTGA) in routine cardiac examination, and to compare its prevalence in fetuses with dTGA, those with other congenital heart diseases (CHDs) and those with normal structural hearts. METHODS This retrospective evaluation involved 1134 fetuses undergoing echocardiography to screen for CHD over a 4-year period. I-shaped sign was defined as the characteristic appearance of the aortic arch, resembling the letter 'I', from the most anterior to the most posterior point of the descending aorta visible in the three vessels and trachea view. The frequency of this sign was evaluated in cases with dTGA, those with other cardiac defects and those with normal cardiac structures. RESULTS CHD was diagnosed in 671 (59.1%) cases, of which 31 (4.6%) had dTGA. I-shaped sign was observed in 30/31 (96.8%) cases of dTGA, compared with 31/640 (4.8%) cases with other cardiac anomalies, which included single ventricle with pulmonary atresia or severe pulmonary stenosis, hypoplastic left heart syndrome with aortic atresia, corrected transposition of the great arteries, and double outlet right ventricle with malposition of the great arteries. I-shaped sign was detected significantly more frequently in the dTGA group compared with the normal group and with the other CHDs group (both P < 0.001) and had 96.8% sensitivity and 97.1% specificity for diagnosis of dTGA. Importantly, I-shaped sign was never observed in fetuses with structurally normal hearts. CONCLUSIONS Detection on echocardiography of an extremely long vessel with a marked I-shape should raise suspicion of cardiac anomaly, especially dTGA. This marker may therefore aid in the prenatal diagnosis of dTGA during routine ultrasound examination.
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Affiliation(s)
- Y Ishii
- Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
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84
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Mistry H, Gardiner HM. The Cost-Effectiveness of Prenatal Detection for Congenital Heart Disease Using Telemedicine Screening. J Telemed Telecare 2013; 19:190-6. [DOI: 10.1258/jtt.2012.120418] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We estimated the longer-term cost-effectiveness of using telemedicine screening for prenatal detection of congenital heart disease (CHD). One hospital in south-east England with a telemedicine service was connected to a fetal cardiology unit in London. A UK health service perspective was adopted. Evidence on costs and outcomes for standard-risk pregnant women during the antenatal period was based on patient-level data. Extrapolation beyond the end of the study (just after delivery) was carried out for the lifetime of children born with and without CHD. Expert opinion and data from published sources was used to populate a decision model. Future costs and benefits were discounted. The main outcome was quality-adjusted life years (QALYs) and results were expressed as cost per QALY gained. Various one-way sensitivity analyses were conducted. The model showed that offering telemedicine screening by specialists to all standard-risk pregnant women was the dominant strategy (i.e. cheaper and more effective). The sensitivity analyses found that the model was robust, and that telemedicine remained the most cost-effective strategy. The study showed that it would be cost-effective to provide telemedicine examinations as part of an antenatal screening programme for all standard-risk women.
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Affiliation(s)
- Hema Mistry
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Helena M Gardiner
- Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College, Hammersmith Campus, London, UK
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85
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Carvalho JS, Allan LD, Chaoui R, Copel JA, DeVore GR, Hecher K, Lee W, Munoz H, Paladini D, Tutschek B, Yagel S. ISUOG Practice Guidelines (updated): sonographic screening examination of the fetal heart. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:348-359. [PMID: 23460196 DOI: 10.1002/uog.12403] [Citation(s) in RCA: 437] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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86
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Menahem S, Teoh M, Wilkinson D. Should clinicians advise terminating a pregnancy following the diagnosis of a serious fetal cardiac abnormality? CASE REPORTS IN PERINATAL MEDICINE 2012. [DOI: 10.1515/crpm-2012-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
An 18-year-old single mother presented for counseling following the diagnosis of a hypoplastic left heart syndrome in the fetus. Despite being encouraged by her family members to terminate the pregnancy, the clinicians involved endeavored to provide information in a non-directive manner in accordance with widely accepted norms for antenatal counseling. Following the consultation, however, the clinicians wondered whether they should have provided more directive advice. In this report, we review the ethics of counseling following the diagnosis of a severe fetal cardiac abnormality. We assess the general and specific arguments in favor of providing directive advice, at least in some circumstances. There may be legitimate concerns about harms to the fetus, to the mother, or to the wider community from continuing a pregnancy. While these arguments yield rare exceptions to the generally accepted practice that antenatal counseling should not be directive, they may still not apply to the more severe forms of congenital cardiac abnormalities.
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Affiliation(s)
- Samuel Menahem
- Fetal Cardiac Unit, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Mark Teoh
- Fetal Cardiac Unit, Southern Health, Department of Obstetrics, Monash University, Melbourne, Australia
| | - Dominic Wilkinson
- Department of Neonatology, Women’s and Children’s Hospital and Adelaide University, Adelaide, Australia
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87
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Abstract
Background: Fetal echocardiography is a well established sensitive tool to diagnose congenital heart disease (CHD) in utero. One of the determinants of effective utilization of fetal echocardiography is its awareness in the general population. The present hospital based study was undertaken to assess the awareness of the need for fetal echocardiography amongst Indian parents. Methods: One thousand one hundred and thirty eight consecutive parents who visited the pediatric cardiology outpatient department of a tertiary care centre over a period of two months were asked to fill up a questionnaire that included their demographic data, educational status, history of CHD in children, awareness of fetal echocardiography and source of information and timing of fetal echocardiogram if performed. The data was categorized and awareness was noted in different groups. Results: The awareness in the study population was 2.2%. Awareness was found to be similar across the study population irrespective of the demographics and high risk status of the parents. Conclusions: The awareness of fetal echocardiography, an important tool in reducing the incidence of complex CHD, thereby impacting public health, is alarmingly low in the population studied. Appropriate action to increase awareness of fetal echocardiography needs to be looked into.
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Affiliation(s)
- Dhanya Warrier
- Department of Pediatric Cardiology, Narayana Hrudayalaya Institute of Medical Sciences, Bangalore, India
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88
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Pinto NM, Keenan HT, Minich LL, Puchalski MD, Heywood M, Botto LD. Barriers to prenatal detection of congenital heart disease: a population-based study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:418-425. [PMID: 21998002 DOI: 10.1002/uog.10116] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the extent and determinants of missed prenatal detection of congenital heart disease (CHD) in a population-based setting. METHODS This was a retrospective cohort study of cases with CHD, excluding minor defects, identified between 1997 and 2007 by a statewide surveillance program. We examined a comprehensive list of potential risk factors for which data were available in the surveillance database from abstracted medical charts. We analyzed the association of fetal, maternal and encounter factors with 1) whether a prenatal ultrasound was performed and 2) prenatal detection of CHD. RESULTS CHD was detected prenatally in only 39% of 1474 cases, with no improvement in detection rate over the 10-year period. Among the 97% (n = 1431) of mothers who underwent one or more ultrasound examinations, 35% were interpreted as abnormal; fetal echocardiography was performed in 27% of the entire cohort. Maternal and encounter factors increasing the adjusted odds of prenatal detection included: family history of CHD (OR, 4.3 (95% CI, 1.9-9.9)), presence of extracardiac defects (OR, 2.7 (95% CI, 1.9-3.9)) and ultrasound location i.e. high risk clinic vs clinic (OR, 2.1 (95% CI, 1.3-3.1)). Defects that would be expected to have an abnormal outflow-tract view were missed more often (64%) than were those that would be expected to have an abnormal four-chamber view (42%). CONCLUSION The majority of CHD cases over the 10-year study period were missed prenatally and detection rates did not increase materially during that time. The failure to detect CHD prenatally was related to encounter characteristics, specifically involving screening ultrasound examinations, which may be targeted for improvement.
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Affiliation(s)
- N M Pinto
- Division of Cardiology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
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89
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Cardiac findings in routine fetal autopsies: more than meets the eye? Eur J Obstet Gynecol Reprod Biol 2012; 163:142-7. [DOI: 10.1016/j.ejogrb.2012.04.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/09/2012] [Accepted: 04/30/2012] [Indexed: 11/17/2022]
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90
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Eleftheriades M, Tsapakis E, Sotiriadis A, Manolakos E, Hassiakos D, Botsis D. Detection of congenital heart defects throughout pregnancy; impact of first trimester ultrasound screening for cardiac abnormalities. J Matern Fetal Neonatal Med 2012; 25:2546-50. [PMID: 22712625 DOI: 10.3109/14767058.2012.703716] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate prospectively the efficacy to screen for congenital heart defects (CHD) during the first trimester nuchal translucency (NT) ultrasound examination by assessing the four chambers' view of fetal heart. METHODS Pregnancies that were examined prospectively by ultrasound in the first trimester (11th-14th week), the second (19th-24th week) and third trimester were included in the study. 3774 fetuses were examined and fetal heart was assessed during the NT scan by examining the four chambers view. Detailed echocardiography was performed during the anomaly and growth scans. Diagnosis of congenital heart defects (CHD) was further confirmed by a fetal cardiologist. RESULTS The four chambers view was obtained in 99.52% of the cases. CHD were diagnosed in 29 fetuses (0.77%). Thirteen cases (44.8%) were detected during the 11-13 weeks' scan, 14 cases (48.3%) during the anomaly scan, 1 CHD (3.5%) during the third trimester scan and 1 case (3.5%) postpartum. CONCLUSION Assessment of the four chambers of fetal heart early in pregnancy was feasible and allowed the detection of 45% of CHD. Additional parameters of fetal cardiac anatomy during the NT scan may further improve the detection rate providing pregnancy management information early in the first trimester.
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91
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Trivedi N, Levy D, Tarsa M, Anton T, Hartney C, Wolfson T, Pretorius DH. Congenital cardiac anomalies: prenatal readings versus neonatal outcomes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:389-399. [PMID: 22368129 DOI: 10.7863/jum.2012.31.3.389] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the variation between prenatal and postnatal diagnosis of congenital cardiac lesions diagnosed by both fetal center primary physicians and fetal pediatric cardiologists at a single tertiary referral center in the United States and evaluate why cases were misdiagnosed. METHODS A retrospective review of all cardiac abnormalities identified prenatally by level II sonography at a tertiary referral fetal center between January 2006 and December 2008 was performed to include any patient with a fetal cardiac abnormality and with a documented autopsy or neonatal follow-up. Congenital heart disease diagnoses were classified as correct, incorrect, or incorrect but within the same spectrum of disease. Cases of correct diagnosis by primary physicians and pediatric cardiologists were compared. RESULTS Sixty patients with fetal heart abnormalities were identified among 8894 patients who had level II sonography. The combined detection rate for fetal heart abnormalities for both primary physicians and pediatric cardiologists together was 81.7%. The detection rates of congenital heart disease were not statistically different between primary physicians and pediatric cardiologists: 77.9% (46 of 59) versus 85.0% (34 of 40; P = .3). The most common cardiac abnormalities misdiagnosed in our study population included pulmonic stenosis, ventricular septal defect, myxoma, truncus arteriosus, and coarctation of the aorta. CONCLUSIONS Congenital heart disease is misdiagnosed in tertiary care centers by both pediatric cardiologists and fetal imaging specialists. We believe that this occurrence is related to multiple factors, including evolution of congenital heart disease, maternal body habitus, associated congenital anomalies, decreased amniotic fluid volume, gestational age at evaluation, imaging techniques, and, most importantly, the experience of the sonographer.
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Affiliation(s)
- Neha Trivedi
- Department of Reproductive Medicine, Perinatal Division, University of California San Diego Medical Center, San Diego, La Jolla, CA 92037, USA
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92
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Galindo A, Gutiérrez-Larraya F, de la Fuente P. Congenital heart defects in fetal life: an overview. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/14722240400023578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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93
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Yu Z, Xi Y, Ding W, Han S, Cao L, Zhu C, Wang X, Guo X. Congenital heart disease in a Chinese hospital: pre- and postnatal detection, incidence, clinical characteristics and outcomes. Pediatr Int 2011; 53:1059-65. [PMID: 21883685 DOI: 10.1111/j.1442-200x.2011.03450.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The pre- and postnatal detection rate, incidence, clinical characteristics and outcomes of congenital heart disease (CHD) have been studied in developed countries for many years, but rarely have large-scale studies been reported in Chinese populations. The aim of the present study was to investigate the pre- and postnatal detection rates, incidence, clinical characteristics and outcomes of CHD in a Chinese hospital in order to improve the future screening and treatment of CHD. METHODS Fetuses without risk factors for CHD were screened using basic cardiac ultrasound examination (BCUE). Fetuses with suspected cardiac malformation revealed by BCUE and fetuses with risk factors were screened using extended cardiac ultrasound examination. Outcomes recorded from fetal, neonatal and postmortem records over 4 years (2006-2009) included: therapeutic termination of pregnancy, spontaneous abortions or stillbirths, deaths at birth or in the neonatal period (before 28 days of age), and rate of birth and clinical characteristics of newborns. RESULTS A total of 34,071 fetuses were screened for CHD during a period of 4 years, of which 173 fetuses were screened for CHD using BCUE and 301 fetuses were screened using extended cardiac ultrasound examination. The incidence of fetal CHD increased from 1.1% in 2006 to 2.4% in 2009 (P < 0.05), yielding an overall incidence of 1.5% (523/34,071). Of the fetuses with CHD, 48.2% (252/523) died before 28 days of age (including intra-uterine death and termination of pregnancy), 51.8% (271/523) lived more than 28 days and the incidence of live newborns with CHD was 0.80% (271/34071). CONCLUSIONS The prevalence of CHD was quite common in this Chinese hospital. Detailed profiles of CHD suggest that, while training programs in obstetric screening at this hospital were beneficial, prenatal intervention, treatment and care of fetal CHD were inefficient and should be strengthened in China.
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Affiliation(s)
- Zhangbin Yu
- Department of Pediatrics, Nanjing Maternal and Child Health Hospital, Nanjing Medical University, Nanjing, China
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94
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Sholler GF, Kasparian NA, Pye VE, Cole AD, Winlaw DS. Fetal and post-natal diagnosis of major congenital heart disease: implications for medical and psychological care in the current era. J Paediatr Child Health 2011; 47:717-22. [PMID: 21449901 DOI: 10.1111/j.1440-1754.2011.02039.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The fetal or post-natal diagnosis of major congenital cardiac abnormality has important medical and psychological consequences. METHODS We reviewed infants who underwent cardiac surgery in the first year of life at the Heart Centre for Children, The Children's Hospital at Westmead during 2009. The aims of this study were to: (i) examine the key features of cardiac diagnosis and clinical outcome, and (ii) consider how these data can inform priorities for the delivery of clinical services. RESULTS Over the 12-month study period, a first cardiac surgical procedure was performed on 195 infants, with 85 infants (44%) diagnosed in the antenatal period. Of the total sample, a subset of 90 babies (46%) underwent their first procedure in the neonatal period, with 62% having had a fetal diagnosis. Major intracardiac lesions including truncus arteriosus (100%), single ventricular lesions (83%), pulmonary atresia with ventricular septal defect (78%) and transposition of the great arteries (53%) were diagnosed prior to birth. Improved haemodynamic stability at initial presentation was found in those with a fetal diagnosis. The overall mortality rate for all patients was 6.1% at 12 months, with a higher mortality in infants with single ventricle. CONCLUSIONS The contemporary paradigm of care for infants with major congenital heart disease requires a multidisciplinary approach to care, with improvements in clinician-clinician and clinician-family communication, and psychological support and education for families. Changes in the allocation of resources are required to meet this model of best practice.
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Affiliation(s)
- Gary F Sholler
- Heart Centre for Children, The Children's Hospital at Westmead, Westmead, Australia.
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96
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Abstract
Prenatal diagnosis of congenital heart disease is now well established for a wide range of cardiac anomalies. Diagnosis of congenital heart disease during fetal life not only identifies the cardiac lesion but may also lead to detection of associated abnormalities. This information allows a detailed discussion of the prognosis with parents. For continuing pregnancies, appropriate preparation can be made to optimize the postnatal outcome. Reduced morbidity and mortality, following antenatal diagnosis, has been reported for coarctation of the aorta, hypoplastic left heart syndrome, and transposition of the great arteries. With regard to screening policy, most affected fetuses are in the “low risk” population, emphasizing the importance of appropriate training for those who undertake such obstetric anomaly scans. As a minimum, the four chamber view of the fetal heart should be incorporated into midtrimester anomaly scans, and where feasible, views of the outflow tracts should also be included, to increase the diagnostic yield. Newer screening techniques, such as measurement of nuchal translucency, may contribute to identification of fetuses at high risk for congenital heart disease and prompt referral for detailed cardiac assessment.
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Affiliation(s)
- John M Simpson
- Director of Pediatric Echocardiography, Department of Congenital Heart Disease, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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97
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Bonnefoy R, Poinsot J, Vaillant MC, Chantepie A. Évolution du diagnostic anténatal des cardiopathies congénitales entre 1991 et 2005 dans une population limitée au département d’Indre-et-Loire. Arch Pediatr 2011; 18:512-7. [DOI: 10.1016/j.arcped.2011.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 01/11/2011] [Accepted: 02/11/2011] [Indexed: 11/25/2022]
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Galindo A, Herraiz I, Escribano D, Lora D, Melchor JC, de la Cruz J. Prenatal Detection of Congenital Heart Defects: A Survey on Clinical Practice in Spain. Fetal Diagn Ther 2010; 29:287-95. [DOI: 10.1159/000322519] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 11/11/2010] [Indexed: 11/19/2022]
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Ramalho C, Brandão O, Matias A, Montenegro N. Systematic fetal autopsy in cases of medical termination of pregnancy due to chromosomal abnormalities: improving the quality of perinatal care? Prenat Diagn 2010; 30:1000-4. [DOI: 10.1002/pd.2605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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100
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Rosenberg KB, Monk C, Kleinman CS, Glickstein JS, Levasseur SM, Simpson LL, Williams IA. Referral for fetal echocardiography is associated with increased maternal anxiety. J Psychosom Obstet Gynaecol 2010; 31:60-9. [PMID: 20443657 PMCID: PMC2866143 DOI: 10.3109/01674821003681472] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Referral for fetal echocardiography (fECHO) is an acute stressor that may induce significant maternal anxiety. To promote good clinical management of expectant mothers in this situation, including adequate screening for possible psychiatric interventions, data are needed regarding the psychosocial functioning of women scheduled for fECHO procedures. OBJECTIVE To investigate the association between fECHO and maternal anxiety. METHODS Pregnant women answered two questionnaires before first fECHO. The Spielberger State-Trait Anxiety Inventory (STAI) assessed how subjects feel "now" (state) versus how they "usually feel" (trait). Separate state and trait anxiety scores were calculated; scores were compared between the study cohort and a gestational age-matched historical cohort of 31 pregnant women who did not undergo fECHO. A second questionnaire developed by the investigators ascertained pregnancy specific concerns and characteristics. RESULTS Forty subjects were enrolled. The mean state score of the fECHO cohort (42.1 +/- 15.1) differed from the historical cohort (32.8 +/- 11.3; p = 0.006); however there was no difference between trait scores (34.7 +/- 10.8 vs. 35.4 +/- 12.8; p = 0.8). A multivariate linear regression model controlling for race and maternal age demonstrated that fECHO was a strong independent predictor of maternal state anxiety score (p = 0.004, beta = 10.4). CONCLUSIONS Pregnant women presenting for fECHO report high anxiety levels compared with women not presenting for fECHO. Clinician awareness and sensitivity are recommended and further investigation of modifiers of anxiety in this high risk group should be explored.
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Affiliation(s)
- Katherine B. Rosenberg
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University College of Physicians & Surgeons, Morgan Stanley Children’s Hospital of New York, New York, New York, United States of America
| | - Catherine Monk
- Department of Psychiatry, Behavioral Medicine, Columbia University Medical Center, New York, New York, United States of America,Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Columbia University College of Physicians & Surgeons, Sloane Hospital for Women, New York, New York, United States of America
| | - Charles S. Kleinman
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University College of Physicians & Surgeons, Morgan Stanley Children’s Hospital of New York, New York, New York, United States of America
| | - Julie S. Glickstein
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University College of Physicians & Surgeons, Morgan Stanley Children’s Hospital of New York, New York, New York, United States of America
| | - Stephanie M. Levasseur
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University College of Physicians & Surgeons, Morgan Stanley Children’s Hospital of New York, New York, New York, United States of America
| | - Lynne L. Simpson
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Columbia University College of Physicians & Surgeons, Sloane Hospital for Women, New York, New York, United States of America
| | - Ismee A. Williams
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University College of Physicians & Surgeons, Morgan Stanley Children’s Hospital of New York, New York, New York, United States of America
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