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Piemonti L, Vettor L, Balducci A, Farina A, Contro E. Assisted reproductive technology and the risk of fetal congenital heart disease: insights from a tertiary-care referral center. Arch Gynecol Obstet 2024:10.1007/s00404-024-07669-x. [PMID: 39085434 DOI: 10.1007/s00404-024-07669-x] [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: 05/21/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE To investigate whether congenital heart diseases exhibit higher rates in pregnancies achieved through assisted reproductive technology (ART) compared to natural conception. METHODS In this retrospective cohort study, multinomial logistic regression was employed to analyze the relationship between categories of congenital heart diseases and three conception groups (IVF, ICSI, and natural pregnancies). The main outcome measures are risks of congenital heart disease categories in IVF and ICSI groups using the natural group as reference. We selected fetuses referred for fetal echocardiography to IRCCS Policlinico Sant'Orsola, Bologna, between January 2005 and November 2023, diagnosed with congenital heart diseases. RESULTS We categorized the congenital heart diseases into six groups based on anatomical and embryological criteria. The estimated risk of left ventricular outflow tract, valvular, conotruncal, and atrioventricular septal defects was lower in the IVF group compared to natural conception. The estimated risk of valvular and atrioventricular septal defects was lower in the ICSI group vs natural. Conversely, the risk for right heart anomalies was higher both in the IVF and ICSI groups compared to natural conception. Heart rhythm diseases were more frequent in IVF pregnancies. When comparing ART methods, valvular defects, conotruncal defects, and right heart anomalies were more frequently observed in the ICSI group, while atrioventricular septal defects were more common in the IVF group. CONCLUSION Significant differences were found in the occurrence of congenital heart diseases in pregnancies conceived through IVF and ICSI, versus those conceived naturally, underscoring the importance of further studying the underlying mechanisms of these associations.
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Affiliation(s)
- Linda Piemonti
- Department of Obstetrics and Gynecology, Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Giuseppe Massarenti, 13, 40138, Bologna, Italy.
| | - Laura Vettor
- Department of Women's and Children's Health Gynecologic and Obstetrics Clinic, University of Padua, Pauda, Italy
| | - Anna Balducci
- Pediatric Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Antonio Farina
- Department of Obstetrics and Gynecology, Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Giuseppe Massarenti, 13, 40138, Bologna, Italy
| | - Elena Contro
- Department of Obstetrics and Gynecology, Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Giuseppe Massarenti, 13, 40138, Bologna, Italy
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Juergensen S, Liu J, Xu D, Zhao Y, Moon-Grady AJ, Glenn O, McQuillen P, Peyvandi S. Fetal circulatory physiology and brain development in complex congenital heart disease: A multi-modal imaging study. Prenat Diagn 2024; 44:856-864. [PMID: 37817395 PMCID: PMC11004088 DOI: 10.1002/pd.6450] [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: 05/03/2023] [Revised: 09/07/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE Fetuses with complex congenital heart disease have altered physiology, contributing to abnormal neurodevelopment. The effects of altered physiology on brain development have not been well studied. We used multi-modal imaging to study fetal circulatory physiology and brain development in hypoplastic left heart syndrome (HLHS) and d-transposition of the great arteries (TGA). METHODS This prospective, cross-sectional study investigated individuals with fetal congenital heart disease and controls undergoing fetal echocardiography and fetal brain MRI. MRI measured total brain volume and cerebral oxygenation by the MRI quantification method T2*. Indexed cardiac outputs (CCOi) and vascular impedances were calculated by fetal echocardiography. Descriptive statistics assessed MRI and echocardiogram measurement relationships by physiology. RESULTS Sixty-six participants enrolled (control = 20; HLHS = 25; TGA = 21), mean gestational age 33.8 weeks (95% CI: 33.3-34.2). Total brain volume and T2* were significantly lower in fetuses with cardiac disease. CCOi was lower in HLHS, correlating with total brain volume - for every 10% CCOi increase, volume increased 8 mm3 (95% CI: 1.78-14.1; p = 0.012). Echocardiography parameters and cerebral oxygenation showed no correlation. TGA showed no CCOi or aortic output correlation with MRI measures. CONCLUSIONS In HLHS, lower cardiac output is deleterious to brain development. Our findings provide insight into the role of fetal cardiovascular physiology in brain health.
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Affiliation(s)
- Stephan Juergensen
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
- Department of Pediatrics, Division of Pediatric Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Jing Liu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Yili Zhao
- Department of Pediatrics, Division of Pediatric Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Anita J Moon-Grady
- Department of Pediatrics, Division of Pediatric Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Orit Glenn
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Patrick McQuillen
- Department of Pediatrics, Division of Critical Care, University of California San Francisco, San Francisco, California, USA
| | - Shabnam Peyvandi
- Department of Pediatrics, Division of Pediatric Cardiology, University of California San Francisco, San Francisco, California, USA
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Janzing P, Nourkami-Tutdibi N, Tutdibi E, Freundt P, von Ostrowski T, Langer M, Zemlin M, Steinhard J. Controlled prospective study on ultrasound simulation training in fetal echocardiography: FESIM II. Arch Gynecol Obstet 2024; 309:2505-2513. [PMID: 37454353 PMCID: PMC11147821 DOI: 10.1007/s00404-023-07133-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To analyze the learning curves of ultrasound novices in fetal echocardiography during structured simulation-based ultrasound training (SIM-UT) including a virtual, randomly moving fetus. METHODS 11 medical students with minimal (< 10 h) prior obstetric ultrasound experience underwent 12 h of structured fetal echocardiography SIM-UT in individual hands-on sessions during a 6-week training program. Their learning progress was assessed with standardized tests after 2, 4, and 6 weeks of SIM-UT. Participants were asked to obtain 11 fetal echocardiography standard planes (in accordance with ISUOG and AHA guidelines) as quickly as possible. All tests were carried out under real life, examination-like conditions on a healthy, randomly moving fetus. Subsequently, we analyzed the rate of correctly obtained images and the total time to completion (TTC). As reference groups, 10 Ob/Gyn physicians (median of 750 previously performed Ob/Gyn scans) and 10 fetal echocardiography experts (median of 15,000 previously performed Ob/Gyn scans) were examined with the same standardized tests. RESULTS The students showed a consistent and steady improvement of their ultrasound performance during the training program. After 2 weeks, they were able to obtain > 95% of the standard planes correctly. After 6 weeks, they were significantly faster than the physician group (p < 0.001) and no longer significantly slower than the expert group (p = 0.944). CONCLUSION SIM-UT is highly effective to learn fetal echocardiography. Regarding the acquisition of the AHA/ISUOG fetal echocardiography standard planes, the students were able to reach the same skill level as the expert group within 6 weeks.
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Affiliation(s)
- Paul Janzing
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, 66421, Homburg/Saar, Germany.
| | - Nasenien Nourkami-Tutdibi
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Erol Tutdibi
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Paula Freundt
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | | | - Martin Langer
- LARA-Praxis für Frauengesundheit, Bocholt, NRW, Germany
| | - Michael Zemlin
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Johannes Steinhard
- Fetal Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
- Prenatal Medicine Center Münster, Münster, NRW, Germany
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Dotson A, Covas T, Halstater B, Ragsdale J. Congenital Heart Disease. Prim Care 2024; 51:125-142. [PMID: 38278566 DOI: 10.1016/j.pop.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
More people are living with congenital heart disease (CHD) because many children now survive to adulthood with advances in medical and surgical treatments. Patients with CHD have ongoing complex health-care needs in the various life stages of infancy, childhood, adolescence, and adulthood. Primary care providers should collaborate with pediatric specialists to provide ongoing care for people living with CHD and to create smooth transitions of care.
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Affiliation(s)
- Andrea Dotson
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Road, Durham, NC 27705, USA.
| | - Tiffany Covas
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Road, Durham, NC 27705, USA
| | - Brian Halstater
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Road, Durham, NC 27705, USA
| | - John Ragsdale
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Road, Durham, NC 27705, USA
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Prats P, Izquierdo MT, Rodríguez MÁ, Rodríguez I, Rodríguez-Melcón A, Serra B, Albaiges G. Assessment of fetal cardiac function in early fetal life: feasibility, reproducibility, and early fetal nomograms. AJOG GLOBAL REPORTS 2024; 4:100325. [PMID: 38586615 PMCID: PMC10994973 DOI: 10.1016/j.xagr.2024.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Fetal cardiology has shown a rapid development in the past decades. Fetal echocardiography is not only used for the detection of structural anomalies but also to assess fetal cardiac function. Assessment of the fetal cardiac function is performed mostly in the second and third trimesters. The study of fetal cardiac function at the end of first trimester has not been investigated properly, and there is a lack of reference values at early gestational weeks. OBJECTIVE This study aimed to assess if the measurement of time-related parameters of cardiac function in the left ventricle of the fetal heart is feasible and reproducible at the end of the first trimester. If possible, we provide nomograms of these parameters from 11 to 13+6 gestational weeks. STUDY DESIGN We conducted a prospective observational study from March to September 2022. The study was carried out in 2 hospitals (Hospital Universitari Dexeus, Barcelona, and Hospital VITAHS 9 Octubre, Valencia, Spain). The scans were performed by 3 specialists in fetal medicine. The exclusion criteria were fetal cardiac rhythm abnormalities, abnormal nuchal translucency, abnormal ductus venosus, fetal malformations, stillbirth, estimated fetal weight <10 percentile, diabetes, and gestational hypertensive disorders. The cardiac function parameters studied in the left ventricle were isovolumetric contraction time, isovolumetric relaxation time, ejection time, filling time, cycle time, myocardial performance index, ejection time fraction, and filling time fraction. We study the feasibility and intra- and interobserver reproducibility of these parameters using the interclass correlation coefficient. Nomograms were created and the percentiles of the values of the different parameters were calculated. RESULTS A total of 409 cases were recruited but only 296 could be included in the statistical analysis once the exclusion criteria were applied. The intraobserver reproducibility study was excellent (interclass correlation coefficient >0.900), and the interobserver reproducibility study was good (interclass correlation coefficient >0.700). The data regression analysis showed that cycle time, filling time, isovolumetric contraction time, and filling time fraction increased with gestational age, whereas ejection time fraction decreased with gestational age and myocardial performance index (mean, 0.43±0.08), isovolumetric relaxation time (mean, 0.04±0.01), and ejection time (mean, 0.16±0.01) remained constant from 11 to 13 weeks. CONCLUSION The study of fetal cardiac function is feasible and reproducible at 11 to 13+6 gestational weeks. Nomograms of the studied parameters are provided.
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Affiliation(s)
- Pilar Prats
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez, and Albaiges)
- Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez-Melcón, and Serra)
| | - M. Teresa Izquierdo
- Gynecologic and Obstetric Ultrasound Unit, Hospital VITHAS 9 Octubre, Valencia, Spain (Dr Izquierdo)
| | - M. Ángeles Rodríguez
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez, and Albaiges)
| | - Ignacio Rodríguez
- Epidemiological Unit, Department Obstetrics, Gynecology, Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Mr Rodríguez)
| | - Alberto Rodríguez-Melcón
- Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez-Melcón, and Serra)
| | - Bernat Serra
- Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez-Melcón, and Serra)
| | - Gerard Albaiges
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez, and Albaiges)
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Karmegaraj B. Foramen ovale flap aneurysm in fetuses associated with and without heart defects: Prenatal diagnosis, imaging, in-utero hemodynamics, pregnancy, and postnatal outcomes. Echocardiography 2024; 41:e15743. [PMID: 38284679 DOI: 10.1111/echo.15743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Isolated redundant foramen ovale flap aneurysm (RFOA) in the absence of restrictive foramen ovale is believed to be a cause for pseudocoarctation of aorta since the impediment of blood flow to the left heart can be severe, resembling the picture of left ventricular hypoplasia with retrograde aortic flow. The primary objective of the study is to find whether RFOA is always a benign lesion. The main focus of the study is to share my experience in particular on fetuses having redundant foramen ovale flap aneurysm developing into coarctation of aorta and to study the associated factors. METHODS Retrospective study (January 2020 to June 2023). All fetuses with RFOA associated with and without congenital heart defects were included. Fetuses with restrictive foramen ovale and RFOA with single ventricle hearts were excluded. The imaging, in-utero hemodynamics, pregnancy, and postnatal outcomes with at least 3 months follow-up were presented. RESULTS During the study period, a total of 1499 fetal echocardiography were performed. Twenty-two fetuses with RFOA were included. Fourteen fetuses had isolated RFOA and eight had associated abnormalities [extracardiac (n = 5); intracardiac (n = 2), Both (n = 1)]. Genetic evaluation were performed only in fetuses with associated defects were normal. Postnatally all isolated RFOA fetuses had no aortic arch obstruction. Fetuses with associated aberrant right subclavian artery, isolated left superior vena cava, absent ductus venosus and ventricular septal defects developed aortic arch obstruction after birth. RFOA causes smallish left ventricle in fetuses with tetralogy of Fallot which recovered to normal size postnatally. CONCLUSION Isolated RFOA can be benign, however, if it is associated with cardiac or extracardiac anomalies predominantly resulted in aortic arch obstruction. Though it is a cause for pseudocoarctation of aorta, through postnatal reassessment of aortic arch is mandatory. Careful search for intracardiac and systemic venous anomalies is recommended. It created confusion regarding adequacy of left ventricle when associated with congenital heart defects.
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Affiliation(s)
- Balaganesh Karmegaraj
- Sowmi Pediatric Heart Centre, Swasthik Fetal Heart unit, Tamilnadu, India
- Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kerala, India
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Tang J, Liang Y, Jiang Y, Liu J, Zhang R, Huang D, Pang C, Huang C, Luo D, Zhou X, Li R, Zhang K, Xie B, Hu L, Zhu F, Xia H, Lu L, Wang H. A multicenter study on two-stage transfer learning model for duct-dependent CHDs screening in fetal echocardiography. NPJ Digit Med 2023; 6:143. [PMID: 37573426 PMCID: PMC10423245 DOI: 10.1038/s41746-023-00883-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/21/2023] [Indexed: 08/14/2023] Open
Abstract
Duct-dependent congenital heart diseases (CHDs) are a serious form of CHD with a low detection rate, especially in underdeveloped countries and areas. Although existing studies have developed models for fetal heart structure identification, there is a lack of comprehensive evaluation of the long axis of the aorta. In this study, a total of 6698 images and 48 videos are collected to develop and test a two-stage deep transfer learning model named DDCHD-DenseNet for screening critical duct-dependent CHDs. The model achieves a sensitivity of 0.973, 0.843, 0.769, and 0.759, and a specificity of 0.985, 0.967, 0.956, and 0.759, respectively, on the four multicenter test sets. It is expected to be employed as a potential automatic screening tool for hierarchical care and computer-aided diagnosis. Our two-stage strategy effectively improves the robustness of the model and can be extended to screen for other fetal heart development defects.
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Affiliation(s)
- Jiajie Tang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Information Management, Wuhan University, Wuhan, China
| | - Yongen Liang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuxuan Jiang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Information Management, Wuhan University, Wuhan, China
| | - Jinrong Liu
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Rui Zhang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Danping Huang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chengcheng Pang
- Cardiovascular Pediatrics/Guangdong Cardiovascular Institute/Medical Big Data Center, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Chen Huang
- Department of Medical Ultrasonics/Shenzhen Longgang Maternal and Child Health Hospital, Shenzhen, China
| | - Dongni Luo
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xue Zhou
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ruizhuo Li
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Medicine, Southern China University of Technology, Guangzhou, China
| | - Kanghui Zhang
- School of Information Management, Wuhan University, Wuhan, China
| | - Bingbing Xie
- School of Information Management, Wuhan University, Wuhan, China
| | - Lianting Hu
- Cardiovascular Pediatrics/Guangdong Cardiovascular Institute/Medical Big Data Center, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Fanfan Zhu
- School of Information Management, Wuhan University, Wuhan, China
| | - Huimin Xia
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Long Lu
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
- School of Information Management, Wuhan University, Wuhan, China.
- Center for Healthcare Big Data Research, The Big Data Institute, Wuhan University, Wuhan, China.
- School of Public Health, Wuhan University, Wuhan, China.
| | - Hongying Wang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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Carvalho JS, Axt-Fliedner R, Chaoui R, Copel JA, Cuneo BF, Goff D, Gordin Kopylov L, Hecher K, Lee W, Moon-Grady AJ, Mousa HA, Munoz H, Paladini D, Prefumo F, Quarello E, Rychik J, Tutschek B, Wiechec M, Yagel S. ISUOG Practice Guidelines (updated): fetal cardiac screening. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:788-803. [PMID: 37267096 DOI: 10.1002/uog.26224] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/04/2023]
Affiliation(s)
- J S Carvalho
- Royal Brompton Hospital, Guy's & St Thomas' NHS Foundation Trust; and Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - R Axt-Fliedner
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, University Hospital Giessen & Marburg, Giessen, Germany
| | - R Chaoui
- Center of Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - J A Copel
- Departments of Obstetrics, Gynecology & Reproductive Sciences, and Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - B F Cuneo
- Children's Hospital Colorado, The Heart Institute, Aurora, CO, USA
| | - D Goff
- Pediatrix Cardiology of Houston and Loma Linda University School of Medicine, Houston, TX, USA
| | - L Gordin Kopylov
- Obstetrical Unit, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - A J Moon-Grady
- Clinical Pediatrics, UC San Francisco, San Francisco, CA, USA
| | - H A Mousa
- Fetal Medicine Unit, University of Leicester, Leicester, UK
| | - H Munoz
- Obstetrics and Gynecology, Universidad de Chile and Clinica Las Condes, Santiago, Chile
| | - D Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - F Prefumo
- Obstetrics and Gynecology Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - E Quarello
- Image 2 Center, Obstetrics and Gynecologic Department, St Joseph Hospital, Marseille, France
| | - J Rychik
- Fetal Heart Program at Children's Hospital of Philadelphia, and Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - B Tutschek
- Pränatal Zürich, Zürich, Switzerland; and Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - M Wiechec
- Department of Gynecology and Obstetrics, Jagiellonian University in Krakow, Krakow, Poland
| | - S Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Mt. Scopus and the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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9
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Faruk Topaloğlu Ö, Koplay M, Kılınçer A, Örgül G, Sedat Durmaz M. Quantitative measurements and morphological evaluation of fetal cardiovascular structures with fetal cardiac MRI. Eur J Radiol 2023; 163:110828. [PMID: 37059007 DOI: 10.1016/j.ejrad.2023.110828] [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: 01/11/2023] [Revised: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE Fetal cardiac magnetic resonance imaging (FCMR) can be used as an imaging modality in fetal cardiovascular evaluation as studied in recent years. We aimed to evaluate cardiovascular morphology using FCMR and to observe the development of cardiovascular structures according to gestational age (GA) in pregnant women. METHOD In our prospective study, 120 pregnant women between 19 and 37 weeks of gestation in whom absence of cardiac anomaly could not be excluded by ultrasonography (US) or, who were referred to us for magnetic resonance imaging (MRI) for suspected non-cardiovascular system pathology, were included. According to the axis of the fetal heart, axial, coronal, and sagittal multiplanar steady-state free precession (SSFP) and 'real time' untriggered SSFP sequence, respectively, were obtained. The morphology of the cardiovascular structures and their relationships with each other were evaluated, and their sizes were measured. RESULTS Seven cases (6.3%) contained motion artefacts that did not allow the assessment and measurement of cardiovascular morphology, and three (2.9%) cases with cardiac pathology in the analysed images were excluded from the study. The study included a total of 100 cases. Cardiac chamber diameter, heart diameter, heart length, heart area, thoracic diameter, and thoracic area were measured in all fetuses. The diameters of the aorta ascendens (Aa), aortic isthmus (Ai), aorta descendens (Ad), main pulmonary artery (MPA), ductus arteriosus (DA, superior vena cava (SVC), and inferior vena cava (IVC) were measured in all fetuses. The left pulmonary artery (LPA) was visualised in 89 patients (89%). The right PA (RPA) was visualised in 99 (99%) cases. Four pulmonary veins (PVs) were seen in 49 (49%) cases, three in 33 (33%), and two in 18 (18%). High correlation values were found for all diameter measurements performed with GW. CONCLUSION In cases where US cannot achieve adequate image quality, FCMR can contribute to diagnosis. The very short acquisition time and parallel imaging technique with the SSFP sequence allow for adequate image quality without maternal or fetal sedation.
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Affiliation(s)
| | - Mustafa Koplay
- Department of Radiology, Selcuk University, Faculty of Medicine, Konya, Turkey
| | - Abidin Kılınçer
- Department of Radiology, Selcuk University, Faculty of Medicine, Konya, Turkey
| | - Gökçen Örgül
- Department of Obstetrics and Gynecology, Selcuk University, Faculty of Medicine, Konya, Turkey
| | - Mehmet Sedat Durmaz
- Department of Radiology, Selcuk University, Faculty of Medicine, Konya, Turkey
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10
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Quaresima P, Fesslova V, Farina A, Kagan KO, Candiani M, Morelli M, Crispi F, Cavoretto PI. How to do a fetal cardiac scan. Arch Gynecol Obstet 2023; 307:1269-1276. [PMID: 36786908 DOI: 10.1007/s00404-023-06951-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Paola Quaresima
- Department of Obstetrics and Gynaecology, Magna Graecia University, viale Europa, 88100, Catanzaro, Italy
| | - Vlasta Fesslova
- Center of Fetal Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), Istituto di Ricovero e cura a carattere scientifico Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Karl Oliver Kagan
- Department of Obstetrics and Gynaecology, University of Tuebingen, Calwerstrasse 7, 72076, Tübingen, Germany
| | - Massimo Candiani
- Department of Obstetrics and Gynaecology, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute; and Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Michele Morelli
- Department of Obstetrics and Gynaecology, Azienda ospedaliera di Cosenza SS Annunziata, Via Felice Migliori 1, Cosenza, Italy
| | - Fàtima Crispi
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research On Rare Diseases (CIBER-ER), Sabino de Arana 1, 08028, Barcelona, Spain
| | - Paolo Ivo Cavoretto
- Department of Obstetrics and Gynaecology, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute; and Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
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11
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Vasciaveo L, Zanzarelli E, D'Antonio F. Fetal cardiac function evaluation: A review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:215-224. [PMID: 36785505 DOI: 10.1002/jcu.23421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 06/18/2023]
Abstract
The aim of this review is to provide an up to date on the current use of fetal echocardiography in assessing the fetal cardiac function and its potential research and clinical applications. Despite classically is been used for prenatal diagnosis of fetal heart defects, assessment of fetal cardiac function has been recently proposed as a fundamental tool to assess pregnancies complicated by several disorders with long-term impact on post-natal cardiovascular health, such as placental insufficiency and fetal growth restriction. In this review we present anatomical and functional fetal cardiac development mechanisms and an overview of the currently available techniques for evaluating fetal heart function.
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Affiliation(s)
- Lorenzo Vasciaveo
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Erika Zanzarelli
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Francesco D'Antonio
- Centre for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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12
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Muñoz H, Enríquez G, Ortega X, Pinto M, Hosiasson S, Germain A, Díaz C, Cortés F. Diagnóstico de cardiopatías congénitas: ecografía de cribado, ecocardiografía fetal y medicina de precisión. REVISTA MÉDICA CLÍNICA LAS CONDES 2023. [DOI: 10.1016/j.rmclc.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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13
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Akalın M, Yalçın M, Demirci O, İsmailov H, Sahap Odacilar A, Dizdarogulları GE, Kahramanoğlu Ö, Ocal A, Akalın EE, Dizdaroğulları M. Positive effects of fetal echocardiography on maternal anxiety: a prospective study in a tertiary center in Turkey. J Psychosom Obstet Gynaecol 2022; 43:585-592. [PMID: 36137219 DOI: 10.1080/0167482x.2022.2124911] [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] [Indexed: 10/14/2022] Open
Abstract
Aim: The aim of this study was to determine the anxiety levels of pregnant women who were referred to a tertiary center for fetal echocardiography (FE) and the effect of FE results on maternal anxiety.Methods: This prospective study was conducted between January 2020 and February 2021 and included 118 pregnant women. The anxiety levels of the participants were evaluated with the Spielberger State-Trait Anxiety Inventory, which evaluates state (STAI-I) and trait (STAI-II) anxiety. STAI-I and STAI-II were administered to participants at first admission using a standard interview technique prior to FE. After the FE was completed, a structured interview was performed and the state anxiety index (STAI-I-R) was re-administered to the participants.Results: Severe congenital heart disease (CHD) was detected in 63 (53.4%) fetuses. The participants' mean STAI-I scores were significantly higher than their mean STAI-II scores (44.19 ± 8.56 and 41.98 ± 5.98, respectively, t = 2.59 and p = 0.011). In pregnant women with fetuses with severe CHD, STAI-I-R scores were significantly lower compared to STAI-I scores (43.48 ± 7.97 and 46.28 ± 7.18, respectively, t = 2.13 and p = 0.037).Conclusion: Referral for FE is associated with increased maternal anxiety, and a structured interview may result in reduced anxiety levels even in those with abnormal FE.
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Affiliation(s)
- Münip Akalın
- Department of Perinatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Murat Yalçın
- Department of Psychiatry, University of Health Sciences Erenköy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Hayal İsmailov
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Ali Sahap Odacilar
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Gizem Elif Dizdarogulları
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Özge Kahramanoğlu
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Aydın Ocal
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Emine Eda Akalın
- Department of Obstetrics and Gynaecology, Bahcesehir University School of Medicine, Istanbul, Turkey
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De Robertis V, Calì G, Corbella P, Formigoni C, Iuculano A, Nonino F, Pasquini L, Prefumo F, Sciarrone A, Stampalija T, Taddei F, Volpe N, Volpe P, Frusca T. Referral scan for congenital anomalies: time to agree on indications. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:597-603. [PMID: 35633512 DOI: 10.1002/uog.24950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Affiliation(s)
| | - Giuseppe Calì
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Unit, Palermo, Italy
| | - Paola Corbella
- Maternal Infant Department SC, Obstetrics and Gynecology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Ambra Iuculano
- Pathophysiology of Human Reproduction and Prenatal Diagnosis, Microcythemia Hospital Unit "A. CaO", Arnas Brotzu, Cagliari, Italy
| | - Francesco Nonino
- Operative Unit of Epidemiology and Statistics, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Lucia Pasquini
- Fetal Medicine Unit, Department for Women and Children Health, Careggi University and Hospital, Florence, Italy
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Sciarrone
- Obstetrics and Gynecological Ultrasound and Prenatal Diagnosis Center, Citta' della Salute e della Scienza, Turin, Italy
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, University of Trieste, Trieste, Italy
| | - Fabrizio Taddei
- Gynecology and Obstetrics, Rovereto and Trento Hospitals, ASST, Trento, Italy
| | - Nicola Volpe
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Paolo Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
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15
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Haxel CS, Johnson JN, Hintz S, Renno MS, Ruano R, Zyblewski SC, Glickstein J, Donofrio MT. Care of the Fetus With Congenital Cardiovascular Disease: From Diagnosis to Delivery. Pediatrics 2022; 150:189887. [PMID: 36317976 DOI: 10.1542/peds.2022-056415c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The majority of congenital cardiovascular disease including structural cardiac defects, abnormalities in cardiac function, and rhythm disturbances can be identified prenatally using screening obstetrical ultrasound with referral for fetal echocardiogram when indicated. METHODS Diagnosis of congenital heart disease in the fetus should prompt assessment for extracardiac abnormalities and associated genetic abnormalities once maternal consent is obtained. Pediatric cardiologists, in conjunction with maternal-fetal medicine, neonatology, and cardiothoracic surgery subspecialists, should counsel families about the details of the congenital heart defect as well as prenatal and postnatal management. RESULTS Prenatal diagnosis often leads to increased maternal depression and anxiety; however, it decreases morbidity and mortality for many congenital heart defects by allowing clinicians the opportunity to optimize prenatal care and plan delivery based on the specific lesion. Changes in prenatal care can include more frequent assessments through the remainder of the pregnancy, maternal medication administration, or, in selected cases, in utero cardiac catheter intervention or surgical procedures to optimize postnatal outcomes. Delivery planning may include changing the location, timing or mode of delivery to ensure that the neonate is delivered in the most appropriate hospital setting with the required level of hospital staff for immediate postnatal stabilization. CONCLUSIONS Based on the specific congenital heart defect, prenatal echocardiogram assessment in late gestation can often aid in predicting the severity of postnatal instability and guide the medical or interventional level of care needed for immediate postnatal intervention to optimize the transition to postnatal circulation.
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Affiliation(s)
- Caitlin S Haxel
- The University of Vermont Children's Hospital, Burlington, Vermont
| | | | - Susan Hintz
- Stanford University, Lucille Salter Packard Children's Hospital, Palo Alto, California
| | - Markus S Renno
- University Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | | - Julie Glickstein
- Columbia University Vagelos School of Medicine, Morgan Stanley Children's Hospital, New York, New York
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16
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Practice variations for fetal and neonatal congenital heart disease within the Children's Hospitals Neonatal Consortium. Pediatr Res 2022; 93:1728-1735. [PMID: 36167818 DOI: 10.1038/s41390-022-02314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/09/2022] [Accepted: 09/03/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many aspects of care for fetuses and neonates with congenital heart disease (CHD) fall outside standard practice guidelines, leading to the potential for significant variation in clinical care for this vulnerable population. METHODS We conducted a cross-sectional survey of site sponsors of the Children's Hospitals Neonatal Consortium, a multicenter collaborative of 41 Level IV neonatal intensive care units to assess key areas of clinical practice variability for patients with fetal and neonatal CHD. RESULTS We received responses from 31 centers. Fetal consult services are shared by neonatology and pediatric cardiology at 70% of centers. Three centers (10%) routinely perform fetal magnetic resonance imaging (MRI) for women with pregnancies complicated by fetal CHD. Genetic testing for CHD patients is routine at 76% of centers. Preoperative brain MRI is standard practice at 5 centers (17%), while cerebral NIRS monitoring is regularly used at 14 centers (48%). Use of electroencephalogram (EEG) after major cardiac surgery is routine in 5 centers (17%). Neurodevelopmental follow-up programs are offered at 30 centers (97%). CONCLUSIONS Many aspects of fetal and neonatal CHD care are highly variable with evolving shared multidisciplinary models. IMPACT Many aspects of fetal and neonatal CHD care are highly variable. Genetic testing, placental examination, preoperative neuroimaging, and postoperative EEG monitoring carry a high yield of finding abnormalities in patients with CHD and these tests may contribute to more precise prognostication and improve care. Evidence-based standards for prenatal and postnatal CHD care may decrease inter-center variability.
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17
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The Application of Knowledge Distillation toward Fine-Grained Segmentation for Three-Vessel View of Fetal Heart Ultrasound Images. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:1765550. [PMID: 35875733 PMCID: PMC9303103 DOI: 10.1155/2022/1765550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/29/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022]
Abstract
Objectives. Measuring anatomical parameters in fetal heart ultrasound images is crucial for the diagnosis of congenital heart disease (CHD), which is highly dependent on the clinical experience of the sonographer. To address this challenge, we propose an automated segmentation method using the channel-wise knowledge distillation technique. Methods. We design a teacher-student architecture to conduct channel-wise knowledge distillation. ROI-based cropped images and full-size images are used for the teacher and student models, respectively. It allows the student model to have both the fine-grained segmentation capability inherited from the teacher model and the ability to handle full-size test images. A total of 1,300 fetal heart ultrasound images of three-vessel view were collected and annotated by experienced doctors for training, validation, and testing. Results. We use three evaluation protocols to quantitatively evaluate the segmentation accuracy: Intersection over Union (IoU), Pixel Accuracy (PA), and Dice coefficient (Dice). We achieved better results than related methods on all evaluation metrics. In comparison with DeepLabv3+, the proposed method gets more accurate segmentation boundaries and has performance gains of 1.8% on mean IoU (66.8% to 68.6%), 2.2% on mean PA (79.2% to 81.4%), and 1.2% on mean Dice (80.1% to 81.3%). Conclusions. Our segmentation method could identify the anatomical structure in three-vessel view of fetal heart ultrasound images. Both quantitative and visual analyses show that the proposed method significantly outperforms the related methods in terms of segmentation results.
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18
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Ogenyi P, Chiegwu HU, England A, Akanegbu UE, Ogbonna OS, Abubakar A, Luntsi G, Zira DJ, Dauda M. Appraisal of trimester-specific fetal heart rate and its role in gestational age prediction. Radiography (Lond) 2022; 28:926-932. [PMID: 35820355 DOI: 10.1016/j.radi.2022.06.015] [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: 01/03/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate and report normal sonographic FHR values among low-risk singleton women across the three trimesters of pregnancy and determine FHR role in gestational age prediction. METHOD A prospective cross-sectional study of 2727 low-risk singleton pregnant women was undertaken. FHR measurements were obtained by a consultant radiologist and three experienced sonographers using transabdominal approach from January 2019 to December 2020. Two FHR measurements were taken for each participant. The fetal lie and presentation were also documented in the first trimester. Data were analysed using SPSS version 24 (IBM, Armonk, NY, USA). RESULT The maternal mean ± SD age was 25.8 ± 6.5 years and mean FHR for first, second and third trimesters were 151 ± 16, 145 ± 6 and 125±6 bpm respectively. The mean ± SD gestational age were 10 ± 2, 19 ± 3 and 34 ± 2 weeks for the first, second and third trimester respectively. Using ANOVA, there were statistically significant differences in FHR across the three trimesters (p ≤ 0.05). A positive correlation existed between maternal age and FHR (r = 0.57, p ≤ 0.05). CONCLUSION This study has established normal values for FHR in first, second and third trimester respectively. Referring physicians, radiologists, sonographers, obstetricians and gynaecologists may consider FHR of (135-167) bpm (139-151) bpm and (119-131) bpm as normal FHR ranges for the first, second and third trimester respectively. This study has also revealed the possibility of gestational age prediction using FHR with the equation [Gestational Age = 87.8 - (0.47) FHR]. IMPLICATIONS FOR PRACTICE This paper provides the most up-to-date sonographic FHR recommendations for fetal management. More importantly, findings from this study also suggests that ultrasound practitioners can use FHR measurements as a reliable alternative for fetal dating.
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Affiliation(s)
- P Ogenyi
- Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
| | - H U Chiegwu
- Department of Radiography, Nnamdi Azikiwe University, Awka
| | - A England
- School of Medicine, University College Cork, Ireland
| | - U E Akanegbu
- Department of Radiography, Nnamdi Azikiwe University, Awka
| | - O S Ogbonna
- Department of Radiography, Nnamdi Azikiwe University, Awka
| | - A Abubakar
- Department of Radiography, University of Maiduguri, Nigeria
| | - G Luntsi
- Department of Radiography, University of Maiduguri, Nigeria
| | - D J Zira
- Department of Radiography, Federal University Lafia, Nigeria
| | - M Dauda
- Department of Medical Physics, Nasarawa State University, Keffi, Nigeria
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19
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Sklansky M, Afshar Y, Anton T, DeVore GR, Platt L, Satou G. Guidance for fetal cardiac imaging in patients with degraded acoustic windows. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:709-712. [PMID: 35118748 DOI: 10.1002/uog.24872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/23/2022] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Affiliation(s)
- M Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Y Afshar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - T Anton
- Department of Reproductive Medicine, University of California, San Diego, CA, USA
| | - G R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
- Fetal Diagnostic Centers, Pasadena, Tarzana and Lancaster, CA, USA
| | - L Platt
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
- Center for Fetal Medicine and Women's Ultrasound, Los Angeles, CA, USA
| | - G Satou
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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20
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Gaeta G, Fesslova V, Villanacci R, Morano D, Candiani M, Pozzoni M, Papale M, Spinillo SL, Chiarello C, Cavoretto PI. Prenatal Diagnosis and Postnatal Outcomes of Left Brachiocephalic Vein Abnormalities: Systematic Review. J Clin Med 2022; 11:jcm11071805. [PMID: 35407413 PMCID: PMC9000070 DOI: 10.3390/jcm11071805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023] Open
Abstract
Abnormalities of the left brachiocephalic vein (LBCVA) are rare and poorly studied prenatally. An association with congenital heart defects (CHD), extracardiac and genetic abnormalities was described. The aim of our study was to estimate the rate and summarize the available evidence concerning prenatal diagnosis, associated anomalies, and outcomes of these anomalies. A systematic literature review was carried out selecting studies reporting on prenatal diagnosis of LBCVA, including unpublished cases from our experience. Frequencies were pooled from cohort studies to calculate prenatal incidence. Pooled proportions were obtained from all the studies including rates of associated CHD, extracardiac or genetic abnormalities and neonatal outcomes. The search resulted in the selection of 16 studies with 311 cases of LBCVA, with an incidence of 0.4% from six cohort studies. CHD occurred in 235/311 (75.6%) fetuses: 23 (7.4%) were major in cases of double, retroesophageal or subaortic course and 212 (68.2%) were minor in cases of absence (always associated with a persistent left superior vena cava) or intrathymic course. Data on other associated outcomes were scarce showing rare extracardiac anomalies (3.5%), rare genetic abnormalities (RASopathies and microdeletions associated with the retroesophageal course), and neonatal outcomes favorable in most cases, particularly in intrathymic forms.
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Affiliation(s)
- Gerarda Gaeta
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (G.G.); (R.V.); (M.C.); (M.P.); (M.P.); (S.L.S.); (P.I.C.)
- Gynecology and Obstetrics Department, University Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Vlasta Fesslova
- Center of Fetal Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097 Milan, Italy;
- Correspondence:
| | - Roberta Villanacci
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (G.G.); (R.V.); (M.C.); (M.P.); (M.P.); (S.L.S.); (P.I.C.)
- Gynecology and Obstetrics Department, University Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Danila Morano
- Center of Fetal Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097 Milan, Italy;
| | - Massimo Candiani
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (G.G.); (R.V.); (M.C.); (M.P.); (M.P.); (S.L.S.); (P.I.C.)
- Gynecology and Obstetrics Department, University Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Mirko Pozzoni
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (G.G.); (R.V.); (M.C.); (M.P.); (M.P.); (S.L.S.); (P.I.C.)
- Gynecology and Obstetrics Department, University Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Margherita Papale
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (G.G.); (R.V.); (M.C.); (M.P.); (M.P.); (S.L.S.); (P.I.C.)
- Gynecology and Obstetrics Department, University Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Silvia Lina Spinillo
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (G.G.); (R.V.); (M.C.); (M.P.); (M.P.); (S.L.S.); (P.I.C.)
- Gynecology and Obstetrics Department, University Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Carmelina Chiarello
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097 Milan, Italy;
| | - Paolo Ivo Cavoretto
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (G.G.); (R.V.); (M.C.); (M.P.); (M.P.); (S.L.S.); (P.I.C.)
- Gynecology and Obstetrics Department, University Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
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Gireadă R, Socolov D, Mihălceanu E, Matasariu R, Ursache A, Akad M, Bujor I, Scripcariu I, Popa RF, Socolov R. The Additional Role of the 3-Vessels and Trachea View in Screening for Congenital Heart Disease. Medicina (B Aires) 2022; 58:medicina58020262. [PMID: 35208585 PMCID: PMC8875090 DOI: 10.3390/medicina58020262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives: Although frequent and associated with high mortality and morbidity rate, congenital heart disease (CHD) has a suboptimal prenatal detection rate, with significant variation according to the scanning protocol. The aim of this study was to evaluate the role of the 3-vessels and trachea view (3VT) in detecting CHD, with or without the use of Color Doppler, with an emphasis on major CHD. Materials and Methods: We performed a retrospective study on 1596 unselected pregnant patients presenting at 11–37 weeks of gestation for a routine anomaly scan. We selected all CHD cases, and we analyzed the performance of the 4-chamber (4C) and 3VT view in detecting CHD. Results: A total of 46 fetuses with CHD were identified, yielding a 2.86% overall incidence, and 0.87% for major CHD. Grayscale 4C detected 47.8% of all CHD, going up to 71.7% by adding grayscale 3VT, with no major CHD remaining undetected by combining grayscale 4C and 3VT. Conclusions: Grayscale 4C and 3VT views are effective in detecting major CHD, thus proving their utility even in a low resource setting.
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Affiliation(s)
- Roxana Gireadă
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
- Department of Obstetrics and Gynecology, Cuza Vodă Hospital, 700038 Iaşi, Romania
| | - Elena Mihălceanu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
- Department of Obstetrics and Gynecology, Cuza Vodă Hospital, 700038 Iaşi, Romania
| | - Roxana Matasariu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
- Department of Obstetrics and Gynecology, Cuza Vodă Hospital, 700038 Iaşi, Romania
- Correspondence: (R.M.); (I.S.)
| | - Alexandra Ursache
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
| | - Mona Akad
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
| | - Iuliana Bujor
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
| | - Ioana Scripcariu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
- Department of Obstetrics and Gynecology, Cuza Vodă Hospital, 700038 Iaşi, Romania
- Correspondence: (R.M.); (I.S.)
| | - Radu Florin Popa
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
| | - Răzvan Socolov
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
- Department of Obstetrics and Gynecology, Elena Doamna Hospital, 700398 Iaşi, Romania
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Prevalence of Congenital Heart Defects in Pregnancies Conceived by Assisted Reproductive Technology: A Cohort Study. J Clin Med 2021. [PMID: 34830645 DOI: 10.3390/jcm10225363.pmid:34830645;pmcid:pmc8621349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND AND AIM OF THE STUDY Pregnancies obtained by assisted reproductive technology (ART) are associated with an increased risk of complications and congenital anomalies, particularly congenital heart defects (CHDs). Therefore, our aim is to evaluate, retrospectively, the prevalence of CHD in ART pregnancies in our two centers and analyze their characteristics and outcomes. METHODS Observational study including fetuses conceived by ART referred between June 2011 and September 2020 and undergoing a fetal cardiac ultrasound scan. Cases with genetic, chromosomal abnormalities or extracardiac malformations were excluded. Population included 1511 pregnancies, which consisted of 269 twins and 1242 singletons, 547 IVF (in vitro fertilization), 773 ICSI (intracytoplasmic sperm injection) and 191 oocyte donations (OD). RESULTS CHDs were found in 29 fetuses, with an overall prevalence of 1.92% (29/1511), 1.85% (23/1242) in singletons and 2.23% in twins (6/269). Thirteen were IVF, eight ICSI and eight OD cases, with a greater risk of CHD after IVF and OD (IVF: 13/29 (44.8%)-one twin; ICSI: 8/29 (27.6%)-three twins); 22 had major and 7 minor defects. Two pregnancies with a hypoplastic left heart were terminated; the majority of live-born cases needed surgery. Three babies died (two post-surgery, one had a late death). CONCLUSIONS Our data show an increased prevalence of CHD after ART with a heterogeneous spectrum of diagnoses, mainly major defects.
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Galdini A, Fesslova VME, Gaeta G, Candiani M, Pozzoni M, Chiarello C, Cavoretto PI. Prevalence of Congenital Heart Defects in Pregnancies Conceived by Assisted Reproductive Technology: A Cohort Study. J Clin Med 2021; 10:5363. [PMID: 34830645 PMCID: PMC8621349 DOI: 10.3390/jcm10225363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND AIM OF THE STUDY Pregnancies obtained by assisted reproductive technology (ART) are associated with an increased risk of complications and congenital anomalies, particularly congenital heart defects (CHDs). Therefore, our aim is to evaluate, retrospectively, the prevalence of CHD in ART pregnancies in our two centers and analyze their characteristics and outcomes. METHODS Observational study including fetuses conceived by ART referred between June 2011 and September 2020 and undergoing a fetal cardiac ultrasound scan. Cases with genetic, chromosomal abnormalities or extracardiac malformations were excluded. Population included 1511 pregnancies, which consisted of 269 twins and 1242 singletons, 547 IVF (in vitro fertilization), 773 ICSI (intracytoplasmic sperm injection) and 191 oocyte donations (OD). RESULTS CHDs were found in 29 fetuses, with an overall prevalence of 1.92% (29/1511), 1.85% (23/1242) in singletons and 2.23% in twins (6/269). Thirteen were IVF, eight ICSI and eight OD cases, with a greater risk of CHD after IVF and OD (IVF: 13/29 (44.8%)-one twin; ICSI: 8/29 (27.6%)-three twins); 22 had major and 7 minor defects. Two pregnancies with a hypoplastic left heart were terminated; the majority of live-born cases needed surgery. Three babies died (two post-surgery, one had a late death). CONCLUSIONS Our data show an increased prevalence of CHD after ART with a heterogeneous spectrum of diagnoses, mainly major defects.
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Affiliation(s)
- Alessandro Galdini
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, University Vita-Salute, Via Olgettina 60, 20132 Milan, Italy; (A.G.); (G.G.); (M.C.); (M.P.); (P.I.C.)
| | - Vlasta M. E. Fesslova
- Center of Fetal Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 Milan, Italy
| | - Gerarda Gaeta
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, University Vita-Salute, Via Olgettina 60, 20132 Milan, Italy; (A.G.); (G.G.); (M.C.); (M.P.); (P.I.C.)
| | - Massimo Candiani
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, University Vita-Salute, Via Olgettina 60, 20132 Milan, Italy; (A.G.); (G.G.); (M.C.); (M.P.); (P.I.C.)
| | - Mirko Pozzoni
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, University Vita-Salute, Via Olgettina 60, 20132 Milan, Italy; (A.G.); (G.G.); (M.C.); (M.P.); (P.I.C.)
| | - Carmelina Chiarello
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Via Morandi 30, 20097 Milan, Italy;
| | - Paolo Ivo Cavoretto
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, University Vita-Salute, Via Olgettina 60, 20132 Milan, Italy; (A.G.); (G.G.); (M.C.); (M.P.); (P.I.C.)
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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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Morlando M, Morelli C, Del Gaizo F, Fusco A, De Fazio F, Di Pietto L, Moccia G, Spinelli Barrile L, Schiattarella A, De Franciscis P, Colacurci N, Russo MG. Aberrant right subclavian artery: the association with chromosomal defects and the related post-natal outcomes in a third level referral centre. J OBSTET GYNAECOL 2021; 42:239-243. [PMID: 34039241 DOI: 10.1080/01443615.2021.1904228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aberrant right subclavian artery (ARSA) is the most common embryologic abnormality of the aortic arch. The presence of ARSA has been previously associated with an increased risk of Down syndrome. ARSA at birth may be associated with dysphagia, respiratory distress and stridor and there is no clear evidence-based management. The aim of this study was to describe the associations with chromosomal abnormalities and the postnatal outcome of fetuses diagnosed with ARSA. We analysed fetuses diagnosed antenatally with ARSA between January 2013 and September 2019 in the fetal echocardiography unit of the Hospital Monaldi, University 'Vanvitelli' of Naples, Italy. The results showed fifty fetuses diagnosed with ARSA, all confirmed after birth. The ARSA was an isolated finding in 46 fetuses (92%), while in 4 fetuses the ARSA was associated with other cardiac and/or extra-cardiac anomalies. Only one fetus was diagnosed with trisomy 21 (2%). In this fetus the ARSA was the only ultrasound anomaly identified. There were no cases necessitating referral due to the presence of compression symptoms at birth. The presence of ARSA was associated with trisomy 21 in the 2% of cases in our series and there were no neonatal complications due to airway compression at birth.IMPACT STATEMENTWhat is already known on this subject? Aberrant right subclavian artery (ARSA) is the most common embryologic abnormality of the aortich arch. ARSA at birth could be associated with dysphagia, respiratory distress and stridor and no evidence-based management of these fetuses has been described yet. The presence of ARSA has been previously associated with an increased risk of Down syndrome.What do the results of this study add? This study confirms known data on association with chromosomal defects and provides some original data on the absence of symptomatology due to tracheal compression with a postnatal follow-up up to three years of age.What are the implications of these findings for clinical practice and/or further research? Our findings suggest that in cases with adequate prenatal assessment performed by experienced clinicians, delivery can safely take place at local hospitals, with no need of referral soon after birth. The use of transthoracic echocardiography to confirm the diagnoses of ARSA after birth and to plan the next follow-up appointments can be supported.
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Affiliation(s)
- Maddalena Morlando
- Prenatal diagnosis and high-risk pregnancy unit, Department of Woman, Child and General and Specialised Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carmela Morelli
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
| | - Fortuna Del Gaizo
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
| | - Adelaide Fusco
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
| | - Federica De Fazio
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
| | - Laura Di Pietto
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
| | - Gianfranco Moccia
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
| | | | - Antonio Schiattarella
- Prenatal diagnosis and high-risk pregnancy unit, Department of Woman, Child and General and Specialised Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale De Franciscis
- Prenatal diagnosis and high-risk pregnancy unit, Department of Woman, Child and General and Specialised Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Colacurci
- Prenatal diagnosis and high-risk pregnancy unit, Department of Woman, Child and General and Specialised Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
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Hogan WJ, Moon-Grady AJ, Zhao Y, Cresalia NM, Nawaytou H, Quezada E, Brook M, McQuillen P, Peyvandi S. Fetal cerebrovascular response to maternal hyperoxygenation in congenital heart disease: effect of cardiac physiology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:769-775. [PMID: 32202689 PMCID: PMC7673795 DOI: 10.1002/uog.22024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/23/2020] [Accepted: 03/13/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Fetal cerebrovascular resistance is influenced by several factors in the setting of intact autoregulation to allow for normal cerebral blood flow and oxygenation. Maternal hyperoxygenation (MH) allows for acute alterations in fetal physiology and can be a tool to test cerebrovascular reactivity in late-gestation fetuses. In this study, we utilized MH to evaluate cerebrovascular reactivity in fetuses with specific congenital heart disease (CHD). METHODS This was a cross-sectional study of fetuses with complex CHD compared to controls without CHD. CHD cases were grouped according to physiology into: left-sided obstructive lesion (LSOL), right-sided obstructive lesion (RSOL) or dextro-transposition of the great arteries (d-TGA). Subjects underwent MH testing during the third-trimester fetal echocardiogram. The pulsatility index (PI) was calculated for the fetal middle cerebral artery (MCA), umbilical artery (UA) and branch pulmonary artery (PA). The change in PI from baseline to during MH was compared between each CHD group and controls. RESULTS Sixty pregnant women were enrolled (CHD, n = 43; control, n = 17). In the CHD group, there were 27 fetuses with LSOL, seven with RSOL and nine with d-TGA. Mean gestational age was 33.9 (95% CI, 33.6-34.2) weeks. At baseline, MCA-PI Z-score was lowest in the LSOL group (-1.8 (95% CI, -2.4 to -1.2)) compared with the control group (-0.8 (95% CI, -1.3 to -0.3)) (P = 0.01). In response to MH, MCA-PI Z-score increased significantly in the control and d-TGA groups but did not change significantly in the LSOL and RSOL groups. The change in MCA-PI Z-score was significantly higher in the control group than in the LSOL group (0.9 (95% CI, 0.42-1.4) vs 0.12 (95% CI, -0.21 to 0.45); P = 0.03). This difference was more pronounced in the LSOL subgroup with retrograde aortic arch flow. Branch PA-PI decreased significantly in response to MH in all groups, with no difference in the change from baseline to MH between the groups, while UA-PI was unchanged during MH compared with at baseline. CONCLUSIONS The fetal cerebrovascular response to MH varies based on the underlying CHD diagnosis, suggesting that cardiovascular physiology may influence the autoregulatory capacity of the fetal brain. Further studies are needed to determine the clinical implications of these findings on long-term neurodevelopment in these at-risk children. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- W J Hogan
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - A J Moon-Grady
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - Y Zhao
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - N M Cresalia
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - H Nawaytou
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - E Quezada
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - M Brook
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - P McQuillen
- Division of Critical Care, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - S Peyvandi
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
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Tidrenczel Z, Hajdu J, Simonyi A, Szabó I, Ács N, Demeter J, Beke A. Trends in the prenatal diagnosis of trisomy 21 show younger maternal age and shift in the distribution of congenital heart disease over a 20-year period. Am J Med Genet A 2021; 185:1732-1742. [PMID: 33683014 DOI: 10.1002/ajmg.a.62162] [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: 03/03/2020] [Revised: 10/20/2020] [Accepted: 02/20/2021] [Indexed: 11/07/2022]
Abstract
Prenatal testing has changed greatly over the past two decades, which may affect the diagnosis of congenital heart disease (CHD) in Down syndrome. The present study aimed to analyze changes in the prevalence and distribution of CHD diagnosed via ultrasonography and fetopathology in 462 fetuses with trisomy 21 between two consecutive 10-year periods (1999-2018), as well as the associations between CHDs, ultrasound markers, and extracardiac malformations. Overall, the frequency of cardiovascular malformations in trisomy 21 was 27.7 and 26.5%, and ultrasound identified 70 and 62% of CHDs during these periods. A profound increase in first-trimester ultrasound findings and associated anomalies with CHDs (ventricular septal defect, Tetralogy of Fallot) since 2009 were observed. Second-trimester nonstructural heart abnormalities were associated with ultrasound anomalies (74%) and major extracardiac malformations (42.9%). During both study periods, mothers carrying fetuses with CHD were significantly younger than those without CHD (p = 0.038, p = 0.009, respectively). Comparing the two 10-year periods, there were no changes in the prevalence and detection of CHDs. Trend analysis revealed that, although the frequency of CHD remained stable, the diagnostic spectrum had shifted between the study periods. Detection of nonstructural heart abnormalities necessitates detailed follow-up for cardiac/extracardiac malformations and chromosomal disorders.
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Affiliation(s)
- Zsolt Tidrenczel
- Genetic Center, Department of Obstetrics and Gynecology, Medical Centre Hungarian Defense Forces, Budapest, Hungary
| | - Julia Hajdu
- Gottsegen György Institute of Cardiology, Budapest, Hungary
| | - Aténé Simonyi
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - István Szabó
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - János Demeter
- Genetic Center, Department of Obstetrics and Gynecology, Medical Centre Hungarian Defense Forces, Budapest, Hungary
| | - Artúr Beke
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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Karmegaraj B, Kumar S, Srimurugan B, Sudhakar A, Simpson JM, Vaidyanathan B. 3D/4D spatiotemporal image correlation (STIC) fetal echocardiography provides incremental benefit over 2D fetal echocardiography in predicting postnatal surgical approach in double-outlet right ventricle. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:423-430. [PMID: 32022380 DOI: 10.1002/uog.21988] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To analyze the incremental benefit of 3D/4D spatiotemporal image correlation (STIC) fetal echocardiography over 2D fetal echocardiography with respect to the accuracy of identification of anatomic details crucial for surgical decision-making and in predicting surgical approach in fetuses with double-outlet right ventricle (DORV). METHODS This was a retrospective study of fetuses with DORV which had undergone both 2D echocardiography and 3D/4D STIC echocardiography and which underwent surgery postnatally in a tertiary pediatric cardiac center in Kerala between October 2015 and March 2019. All such cases with normal atrial arrangement, concordant atrioventricular connections and balanced ventricles were included. 2D and 3D/4D STIC fetal echocardiographic data were analyzed by two experienced observers blinded to the other dataset. Anatomic variables crucial for surgical decision-making, i.e. location and routability of the ventricular septal defect, relationship of the great arteries and presence of outflow obstruction, were compared between the two modalities with respect to agreement with postnatal echocardiography. The accuracy of prenatal prediction of the surgical pathway was compared between 2D and 3D/4D modalities with respect to the procedure undertaken. RESULTS Included in the study were 22 fetuses with DORV which had undergone both 2D and 3D/4D imaging as well as postnatal surgery. Accuracy of prenatal interpretation of all four anatomic variables was significantly higher using 3D/4D STIC than using 2D fetal echocardiography (19/22 (86.4%) vs 8/22 (36.4%), P < 0.001). Surgical procedures included single-stage repair in 14 (63.5%) patients and a multistage approach in eight (36.4%). Prenatal prediction of the surgical pathway was significantly more accurate on 3D/4D STIC than on 2D echocardiography (20/22 (90.9%) vs 12/22 (54.5%), P = 0.021). Prenatal predictive accuracy of single-stage biventricular repair was significantly better for 3D/4D STIC than for 2D echocardiography (14/14 (100%) vs 8/14 (57.1%), P = 0.04). CONCLUSION Addition of 3D/4D STIC to conventional 2D fetal echocardiography confers incremental benefit on the accuracy of identification of anatomic details crucial for surgical decision-making and the prediction of postnatal surgical approach in fetuses with DORV, thereby potentially aiding prenatal counseling. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B Karmegaraj
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - S Kumar
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - B Srimurugan
- Department of Cardiovascular Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - A Sudhakar
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - J M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - B Vaidyanathan
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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Yagel S, Valsky DV. Re: ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 1: performance of screening examination and indications for targeted neurosonography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:173-174. [PMID: 33387414 DOI: 10.1002/uog.23559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/21/2020] [Indexed: 06/12/2023]
Affiliation(s)
- S Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - D V Valsky
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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30
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Pinto NM, Morris SA, Moon-Grady AJ, Donofrio MT. Prenatal cardiac care: Goals, priorities & gaps in knowledge in fetal cardiovascular disease: Perspectives of the Fetal Heart Society. PROGRESS IN PEDIATRIC CARDIOLOGY 2020; 59:101312. [PMID: 33100800 PMCID: PMC7568498 DOI: 10.1016/j.ppedcard.2020.101312] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/12/2020] [Indexed: 12/15/2022]
Abstract
Perinatal cardiovascular care has evolved considerably to become its own multidisciplinary field of care. Despite advancements, there remain significant gaps in providing optimal care for the fetus, child, mother, and family. Continued advancement in detection and diagnosis, perinatal care and delivery planning, and prediction and improvement of morbidity and mortality for fetuses affected by cardiac conditions such as heart defects or functional or rhythm disturbances requires collaboration between the multiple types of specialists and providers. The Fetal Heart Society was created to formalize and support collaboration between individuals, stakeholders, and institutions. This article summarizes the challenges faced to create the infrastructure for advancement of the field and the measures the FHS is undertaking to overcome the barriers to support progress in the field of perinatal cardiac care. Progress in perinatal cardiology is challenged by the rarity of fetal cardiac disease, care variation, and barriers to collaboration. The Fetal Heart Society was founded to formalize collaboration between the multiple disciplines in perinatal cardiac care. The FHS facilitates interdisciplinary multicenter research, education and advocacy to provide optimal perinatal cardiac care.
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Affiliation(s)
- Nelangi M Pinto
- Division of Cardiology, Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, UT, United States of America.,Fetal Heart Society, United States of America
| | - Shaine A Morris
- Division of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States of America.,Fetal Heart Society, United States of America
| | - Anita J Moon-Grady
- Division of Cardiology, Department of Pediatrics, University of California San Francisco and UCSF Benioff Children's Hospitals, United States of America
| | - Mary T Donofrio
- Division of Cardiology, Department of Pediatrics, Children's National Hospital and George Washington University School of Medicine and Health Sciences, United States of America.,Fetal Heart Society, United States of America
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Cavoretto PI, Sotiriadis A, Girardelli S, Spinillo S, Candiani M, Amodeo S, Farina A, Fesslova V. Postnatal Outcome and Associated Anomalies of Prenatally Diagnosed Right Aortic Arch with Concomitant Right Ductal Arch: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2020; 10:diagnostics10100831. [PMID: 33076538 PMCID: PMC7602867 DOI: 10.3390/diagnostics10100831] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022] Open
Abstract
Right aortic arch presents a reported incidence of 0.1% of the general population; the aim of our study was to evaluate the risk of associated intracardiac (ICA), extracardiac (ECA), or chromosomal abnormalities in fetuses with right aortic arch (RAA) and concomitant right ductal arch (RDA). A systematic review of the literature selected 18 studies including 60 cases of RAA/RDA. A meta-analysis with a random effect model calculated for each outcome the pooled crude proportion of associated abnormal outcomes in cases of RAA/RDA and the pooled proportions and odds ratios in RAA with LDA or RDA. Quality assessment of the included studies was achieved using the NIH quality assessment tool for case series studies. RAA/RDA presents risk of associated conotruncal CHDs of about 30% and risk of 22q11 microdeletion in the region of 1%. Two-thirds of 22q11 microdeletions had concomitant thymic hypoplasia and no other chromosomal defects were described. Risks for ICA, ECA, 22q11 microdeletion, and aberrant left subclavian artery are not substantially different in RAA with right or left arterial duct. RAA increases the risk of associated cardiac defects regardless of laterality of the ductal arch. In isolated RDA/RAA cases, absolute risks of extracardiac associated problems or surgery are rather low, we would therefore recommend reassurance, particularly when the thymus and karyotype are normal.
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Affiliation(s)
- Paolo Ivo Cavoretto
- Obstetrics and Gynecology Department, IRCCS San Raffaele Hospital, University Vita-Salute, 20132 Milan, Italy; (S.G.); (S.S.); (M.C.)
- Correspondence:
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Serena Girardelli
- Obstetrics and Gynecology Department, IRCCS San Raffaele Hospital, University Vita-Salute, 20132 Milan, Italy; (S.G.); (S.S.); (M.C.)
| | - Silvia Spinillo
- Obstetrics and Gynecology Department, IRCCS San Raffaele Hospital, University Vita-Salute, 20132 Milan, Italy; (S.G.); (S.S.); (M.C.)
| | - Massimo Candiani
- Obstetrics and Gynecology Department, IRCCS San Raffaele Hospital, University Vita-Salute, 20132 Milan, Italy; (S.G.); (S.S.); (M.C.)
| | - Silvia Amodeo
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), Sant’Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy; (S.A.); (A.F.)
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), Sant’Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy; (S.A.); (A.F.)
| | - Vlasta Fesslova
- Center of Fetal Cardiology, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy;
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Ulm B, Muin D, Scharrer A, Prayer D, Dovjak G, Kasprian G. Prenatal ultrasound and magnetic resonance evaluation and fetal outcome in high-risk fetal tumors: A retrospective single-center cohort study over 20 years. Acta Obstet Gynecol Scand 2020; 99:1534-1545. [PMID: 32525215 PMCID: PMC7689914 DOI: 10.1111/aogs.13933] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/23/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022]
Abstract
Introduction Fetal tumors are rare and usually followed by poor outcome. We describe our single‐center experience with fetal tumors evaluated by ultrasound and magnetic resonance imaging (MRI). Our aims were to evaluate mortality and morbidity including long‐term outcome and to determine which ultrasound and MRI characteristics were helpful for pre‐ and perinatal management. Material and methods We conducted a retrospective analysis on prenatally diagnosed tumors between 1998 and 2018. Poor outcome included fetal or neonatal death and survival with serious illness. MRI addressed tumor morphology (sacrococcygeal teratomas), compromise of surrounding structures (head and neck tumors) and early depiction of brain alterations specific to tuberous sclerosis (rhabdomyomas). Results Of 68 pregnancies, 15 (22%) were terminated and eight children (8/53, 15%) died pre‐ or postnatally. Of the 45 survivors (45/68, 66%), 24 (24/45, 53%) were healthy, eight (8/45, 18%) had a minor illness and 13 (13/45, 29%) a serious illness. Diffusion‐ and T1‐weighted MRI reliably predicted tumor morphology in teratomas. To detect head and neck tumors critical to airway obstruction, MRI was superior to ultrasound in delivery planning. Rhabdomyomas were frequently associated with tuberous sclerosis, regardless of their number or size in ultrasound; MRI could depict specific brain alterations from the early third trimester onwards. For several rare tumors, MRI provided critical differential diagnoses that could not be clearly displayed in ultrasound. Conclusions The rate of survivors with serious long‐term illness among fetuses with prenatal diagnosis of a tumor was high. MRI is specifically helpful for risk stratification in fetal teratomas and delivery planning in head and neck tumors.
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Affiliation(s)
- Barbara Ulm
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Dana Muin
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Anke Scharrer
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Gregor Dovjak
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
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Yagel S, Moon-Grady AJ. Fetal cardiac evaluation services for low-risk pregnancies: how can we improve? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:726-727. [PMID: 32478982 DOI: 10.1002/uog.22052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
Linked Comment: Ultrasound Obstet Gynecol 2020; 55:747-757.
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Affiliation(s)
- S Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A J Moon-Grady
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
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Biancardi M, de Sa RAM. Behavior of fetal longitudinal myocardial fibers assessed by speckle tracking to obtain strain and strain rate values for low-risk pregnancies. J Perinat Med 2020; 48:144-152. [PMID: 31834865 DOI: 10.1515/jpm-2019-0342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/05/2019] [Indexed: 01/27/2023]
Abstract
Objective To analyze the behavior of fetal longitudinal myocardial fibers assessed by speckle tracking (STE) after fetal viability. Methods A cross-sectional study was performed in 156 women with normal singleton pregnancies from 22 to 31 weeks of gestation. Strain (S) and strain rate (SR) values were measured in both ventricles during the fetal cardiac cycle. The population was divided into five gestational age groups based on 2-week intervals. The correlations of maternal variables with the S and SR variables and intra-observer analysis were performed. Results There was a significant difference in the S and SR values of the left ventricle (LV) among the gestational age groups (P = 0.007). Significantly higher S and SR values were observed in early age groups demonstrating reductions in LV S and SR values at 26 weeks, followed by stabilization. For the right ventricle (RV), there was no significant difference between gestational age groups. Significant intra-observer agreement was observed for S values of the RV (P = 0.008) and LV (P = 0.0004) and SR values of the RV (P = 0.0001) and LV (P = 0.015). Conclusion Decreases in the S and SR values of the LV occurred after 26 weeks, followed by stabilization. No significant difference was observed in the S or SR value of the RV among the gestational age groups, and no significant association of any maternal variable evaluated with S and SR values was observed. Significant intra-observer agreement was obtained among the results.
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Affiliation(s)
- Mariana Biancardi
- Fernandes Figueira Institute - FIOCRUZ, Av. Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
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Minsart AF, Boucoiran I, Delrue MA, Audibert F, Abadir S, Lapierre C, Lemyre E, Raboisson MJ. Left Superior Vena Cava in the Fetus: A Rarely Isolated Anomaly. Pediatr Cardiol 2020; 41:230-236. [PMID: 31720744 DOI: 10.1007/s00246-019-02246-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022]
Abstract
The frequency of chromosomal anomalies among fetuses with isolated persistent left superior vena cava (PLSVC) is still debated. The objective of the present study was to assess the prevalence of genetic and morphological anomalies identified in fetuses with PLSVC. We conducted a single-center retrospective study including all fetuses diagnosed with a PLSVC between 2010 and 2017. PLSVC was categorized as isolated or associated according to antenatal diagnosis of associated congenital heart defects, hypoplastic aortic isthmus, abnormal venous/arterial connections, and extracardiac anomalies. Among 229 fetuses diagnosed with PLSVC, 39 cases (17%) were strictly isolated and no syndromic/genetic anomaly or aortic coarctation was diagnosed. Seventy-two fetuses had a cardiovascular defect with a rate of genetic anomalies of 22%, 29 had an extracardiac malformation, and 89 had both an extracardiac and a cardiovascular defect. Among fetuses with abnormal development of the arterial/venous system as the only associated anomaly such as aberrant right subclavian artery or absent ductus venosus, 22% had a genetic anomaly. Overall, sixty-five fetuses or infants had a genetic concern, including 23 aneuploidies, 15 pathogenic micro-deletions/duplications, and 5 variants of unknown significance; 12 patients had VACTERL association, and 12 heterotaxy syndrome. Seven infants had an aortic coarctation diagnosed at birth.In conclusion, a thorough prenatal ultrasound examination is paramount, and the identification of variants of the venous/arterial system in addition to PLSVC should raise suspicion for genetic or morphologic abnormalities. Invasive prenatal diagnosis with array-CGH should be offered when PLSVC is non-isolated, after a detailed ultrasound evaluation in a tertiary center.
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Affiliation(s)
- Anne-Frédérique Minsart
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Isabelle Boucoiran
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Marie-Ange Delrue
- Department of Genetics, Université de Montréal - Sainte-Justine University Hospital, Montreal, QC, Canada
| | - François Audibert
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Sylvia Abadir
- Department of Fetal and Pediatric Cardiology, Université de Montréal - Sainte-Justine University Hospital, Montreal, QC, Canada
| | - Chantale Lapierre
- Department of Radiology, Université de Montréal - Sainte-Justine University Hospital, Montreal, QC, Canada
| | - Emmanuelle Lemyre
- Department of Genetics, Université de Montréal - Sainte-Justine University Hospital, Montreal, QC, Canada
| | - Marie-Josée Raboisson
- Department of Fetal and Pediatric Cardiology, Université de Montréal - Sainte-Justine University Hospital, Montreal, QC, Canada
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Nagata H, Glick L, Lougheed J, Grattan M, Mondal T, Thakur V, Schwartz SM, Jaeggi E. Prenatal Diagnosis of Transposition of the Great Arteries Reduces Postnatal Mortality: A Population-Based Study. Can J Cardiol 2020; 36:1592-1597. [PMID: 32622839 DOI: 10.1016/j.cjca.2020.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Transposition of the great arteries (TGA) may present as a life-threatening neonatal malformation. Although prenatal detection facilitates the perinatal management, the impact on outcome is controversial. METHODS This study reviewed the differences in prenatal diagnosis of TGA from 2009 to 2014 among the 5 geographic areas in Ontario and compared the management, morbidity, and mortality among neonates with a prenatal (prenatal cohort; n = 70) vs a postnatal (postnatal cohort; n = 76) anomaly diagnosis. Cases were identified from prospective databases of the provincial cardiac tertiary centres and the coroner's office. RESULTS Prenatal TGA detection rates varied significantly among areas (median: 50%; range: 14% to 72%; P = 0.03). Compared with the postnatal cohort, time from birth to tertiary care admission (1.4 vs 10.4 hours, P < 0.001), prostaglandin therapy (0.1 vs 5.3 hours; P < 0.001), balloon atrial septostomy (5.3 vs 14.9 hours; P <0.001), and arterial switch operation (6 vs 9 days, P = 0.002) was significantly shorter in the prenatal cohort. Although other preoperative variables-including the need of ventilation and mechanical support, morbidity score, and lowest pH and preductal oxygen saturations-were comparable, a prenatal diagnosis was associated with improved 1-year survival (odds ratio: 0.108; 95% confidence interval, 0.013-0.88; P = 0.0184). CONCLUSIONS Prenatal diagnosis of TGA significantly shortened time intervals from birth to neonatal care and surgery and was associated with improved survival. The prenatal detection rate of TGA in Ontario was low (50% or less) outside of Metropolitan Toronto, suggesting the need for new strategies to further improve intraprovincial detection rates.
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Affiliation(s)
- Hazumu Nagata
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lauren Glick
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jane Lougheed
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Michael Grattan
- Children's Hospital of Western Ontario, London, Ontario, Canada
| | | | - Varsha Thakur
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Edgar Jaeggi
- The Hospital for Sick Children, Toronto, Ontario, Canada.
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Mir A, Ahmed K, Jabeen F, Jan M, Radhakrishnan S. Prenatal echocardiographic diagnosis of congenital heart disease in high-risk antenatal mothers in a tertiary care center and their postnatal outcome: An experience from third world. HEART INDIA 2020. [DOI: 10.4103/heartindia.heartindia_9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tramontana A, Hartmann B, Hafner E. DiGeorge syndrome chromosome region deletion and duplication: Prenatal genotype-phenotype variability in fetal ultrasound and MRI. Prenat Diagn 2019; 39:1225-1234. [PMID: 31647121 DOI: 10.1002/pd.5572] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/01/2019] [Accepted: 09/21/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of the study was to assess genotype-phenotype correlation of prenatally diagnosed fetal DGS and dup22q11 syndrome by fetal molecular genetic analysis, fetal ultrasound, and/or MRI. METHODS In this retrospective consecutive case series, pregnant women were screened for fetal anomalies during a period of 10 years. Fetal genotype was assessed in 72 cases upon the occurrence of five prenatal fetal phenotypic features: cardiac anomalies, hypo/aplastic thymus, craniofacial malformations, urinary abnormalities, or IUGR; genotype-phenotype correlation was tested to potentially improve prenatal diagnosis of fetal DGS and dup22q11 syndrome. RESULTS Fetal genotypes of deletions or duplications in proximal clusters of LCR22s (A-B) were associated with fetal cardiac anomalies in combination with hypo/aplastic thymus and craniofacial malformations, suggesting a correlation with deleted HIRA. TOF associated with aplastic thymus in combination with renal defects indicated a relevant correlation with TBX1 deletion. Deletions in central LCR22s (B-D) with the loss of CRKL supposed a trend of genotype-phenotype correlation with fetal urinary abnormalities. CONCLUSION Genotype-phenotype correlation might improve prenatal diagnosis of fetal DGS and dup22q11 syndrome. Hence, prenatal screening and counseling is highly enhanced by a combination of fetal molecular genetic analysis, fetal ultrasound, and/or MRI. The implications of these findings remain to be explored.
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Affiliation(s)
- Allessandra Tramontana
- Department of Gynecology and Obstetrics, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
| | - Beda Hartmann
- Department of Gynecology and Obstetrics, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
| | - Erich Hafner
- Department of Gynecology and Obstetrics, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
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Clerici G, Romanelli M, Tosto V, Tsibizova V, Di Renzo GC. Fetal transient tricuspid valve regurgitation: sonographic features and clinical evolution. J Matern Fetal Neonatal Med 2019; 34:2435-2439. [PMID: 31550963 DOI: 10.1080/14767058.2019.1667326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To analyze the prevalence, the sonographic features, the clinical evolution and significance of fetal tricuspid valve regurgitation (TR). STUDY DESIGN This is a prospective study. Serial ultrasound examinations were performed at 20-23, at 26-29 and at 30-34 gestational weeks in 675 consecutive singleton pregnancies with fetal normal growth and normal cardiac anatomy. The fetal tricuspid valve regurgitation was classified according to its duration, to the peak of jet maximum velocity and to its maximum spatial extension. A clinical examination and echocardiography were performed in neonates after birth. RESULTS During the first examination (20-23 weeks), 32 cases of tricuspid valve regurgitation were identified. The prevalence of tricuspid regurgitation was 4.74%. The large majority of TR cases were not-holosystolic (87.5%), with a maximum velocity below 2 m/sec (80-130 cm/sec in 84% cases and 180-200 cm/sec in 16% cases) and with a little spatial extension (type I or II in 87.5% cases). Following this hemodynamic phenomenon during the following weeks, we found that it disappeared around 29 weeks in all cases. CONCLUSIONS Tricuspid regurgitation observed during the second trimester can be considered a transient and functional hemodynamic phenomenon, without apparent pathological significance.
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Affiliation(s)
- Graziano Clerici
- European Medical and Research Center (CEMER), University of Perugia, Perugia, Italy.,Department of Obstetrics and Gynecology, I.M. Sechenov First State University of Moscow, Moscow, Russia
| | - Maila Romanelli
- European Medical and Research Center (CEMER), University of Perugia, Perugia, Italy.,Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Valentina Tosto
- Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | | | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology, I.M. Sechenov First State University of Moscow, Moscow, Russia.,Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
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Quarello E. [The left outflow tract: Normal features]. ACTA ACUST UNITED AC 2019; 47:680-688. [PMID: 31352143 DOI: 10.1016/j.gofs.2019.07.009] [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: 11/29/2018] [Indexed: 10/26/2022]
Abstract
Congenital heart disease remains an important cause of perinatal morbidity and mortality. Screening for these is based on a good knowledge of normal fetal heart anatomy and ultrasound views to be performed. After recommending the use of the four chambers and the right outflow tract views in 2005, CNEOF proposes recently adding the left outflow tract assessment. The use of this one should sensitize the operator to the notion of sweeping essential to obtain all these views and make it possible to improve the detection of the conal VSD and conotruncal pathologies.
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Affiliation(s)
- E Quarello
- Unité d'échographie et de diagnostic prénatal, hôpital Saint-Joseph, 26, boulevard de Louvain, 13285 Marseille cedex 08, France; Image(2), 6, rue Rocca, 13008 Marseille, France.
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Chaoui R, Abuhamad A, Martins J, Heling K. Recent Development in Three and Four Dimension Fetal Echocardiography. Fetal Diagn Ther 2019; 47:345-353. [DOI: 10.1159/000500454] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022]
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Peixoto AB, Bravo-Valenzuela NJM, Martins WP, Mattar R, Moron AF, Araujo Júnior E. Reference ranges for the left ventricle modified myocardial performance index, respective time periods, and atrioventricular peak velocities between 20 and 36 + 6 weeks of gestation. J Matern Fetal Neonatal Med 2019; 34:456-465. [PMID: 30999802 DOI: 10.1080/14767058.2019.1609933] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To establish reference ranges for the fetal left ventricle (LV) modified myocardial performance index (Mod-MPI), respective time periods, and right and left atrioventricular peak velocities between 20 and 36 + 6 weeks of gestation.Methods: This cross-sectional study evaluated 360 low-risk singleton pregnancies between 20 and 36 + 6 weeks of gestation. The LV Mod-MPI was calculated as (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. Polynomial regression was used to obtain the best-fit using Mod-MPI and atrioventricular peak velocity measurements and gestational age (GA) with adjustments using the coefficient of determination (R2). The intra- and interobserver reliability was evaluated using the concordance correlation coefficient (CCC).Results: LV Mod-MPI (R2 = 0.026, p = .002) and isovolumetric relaxation time (IRT) (R2 = 0.036, p < .001) significantly increased with advancing GA. Isovolumetric contraction time (ICT) and ejection time (ET) did not significantly change with GA. RV and LV E wave, A wave, and E/A ratio significantly increased with GA (p < .001). The mean of each parameter ranged as follows: LV Mod-MPI (0.44-0.47 s), IRT (0.041-0.045 s), ICT (0.032-0.034 s), ET (0.167-0.167 s), RV E (30.2-46.91 cm/s), RV A (47.1-60.7 cm/s), RV E/A (0.65-0.78 cm/s), LV E (27.0-41.4 cm/s), LV A (43.2-53.8 cm/s), and LV E/A (0.63-0.78 cm/s). Only LV A wave measurements demonstrated an intraobserver CCC >0.80. The remaining intra- and interobserver reproducibility parameters demonstrated lower CCC.Conclusions: Reference values were replicated for the fetal LV Mod-MPI and LV and RV transvalvular peak velocities between 20 and 36 + 6 weeks of gestation.
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Affiliation(s)
- Alberto Borges Peixoto
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.,Mario Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, Brazil.,Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | | | - Wellington P Martins
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.,Department of Reproductive Medicine, SEMEAR fertilidade, Ribeirão Preto, Brazil
| | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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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: 19] [Impact Index Per Article: 3.2] [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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Kanwal A, Sheikh AM, Saher T. Determining the factors causing delayed referral for fetal echocardiography at a tertiary care hospital. J Saudi Heart Assoc 2017; 30:205-210. [PMID: 29983496 PMCID: PMC6026400 DOI: 10.1016/j.jsha.2017.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/22/2017] [Accepted: 12/10/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To determine the factors causing delayed referral for fetal echocardiography at a tertiary care hospital. Background Timely referral for fetal echocardiogram is considered essential for identification of congenital heart diseases, interventions, and counseling of parents. The present study highlights the factors associated with delayed referral for fetal echocardiography. Material and methods This prospective study includes a total of 200 pregnant females who were referred for fetal echocardiography. The data collected included referral indications, gestational age, maternal age, educational status, referral personale, and final diagnosis on echocardiography. Results The mean gestational age of presentation was found to be 33 weeks [standard deviation (SD), 4.8 weeks]. Among 200 females, 24% were referred at second trimester, 69% presented at third trimester, and 6% of the females presented at term. No female presented before 18 weeks of gestation. Our results showed that most of the females (94%) were referred by their gynecologist. Eighty-nine percent of the females were booked since the first trimester. The most common indication for referral was unexplained death of children (60%). Of 200 pregnant women, 40% were found to be illiterate and 60% were educated. However, the mean gestational age of presentation of illiterate females was 32.9 weeks (SD, 4.2 weeks), and for educated women it was 33 weeks (SD, 5 weeks). Congenital heart disease was diagnosed in 12% of the cases. Conclusion On the basis of the results, it could be concluded that delayed presentation for fetal echocardiography was not associated with the educational status of females. By contrast, referral personnel were found to be responsible for the delayed referral of females. Therefore, we strongly recommend that both pregnant women and gynecologists be educated about the importance of timely diagnosis for identification of congenital heart diseases.
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Affiliation(s)
- Asma Kanwal
- Department of Pediatric Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, PakistanaPakistan
| | - Abdul Malik Sheikh
- Department of Pediatric Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, PakistanaPakistan
| | - Tayyaba Saher
- Department of Pediatric Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, PakistanaPakistan
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Di Bernardo S, Mivelaz Y, Epure AM, Vial Y, Simeoni U, Bovet P, Estoppey Younes S, Chiolero A, Sekarski N. Assessing the consequences of gestational diabetes mellitus on offspring's cardiovascular health: MySweetHeart Cohort study protocol, Switzerland. BMJ Open 2017; 7:e016972. [PMID: 29138200 PMCID: PMC5695409 DOI: 10.1136/bmjopen-2017-016972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/24/2017] [Accepted: 08/17/2017] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a state of glucose intolerance with onset during pregnancy. GDM carries prenatal and perinatal risks as well as long-term risks for the mother and her child. GDM may be involved in the foetal programming of long-term cardiovascular health. However, evidence is sparse and the effect of GDM on cardiovascular health is unknown. To address these issues, we will conduct MySweetHeart Cohort study. The objectives are to assess the effect of GDM on offspring's cardiovascular health early in life by using surrogate markers of cardiovascular disease and atherosclerosis. METHODS AND ANALYSIS This is a cohort study of 100 offspring of women with GDM and 100 offspring of women without GDM. At inclusion, a baseline assessment of the mothers will be conducted through means of self-report questionnaires, a researcher-administrated interview, blood pressure and anthropometric measurements, and a maternal blood sampling. Between the 30th and 34th weeks of gestation, a foetal echography will be performed to assess the foetal cardiac structure and function, the fetomaternal circulation and the hepatic volume. At birth, maternal and neonatal characteristics will be assessed. An echocardiography will be performed to assess cardiac structure and function 2-7 days after birth; carotid intima-media thickness will be also measured to assess vascular structure. MySweetHeart Cohort is linked to MySweetHeart Trial (clinicaltrials.gov/ct2/show/NCT02890693), a randomised controlled trial assessing the effect of a multidimensional interdisciplinary lifestyle and psychosocial intervention to improve the cardiometabolic and mental health of women with GDM and their offspring. A long-term follow-up of children is planned. ETHICS AND DISSEMINATION Ethical approval has been obtained through the state Human Research Ethics Committee of the Canton de Vaud (study number 2016-00745). We aim to disseminate the findings through regional, national and international conferences and through peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (clinicaltrials.gov/ct2/show/NCT02872974).
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Affiliation(s)
- Stefano Di Bernardo
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Yvan Mivelaz
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Adina Mihaela Epure
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Yvan Vial
- Obstetrics and Gynaecology Division, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Umberto Simeoni
- DOHaD Laboratory, Paediatrics Division, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Sandrine Estoppey Younes
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nicole Sekarski
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
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46
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Fetale Herzdiagnostik. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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DeVore GR, Satou G, Sklansky M. Abnormal Fetal Findings Associated With a Global Sphericity Index of the 4-Chamber View Below the 5th Centile. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2309-2318. [PMID: 28556937 DOI: 10.1002/jum.14261] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the global sphericity index (GSI) of the 4-chamber view and correlate the results with abnormal ultrasound findings. METHODS The epicardial end-diastolic basal-apical length (BAL) and transverse length (TL) of the 4-chamber view were measured to compute the GSI (BAL/TL) in 200 control fetuses between 20 and 40 weeks' gestation. Three hundred study fetuses were prospectively examined between 17 and 39 weeks' gestation. The GSI, Z score, and centile were computed for each of the fetuses. RESULTS The GSI (1.233; SD, 0.0953) in the control fetuses was independent of gestational age. Eighteen percent of the study fetuses (55 of 300) had a GSI below the 5th centile (<1.08), of whom 96% (53 of 55) had additional abnormal ultrasound findings. Fetuses with an estimated fetal weight below the 10th centile had a significantly (P < .05) higher rate of an umbilical artery Doppler pulsatility index above the 95th centile (27% versus 17.7%), a middle cerebral artery Doppler pulsatility index below the 5th centile (27% versus 0%), an abnormal cerebroplacental ratio (27% versus 4.5%), and an amniotic fluid index of less than 5 cm (36% versus 9%). The TL was significantly increased compared with the BAL in fetuses with cardiac dysfunction, irrespective of the estimated fetal weight. CONCLUSIONS An abnormal GSI below the 5th centile is associated with abnormal fetal ultrasound findings.
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Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California, USA
| | - Gary Satou
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Yeo L, Romero R. Color and power Doppler combined with Fetal Intelligent Navigation Echocardiography (FINE) to evaluate the fetal heart. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:476-491. [PMID: 28809063 PMCID: PMC5656930 DOI: 10.1002/uog.17522] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/23/2017] [Accepted: 03/03/2017] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To evaluate the performance of color and bidirectional power Doppler ultrasound combined with Fetal Intelligent Navigation Echocardiography (FINE) in examining the fetal heart. METHODS A prospective cohort study was conducted of fetuses in the second and third trimesters with a normal heart or with congenital heart disease (CHD). One or more spatiotemporal image correlation (STIC) volume datasets, combined with color or bidirectional power Doppler (S-flow) imaging, were acquired in the apical four-chamber view. Each successfully obtained STIC volume was evaluated by STICLoop™ to determine its appropriateness before applying the FINE method. Visualization rates for standard fetal echocardiography views using diagnostic planes and/or Virtual Intelligent Sonographer Assistance (VIS-Assistance®) were calculated for grayscale (removal of Doppler signal), color Doppler and S-flow Doppler. In four cases with CHD (one case each of tetralogy of Fallot, hypoplastic left heart and coarctation of the aorta, interrupted inferior vena cava with azygos vein continuation and asplenia, and coarctation of the aorta with tricuspid regurgitation and hydrops), the diagnostic potential of this new technology was presented. RESULTS A total of 169 STIC volume datasets of the normal fetal heart (color Doppler, n = 78; S-flow Doppler, n = 91) were obtained from 37 patients. Only a single STIC volume of color Doppler and/or a single volume of S-flow Doppler per patient were analyzed using FINE. Therefore, 60 STIC volumes (color Doppler, n = 27; S-flow Doppler, n = 33) comprised the final study group. Median gestational age at sonographic examination was 23 (interquartile range, 21-27.5) weeks. Color Doppler FINE generated nine fetal echocardiography views (grayscale) using (1) diagnostic planes in 73-100% of cases, (2) VIS-Assistance in 100% of cases, and (3) a combination of diagnostic planes and/or VIS-Assistance in 100% of cases. The rate of generating successfully eight fetal echocardiography views with appropriate color and S-flow Doppler information was 89-100% and 91-100% of cases, respectively, using a combination of diagnostic planes and/or VIS-Assistance. However, the success rate for the ninth echocardiography view (i.e. superior and inferior venae cavae) was 33% and 30% for color and S-flow Doppler, respectively. In all four cases of CHD, color Doppler FINE demonstrated evidence of abnormal fetal cardiac anatomy and/or hemodynamic flow. CONCLUSIONS The FINE method applied to STIC volumes of normal fetal hearts acquired with color or bidirectional power Doppler information can generate successfully eight to nine standard fetal echocardiography views (via grayscale, color Doppler or power Doppler) in the second and third trimesters. In cases of CHD, color Doppler FINE demonstrates successfully abnormal anatomy and/or Doppler flow characteristics. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L. Yeo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNIHBethesdaMD and Detroit, MIUSA
- Detroit Medical CenterHutzel Women's HospitalDetroitMIUSA
- Department of Obstetrics and GynecologyWayne State University School of MedicineDetroitMIUSA
| | - R. Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNIHBethesdaMD and Detroit, MIUSA
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMIUSA
- Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingMIUSA
- Center for Molecular Medicine and GeneticsWayne State UniversityDetroitMIUSA
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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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50
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Jicinska H, Vlasin P, Jicinsky M, Grochova I, Tomek V, Volaufova J, Skovranek J, Marek J. Does First-Trimester Screening Modify the Natural History of Congenital Heart Disease? Circulation 2017; 135:1045-1055. [DOI: 10.1161/circulationaha.115.020864] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/13/2017] [Indexed: 11/16/2022]
Abstract
Background:
The study analyzed the impact of first-trimester screening on the spectrum of congenital heart defects (CHDs) later in pregnancy and on the outcome of fetuses and children born alive with a CHD.
Methods:
The spectrum of CHDs, associated comorbidities, and outcome of fetuses, either diagnosed with a CHD in the first trimester (Group I, 127 fetuses) or only in the second-trimester screening (Group II, 344 fetuses), were analyzed retrospectively between 2007 and 2013. Second-trimester fetuses diagnosed with a CHD between 2007 and 2013 were also compared with Group III (532 fetuses diagnosed with a CHD in the second trimester from 1996 to 2001, the period before first-trimester screening was introduced).
Results:
The spectrum of CHDs diagnosed in the first and second trimesters in the same time period differed significantly, with a greater number of comorbidities (
P
<0.0001), CHDs with univentricular outcome (
P
<0.0001), intrauterine deaths (
P
=0.01), and terminations of pregnancy (
P
<0.0001) in Group I compared with Group II. In Group III, significantly more cases of CHDs with univentricular outcome (
P
<0.0001), intrauterine demise (
P
=0.036), and early termination (
P
<0.0001) were identified compared with fetuses diagnosed with CHDs in the second trimester between 2007 and 2013. The spectrum of CHDs seen in the second-trimester groups differed after first-trimester screening was implemented.
Conclusions:
First-trimester screening had a significant impact on the spectrum of CHDs and the outcomes of pregnancies with CHDs diagnosed in the second trimester. Early detection of severe forms of CHDs and significant comorbidities resulted in an increased pregnancy termination rate in the first trimester.
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Affiliation(s)
- Hana Jicinska
- From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children’s Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health–New Orleans, School of Public Health (J.V.); and Great Ormond
| | - Pavel Vlasin
- From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children’s Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health–New Orleans, School of Public Health (J.V.); and Great Ormond
| | - Michal Jicinsky
- From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children’s Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health–New Orleans, School of Public Health (J.V.); and Great Ormond
| | - Ilga Grochova
- From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children’s Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health–New Orleans, School of Public Health (J.V.); and Great Ormond
| | - Viktor Tomek
- From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children’s Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health–New Orleans, School of Public Health (J.V.); and Great Ormond
| | - Julia Volaufova
- From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children’s Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health–New Orleans, School of Public Health (J.V.); and Great Ormond
| | - Jan Skovranek
- From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children’s Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health–New Orleans, School of Public Health (J.V.); and Great Ormond
| | - Jan Marek
- From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children’s Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health–New Orleans, School of Public Health (J.V.); and Great Ormond
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