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Fang Y, Pan Y, Shen L, Luo T, Xu W, Tao S, He H, Zhao B. Prenatal features and postnatal follow-up of congenital ventricular outpouching: A retrospective study of two centers in China. Echocardiography 2024; 41:e15747. [PMID: 38284682 DOI: 10.1111/echo.15747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVES Congenital ventricular outpouching (CVO) is a rare cardiac malformation that can manifest as congenital ventricular aneurysm (CVA) and/or congenital ventricular diverticula (CVD). In this study, we describe the prenatal features and postnatal follow-up of 27 cases of CVO. METHODS The clinical data of 27 patients with CVO who attended Sir Run Run Shaw Hospital Affiliated to the Medical College of Zhejiang University (Zhejiang Province, China) and Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University (Zhejiang Province, China) from April 2013 to October 2022 were retrospectively analyzed. The patients were also followed up by telephone. The prenatal characteristics and postnatal outcomes of the patients with CVO were evaluated. RESULTS CVO was detected in 26 cases prenatally, 14 (51.85%) were diagnosed with CVA, nine (33.33%) were diagnosed with CVD, three (11.11%) were equivocal for CVA/CVD, and one (3.70%) was detected with CVA postnatally. Six patients underwent follow-up fetal echocardiography approximately 4 weeks after the initial echocardiography examination, and a significant difference in CVO size was observed between the two examinations (P = .02). Eight patients (29.63%) demonstrated cardiovascular dysfunction, and the median CVO size in fetuses with and without cardiovascular dysfunction was 205 (range: 169-396) mm2 and 124 (range: 92-154.5) mm2 , respectively (P = .01). Correlation was found between CVO size and fetal cardiac dysfunction (p = .000, r = .778). Eight patients (29.63%) had cardiac/extracardiac defects. Thirteen patients were live born, 12 were terminated pregnancies, and two were lost to follow-up. The postpartum size of the CVOs remained stable in six patients, decreased in two patients, dissolved in three patients, and were surgically removed in two patients. With the exception of one patient with CVA complicated with complex congenital cardiac malformation who underwent surgical treatment after birth and who had postoperative left ventricular dysfunction (Case 1), the prognosis of all of the patients was good. CONCLUSION CVO is often associated with cardiac malformations. The size of prenatal CVOs can increase with gestational development, and cardiovascular dysfunction is significantly related to CVO size. The postpartum prognosis of patients with CVO is good. Echocardiography plays a key role in the diagnosis of congenital ventricular outpouching. Prenatal counseling should be cautious regarding the diagnosis and the prognosis although our cases had a favorable prognosis.
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Affiliation(s)
- Yanchun Fang
- Department of Ultrasound Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Yihong Pan
- Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Liping Shen
- Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Ting Luo
- Department of Ultrasound Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Weiming Xu
- Department of Pathology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Shuangshuang Tao
- Department of Ultrasound Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Hailing He
- Department of Ultrasound Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Bowen Zhao
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China
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Xu R, Zhou D, Liu Y, Yao L, Xie L, Liu M, Zhou Q, Zeng S. Impaired Elastic Properties of the Ascending Aorta in Fetuses With Coarctation of the Aorta. J Am Heart Assoc 2023; 12:e028015. [PMID: 36645085 PMCID: PMC9939075 DOI: 10.1161/jaha.122.028015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Abnormal aortic elastic properties are major notable vasculopathy involved in coarctation of the aorta (CoA). However, there are no reports on aortic wall elastic characteristics in fetuses with CoA. Methods and Results Fifty-six fetuses with CoA and 56 normal controls were included in this prospective case-control study. The dimensions of the cardiac chamber, the size of the aorta, left ventricular myocardial performance indexes, and aortic elastic properties, including the global circumferential strain, fractional area change and mean longitudinal strain, were measured serially in utero. The global circumferential strain, fractional area change, and mean longitudinal strain in fetuses with CoA were smaller than those in the normal group at both the first and last examinations (18.50% versus 37.73% for global circumferential strain, 38.90% versus 57.55% for fractional area change, 6.61% versus 11.81% for mean longitudinal strain at first scan, 16.62% versus 42.05% for global circumferential strain, 36.54% versus 59.7% for fractional area change, 6.2% versus 11.46% for mean longitudinal strain at last scan, all P<0.001). There were negative correlations between aortic elastic properties and left ventricular myocardial performance indexes in fetuses with CoA (P<0.01). Aortic elastic properties were correlated positively with aortic isthmus size in fetuses with CoA (P<0.01). Conclusions Aortic strain and the fractional area change were decreased in fetuses with CoA. Impairments of these aortic elastic properties were associated with diminished heart function and aortic isthmus size in utero. Further large-scale longitudinal studies are required to confirm the potential predictive value of cardiovascular morbidity (ie, hypertension) in fetuses with CoA.
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Affiliation(s)
- Ran Xu
- Department of Ultrasound DiagnosisThe Second Xiangya Hospital, Central South UniversityChangshaHunanChina,Department of UrologyThe Second Xiangya Hospital, Central South UniversityChangshaHunanChina
| | - Dan Zhou
- Department of Ultrasound DiagnosisThe Second Xiangya Hospital, Central South UniversityChangshaHunanChina
| | - Yushan Liu
- Department of Ultrasound DiagnosisThe Second Xiangya Hospital, Central South UniversityChangshaHunanChina
| | - Longmei Yao
- Department of Ultrasound DiagnosisThe Second Xiangya Hospital, Central South UniversityChangshaHunanChina
| | - Li Xie
- Department of Cardiology and Cardiovascular surgeryThe Second Xiangya Hospital, Central South UniversityChangshaHunanChina
| | - Minghui Liu
- Department of Ultrasound DiagnosisThe Second Xiangya Hospital, Central South UniversityChangshaHunanChina
| | - Qichang Zhou
- Department of Ultrasound DiagnosisThe Second Xiangya Hospital, Central South UniversityChangshaHunanChina
| | - Shi Zeng
- Department of Ultrasound DiagnosisThe Second Xiangya Hospital, Central South UniversityChangshaHunanChina
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Lin L, Murakami T, Shiono J, Kodama O, Yamada N, Ohtani H, Horigome H. Congenital right ventricular diverticulum formed by pulmonary regurgitative jet flow in a fetus with tetralogy of Fallot and absent pulmonary valve. Cardiovasc Pathol 2020; 50:107295. [PMID: 33002584 DOI: 10.1016/j.carpath.2020.107295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022] Open
Abstract
Congenital ventricular diverticulum is a rare anomaly with an unclear pathology. Here, we report a male fetus at 24 weeks of gestation, diagnosed with right ventricular diverticulum associated with tetralogy of Fallot and absent pulmonary valve. The diverticulum was located at the anterosuperior wall of the right ventricle and faced into the massive pulmonary regurgitation flow jet. Intrauterine fetal death from heart failure resulted at 26 weeks of gestation. An autopsy revealed significant subendocardial fibrosis in the diverticular wall without inflammatory cell infiltration. Clinical and pathologic features suggested that the regurgitative blood flow contributed to the formation of the right ventricular diverticulum.
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Affiliation(s)
- Lisheng Lin
- Department of Pediatric Cardiology, Ibaraki Children's Hospital, Mito, Japan; Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Takashi Murakami
- Department of Pediatric Cardiology, Ibaraki Children's Hospital, Mito, Japan; Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Junko Shiono
- Department of Pediatric Cardiology, Ibaraki Children's Hospital, Mito, Japan
| | - Osamu Kodama
- Department of Obstetrics and Gynecology, Mito Saiseikai General Hospital, Mito, Japan
| | - Naoki Yamada
- Department of Obstetrics and Gynecology, Mito Saiseikai General Hospital, Mito, Japan
| | - Haruo Ohtani
- Department of Pathology, Ibaraki Children's Hospital, Mito, Japan; Department of Pathology, Mito Saiseikai General Hospital, Mito, Japan
| | - Hitoshi Horigome
- Department of Pediatric Cardiology, Ibaraki Children's Hospital, Mito, Japan; Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Zheng M, Sun L, Liu X, Wang X, He Y. Autopsy and postnatal follow-up of prenatally diagnosed ventricular outpouchings. Prenat Diagn 2020; 40:681-688. [PMID: 31990991 DOI: 10.1002/pd.5646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Prenatal ventricular outpouchings (VOs), which include congenital ventricular aneurysms (CAs) and congenital ventricular diverticula (CD), are very rare. We describe the features and outcomes of prenatal VOs diagnosed over a 4-year period. METHODS Retrospective cohort study of cases of prenatal diagnoses of CAs and CD at our center between June 2014 and January 2018. The prenatal and postnatal echocardiogram data were reviewed, and telephone follow-up was conducted of liveborn cases. RESULTS A total of 25 VOs were identified. Two were lost to follow-up, 15 chose termination of pregnancy, and eight resulted in livebirths. Only two cases underwent autopsy: Histopathology showed that the CA wall was substituted by collagen fibers. At follow-up, none of the eight liveborn babies experienced adverse events, and three VOs near the tricuspid annulus almost disappeared, though one was extremely large. CONCLUSIONS In our center, all liveborn babies with VO had good prognoses. We hypothesize that VOs located near the right ventricular annulus may be caused by prenatally unbalanced pressure, given their decrease in size after birth when the right heart pressure declines.
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Affiliation(s)
- Min Zheng
- Beijing Key Laboratory of Maternal-Fetal Medicine and Fetal Heart Disease & Echocardiography Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lin Sun
- Beijing Key Laboratory of Maternal-Fetal Medicine and Fetal Heart Disease & Echocardiography Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaowei Liu
- Beijing Key Laboratory of Maternal-Fetal Medicine and Fetal Heart Disease & Echocardiography Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Wang
- Beijing Key Laboratory of Maternal-Fetal Medicine and Fetal Heart Disease & Echocardiography Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yihua He
- Beijing Key Laboratory of Maternal-Fetal Medicine and Fetal Heart Disease & Echocardiography Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Weidenbach M, Wannenmacher B, Paech C, Wagner R. Large nonapical right ventricular diverticulum in a patient with atrioventricular septal defect. Ann Pediatr Cardiol 2018; 11:222-223. [PMID: 29922027 PMCID: PMC5963244 DOI: 10.4103/apc.apc_149_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Congenital diveticula and aneurysm of the heart are rare and most often located at the apex of the left ventricle. They pose a significant risk for cardiac failure and arrhythmias. In contrast, nonapical diverticula of the right ventricle (RV) have a much more benign course. We present a child with Trisomy 21, atrioventricular septal defect, and large nonapical diverticulum of the RV that was neither addressed during surgery nor needed any medical treatment during 1-year follow-up.
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Affiliation(s)
- Michael Weidenbach
- Department of Pediatric Cardiology, Heart Center Leipzig - University Hospital, Leipzig 04289, Germany
| | - Bardo Wannenmacher
- Department of Pediatric Cardiology, Heart Center Leipzig - University Hospital, Leipzig 04289, Germany
| | - Christian Paech
- Department of Pediatric Cardiology, Heart Center Leipzig - University Hospital, Leipzig 04289, Germany
| | - Robert Wagner
- Department of Pediatric Cardiology, Heart Center Leipzig - University Hospital, Leipzig 04289, Germany
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Athiel Y, Barrois M, Bault JP, Cohen L, Leroy B, Quibel T. Fetal diagnosis of right cardiac ventricular aneurysms: A report of three cases. J Gynecol Obstet Hum Reprod 2018; 47:481-485. [PMID: 29932991 DOI: 10.1016/j.jogoh.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/06/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
Congenital ventricular aneurysms and diverticula are rare congenital heart diseases, currently accessible to prenatal diagnosis. Information on the natural course of ventricular aneurysm or diverticulum detected during fetal life is limited as there are only few case reports and case series enumerating the defect. We aimed to describe through three cases, the prenatal features and clinical outcomes of fetal cardiac aneurysms. The first one was diagnosed during the second trimester and spontaneous evolution was favorable. The two others were diagnosed in the first trimester with a large and early pericardial effusion. For one, the parents opted for termination of pregnancy at 15 weeks of gestation and the other showed a spontaneous regression of the effusion and no hemodynamic compromise.
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Affiliation(s)
- Yoann Athiel
- Department of Gynecology and Obstetrics, CHI Poissy-Saint-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France.
| | - Mathilde Barrois
- Department of Gynecology and Obstetrics, CHI Poissy-Saint-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France
| | - Jean-Philippe Bault
- Department of Gynecology and Obstetrics, CHI Poissy-Saint-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France; Department of Gynecology and Obstetrics, CH Bicêtre, 31, rue du Général-Leclerc, 94270 Kremlim-Bicêtre, France
| | - Laurence Cohen
- Department of Echocardiography (CEDEF), 15, rue Pottier, 78150 Le Chesnay, France
| | - Brigitte Leroy
- Department of Foetopathology, CHI Poissy-Saint-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France
| | - Thibaud Quibel
- Department of Gynecology and Obstetrics, CHI Poissy-Saint-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France
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Garcia Rodriguez R, Garcia Delgado R, Obreros Zegarra L, Emergui Zhrizen Y, Armas Roca M, Castellano Medina M, Garcia Hernandez JA. Fetal Pericardiocentesis. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10311081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Fetal pericardiocentesis is a safe and effective procedure that is used to drain pericardial effusion in selected fetuses. The aim of the procedure is to reduce the risk of pulmonary hypoplasia, the development of cardiac tamponade and fetal hydrops, and in some cases to allow fetal lung maturity, improving fetal extraction with a better haemodynamic and respiratory condition. In this review, we discuss the indications, technical procedure, and the outcomes of the fetal pericardiocentesis reported in the literature.
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Affiliation(s)
- Raquel Garcia Rodriguez
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Raquel Garcia Delgado
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Luciana Obreros Zegarra
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Yonit Emergui Zhrizen
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Marta Armas Roca
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Margarita Castellano Medina
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Jose Angel Garcia Hernandez
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
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