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Carrasco D, Guedes-Martins L. Cardiac Axis in Early Gestation and Congenital Heart Disease. Curr Cardiol Rev 2024; 20:CCR-EPUB-137797. [PMID: 38279755 PMCID: PMC11071675 DOI: 10.2174/011573403x264660231210162041] [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: 07/07/2023] [Revised: 09/06/2023] [Accepted: 10/17/2023] [Indexed: 01/28/2024] Open
Abstract
Congenital heart defects represent the most common structural anomalies observed in the fetal population, and they are often associated with significant morbidity and mortality. The fetal cardiac axis, which indicates the orientation of the heart in relation to the chest wall, is formed by the angle between the anteroposterior axis of the chest and the interventricular septum of the heart. Studies conducted during the first trimester have demonstrated promising outcomes with respect to the applicability of cardiac axis measurement in fetuses with congenital heart defects as well as fetuses with extracardiac and chromosomal anomalies, which may result in improved health outcomes and reduced healthcare costs. The main aim of this review article was to highlight the cardiac axis as a reliable and powerful marker for the detection of congenital heart defects during early gestation, including defects that would otherwise remain undetectable through the conventional four-chamber view.
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Affiliation(s)
- D. Carrasco
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto, Serviço de Obstetrícia - Centro Materno Infantil do Norte, Porto 4099-001, Portugal
| | - L. Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto, Serviço de Obstetrícia - Centro Materno Infantil do Norte, Porto 4099-001, Portugal
- Centro Hospitalar Universitário do Porto EPE, Centro Materno Infantil do Norte, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
- Unidade de Investigação e Formação-Centro Materno Infantil do Norte, 4099-001 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, 4200-319, Portugal
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Ling W, Wu Q, Guo S, Li S, Ma H, Huang B, Zeng L, Dang T, Liu M, Qiu X, Weng Z. Four-section approach of fetal congenital heart disease at 11-13 +6 weeks. Front Cardiovasc Med 2023; 10:1206042. [PMID: 37692039 PMCID: PMC10483229 DOI: 10.3389/fcvm.2023.1206042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
Objective The objective of the study is to explore the value of the four-section approach in detecting fetal heart defects in the first trimester (11-13+6 weeks), analyze the reasons for the inconsistency between the results of ultrasound examination in the first trimester and subsequent verification, and describe the most common abnormal flow patterns of four sections. Materials and methods Between June 2019 and June 2021, a prenatal four-section approach (upper abdominal transverse section, four-chamber section, three vessel-trachea section, and bilateral subclavian artery section) with verification results in early pregnancy was analyzed. Results In total, 9,533 fetuses were included. Finally, 176 fetuses with congenital heart disease (CHD), containing 34 types, were identified. The total detection rate of cardiac abnormalities was 1.85%. 102 cases were accurately diagnosed by ultrasonography during early pregnancy. A total of 74 fetuses who had inconsistent results between fetal cardiac ultrasound and verification in early pregnancy were reported, of which the cases of 22 fetuses were inconsistent due to disease evolution and progression and the cases of 52 fetuses were inconsistent due to missed diagnosis and misdiagnosis. The sensitivity, specificity, positive predictive value, and negative predictive value of the four-section approach were 67.05%, 99.96%, 96.58%, and 99.33%, respectively. In this study, a total of 30 abnormal ultrasonic imaging patterns in four sections were summarized. Conclusion We confirmed that the four-section approach in early pregnancy has a good diagnostic efficacy for fetal CHD. Intrauterine evolution of the fetal heart, missed diagnosis, and misdiagnosis are the reasons for the inconsistency between the results of early pregnancy ultrasound and subsequent verification. This study also presents the abnormal imaging patterns of four scan sections of CHD in early pregnancy, which are instructive for the rapid identification and diagnosis of CHD in the first trimester.
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Affiliation(s)
- Wen Ling
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiumei Wu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shan Guo
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shangqing Li
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hong Ma
- Department of Pathology, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Biying Huang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Liqin Zeng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Tingting Dang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Min Liu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiuqing Qiu
- Department of Obstetrics & Gynecology, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zongjie Weng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Savoia F, Scala C, Coppola M, Riemma G, Vitale SG, Mikuš M, Schiattarella A, La Verde M, Colacurci N, De Franciscis P, Morlando M. The diagnostic performance of the ductus venosus for the detection of cardiac defects in the first trimester: a systematic review and diagnostic test accuracy meta-analysis. Arch Gynecol Obstet 2023; 308:435-451. [PMID: 36315269 PMCID: PMC10293352 DOI: 10.1007/s00404-022-06812-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Abnormal flow in the ductus venosus (DV) has been reported to be associated with adverse perinatal outcome, chromosomal abnormalities, and congenital heart defects (CHD). Aneuploid fetuses have increased risk of CHD, but there are discrepancies on the performance of this markers in euploid fetuses. The aim of this meta-analysis was to establish the predictive accuracy of DV for CHD. METHODS MEDLINE, EMBASE, and CINAHL were searched from inception to February 2022. No language or geographical restrictions were applied. Inclusion criteria regarded observational and randomized studies concerning first-trimester DV flow as CHD marker. Random effect meta-analyses to calculate risk ratio (RR) with 95% confidence interval (CI), hierarchical summary receiver-operating characteristics (HSROC), and bivariate models to evaluate diagnostic accuracy were used. Primary outcome was the diagnostic performance of DV in detecting prenatal CHD by means of area under the curve (AUROC). Subgroup analysis for euploid, high-risk, and normal NT fetuses was performed. Quality assessment of included papers was performed using QUADAS-2. RESULTS Twenty two studies, with a total of 204.829 fetuses undergoing first trimester scan with DV Doppler evaluation, fulfilled the inclusion criteria for this systematic review. Overall, abnormal DV flow at the time of first trimester screening was associated to an increased risk of CHD (RR 6.9, 95% CI 3.7-12.6; I2 = 95.2%) as well in unselected (RR: 6.4, 95% CI 2.5-16.4; I2 = 93.3%) and in euploid (RR: 6.45, 95% CI 3.3-12.6; I2 = 95.8%) fetuses. The overall diagnostic accuracy of abnormal DV in detecting CHD was good in euploid fetuses with an AUROC of 0.81 (95% CI 0.78-0.84), but it was poor in the high-risk group with an AUROC of 0.66 (95% CI 0.62-0.70) and in the unselected population with an AUROC of 0.44 (95% CI 0.40-0.49). CONCLUSIONS Abnormal DV in the first trimester increases the risk of CHD with a moderate sensitivity for euploid fetuses. In combination with other markers (NT, TV regurgitation) could be helpful to identify fetuses otherwise considered to be at low risk for CHD. In addition to the improvement of the fetal heart examination in the first trimester, this strategy can increase the detection of major CHD at earlier stage of pregnancy.
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Affiliation(s)
- Fabiana Savoia
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carolina Scala
- Division of Obstetrics and Gynecology, Gaslini Institute, Genoa, Italy
| | - Marlene Coppola
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maddalena Morlando
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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Karim JN, Bradburn E, Roberts N, Papageorghiou AT. First-trimester ultrasound detection of fetal heart anomalies: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:11-25. [PMID: 34369613 PMCID: PMC9305869 DOI: 10.1002/uog.23740] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/09/2021] [Accepted: 07/16/2021] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To determine the diagnostic accuracy of ultrasound at 11-14 weeks' gestation in the detection of fetal cardiac abnormalities and to evaluate factors that impact the detection rate. METHODS This was a systematic review of studies evaluating the diagnostic accuracy of ultrasound in the detection of fetal cardiac anomalies at 11-14 weeks' gestation, performed by two independent reviewers. An electronic search of four databases (MEDLINE, EMBASE, Web of Science Core Collection and The Cochrane Library) was conducted for studies published between January 1998 and July 2020. Prospective and retrospective studies evaluating pregnancies at any prior level of risk and in any healthcare setting were eligible for inclusion. The reference standard used was the detection of a cardiac abnormality on postnatal or postmortem examination. Data were extracted from the included studies to populate 2 × 2 tables. Meta-analysis was performed using a random-effects model in order to determine the performance of first-trimester ultrasound in the detection of major cardiac abnormalities overall and of individual types of cardiac abnormality. Data were analyzed separately for high-risk and non-high-risk populations. Preplanned secondary analyses were conducted in order to assess factors that may impact screening performance, including the imaging protocol used for cardiac assessment (including the use of color-flow Doppler), ultrasound modality, year of publication and the index of sonographer suspicion at the time of the scan. Risk of bias and quality assessment were undertaken for all included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS The electronic search yielded 4108 citations. Following review of titles and abstracts, 223 publications underwent full-text review, of which 63 studies, reporting on 328 262 fetuses, were selected for inclusion in the meta-analysis. In the non-high-risk population (45 studies, 306 872 fetuses), 1445 major cardiac anomalies were identified (prevalence, 0.41% (95% CI, 0.39-0.43%)). Of these, 767 were detected on first-trimester ultrasound examination of the heart and 678 were not detected. First-trimester ultrasound had a pooled sensitivity of 55.80% (95% CI, 45.87-65.50%), specificity of 99.98% (95% CI, 99.97-99.99%) and positive predictive value of 94.85% (95% CI, 91.63-97.32%) in the non-high-risk population. The cases diagnosed in the first trimester represented 63.67% (95% CI, 54.35-72.49%) of all antenatally diagnosed major cardiac abnormalities in the non-high-risk population. In the high-risk population (18 studies, 21 390 fetuses), 480 major cardiac anomalies were identified (prevalence, 1.36% (95% CI, 1.20-1.52%)). Of these, 338 were detected on first-trimester ultrasound examination and 142 were not detected. First-trimester ultrasound had a pooled sensitivity of 67.74% (95% CI, 55.25-79.06%), specificity of 99.75% (95% CI, 99.47-99.92%) and positive predictive value of 94.22% (95% CI, 90.22-97.22%) in the high-risk population. The cases diagnosed in the first trimester represented 79.86% (95% CI, 69.89-88.25%) of all antenatally diagnosed major cardiac abnormalities in the high-risk population. The imaging protocol used for examination was found to have an important impact on screening performance in both populations (P < 0.0001), with a significantly higher detection rate observed in studies using at least one outflow-tract view or color-flow Doppler imaging (both P < 0.0001). Different types of cardiac anomaly were not equally amenable to detection on first-trimester ultrasound. CONCLUSIONS First-trimester ultrasound examination of the fetal heart allows identification of over half of fetuses affected by major cardiac pathology. Future first-trimester screening programs should follow structured anatomical assessment protocols and consider the introduction of outflow-tract views and color-flow Doppler imaging, as this would improve detection rates of fetal cardiac pathology. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J. N. Karim
- Nuffield Department of Women's & Reproductive HealthUniversity of OxfordOxfordUK
| | - E. Bradburn
- Nuffield Department of Women's & Reproductive HealthUniversity of OxfordOxfordUK
| | - N. Roberts
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | - A. T. Papageorghiou
- Nuffield Department of Women's & Reproductive HealthUniversity of OxfordOxfordUK
- Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
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Atli EI, Atli E, Yalcintepe S, Demir S, Kalkan R, Akurut C, Ozen Y, Gurkan H. Investigation of Genetic Alterations in Congenital Heart Diseases in Prenatal Period. Glob Med Genet 2021; 9:29-33. [PMID: 35169781 PMCID: PMC8837410 DOI: 10.1055/s-0041-1736566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2022] Open
Abstract
The prenatal diagnosis of congenital heart disease (CHD) is important because of mortality risk. The onset of CHD varies, and depending on the malformation type, the risk of aneuploidy is changed. To identify possible genetic alterations in CHD, G-banding, chromosomal microarray or if needed DNA mutation analysis and direct sequence analysis should be planned. In present study, to identify genetic alterations, cell culture, karyotype analysis, and single nucleotide polymorphism, array analyses were conducted on a total 950 samples. Interventional prenatal genetic examination was performed on 23 (2, 4%, 23/950) fetal CHD cases. Chromosomal abnormalities were detected in 5 out of 23 cases (21, 7%). Detected chromosomal abnormalities were 10q23.2 deletion, trisomy 18, 8p22.3-p23.2 deletion, 8q21.3-q24.3 duplication, 11q24.2q24.5 (9 Mb) deletion, and 8p22p12 (16.8 Mb) deletion. Our study highlights the importance of genetic testing in CHD.
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Affiliation(s)
- Emine Ikbal Atli
- Department of Medical Genetics, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Engin Atli
- Department of Medical Genetics, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Sinem Yalcintepe
- Department of Medical Genetics, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Selma Demir
- Department of Medical Genetics, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Rasime Kalkan
- Department of Medical Genetics, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Cisem Akurut
- Department of Medical Genetics, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Yasemin Ozen
- Department of Medical Genetics, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Hakan Gurkan
- Department of Medical Genetics, Faculty of Medicine, Trakya University, Edirne, Turkey
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Perinatal results of antenatally detected hypoplastic left heart syndrome in a single tertiary center: experience of 5 years time. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.955838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ultrasound Patterns in the First Trimester Diagnosis of Congenital Heart Disease. J Clin Med 2021; 10:jcm10153206. [PMID: 34361992 PMCID: PMC8347903 DOI: 10.3390/jcm10153206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/21/2022] Open
Abstract
Congenital heart disease (CHD) is the most common birth defect, with a reported prevalence of 5–12 per 1000 live births. Very recently, the American Institute of Ultrasound in Medicine published a guideline recommending the use of the four-chamber and the three-vessel and trachea views to screen for CHD in the first trimester of pregnancy. Our aim is to present abnormal image patterns that are seen in the four-chamber, three-vessel, and trachea views of the fetal heart in the first trimester and to describe their association with specific CHD types. We used a total of 29 cases of CHD from the archives of Filantropia Hospital and the Maternal and Child Health Institute (INSMC) fetal medicine units. We selected cases with a clear and well-documented diagnosis of the CHD type. We identified a series of repeating color doppler flow patterns seen in the four-chamber, three-vessel, and trachea views of the studied cases. Our observations could be developed into a diagnosis algorithm to orientate the examiner to the most likely type of CHD in individual cases.
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Oşvar FN, Raţiu AC, Voiţă-Mekereş F, Voiţă GF, Bonţea MG, Racoviţă M, Mekereş GM, Bodog FD. Cardiac axis evaluation as a screening method for detecting cardiac abnormalities in the first trimester of pregnancy. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:137-142. [PMID: 32747904 PMCID: PMC7728130 DOI: 10.47162/rjme.61.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Congenital cardiac abnormalities refer to especially anatomic malformations of the heart that normally occur during fetal heart development, before eight weeks after conception. Aim: The aim is to investigate the association between cardiac axis and congenital heart abnormalities for a potential underline clinical application of cardiac axis evaluation during detection by abnormalities at the time of first trimester ultrasound. It is known that aneuploids can be associated in almost half of cases with cardiac abnormalities, so the angle of the cardiac axis could be a potential indirect marker for the detection of aneuploids in the first trimester of pregnancy. Being easy to obtain, from the cross-section at the chest level with the visualization of the four chambers, does not require additional sections to those provided in the current guides, we aim to prove its usefulness in diagnosing aneuploids and congenital cardiac abnormalities along with the translucent nuchal flow, at the level of the venous duct and the presence of tricuspid regurgitation. Conclusions: Cardiac axis has a higher value for the detection of congenital cardiac abnormalities with respect to the nuchal translucency, tricuspid regurgitation and inverted A wave at the level of the venous duct.
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Affiliation(s)
- Florina Nela Oşvar
- Department of Morphology, Faculty of Medicine and Pharmacy, University of Oradea, Romania; ,
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Dudnikov O, Quinton AE, Alphonse J. The detection rate of first trimester ultrasound in the diagnosis of congenital heart defects: A narrative review. SONOGRAPHY 2021. [DOI: 10.1002/sono.12253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Oleksandr Dudnikov
- Central Queensland University Brisbane Australia
- Medical Imaging Department Toowoomba Hospital South Toowoomba Australia
| | - Ann Elizabeth Quinton
- School of Health, Medical and Applied Science Central Queensland University Sydney Australia
- Discipline of Obstetrics, Gynaecology and Neonatology Sydney Medical School, University of Sydney Camperdown Australia
- Nepean Hospital Penrith Kingswood Australia
| | - Jennifer Alphonse
- School of Health, Medical and Applied Science Central Queensland University Sydney Australia
- Sydney Ultrasound for Women Sydney Australia
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Faber JW, Hagoort J, Moorman AFM, Christoffels VM, Jensen B. Quantified growth of the human embryonic heart. Biol Open 2021; 10:bio.057059. [PMID: 33495211 PMCID: PMC7888713 DOI: 10.1242/bio.057059] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The size and growth patterns of the components of the human embryonic heart have remained largely undefined. To provide these data, three-dimensional heart models were generated from immunohistochemically stained sections of ten human embryonic hearts ranging from Carnegie stage 10 to 23. Fifty-eight key structures were annotated and volumetrically assessed. Sizes of the septal foramina and atrioventricular canal opening were also measured. The heart grows exponentially throughout embryonic development. There was consistently less left than right atrial myocardium, and less right than left ventricular myocardium. We observed a later onset of trabeculation in the left atrium compared to the right. Morphometry showed that the rightward expansion of the atrioventricular canal starts in week 5. The septal foramina are less than 0.1 mm2 and are, therefore, much smaller than postnatal septal defects. This chronological, graphical atlas of the growth patterns of cardiac components in the human embryo provides quantified references for normal heart development. Thereby, this atlas may support early detection of cardiac malformations in the foetus.This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Jaeike W Faber
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
| | - Jaco Hagoort
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
| | - Antoon F M Moorman
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
| | - Vincent M Christoffels
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
| | - Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
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Moleiro ML, Guedes-Martins L. Prenatal diagnosis of absent pulmonary valve syndrome. BMJ Case Rep 2021; 14:14/1/e240567. [PMID: 33414127 PMCID: PMC7797262 DOI: 10.1136/bcr-2020-240567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Maria Lúcia Moleiro
- Department of Women and Reproductive Medicine, Centro Hospitalar do Porto, Porto, Portugal
| | - Luís Guedes-Martins
- Department of Women and Reproductive Medicine, Centro Hospitalar do Porto, Porto, Portugal
- Department of Experimental Biology, University of Porto, Porto, Portugal
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12
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De Robertis V, Persico N, Volpe G, Rembouskos G, Fabietti I, Olivieri C, Giudicepietro A, Volpe P. Tetralogy of Fallot and Outlet Ventricular Septal Defect with Anterior Malalignment Detected at Early Fetal Echocardiography. Fetal Diagn Ther 2020; 47:1-7. [PMID: 32683367 DOI: 10.1159/000508877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine the evolution of tetralogy of Fallot (TOF) and outlet ventricular septal defect (VSD) with anterior malalignment (am) from the initial diagnosis at early fetal echocardiography through the gestation and to evaluate the impact of the first-trimester scan on the outcome. METHODS We identified cases of TOF or outlet VSD with am diagnosed before 16 weeks' gestation. For all cases, prenatal data and pregnancy outcomes were evaluated. In continuing pregnancies, the evolution in severity of the disease was assessed. RESULTS Fifty-one fetuses with TOF or outlet VSD with am were diagnosed at early fetal echocardiography. Parents opted for termination of pregnancy in all 23 cases associated with additional anomalies. In 2 of 28 continuing pregnancies, there was an intrauterine death. In the remaining 26, there was progression in severity in 7 (by 20-22 weeks in 3 cases and during the third trimester in the remaining 4). CONCLUSIONS TOF and outlet VSD with am diagnosed before 16 weeks' gestation can progress in severity throughout pregnancy in over one-quarter of cases. In addition, a high proportion of cases diagnosed in the first trimester may have associated extracardiac anomalies, with a significant impact on clinical management and on the rate of early termination of pregnancy.
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Affiliation(s)
| | - Nicola Persico
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Grazia Volpe
- Maternal Infant Department SC, Obstetrics and Gynecology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Isabella Fabietti
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Paolo Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy,
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Efficacy of fetal cardiac axis evaluation in the first trimester as a screening tool for congenital heart defect or aneuploidy. Obstet Gynecol Sci 2020; 63:278-285. [PMID: 32489972 PMCID: PMC7231943 DOI: 10.5468/ogs.2020.63.3.278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 11/08/2022] Open
Abstract
Objective To prove the efficacy of determining the abnormal fetal cardiac axis for screening congenital heart defects (CHDs) and predicting fetal aneuploidy at 11.0 to 13.6 weeks of pregnancy. Methods This retrospective study was performed at a single high-risk pregnancy center. The fetal cardiac axis was evaluated between 11.0 and 13.6 weeks of gestation in 142 fetuses. The cardiac axis in a 4-chamber view was measured as the angle between the line tracing the long axis of the heart and the line bisecting the thorax in the anteroposterior direction. A CHD was confirmed based on the second- to third-trimester fetal status or postnatal imaging. Aneuploidy was diagnosed using chorionic villus sampling, amniocentesis, or genetic testing after birth. Fisher's exact test was performed to assess the association between the fetal cardiac axis and the abnormal fetal status. A 2-way contingence table analysis was performed to confirm the efficacy of the fetal cardiac axis as a screening tool. Results Among the 142 fetuses, 10 had a CHD while 17 had aneuploidy. The abnormal fetal cardiac axis was significantly associated with CHDs (P=0.013) and aneuploidy (P=0.010). None of the fetuses with CHDs or aneuploidy had an isolated abnormal cardiac axis alone without other sonographic findings. The sensitivity of the fetal cardiac axis was 50.0% for CHDs and 41.2% for aneuploidy. Conclusion The fetal cardiac axis can be an additional helpful tool for prenatal screening of CHDs and aneuploidy in the first trimester.
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Yu D, Sui L, Zhang N. Performance of First-Trimester Fetal Echocardiography in Diagnosing Fetal Heart Defects: Meta-analysis and Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:471-480. [PMID: 31463979 DOI: 10.1002/jum.15123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/20/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Early fetal echocardiography is becoming increasing common during the nuchal translucency scan period. The aim of this meta-analysis was to assess the accuracy of first-trimester fetal echocardiography in diagnosing congenital heart defects (CHDs). METHODS The databases of PubMed, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature were systematically searched for the candidate articles, and the references of included studies were also examined. We recorded the characteristics of the included studies and assessed the quality of each study by the Quality Assessment of Diagnostic Accuracy Studies tool. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated with Meta-Disc version 1.4 software (Ramón y Cajal Hospital, Madrid, Spain). We also evaluated the publication bias by using Stata version 12.0 software (StataCorp, College Station, TX). RESULTS This meta-analysis included 18 studies with 26,201 fetal hearts. The overall pooled sensitivity, specificity, PLR, and NLR were 0.750, 0.999, 392.95, and 0.277, respectively. The DOR and AUC were 1736.0 and 0.9331. The pooled sensitivity, specificity, PLR, NLR, DOR, and AUC for major CHDs were 0.838, 1.000, 725.69, 0.203, 5084.8, and 0.9617. CONCLUSIONS First-trimester fetal echocardiography had high value in diagnosing CHDs, especially major CHDs.
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Affiliation(s)
- Dongmei Yu
- Department of Special Examinations, Qingdao Women and Children's Hospital, Qingdao, China
| | - Lun Sui
- Department of Special Examinations, Qingdao Women and Children's Hospital, Qingdao, China
| | - Nan Zhang
- Department of Special Examinations, Qingdao Women and Children's Hospital, Qingdao, China
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15
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AIUM Practice Parameter for the Performance of Fetal Echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:E5-E16. [PMID: 31846540 DOI: 10.1002/jum.15188] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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16
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Ebrashy A, Aboulghar M, Elhodiby M, El-Dessouky SH, Elsirgany S, Gaafar HM, Sheta SS, Kamal R, Negm S, El Sheikhah A, Idris O, Abd-El-Kader M, Ehab M, Momtaz M. Fetal heart examination at the time of 13 weeks scan: a 5 years' prospective study. J Perinat Med 2019; 47:871-878. [PMID: 31494637 DOI: 10.1515/jpm-2019-0222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/26/2019] [Indexed: 12/22/2022]
Abstract
Objective To evaluate our ability in classifying the fetal heart as normal or abnormal during the 1st trimester scan through fetal cardiac examination and determining the best time for this examination. Methods This was a prospective study performed on 3240 pregnant women to examine the fetal heart. Four chambers view and ventricular outflow tracts were mainly examined during the scan. We used grayscale and color mapping in the diagnosis. Color Doppler was used if additional information was needed, and all patients were rescanned during the 2nd trimester to confirm or negate our diagnosis. Results The cardiac findings were normal at both scans in 3108 pregnancies. The same cardiac abnormality was detected at both scans in 79 cases. In 36 cases there was false-positive diagnosis at the early scan; in 20 of these cases, there were mildly abnormal functional findings early in pregnancy with no abnormality found later. In 17 fetuses, there was discordance between the early and later diagnosis due to missed or incorrect diagnoses. The best time to do fetal heart examination during 1st trimester is between 13 and 13 + 6 weeks. Conclusion A high degree of accuracy in the identification of congenital heart disease (CHD) can be achieved by a 1st trimester fetal echocardiography.
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Affiliation(s)
- Alaa Ebrashy
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo 11435, Egypt
| | - Mona Aboulghar
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Mohamed Elhodiby
- Department of Obstetrics and Gynecology, Faculty of Medicine, M.U.S.T. University, Cairo, Egypt
| | - Sara H El-Dessouky
- Prenatal Diagnosis and Fetal Medicine Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Sherif Elsirgany
- Reproductive Health Research Department, National Research Centre, Cairo, Egypt
| | - Hassan M Gaafar
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Sahar S Sheta
- Department of Paediatrics, Cairo University, Cairo, Egypt
| | - Rasha Kamal
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Sherif Negm
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Ahmed El Sheikhah
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Omaima Idris
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Mohamed Abd-El-Kader
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Mohamed Ehab
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Mohamed Momtaz
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
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Duta S, Veduta A, Vayna AM, Panaitescu A, Nedelea F, Peltecu G. The outcome of structural heart defects diagnosed in the first trimester of pregnancy. J Matern Fetal Neonatal Med 2019; 34:1389-1394. [PMID: 31282223 DOI: 10.1080/14767058.2019.1637849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE We present the results of a detailed protocol of fetal heart examination in the first trimester, in a fetal medicine unit in Romania. METHODS Since October 2009, in Filantropia Hospital in Bucharest, we have systematically assessed pregnancies at 11-14 weeks to screen for aneuploidies and for major fetal structural defects. The fetal anatomy examination protocol included the detailed assessment of the fetal heart. This was performed using the same principles as for the second trimester examination, in the entire cohort. RESULTS Our population consisted of 7693 patients and 7816 embryos. The protocol for the ultrasound evaluation of the fetal heart was completed for 7597 embryos (97.2%). The outcome is known for 6912 cases (90.9%). We diagnosed 39 heart defects - 30 in the first trimester, seven in the second trimester, two postnatally. Twenty of the 39 heart defects were isolated cardiac malformations. Twelve of the isolated heart defects were diagnosed in the first trimester. The sensitivity of the first trimester ultrasound in identifying major heart defects was 76.92%. The overall survival in cases of isolated congenital heart disease diagnosed in the first trimester was significantly lower than the survival in the cases diagnosed in the second trimester. CONCLUSIONS Many (76.92%) of the significant heart defects can be diagnosed by ultrasound examination, in the first trimester. Our study is an argument for developing the multidisciplinary approach needed for the management of early detected structural heart disease.
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Affiliation(s)
- Simona Duta
- Filantropia Clinical Hospital, Bucharest, Romania
| | - Alina Veduta
- Filantropia Clinical Hospital, Bucharest, Romania
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Zheng MM, Tang HR, Zhang Y, Ru T, Li J, Xu BY, Xu Y, Hu YL. Contribution of the Fetal Cardiac Axis and V-Sign Angle in First-Trimester Screening for Major Cardiac Defects. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1179-1187. [PMID: 30208223 DOI: 10.1002/jum.14796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/17/2018] [Accepted: 07/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To estimate the potential value of fetal assessment for the cardiac axis (CAx) and V-sign angle (VSA) in the first trimester in the prediction of fetal major cardiac defects. METHODS A cohort study was conducted from December 2015 to June 2016. Patients with singleton pregnancies and crown-rump length from 45 to 84 mm were recruited to undergo nuchal translucency sonography. The CAx on the 4-chamber view and the VSA on the 3-vessel and trachea view with Doppler mapping were measured. The estimated performance of different combinations of increased fetal nuchal translucency, CAx, and VSA in screening for major cardiac defects was examined. RESULTS The study population of fetuses included 30 fetuses with major cardiac defects and 1538 normal fetuses. The CAx and VSA were 30° to 60° and 30° to 40°, respectively, according to the 2.5th and 97.5th percentiles in normal fetuses. When cases of isolated septal wall defects and an isolated right aortic arch were excluded, nuchal translucency above the 95th percentile, an abnormal CAx, and an abnormal VSA were observed in 63.3% (19 of 30), 63.3% (19 of 30), and 66.7% (20 of 30) of fetuses with major cardiac defects, respectively, and in 4.6% (71 of 1538), 2.0% (30 of 1538), and 5.6% (86 of 1538) of those without cardiac defects. Either an abnormal CAx or VSA was found in 93.3% (28 of 30) of the fetuses with cardiac defects and in 7.3% (113 of 1538) of those without cardiac defects. CONCLUSION Assessment of the CAx and VSA is helpful in defining a population at risk for major cardiac defects in the first trimester.
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Affiliation(s)
- Ming M Zheng
- Department of Obstetrics and Gynecology, the Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Hui R Tang
- Department of Obstetrics and Gynecology, the Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Yan Zhang
- Department of Obstetrics and Gynecology, the Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Tong Ru
- Department of Obstetrics and Gynecology, the Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Jie Li
- Department of Obstetrics and Gynecology, the Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Bi Y Xu
- Department of Obstetrics and Gynecology, the Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Yan Xu
- Department of Obstetrics and Gynecology, the Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Ya L Hu
- Department of Obstetrics and Gynecology, the Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu, China
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Asoglu MR, Yao R, Seger L, Turan OM, Turan S. Applicability of Standardized Early Fetal Heart Examination in the Obese Population. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1269-1277. [PMID: 30251391 DOI: 10.1002/jum.14807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This study aimed to evaluate the impact of obesity on early evaluation of fetal cardiac landmarks using a standardized examination method at the time of nuchal translucency scan. METHODS This was a cross-sectional study of an ongoing prospective cohort at high risk for congenital heart defects. We used a standardized examination protocol using 2-dimensional sonography with power Doppler in the evaluation of fetal cardiac landmarks consisting of 4-chamber view, outflow tract relationship, and transverse arches view. The study population was stratified based on maternal body mass index into nonobese (<30 kg/m2 ) and obese (≥30 kg/m2 ). Groups were compared in terms of satisfactory evaluation of fetal cardiac landmarks, transvaginal sonography use, and scan times required for the evaluations. Subanalysis was performed by further categorizing obesity into nonmorbid obesity (30.0-39.9 kg/m2 ) and morbid obesity (≥40 kg/m2 ). RESULTS A total of 190 patients were evaluated. Of these, 48.4% (n = 92) were obese. The most common indication for fetal cardiac assessment was maternal pregestational diabetes mellitus (42.6%). Transvaginal sonography was utilized in one nonobese woman (1.4%) and 11 obese women (12%) (P = .002). The satisfactory evaluation of 4-chamber view, outflow tract relationship, transverse arches view, and all views were not significantly different between groups (P > .05). The scan time was about 5 minutes longer in the obese group compared with nonobese group (P = .020). CONCLUSIONS Obesity does not hamper early evaluation of fetal cardiac landmarks around the time of nuchal translucency scan. However, obese patients are more likely to require transvaginal examinations.
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Affiliation(s)
- Mehmet Resit Asoglu
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ruofan Yao
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lindsey Seger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ozhan Mehmet Turan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sifa Turan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
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20
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McBrien A, Hornberger LK. Early fetal echocardiography. Birth Defects Res 2018; 111:370-379. [PMID: 30430770 DOI: 10.1002/bdr2.1414] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 09/27/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To explore the technical aspects and clinical utility of early fetal echocardiography and screening of the fetal heart in early pregnancy. Also, to document differences in cardiac structure and function which can be demonstrated in the late first/early second trimesters. METHODS In addition to summarizing our own experiences of late first/early second trimester fetal echocardiography, we reviewed the literature to explore clinical indications for, technical aspects, safety, accuracy, strengths and weaknesses of early fetal echocardiography. RESULTS In the current era, an increasing number of fetuses are identified as being at risk of congenital heart disease from as early as the late first trimester. In experienced hands, early fetal echocardiography can pick up a high proportion of congenital heart disease with good reliability for the majority of lesions. Early fetal echocardiography is relatively poor at assessing pulmonary veins, the atrioventricular valves and lesions that typically occur later or progress during the course of pregnancy. There is increasing interest in widespread implementation of an early obstetric anomaly screen which includes an assessment of the fetal heart for all pregnancies. There are a variety of hemodynamic differences in the late first/early second trimester compared with later in pregnancy. CONCLUSION Early fetal echocardiography is has become an established tool for detection of congenital heart disease. It affords opportunities to learn about the true spectrum and progression of congenital heart disease in-utero. Operators should be mindful of safety issues, technical aspects and hemodynamic findings which differ when performing echocardiograms at this stage of pregnancy.
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Affiliation(s)
- Angela McBrien
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, Cardiovascular Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa K Hornberger
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, Cardiovascular Research Institute, University of Alberta, Edmonton, Alberta, Canada.,The Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
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21
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Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P, Lang IM, Morais J, Pieper PG, Presbitero P, Price S, Rosano GMC, Seeland U, Simoncini T, Swan L, Warnes CA. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39:3165-3241. [PMID: 30165544 DOI: 10.1093/eurheartj/ehy340] [Citation(s) in RCA: 1148] [Impact Index Per Article: 191.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Pasternok M, Nocun A, Knafel A, Grzesiak M, Orzechowski M, Konarska K, Ludwin A, Ludwin I, Zymroz P, Parzynska A, Wiechec M. "Y Sign" at the Level of the 3-Vessel and Trachea View: An Effective Fetal Marker of Aortic Dextroposition Anomalies in the First Trimester. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1869-1880. [PMID: 29280176 DOI: 10.1002/jum.14533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/22/2017] [Accepted: 10/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The "Y sign" at the level of the 3-vessel and trachea view corresponds to thinning of main pulmonary artery and arterial duct and a dilated transverse aortic arch. The purpose of this study was to evaluate the Y sign for the diagnosis of aortic dextroposition anomalies at the time of the first-trimester scan and to assess the screening performance of only the Y sign, only abnormal left axis deviation (axis sign), and their combination for the diagnosis of aortic dextroposition anomalies. METHODS A prospective evaluation of 6025 pregnant women undergoing first-trimester ultrasonography was conducted. The cardiac axis was measured in all examined patients and considered abnormal (positive axis sign) at greater than 57 °. The frequency of the Y sign and the axis sign was assessed for this population, and their screening performance for the diagnosis of aortic dextroposition anomalies was calculated. RESULTS A total of 5775 patients fulfilled the inclusion criteria. Aortic dextroposition anomalies were diagnosed in 17 cases (tetralogy of Fallot in 8 and Fallot-like double-outlet right ventricle in 9). The Y sign was found in 18 of 5775 (0.3%) fetuses examined, of which 7 of 18 were confirmed with tetralogy of Fallot, 9 of 18 with a Fallot-like double-outlet right ventricle, and 2 of 18 with pulmonary stenosis. A positive axis sign of greater than 57 ° was found in 20 fetuses, including 4 with normal heart anatomy. The sensitivity values of the Y sign, the axis sign, and their combination were 94%, 76%, and 94%, respectively. CONCLUSIONS Visualization of the Y sign should increase the suspicion of aortic dextroposition anomalies in the late first trimester. The screening performance of the Y sign alone and in combination with an abnormal cardiac axis was high and may aid in the early diagnosis of aortic dextroposition anomalies in the fetus.
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Affiliation(s)
| | | | - Anna Knafel
- Departments of Gynecology and Obstetrics, Jagiellonian University, Krakow, Poland
| | - Mariusz Grzesiak
- Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | | | - Katarzyna Konarska
- Departments of Pediatric Cardiology, Jagiellonian University, Krakow, Poland
| | - Artur Ludwin
- Dobreusg Ultrasound Group Practice, Krakow, Poland
| | - Inga Ludwin
- Dobreusg Ultrasound Group Practice, Krakow, Poland
| | - Piotr Zymroz
- Department of Gynecology and Obstetrics, Frederic Chopin Clinical District Hospital No. 1, Rzeszow, Poland
| | - Anna Parzynska
- Departments of Gynecology and Obstetrics, Jagiellonian University, Krakow, Poland
| | - Marcin Wiechec
- Dobreusg Ultrasound Group Practice, Krakow, Poland
- Departments of Gynecology and Obstetrics, Jagiellonian University, Krakow, Poland
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Contro E, Stefani L, Berto S, Lapucci C, Arcelli D, Prandstraller D, Perolo A, Rizzo N, Farina A. Circulating mRNA in Maternal Plasma at the Second Trimester of Pregnancy: A Possible Screening Tool for Cardiac Conotruncal and Left Ventricular Outflow Tract Abnormalities. Mol Diagn Ther 2018; 21:653-661. [PMID: 28744745 DOI: 10.1007/s40291-017-0295-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Maternal plasma is a source of circulating placental nucleic acids. This study was designed to detect aberrantly expressed placental mRNA genes circulating in the maternal plasma of pregnancies affected with fetal conotruncal anomalies (CNTRA) and left-ventricular outflow tract (LVOT) obstruction in the second trimester of pregnancy. METHODS This was a retrospective monocentric study conducted from 1 Jan 2016 to 31 Dec 2016. NanoString technology was used to identify aberrantly expressed genes, comparing 36 women carrying a fetus with CNTRA or LVOT obstruction to 42 controls at 19-24 weeks of gestation. The genes with differential expression were subsequently tested using real-time polymerase chain reaction. Linear discriminant analysis was used to combine all the mRNA species with discriminant ability for CNTRA and LVOT obstruction. A multivariable receiver operating characteristic (ROC) curve having the estimated discriminant score as an explanatory variable was generated for the two affected groups versus controls. RESULTS Three genes with differential expression, namely MAPK1, IQGAP1 and Visfatin were found. The ROC curves yielded detection rates of 60 and 62.5% at a false-positive rate of 5% for CNTRA and LVOT, respectively. CONCLUSIONS These data suggested that molecular screening of CNTRA and LVOT obstruction in the second trimester is feasible. Prospective studies are needed to test the discriminant ability of these genes and to calculate the predictive positive value in the general population.
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Affiliation(s)
- Elena Contro
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC) Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | | | | | - Diego Arcelli
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC) Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Daniela Prandstraller
- Pediatric Cardiology and Adult Congenital Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Antonella Perolo
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC) Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nicola Rizzo
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC) Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC) Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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24
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Levels of Circulating mRNA for the Tenascin-X (TNXB) Gene in Maternal Plasma at the Second Trimester in Pregnancies with Isolated Congenital Ventricular Septal Defects. Mol Diagn Ther 2018; 22:235-240. [DOI: 10.1007/s40291-018-0321-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Preen C, Munn Z, Raju S, Flack N. Second trimester ultrasound detection of fetal anomalies in the obese obstetrical population: a systematic review protocol. ACTA ACUST UNITED AC 2018; 16:328-335. [PMID: 29419619 DOI: 10.11124/jbisrir-2017-003505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to identify, appraise and synthesize the best available evidence on the impact of maternal obesity on mid second trimester ultrasound detection of fetal anomalies in pregnancy.
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Affiliation(s)
- Christina Preen
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,Lyell McEwin Hospital, SA Health, Adelaide, Australia
| | - Zachary Munn
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Smita Raju
- Royal Adelaide Hospital, SA Health, Adelaide, Australia
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Asoglu MR, Gabbay-Benziv R, Turan OM, Turan S. Exposure of the developing heart to diabetic environment and early cardiac assessment: A review. Echocardiography 2018; 35:244-257. [DOI: 10.1111/echo.13811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Mehmet R. Asoglu
- ObstetricsGynecology & Reproductive Sciences; University of Maryland School of Medicine; Baltimore MD USA
| | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology; Hillel Yaffe Medical Center; Hadera Israel
| | - Ozhan M. Turan
- ObstetricsGynecology & Reproductive Sciences; University of Maryland School of Medicine; Baltimore MD USA
| | - Sifa Turan
- ObstetricsGynecology & Reproductive Sciences; University of Maryland School of Medicine; Baltimore MD USA
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N o 352 - Mise à jour technique : Le rôle de l'examen échographique précoce et exhaustif de l'anatomie fœtale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:1212-1220. [PMID: 29197488 DOI: 10.1016/j.jogc.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Nevo O, Brown R, Glanc P, Lim K. No. 352-Technical Update: The Role of Early Comprehensive Fetal Anatomy Ultrasound Examination. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:1203-1211. [DOI: 10.1016/j.jogc.2017.06.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Lakshmy SR, Jain B, Rose N. Role of HDLive in Imaging the Fetal Heart. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1267-1278. [PMID: 28295440 DOI: 10.7863/ultra.16.05071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/06/2016] [Indexed: 06/06/2023]
Abstract
HDLive is a rendering methodology that generates realistic images of the human fetus from sonographic data. The objective of this study is to demonstrate the utility of high-definition live in evaluating fetal heart especially in the first trimester (11-14-week) scan. The normal atrioventricular valve and its abnormalities along with septal defects can be vividly demonstrated with this technique, and eight cases with cardiac defects are illustrated. Its use in the first-trimester evaluation of heart would give a better perspective of the cardiac malformation, which provides the opportunity for counseling options early in pregnancy.
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Affiliation(s)
| | - Bharat Jain
- Department of Radiology, Vinayaka Mission's Kirupananda Variyar Medical College & Hospitals, Tamilnadu, India
| | - Nity Rose
- Department of Radiology, Vinayaka Mission's Kirupananda Variyar Medical College & Hospitals, Tamilnadu, India
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Quarello E, Lafouge A, Fries N, Salomon LJ. Basic heart examination: feasibility study of first-trimester systematic simplified fetal echocardiography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:224-230. [PMID: 26799640 DOI: 10.1002/uog.15866] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/16/2016] [Accepted: 01/18/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE First-trimester fetal cardiac screening examinations in low-risk populations should not have to meet the specifications required for high-risk populations. Our aim was to evaluate a simplified fetal echocardiographic ('basic heart') examination for early detection of severe congenital heart defects in a low-risk population. METHODS This was a first-trimester national 'flash study', performed over a 2-week period. Each observer was requested to perform simplified echocardiography without modifying the time and methods deemed necessary for the routine first-trimester ultrasound examination, in fetuses with crown-rump length between 45 and 84 mm. This basic heart assessment used targeted cross-sections of the four-chamber view (4CV) and of the three vessels and trachea (3VT) view, using color and/or directional power Doppler. All examinations were then reviewed offline and scored for quality by a qualified expert. RESULTS Sixty observers performed a total of 597 first-trimester ultrasound examinations, each performing an average of 10 (range, 1-26) procedures. Examinations were conducted transabdominally (79%; 472/597), transvaginally (3%; 17/597) or both (18%; 108/597). In 8% (45/597) of cases, the fetal back was anterior, in 18% (108/597) it was on the left side, in 63% (377/597) it was posterior and in 11% (67/597) it was on the right side. It became clear during scoring by the expert that, unlike the Herman quality score for nuchal translucency measurement, it was difficult to assess the quality of these images without taking into account normality of the heart itself. Analysis of scores showed that the 4CV was obtained successfully and was deemed normal in 86% (512/597) of the patients, in 7% (41/597) it was deemed technically infeasible and in 7% (44/597) it was deemed feasible but atypical, which may have been due to the presence of an abnormality or to poor quality of the image. The 3VT view was obtained successfully and was normal in 79% (472/597) of the patients, in 13% (78/597) it was technically infeasible and in 8% (47/597) it was deemed feasible but atypical. Both the 4CV and the 3VT view were obtained successfully and were normal in 73% (435/597) of patients. CONCLUSION It is possible for a trained operator to perform simplified fetal echocardiography during the routine first-trimester ultrasound examination in a low-risk population. In most cases, our basic heart examination can be used to reassure parents or identify potential problems to be clarified as early as possible in the second trimester. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E Quarello
- Unité d'Échographies Obstétricales et de Diagnostic Anténatal, Hôpital Saint Joseph, Marseille, France
- Institut de Médecine de la Reproduction, Marseille, France
| | - A Lafouge
- Cabinet de Gynécologie et Obstétrique, Hyères, France
| | - N Fries
- Collège Français d'Échographie Fœtale, Chateaubriant, France
| | - L J Salomon
- Service d'Obstétrique et de Médecine Fœtale, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
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Curti A, Lapucci C, Berto S, Prandstraller D, Perolo A, Rizzo N, Farina A. Maternal plasma mRNA species in fetal heart defects: a potential for molecular screening. Prenat Diagn 2016; 36:738-43. [PMID: 27257136 DOI: 10.1002/pd.4853] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/29/2016] [Accepted: 05/30/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To verify the hypothesis that aberrant placental mRNA genes related to cardiogenesis can be detected in maternal plasma at the second trimester of pregnancy. METHODS NanoString technology was used to identify aberrant genes, comparing 39 women carrying a fetus with a congenital heart defect (CHD) to 31 controls at 19-24 weeks of gestation. The genes with differential expression were subsequently tested using real time polymerase chain reaction. Linear discriminant analysis (LDA) was used to combine all the mRNA species with discriminant ability for CHD. A multivariable receiver operating characteristic (ROC) curve having the estimated discriminant score as an explanatory variable was generated. RESULTS Six genes with differential expression, namely FALZ, PAPP-A, PRKACB, SAV1, STK4 and TNXB2, were found. The ROC curve yielded a detection rate of 66.7% at a false positive rate of 10%. A higher discriminant score (>75(th) centile) was reached for 14 CHD cases (82.4%) and only 1 control (5.8%). Two cases (11.8%) of heart rhythm disorders also yielded a discriminant score value >75(th) centile. CONCLUSION These data represent a step forward in the screening of CHDs. Additional studies are needed to detect more mRNAs with discriminant ability and to move the first trimester screening.
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Affiliation(s)
- Alessandra Curti
- Department of Medicine and Surgery, Division of Obstetrics and Prenatal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | | | - Daniela Prandstraller
- Pediatric Cardiology and Adult Congenital Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonella Perolo
- Department of Medicine and Surgery, Division of Obstetrics and Prenatal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nicola Rizzo
- Department of Medicine and Surgery, Division of Obstetrics and Prenatal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Farina
- Department of Medicine and Surgery, Division of Obstetrics and Prenatal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Sotiriadis A, Papatheodorou SI, Martins WP. Synthesizing Evidence from Diagnostic Accuracy TEsts: the SEDATE guideline. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:386-395. [PMID: 26411461 DOI: 10.1002/uog.15762] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 09/18/2015] [Indexed: 06/05/2023]
Affiliation(s)
- A Sotiriadis
- Aristotle University of Thessaloniki, 2nd Department of Obstetrics and Gynecology, Thessaloniki, Greece
| | - S I Papatheodorou
- Department of Health Sciences, Cyprus Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - W P Martins
- Ribeirao Preto Medical School, University of Sao Paulo (FMRP-USP), Ribeirao Preto, Brazil
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Hutchinson JC, Arthurs OJ, Ashworth MT, Ramsey AT, Mifsud W, Lombardi CM, Sebire NJ. Clinical utility of postmortem microcomputed tomography of the fetal heart: diagnostic imaging vs macroscopic dissection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:58-64. [PMID: 26415141 DOI: 10.1002/uog.15764] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 09/11/2015] [Accepted: 09/18/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Congenital cardiac malformations are commonly identified at perinatal autopsy, which can be challenging in fetuses of early gestation and in macerated fetuses. Our objective was to examine fetal complex congenital heart disease by microcomputed tomography (micro-CT), using standard autopsy as the gold standard. METHODS In this ethically approved study, ex-vivo isolated fetal heart and fetal heart-lung blocks underwent iodine preparation prior to micro-CT, and were fixed in formalin after the micro-CT examination. Images were acquired using a microfocus-CT scanner with individual specimen image optimization. Twenty-one indices assessed normally at autopsy were evaluated for each dataset. Cardiac dissection was performed using a dissecting microscope within 24 h of the micro-CT examination. RESULTS We examined six fetal hearts, comprising five with complex congenital cardiac malformations at a gestational age of 17-23 weeks and an anatomically normal heart of 23 weeks' gestation for reference. All specimens demonstrated excellent internal contrast at micro-CT examination, and the correct overall diagnosis was made in all cases. There was agreement for 114/126 indices assessed on micro-CT and at autopsy dissection (overall concordance of 95.8% (95% CI, 90.5-98.2%)). Micro-CT was particularly useful in the assessment of ventricular morphology in macerated fetuses. CONCLUSIONS Micro-CT of small ex-vivo fetal specimens can provide highly accurate three-dimensional rendering of complex congenital fetal heart disease. This approach represents a significant advance in postmortem imaging and confirms the potential of this technology for non-invasive examination of small fetuses and organs.
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Affiliation(s)
- J C Hutchinson
- Institute of Child Health, UCL, London, UK
- Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
| | - O J Arthurs
- Institute of Child Health, UCL, London, UK
- Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - M T Ashworth
- Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
| | | | - W Mifsud
- Institute of Child Health, UCL, London, UK
- Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
| | - C M Lombardi
- Department of Radiology, Studio Diagnostico Eco, Vimercate, Milan, Italy
| | - N J Sebire
- Institute of Child Health, UCL, London, UK
- Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
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Zhang YF, Zeng XL, Zhao EF, Lu HW. Diagnostic Value of Fetal Echocardiography for Congenital Heart Disease: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2015; 94:e1759. [PMID: 26496297 PMCID: PMC4620824 DOI: 10.1097/md.0000000000001759] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/11/2015] [Accepted: 09/15/2015] [Indexed: 11/25/2022] Open
Abstract
Prenatal diagnosis of fetal congenital heart disease (CHD) has been shown to have a significant effect on prenatal and postnatal management and outcomes. However, the factors influencing the diagnostic accuracy and which pregnant trimester is the most adaptive for fetal heart disease remain uncertain despite of extensive researches. The aim of the present study was to evaluate the accuracy of echocardiography for detecting CHD and potential influence factors.We searched Chinese Biomedical Database (CBM), Medline, ISI Web of Knowledge, the Cochrane Library, and China National Knowledge Infrastructure (CNKI) to identify relevant studies from January 1, 1990 to August 13, 2015.Overall, the pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio were 68.5% (95% confidence interval [CI], 66.8%-70.2%), 99.8% (95% CI, 99.7%-99.8%), 3026.9 (95% CI, 1417.9-6461.8), 659.41 (95% CI, 346.38-1255.3), and 0.246 (95% CI, 0.187-0.324) respectively (AUC = 0.9924). The pooled sensitivity of basic cardiac echocardiographic examination (BCEE), extended cardiac echocardiographic examination (ECEE), BCEE plus outflow tract view (BCEE + OTV), BCEE + OTV + 3VTV (BCEE plus outflow tract view plus three vessel and trachea view) for the prenatal diagnosis of CHD were 49.0%, 75.5%, 66.1%, and 83.7% respectively. The pooled sensitivity of the prenatal echocardiographic diagnosis of CHD during the first trimester, second trimester, the second to third trimester were 60.3%, 60.9%, and 77.4%, respectively. The pooled sensitivity of BCEE and ECEE for the prenatal diagnosis of CHD during the second to third trimester was significantly higher than that during the second trimester. The pooled sensitivity of the prenatal echocardiographic diagnosis of CHD for pregnancies with low risk, high risk, low and high risk, and unselected risk were 45.4%, 85.1%, 89.1%, and 66.2%, respectively. The sensitivity analysis was robust and risk level was significant source of heterogeneity. Deek test indicated no potential significant publication bias.Prenatal ultrasound is a powerful tool for the diagnosis of CHD; however, echocardiography has individual sensitivity for different gestation period, different levels of risk, and different echo-views.
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Affiliation(s)
- Ya-Fei Zhang
- From the Department of General Surgery, Second Affiliated Hospital (Y-FZ, H-WL); Department of Obstetrics and Gynecology, First Affiliated Hospital (X-LZ); and Department of Ultrasound, Second Affiliated Hospital, Xi'an Jiaotong University, School of Medicine, Xi'an, Shaanxi, China (E-FZ)
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Kehler L, Biro O, Lazar L, Rigo J, Nagy B. Elevated hsa-miR-99a levels in maternal plasma may indicate congenital heart defects. Biomed Rep 2015; 3:869-873. [PMID: 26623032 DOI: 10.3892/br.2015.510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/04/2015] [Indexed: 01/16/2023] Open
Abstract
The current standard for prenatal screening is mostly based on biochemical marker tests and the use of ultrasonography. There is no secure stand-alone screening marker for congenital heart defects (CHDs). MicroRNAs (miRNAs) that are associated with cardiogenesis enter the maternal peripheral bloodstream during pregnancy and allow non-invasive prenatal testing (NIPT). The present study investigated the plasma expression profile of fetal hsa-miR-99a in maternal blood. Peripheral blood samples were collected from 39 pregnant patients, comprising 22 with CHD-positive fetuses and 17 with CHD-free controls. miRNAs were isolated from the maternal serum and reverse transcription-quantitative polymerase chain reaction was carried out to determine the expression of hsa-miR-99a. While the miRNA concentrations were almost identical among the affected and control groups (5.54 vs. 6.40 ng/µl), significantly upregulated hsa-miR-99a levels were identified in the affected group (1.78×10-2±3.53×10-2 vs. 1.09×10-3±3.55×10-3 ng/µl, P=0.038). In conclusion, according to the present study, hsa-miR-99a is involved in cardiac malformation and may serve as a biomarker during fetal development, and therefore presents as a candidate for monitoring cardiomyogenesis and potential use as a NIPT-biomarker for fetal CHD.
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Affiliation(s)
- Lars Kehler
- First Department of Obstetrics and Gynecology, Semmelweis University Budapest, H-1088 Budapest, Hungary
| | - Orsolya Biro
- First Department of Obstetrics and Gynecology, Semmelweis University Budapest, H-1088 Budapest, Hungary
| | - Levente Lazar
- First Department of Obstetrics and Gynecology, Semmelweis University Budapest, H-1088 Budapest, Hungary
| | - Janos Rigo
- First Department of Obstetrics and Gynecology, Semmelweis University Budapest, H-1088 Budapest, Hungary
| | - Balint Nagy
- First Department of Obstetrics and Gynecology, Semmelweis University Budapest, H-1088 Budapest, Hungary
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Mogra R, Saaid R, Kesby G, Hayward J, Malkoun J, Hyett J. Early fetal echocardiography: Experience of a tertiary diagnostic service. Aust N Z J Obstet Gynaecol 2015. [DOI: 10.1111/ajo.12379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ritu Mogra
- Department of High Risk Obstetrics, RPA Women and Babies; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Discipline of Obstetrics, Gynaecology and Neonatology; Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Sydney Ultrasound for Women; Sydney New South Wales Australia
| | - Rahmah Saaid
- Department of High Risk Obstetrics, RPA Women and Babies; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Greg Kesby
- Department of High Risk Obstetrics, RPA Women and Babies; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Sydney Ultrasound for Women; Sydney New South Wales Australia
| | - Janette Hayward
- Sydney Ultrasound for Women; Sydney New South Wales Australia
| | - Jessica Malkoun
- Sydney Ultrasound for Women; Sydney New South Wales Australia
| | - Jon Hyett
- Department of High Risk Obstetrics, RPA Women and Babies; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Discipline of Obstetrics, Gynaecology and Neonatology; Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
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Kakkad V, Dahl J, Ellestad S, Trahey G. In vivo application of short-lag spatial coherence and harmonic spatial coherence imaging in fetal ultrasound. ULTRASONIC IMAGING 2015; 37:101-16. [PMID: 25116292 PMCID: PMC4326611 DOI: 10.1177/0161734614547281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Fetal scanning is one of the most common applications of ultrasound imaging and serves as a source of vital information about maternal and fetal health. Visualization of clinically relevant structures, however, can be severely compromised in difficult-to-image patients due to poor resolution and the presence of high levels of acoustical noise or clutter. We have developed novel coherence-based beamforming methods called Short-Lag Spatial Coherence (SLSC) imaging and Harmonic Spatial Coherence imaging (HSCI), and applied them to suppress the effects of clutter in fetal imaging. This method is used to create images of the spatial coherence of the backscattered ultrasound as opposed to images of echo magnitude. We present the results of a patient study to assess the benefits of coherence-based beamforming in the context of first trimester fetal exams. Matched fundamental B-mode, SLSC, harmonic B-mode, and HSCI images were generated using raw radio frequency data collected on 11 volunteers in the first trimester of pregnancy. The images were compared for qualitative differences in image texture and target conspicuity as well as using quantitative imaging metrics such as signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and contrast. SLSC and HSCI showed statistically significant improvements across all imaging metrics compared with B-mode and harmonic B-mode, respectively. These improvements were greatest for poor quality B-mode images where contrast of anechoic targets was improved from 15 dB in fundamental B-mode to 27 dB in SLSC and 17 dB in harmonic B-mode to 30 dB in HSCI. CNR improved from 1.4 to 2.5 in the fundamental images and 1.4 to 3.1 in the harmonic case. These results exhibit the potential of coherence-based beamforming to improve image quality and target detectability, especially in high noise environments.
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Affiliation(s)
- Vaibhav Kakkad
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Jeremy Dahl
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Sarah Ellestad
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Gregg Trahey
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
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Evaluation of Fetal Pulmonary Veins During Early Gestation by Pulsed Doppler Ultrasound: A Feasibility Study. JOURNAL OF FETAL MEDICINE 2015. [DOI: 10.1007/s40556-015-0038-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chan C, Costain G, Ogura L, Silversides CK, Chow EWC, Bassett AS. Reproductive Health Issues for Adults with a Common Genomic Disorder: 22q11.2 Deletion Syndrome. J Genet Couns 2015; 24:810-21. [PMID: 25579115 DOI: 10.1007/s10897-014-9811-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 12/12/2014] [Indexed: 12/25/2022]
Abstract
22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion syndrome in humans. Survival to reproductive age and beyond is now the norm. Several manifestations of this syndrome, such as congenital cardiac disease and neuropsychiatric disorders, may increase risk for adverse pregnancy outcomes in the general population. However, there are limited data on reproductive health in 22q11.2DS. We performed a retrospective chart review for 158 adults with 22q11.2DS (75 male, 83 female; mean age 34.3 years) and extracted key variables relevant to pregnancy and reproductive health. We present four illustrative cases as brief vignettes. There were 25 adults (21 > age 35 years; 21 female) with a history of one or more pregnancies. Outcomes for women with 22q11.2DS, compared with expectations for the general population, showed a significantly elevated prevalence of small for gestational age liveborn offspring (p < 0.001), associated mainly with infants with 22q11.2DS. Stillbirths also showed elevated prevalence (p < 0.05). Not all observed adverse events appeared to be attributable to transmission of the 22q11.2 deletion. Recurring issues relevant to reproductive health in 22q11.2DS included the potential impact of maternal morbidities, inadequate social support, unsafe sexual practices, and delayed diagnosis of 22q11.2DS and/or lack of genetic counseling. These preliminary results emphasize the importance of early diagnosis and long term follow-up that could help facilitate genetic counseling for men and women with 22q11.2DS. We propose initial recommendations for pre-conception management, educational strategies, prenatal planning, and preparation for possible high-risk pregnancy and/or delivery.
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Affiliation(s)
- Chrystal Chan
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Undergraduate Medical Education, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gregory Costain
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Undergraduate Medical Education, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lucas Ogura
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Candice K Silversides
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada.,Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Toronto, ON, Canada.,Obstetric Medicine Program, Mount Sinai Hospital, Toronto, ON, Canada
| | - Eva W C Chow
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Anne S Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada. .,Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada. .,Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Toronto, ON, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada. .,Department of Psychiatry, and Toronto General Research Institute, University Health Network, Toronto, ON, Canada. .,The Dalglish Family Hearts and Minds Clinic for 22q11.2 Deletion Syndrome, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
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Turan S, Turan OM, Desai A, Harman CR, Baschat AA. First-trimester fetal cardiac examination using spatiotemporal image correlation, tomographic ultrasound and color Doppler imaging for the diagnosis of complex congenital heart disease in high-risk patients. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:562-567. [PMID: 24585667 DOI: 10.1002/uog.13341] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/26/2014] [Accepted: 02/10/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE A four-dimensional (4D) fetal echocardiographic technique utilizing spatiotemporal image correlation, tomographic ultrasound imaging display (STIC-TUI echo) and color Doppler has previously been shown to be effective in displaying the examination planes constituting the extended cardiac examination. The aim of this study was to evaluate the performance of this first-trimester STIC-TUI echo technique in identifying complex congenital heart disease (CHD) in high-risk pregnancies. METHODS This was a prospective study of patients presenting at first-trimester screening who were at high risk for CHD owing to pregestational diabetes, in-vitro fertilization (IVF), increased nuchal translucency (NT) thickness, first-trimester tricuspid regurgitation or reversed ductus venosus (DV) a-wave, a previous child with CHD or who were on anticonvulsant medication. First-trimester STIC-TUI echo was performed, and the findings were correlated with second-trimester echocardiography and post-delivery echo findings in survivors. RESULTS One hundred and sixty-four fetuses from 152 patients were enrolled (77 diabetics, 38 IVF, 14 with increased NT, 23 cases of tricuspid regurgitation or reversed a-wave in the DV, 22 with prior CHD and two on anticonvulsants). STIC-TUI echo was abnormal in 20 (12%), showing atrioventricular canal defect (n = 9), hypoplastic left heart (n = 2), pulmonary stenosis (n = 2), right aortic arch (n = 1), interrupted aortic arch (n = 1), tricuspid atresia (n = 1), heterotaxy (n = 1), persistent truncus arteriosus (n = 1), double outlet right ventricle and ventricular septal defect (n = 1) and double inlet ventricle with transposition of the great arteries (n = 1). 85% of these anomalies were evident in the four-chamber view plane of the TUI display, and the remainder were diagnosed in the outflow tract planes with color Doppler imaging. In 13, CHD was isolated while seven had extracardiac anomalies. Thirteen fetuses had aneuploidy and all 13 underwent first-trimester termination of pregnancy. In the remaining seven, second-trimester echocardiography and neonatal echo/postmortem examination confirmed anomalies (two stillborn neonates, one neonatal death, four live births). Two cases of CHD missed by first-trimester STIC-TUI echo were diagnosed on second-trimester echo. Accordingly, first-trimester STIC-TUI echo had 91% sensitivity and 100% specificity for the detection of CHD. CONCLUSIONS First-trimester 4D echocardiography using a standardized application of STIC, TUI and color Doppler imaging is effective in displaying the imaging planes that are necessary for achieving the diagnosis of complex cardiac anomalies in high-risk patients. Optimal imaging of the four-chamber view with two-dimensional ultrasound is the major determinant of successful volume acquisition.
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Affiliation(s)
- S Turan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
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Abstract
First trimester sonography is a widely used technique to examine the foetus early in pregnancy. The desire to recognise complex anatomy already in early developmental stages stresses the need for a thorough knowledge of basic developmental processes as well as recognition of cardiac compartments based on their morphology. In this paper, we describe the possibilities and limitations of sonographic assessment of the foetal heart between 10 and 14 weeks of gestation and correlate this to morphology. Examples of the most commonly detected congenital anomalies are atrioventricular septal defects, transposition of the great arteries, and hypoplastic left heart, which are shown in this paper.
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Clur SAB, Bilardo CM. Early detection of fetal cardiac abnormalities: how effective is it and how should we manage these patients? Prenat Diagn 2014; 34:1235-45. [DOI: 10.1002/pd.4466] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 07/07/2014] [Accepted: 07/16/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Sally-Ann B. Clur
- Department of Pediatric Cardiology of the Emma Children's Hospital; Academic Medical Centre; Amsterdam The Netherlands
- The Centre for Congenital Heart Anomalies Amsterdam-Leiden (CAHAL); Amsterdam The Netherlands
| | - Caterina M. Bilardo
- Department of Obstetrics and Gynecology; Academic Medical Centre, Amsterdam; The Netherlands
- Department of Obstetrics and Gynecology, University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
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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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Espinoza J, Lee W, Viñals F, Martinez JM, Bennasar M, Rizzo G, Belfort M. Collaborative study of 4-dimensional fetal echocardiography in the first trimester of pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE 2014; 33:1079-84. [PMID: 24866615 DOI: 10.7863/ultra.33.6.1079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Accumulating evidence supports a role for 2-dimensional fetal echocardiography in the first trimester of pregnancy for the identification of congenital heart defects. Our objective was to investigate the role of 4-dimensional (4D) sonography in the identification of congenital heart defects between 11 and 15 weeks of pregnancy. METHODS This study included 4 centers with expertise in first-trimester 4D fetal echocardiography. Fetuses with and without confirmed heart defects were evaluated between 11 and 15 weeks and their volume data sets were uploaded onto a centralized file transfer protocol server. RESULTS Forty-eight volume data sets from fetuses with normal (n = 17) and abnormal (n = 16) hearts were evaluated. Overall, the median (range) accuracy, sensitivity, and specificity, as well as the positive and negative likelihood ratios, for the identification of fetuses with congenital heart defects were 79% (77%-83%), 90% (70%-96%), 59% (58%-93%), 2.35 (2.05-9.80), and 0.18 (0.08-0.32), respectively. CONCLUSIONS (1) Four-dimensional fetal echocardiography can be performed in the first and early second trimesters of pregnancy; and (2) 4D volume data sets obtained from fetuses between 11 and 15 weeks can be remotely acquired and accurately interpreted by different centers.
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Affiliation(s)
- Jimmy Espinoza
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas USA (J.E., W.L., M.B.); Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan USA (J.E., W.L.); Centro AGB Ultrasonografía, Clínica Sanatorio Aleman, Concepción, Chile (F.V.); Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia, i Neonatologia, Hospital Clinic, University of Barcelona, Barcelona, Spain (J.M.M., M.B.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.).
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas USA (J.E., W.L., M.B.); Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan USA (J.E., W.L.); Centro AGB Ultrasonografía, Clínica Sanatorio Aleman, Concepción, Chile (F.V.); Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia, i Neonatologia, Hospital Clinic, University of Barcelona, Barcelona, Spain (J.M.M., M.B.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Fernando Viñals
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas USA (J.E., W.L., M.B.); Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan USA (J.E., W.L.); Centro AGB Ultrasonografía, Clínica Sanatorio Aleman, Concepción, Chile (F.V.); Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia, i Neonatologia, Hospital Clinic, University of Barcelona, Barcelona, Spain (J.M.M., M.B.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Josep Maria Martinez
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas USA (J.E., W.L., M.B.); Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan USA (J.E., W.L.); Centro AGB Ultrasonografía, Clínica Sanatorio Aleman, Concepción, Chile (F.V.); Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia, i Neonatologia, Hospital Clinic, University of Barcelona, Barcelona, Spain (J.M.M., M.B.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Mar Bennasar
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas USA (J.E., W.L., M.B.); Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan USA (J.E., W.L.); Centro AGB Ultrasonografía, Clínica Sanatorio Aleman, Concepción, Chile (F.V.); Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia, i Neonatologia, Hospital Clinic, University of Barcelona, Barcelona, Spain (J.M.M., M.B.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas USA (J.E., W.L., M.B.); Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan USA (J.E., W.L.); Centro AGB Ultrasonografía, Clínica Sanatorio Aleman, Concepción, Chile (F.V.); Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia, i Neonatologia, Hospital Clinic, University of Barcelona, Barcelona, Spain (J.M.M., M.B.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
| | - Michael Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas USA (J.E., W.L., M.B.); Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan USA (J.E., W.L.); Centro AGB Ultrasonografía, Clínica Sanatorio Aleman, Concepción, Chile (F.V.); Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia, i Neonatologia, Hospital Clinic, University of Barcelona, Barcelona, Spain (J.M.M., M.B.); and Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (G.R.)
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Accuracy of ultrasonography at 11-14 weeks of gestation for detection of fetal structural anomalies: a systematic review. Obstet Gynecol 2014; 122:1160-7. [PMID: 24201688 DOI: 10.1097/aog.0000000000000015] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To review the literature concerning the efficacy of early ultrasonography (at 11-14 weeks of gestation) to identify fetal malformations. DATA SOURCES A search in PubMed, MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov was performed (January 2000 to December 2012). Keywords were: fetal anatomy, fetal echocardiography, nuchal translucency, fetal structural anomalies, fetal malformations, prenatal diagnosis, prenatal screening, and first-trimester ultrasonography. METHODS OF STUDY SELECTION Inclusion criteria were: fetal anatomy examination at early ultrasonography and diagnosis of fetal malformations confirmed by postnatal or postmortem examination. Data abstracted were: sample size, location of structural defect, ultrasound modality, presence of multiple defects, and study population. Pooled detection rate was calculated for each malformation and compared with χ. Differences were considered statistically significant if P<.05. TABULATION, INTEGRATION, AND RESULTS From 1,203 articles, 19 were included. Overall, we pooled 78,002 fetuses undergoing ultrasonography at 11-14 weeks, of which 996 were malformed, leading to prevalence of malformation of 12 per 1,000. The overall detection rate was 472 of 957 (51%). The highest detection rate was achieved for neck anomalies (92%), whereas limbs (34%), face (34%), and genitourinary anomalies (34%) were associated with the lowest detection rate. At 14 weeks of gestation or less, fetal echocardiography detected 53% of congenital heart disease compared with 43% by complete scan (P=.040). The use of Doppler did not improve the detection rate for congenital heart defects (52% compared with 44%, respectively; P=.11). Multiple defects were identified more frequently than isolated malformations (60% compared with 44%; P=.005). The detection rate was higher combining transabdominal and transvaginal techniques (62%) than either abdominal (51%) or transvaginal (34%; P<.001). Detection rate was higher in women at high risk (65%) than unselected population (50% P=.001). CONCLUSION Because of the natural history of fetal defects and the late development of some organ systems, a number of fetal malformations remain undetected by early ultrasonography.
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Dewi DEO, Abduljabbar HN, Supriyanto E. Review on Advanced Techniques in 2-D Fetal Echocardiography: An Image Processing Perspective. LECTURE NOTES IN BIOENGINEERING 2014. [DOI: 10.1007/978-981-4585-72-9_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Farina A, Arcelli D. Congenital heart defects: is it time to explore maternal blood for a non-invasive genetic screening test? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:109-110. [PMID: 24265201 DOI: 10.1002/uog.13259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- A Farina
- Division of Prenatal Medicine, DIMEC University of Bologna, Bologna, Italy
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Zidere V, Bellsham-Revell H, Persico N, Allan LD. Comparison of echocardiographic findings in fetuses at less than 15 weeks' gestation with later cardiac evaluation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:679-686. [PMID: 23703918 DOI: 10.1002/uog.12517] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 05/14/2013] [Accepted: 05/17/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To compare the echocardiographic findings in fetuses at < 15 weeks' gestation with a later follow-up scan, and determine both the accuracy of early diagnosis and the frequency of findings that change between scans. METHODS For the period 2002 to the end of 2009, we searched our database for all patients who had had a detailed fetal echocardiogram at less than 15 completed weeks' gestation and a repeat scan at least 6 weeks later. RESULTS Of 1200 patients fulfilling our selection criteria, the cardiac findings were normal at both scans in 1069. In 46 cases the same cardiac abnormality was seen at both scans. There was a false-positive diagnosis at early scan in seven cases. In 50 cases, there were mildly abnormal functional findings early in pregnancy with no abnormality found later. In 29 fetuses, there was discordance between the early and later morphological diagnosis, 15/29 being considered significant differences, with 10/15 representing true progression of findings between the early and later scans, rather than missed or incorrect diagnoses. CONCLUSIONS A high degree of accuracy in the identification of congenital heart disease can be achieved by early fetal echocardiography (sensitivity 84.8 (95% CI, 75.0-91.9)%, specificity 95.3 (95% CI, 93.9-96.4)%), although the identification of every case of tetralogy of Fallot and small atrioventricular septal defects presents particular diagnostic challenges at this gestational age. A small but significant group showed progression of findings during this stage of rapid fetal heart growth, particularly in obstructive lesions.
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Affiliation(s)
- V Zidere
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK; Department of Congenital Heart Disease, Evelina Children's Hospital, London, UK
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