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AIUM Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:E20-E32. [PMID: 38224490 DOI: 10.1002/jum.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024]
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Liang B, Peng F, Luo D, Zeng Q, Wen H, Zheng B, Zou Z, An L, Wen H, Wen X, Liao Y, Yuan Y, Li S. Automatic segmentation of 15 critical anatomical labels and measurements of cardiac axis and cardiothoracic ratio in fetal four chambers using nnU-NetV2. BMC Med Inform Decis Mak 2024; 24:128. [PMID: 38773456 PMCID: PMC11106923 DOI: 10.1186/s12911-024-02527-x] [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: 02/22/2024] [Accepted: 05/02/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Accurate segmentation of critical anatomical structures in fetal four-chamber view images is essential for the early detection of congenital heart defects. Current prenatal screening methods rely on manual measurements, which are time-consuming and prone to inter-observer variability. This study develops an AI-based model using the state-of-the-art nnU-NetV2 architecture for automatic segmentation and measurement of key anatomical structures in fetal four-chamber view images. METHODS A dataset, consisting of 1,083 high-quality fetal four-chamber view images, was annotated with 15 critical anatomical labels and divided into training/validation (867 images) and test (216 images) sets. An AI-based model using the nnU-NetV2 architecture was trained on the annotated images and evaluated using the mean Dice coefficient (mDice) and mean intersection over union (mIoU) metrics. The model's performance in automatically computing the cardiac axis (CAx) and cardiothoracic ratio (CTR) was compared with measurements from sonographers with varying levels of experience. RESULTS The AI-based model achieved a mDice coefficient of 87.11% and an mIoU of 77.68% for the segmentation of critical anatomical structures. The model's automated CAx and CTR measurements showed strong agreement with those of experienced sonographers, with respective intraclass correlation coefficients (ICCs) of 0.83 and 0.81. Bland-Altman analysis further confirmed the high agreement between the model and experienced sonographers. CONCLUSION We developed an AI-based model using the nnU-NetV2 architecture for accurate segmentation and automated measurement of critical anatomical structures in fetal four-chamber view images. Our model demonstrated high segmentation accuracy and strong agreement with experienced sonographers in computing clinically relevant parameters. This approach has the potential to improve the efficiency and reliability of prenatal cardiac screening, ultimately contributing to the early detection of congenital heart defects.
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Affiliation(s)
- Bocheng Liang
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Fengfeng Peng
- Department of Computer Science and Electronic Engineering, Hunan University, Changsha, 410082, China
| | - Dandan Luo
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Qing Zeng
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Huaxuan Wen
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Bowen Zheng
- Department of Computer Science and Electronic Engineering, Hunan University, Changsha, 410082, China
| | - Zhiying Zou
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Liting An
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Huiying Wen
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Xin Wen
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Yimei Liao
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Ying Yuan
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Shengli Li
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China.
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Savitsky LM, Hamilton C, Sterrett M, Olerich K, Ma K, Albright CM. Universal Fetal Echocardiography for Pregestational Diabetes Mellitus: A Cost-Effectiveness Analysis. Obstet Gynecol 2024:00006250-990000000-01035. [PMID: 38422504 DOI: 10.1097/aog.0000000000005538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To evaluate the cost effectiveness of universal fetal echocardiogram for patients with pregestational diabetes mellitus by first-trimester hemoglobin A1c (Hb A1c) level. METHODS We developed a cost-effectiveness model comparing two strategies of screening for critical fetal congenital heart disease among patients with diabetes: universal fetal echocardiogram and fetal echocardiogram only after abnormal findings on detailed anatomy ultrasonogram. We excluded ventricular septal defect, atrial septal defects, and bicuspid aortic valve from the definition of critical fetal congenital heart disease. Probabilities and costs were derived from the literature. We used individual models to evaluate different scenarios: first-trimester Hb A1c lower than 6.5%, Hb A1c 6.5-9.0%, and Hb A1c higher than 9.0%. Primary outcomes included fetal death, neonatal death, and false-positive and false-negative results. A cost-effectiveness threshold was set at $100,000 per quality-adjusted life-year. Univariable sensitivity analyses were performed to investigate the drivers of the model. RESULTS Universal fetal echocardiogram is not cost effective except for when first-trimester Hb A1c level is higher than 9.0% (incremental cost-effectiveness ratio $638,100, $223,693, and $67,697 for Hb A1c lower than 6.5%, 6.5-9.0%, and higher than 9.0%, respectively). The models are sensitive to changes in the probability of congenital heart disease at a given Hb A1c level, as well as the cost of neonatal transfer to a higher level of care. Universal fetal echocardiogram became both cost saving and more effective when the probability of congenital heart disease reached 14.48% (15.4 times the baseline risk). In the Monte Carlo simulation, universal fetal echocardiogram is cost effective in 22.7%, 48.6%, and 62.3% of scenarios for each of the three models, respectively. CONCLUSION For pregnant patients with first-trimester Hb A1c levels lower than 6.5%, universal fetal echocardiogram was not cost effective, whereas, for those with first-trimester Hb A1c levels higher than 9.0%, universal fetal echocardiogram was cost effective. For those with intermediate Hb A1c levels, universal fetal echocardiogram was cost effective in about 50% of cases; therefore, clinical judgment based on individual patient values, willingness to pay to detect congenital heart disease, and resource availability needs to be considered.
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Affiliation(s)
- Leah M Savitsky
- Department of Obstetrics and Gynecology, University of Washington, and the Department of Maternal-Fetal Medicine, Providence Swedish Hospital, Seattle, Washington; and the Department of Maternal-Fetal Medicine, Kaiser San Diego, San Diego, California
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Socha MW, Flis W, Wartęga M. Epigenetic Genome Modifications during Pregnancy: The Impact of Essential Nutritional Supplements on DNA Methylation. Nutrients 2024; 16:678. [PMID: 38474806 DOI: 10.3390/nu16050678] [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: 01/28/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Pregnancy is an extremely stressful period in a pregnant woman's life. Currently, women's awareness of the proper course of pregnancy and its possible complications is constantly growing. Therefore, a significant percentage of women increasingly reach for various dietary supplements during gestation. Some of the most popular substances included in multi-ingredient supplements are folic acid and choline. Those substances are associated with positive effects on fetal intrauterine development and fewer possible pregnancy-associated complications. Recently, more and more attention has been paid to the impacts of specific environmental factors, such as diet, stress, physical activity, etc., on epigenetic modifications, understood as changes occurring in gene expression without the direct alteration of DNA sequences. Substances such as folic acid and choline may participate in epigenetic modifications by acting via a one-carbon cycle, leading to the methyl-group donor formation. Those nutrients may indirectly impact genome phenotype by influencing the process of DNA methylation. This review article presents the current state of knowledge on the use of folic acid and choline supplementation during pregnancy, taking into account their impacts on the maternal-fetal unit and possible pregnancy outcomes, and determining possible mechanisms of action, with particular emphasis on their possible impacts on epigenetic modifications.
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Affiliation(s)
- Maciej W Socha
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland
- Department of Obstetrics and Gynecology, St. Adalbert's Hospital in Gdańsk, Copernicus Healthcare Entity, Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Wojciech Flis
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland
- Department of Obstetrics and Gynecology, St. Adalbert's Hospital in Gdańsk, Copernicus Healthcare Entity, Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Mateusz Wartęga
- Department of Pathophysiology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland
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Jacquemyn X, Kutty S, Manlhiot C. The Lifelong Impact of Artificial Intelligence and Clinical Prediction Models on Patients With Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:440-452. [PMID: 38161675 PMCID: PMC10755786 DOI: 10.1016/j.cjcpc.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/24/2023] [Indexed: 01/03/2024]
Abstract
Medical advancements in the diagnosis, surgical techniques, perioperative care, and continued care throughout childhood have transformed the outlook for individuals with tetralogy of Fallot (TOF), improving survival and shifting the perspective towards lifelong care. However, with a growing population of survivors, longstanding challenges have been accentuated, and new challenges have surfaced, necessitating a re-evaluation of TOF care. Availability of prenatal diagnostics, insufficient information from traditional imaging techniques, previously unforeseen medical complications, and debates surrounding optimal timing and indications for reintervention are among the emerging issues. To address these challenges, the integration of artificial intelligence and machine learning holds great promise as they have the potential to revolutionize patient management and positively impact lifelong outcomes for individuals with TOF. Innovative applications of artificial intelligence and machine learning have spanned across multiple domains of TOF care, including screening and diagnosis, automated image processing and interpretation, clinical risk stratification, and planning and performing cardiac interventions. By embracing these advancements and incorporating them into routine clinical practice, personalized medicine could be delivered, leading to the best possible outcomes for patients. In this review, we provide an overview of these evolving applications and emphasize the challenges, limitations, and future potential for integrating them into clinical care.
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Affiliation(s)
- Xander Jacquemyn
- Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Shelby Kutty
- Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Kanneganti A, Gosavi AT, Lim MXK, Li WLS, Chia DA, Choolani MA, Chen CK, Biswas A. Fetal congenital heart diseases: Diagnosis by anatomical scans, echocardiography and genetic tests. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:420-431. [PMID: 38920167 DOI: 10.47102/annals-acadmedsg.2022472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Objective To determine the distribution of major fetal congenital heart diseases (CHDs) diagnosed antenatally during routine second-trimester obstetric anatomical scans in an unselected population at a single tertiary centre and to characterise and stratify risk factors, genetic diagnosis and long-term health at 4 years old. Method A single-centre cohort study of all major fetal CHDs detected on routine obstetric fetal anatomical ultrasound scans between January 2014 and December 2017 was performed in an unselected population. Demographic details, fetal echocardiogram reports, genetic test results, delivery outcomes and postnatal progress were stratified by CHD subtype. Results Of 20,031 screened pregnancies, 109 pregnancies (0.53%) had major fetal CHDs. The most common subtypes were coarctation of aorta (17.4%), transposition of great arteries (16.5%), and tetralogy of Fallot and univentricular hearts (13.8% each). Of the 60.5% that underwent confirmatory genetic testing-mostly conventional karyotyping and testing for 22q11 microdeletion-about a quarter had abnormalities, of which 22q microdeletion was the most common. We had complete obstetric data in 85 pregnancies (78%), of which 76.5% progressed to live birth. Among these, 92.1% of postnatal echocardiograms concurred with antenatal ones. At 4 years old, 43.2% of offspring had no medical or developmental issues, 20.0% had mild medical or developmental issues, 21.5% had major medical or developmental issues, and 12.3% had deceased. Conclusion Fetal echocardiograms accurately diagnose CHDs. Future studies should evaluate the roles of chromosomal microarray and next-generation sequencing in diagnosing CHD.
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Affiliation(s)
- Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Arundhati Tushar Gosavi
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mei Xian Karen Lim
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Wei Ling Sarah Li
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Dawn Ak Chia
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Mahesh Arjandas Choolani
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching Kit Chen
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cardiology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Arijit Biswas
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Wang B, Verrocchi J, Liew D, Zentner D. Does Down syndrome influence the outcomes of congenital cardiac surgery? A systematic review and meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:240-248. [PMID: 35612980 DOI: 10.1093/ehjqcco/qcac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Congenital cardiac surgery for individuals with Down syndrome (DS) has historically occurred at a reduced frequency. Little data are available regarding long-term post-congenital cardiac surgical outcomes. Limited sample sizes and clinical heterogeneity require a pooled analysis approach. AIMS To compare long-term outcomes post-congenital heart surgery between adults with and without DS. METHODS Databases (Medline, Embase, and PubMed) were searched utilizing terms related to DS and congenital heart disease.Studies that enrolled adults (>18 years) with operated congenital heart disease and compared long-term outcomes with respect to DS presence were included. All study designs were included, but those with limited/peri-operative follow-up, non-English texts, case studies, and literature reviews were excluded.Blinded screening, data extraction, and quality assessment were independently conducted by two reviewers. QUIPS criteria were used for risk of bias analysis. Both random- and fixed-effects models were used for meta-analysis. RESULTS A total of 23 studies (n = 10 466) were included. Risk of bias was frequently high due to unblinded retrospective study designs and analyses limited in adjustment for other prognostic factors.Meta-analysis demonstrated no effect of DS on long-term mortality [hazard ratio (HR) 0.86, 95% confidence interval (95% CI) 0.6-1.23], to a maximum described follow-up of 38 years. Lower cardiac reoperation risk (HR 0.6, 95% CI 0.46-0.78) for individuals with DS was found on pooled analysis. Meta-analysis was limited by between-study variation. CONCLUSION DS does not affect post-congenital cardiac surgical survival in adulthood. Reduced reoperation may reflect challenges in assessing functional and symptomatic status and/or concerns regarding perceived reoperation difficulties or likely benefits.
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Affiliation(s)
- Benjamen Wang
- Cardiology Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Justin Verrocchi
- Monash Medical Centre, Monash Health, Clayton, VIC 3168, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Dominica Zentner
- Cardiology Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
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Impact of clinical research on public health policy of neonatal screening for congenital heart disease in China. Chin Med J (Engl) 2022; 135:1261-1263. [PMID: 35830175 PMCID: PMC9433059 DOI: 10.1097/cm9.0000000000002031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Wang X, Bryan C, Li Y, Pan R, Liu Y, Chen W, Ma KL. Umbra: A Visual Analysis Approach for Defense Construction Against Inference Attacks on Sensitive Information. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2022; 28:2776-2790. [PMID: 33180726 DOI: 10.1109/tvcg.2020.3037670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Collecting and analyzing anonymous personal information is required as a part of data analysis processes, such as medical diagnosis and restaurant recommendation. Such data should ostensibly be stored so that specific individual information cannot be disclosed. Unfortunately, inference attacks-integrating background knowledge and intelligent models-hinder classic sanitization techniques like syntactic anonymity and differential privacy from exhaustively protecting sensitive information. As a solution, we introduce a three-stage approach empowered within a visual interface, which depicts underlying inference behaviors via a Bayesian Network and supports a customized defense against inference attacks from unknown adversaries. In particular, our approach visually explains the process details of the underlying privacy preserving models, allowing users to verify if the results sufficiently satisfy the requirements of privacy preservation. We demonstrate the effectiveness of our approach through two case studies and expert reviews.
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Truong VT, Nguyen BP, Nguyen-Vo TH, Mazur W, Chung ES, Palmer C, Tretter JT, Alsaied T, Pham VT, Do HQ, Do PTN, Pham VN, Ha BN, Chau HN, Le TK. Application of machine learning in screening for congenital heart diseases using fetal echocardiography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1007-1015. [PMID: 35192082 DOI: 10.1007/s10554-022-02566-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/13/2022] [Indexed: 11/05/2022]
Abstract
There is a growing body of literature supporting the utilization of machine learning (ML) to improve diagnosis and prognosis tools of cardiovascular disease. The current study was to investigate the impact that the ML framework may have on the sensitivity of predicting the presence or absence of congenital heart disease (CHD) using fetal echocardiography. A comprehensive fetal echocardiogram including 2D cardiac chamber quantification, valvar assessments, assessment of great vessel morphology, and Doppler-derived blood flow interrogation was recorded. The postnatal echocardiogram was used to ascertain the diagnosis of CHD. A random forest (RF) algorithm with a nested tenfold cross-validation was used to train models for assessing the presence of CHD. The study population was derived from a database of 3910 singleton fetuses with maternal age of 28.8 ± 5.2 years and gestational age at the time of fetal echocardiography of 22.0 weeks (IQR 21-24). The proportion of CHD was 14.1% for the studied cohort confirmed by post-natal echocardiograms. Our proposed RF-based framework provided a sensitivity of 0.85, a specificity of 0.88, a positive predictive value of 0.55 and a negative predictive value of 0.97 to detect the CHD with the mean of mean ROC curves of 0.94 and the mean of mean PR curves of 0.84. Additionally, six first features, including cardiac axis, peak velocity of blood flow across the pulmonic valve, cardiothoracic ratio, pulmonary valvar annulus diameter, right ventricular end-diastolic diameter, and aortic valvar annulus diameter, are essential features that play crucial roles in adding more predictive values to the model in detecting patients with CHD. ML using RF can provide increased sensitivity in prenatal CHD screening with very good performance. The incorporation of ML algorithms into fetal echocardiography may further standardize the assessment for CHD.
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Affiliation(s)
- Vien T Truong
- The Christ Hospital Health Network, Cincinnati, OH, USA
- The Lindner Research Center, Cincinnati, OH, USA
| | - Binh P Nguyen
- School of Mathematics and Statistics, Victoria University of Wellington, Wellington, New Zealand
| | - Thanh-Hoang Nguyen-Vo
- School of Mathematics and Statistics, Victoria University of Wellington, Wellington, New Zealand
| | | | | | | | - Justin T Tretter
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Tarek Alsaied
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Vy T Pham
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Huan Q Do
- Heart Institute of HCMC, Ho Chi Minh City, Vietnam
| | | | - Vinh N Pham
- Heart Center, Tam Anh General Hospital, Ho Chi Minh City, Vietnam
| | - Ban N Ha
- Heart Institute of HCMC, Ho Chi Minh City, Vietnam
| | - Hoa N Chau
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Tuyen K Le
- Heart Institute of HCMC, Ho Chi Minh City, Vietnam.
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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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Lee‐Tannock A. Detection of congenital heart disease (
CHD
) in the first trimester. SONOGRAPHY 2021. [DOI: 10.1002/sono.12290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Alison Lee‐Tannock
- Mater Centre for Maternal Fetal Medicine South Brisbane Queensland Australia
- QPCS, Queensland Children's Hospital, Stanley St South Brisbane Queensland Australia
- Mater Research Institute/University of Queensland (MRI) South Brisbane Queensland Australia
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13
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de Carvalho HT, Chiquillo MPL, Tanaka SN, de Castro ACAV, Kummer L, Roscani MG. Accuracy of obstetric ultrasonography compared to fetal echocardiography in diagnosis of congenital heart disease at a secondary level hospital in Brazil: A pilot study. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Simonyi A, Eros FR, Hajdu J, Beke A. Effectiveness of fetal ultrasound diagnostics in cardiac malformations and association with polyhydramnios and oligohydramnios. Quant Imaging Med Surg 2021; 11:2994-3004. [PMID: 34249629 PMCID: PMC8250007 DOI: 10.21037/qims-20-823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/17/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Examine the effectiveness of prenatal ultrasound diagnostics in the detection of cardiovascular malformations, and their association with polyhydramnios and oligohydramnios. METHODS We examined the fetal ultrasonography and postnatal clinical/fetopathological data of 372 newborns/fetuses over a 7-year period in a tertiary centre. Fetal echocardiography was performed in cases of suspected US findings between 18-32 weeks. During the ultrasound the amniotic fluid amount was measured and the amniotic fluid index (AFI) or largest amniotic fluid pocket was determined. RESULTS Prenatal ultrasonographic results and postnatal/fetopathological diagnosis were fully congruent in 236/372 cases (63.4%), and in 66/372 cases of cardiovascular anomalies (17.7%) the discovery was partial, while in 70/372 cases no fetal cardiovascular anomalies were diagnosed during pregnancy (18.8%) (false negative). Cardiovascular malformations were isolated in 255 cases, in 172 of which (67.5%) the results of prenatal ultrasonography and postnatal diagnostics were fully congruent. In 43 cases (16.9%) the prenatal discovery was partial, and in 40 cases (15.7%) there was no prenatal recognition of the malformation. Cardiovascular abnormalities were found as a part of multiple malformations in 76 cases. In 41 fetuses the cardiovascular malformation was associated with chromosomal abnormalities. Cardiovascular malformations were significantly associated with polyhydramnios. Although in some of the cardiovascular malformations the association rate with polyhydramnios was high (AVSD, double outlet right ventricle, tetralogy of Fallot), we found a moderate association rate (19.7%). The association with oligohydramnios was 8.57%. CONCLUSIONS Echocardiography plays an important role in the prenatal diagnostics. In cases of polyhydramnios and oligohydramnios, fetal echocardiography should be performed.
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Affiliation(s)
- Atene Simonyi
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Fanni Rebeka Eros
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Julia Hajdu
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
- Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | - Artur Beke
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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15
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Raucher Sternfeld A, Betzer T, Tamir A, Mizrachi Y, Assa S, Bar J, Gindes L. Can Fetal Echocardiographic Measurements of the Left Ventricular Outflow Tract Angle Detect Fetuses with Conotruncal Cardiac Anomalies? Diagnostics (Basel) 2021; 11:1185. [PMID: 34209961 PMCID: PMC8303209 DOI: 10.3390/diagnostics11071185] [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] [Received: 06/01/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The angle between the inter-ventricular septum and the ascending aorta can be measured during a sonographic fetal survey while viewing the left ventricular outflow tract (LVOT angle). Our aim was to compare the LVOT angle between fetuses with and without conotruncal cardiac anomaliesrmations. METHODS In this prospective observational study, we compared the LVOT angle between normal fetuses, at different gestational age, and fetuses with cardiac malformations. RESULTS The study included 302 fetuses screened at gestational age of 12-39 weeks. The LVOT angle ranged from 127 to 163 degrees (mean 148.2), in 293 fetuses with normal hearts, and was not correlated with gestational age. The LVOT angle was significantly wider in fetuses with D-transposition of the great arteries (D-TGA, eight fetuses) and valvar aortic stenosis (AS, three fetuses), than in fetuses with normal hearts (164.8 ± 5.0 vs. 148.2 ± 5.4, respectively, p < 0.001). Conversely, the LVOT angle was significantly narrower in fetuses with complete atrioventricular canal defect (AVC, eight fetuses), than in fetuses with normal hearts (124.8 ± 2.4 vs. 148.2 ± 5.4, respectively, p < 0.001). On ROC analysis, an angle of 159.6 degrees or higher had a sensitivity of 100% and a specificity of 97.3% for the detection of TGA or AS, whereas an angle of 128.8 degrees or lower had a sensitivity of 100% and a specificity of 99.7% for the detection of AVC defect. CONCLUSIONS The LVOT angle is constant during pregnancy, and differs significantly in fetuses with TGA/AS, and AVC, compared to fetuses with normal hearts (wider and narrower, respectively).
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Affiliation(s)
- Alona Raucher Sternfeld
- Pediatric Cardiology Unit, Department of Pediatrics, Wolfson Medical Center, Holon 5822012, Israel; (A.R.S.); (A.T.); (S.A.)
- Pediatric Cardiology Clinic, Maccabi Health Services, Rishon-Lezion 7565016, Israel
| | - Tal Betzer
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 5822012, Israel; (T.B.); (Y.M.); (J.B.)
| | - Akiva Tamir
- Pediatric Cardiology Unit, Department of Pediatrics, Wolfson Medical Center, Holon 5822012, Israel; (A.R.S.); (A.T.); (S.A.)
- Pediatric Cardiology Clinic, Maccabi Health Services, Rishon-Lezion 7565016, Israel
| | - Yossi Mizrachi
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 5822012, Israel; (T.B.); (Y.M.); (J.B.)
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel
| | - Sagie Assa
- Pediatric Cardiology Unit, Department of Pediatrics, Wolfson Medical Center, Holon 5822012, Israel; (A.R.S.); (A.T.); (S.A.)
- Pediatric Cardiology Clinic, Maccabi Health Services, Rishon-Lezion 7565016, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 5822012, Israel; (T.B.); (Y.M.); (J.B.)
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel
| | - Liat Gindes
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 5822012, Israel; (T.B.); (Y.M.); (J.B.)
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel
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16
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Arnaout R, Curran L, Zhao Y, Levine JC, Chinn E, Moon-Grady AJ. An ensemble of neural networks provides expert-level prenatal detection of complex congenital heart disease. Nat Med 2021; 27:882-891. [PMID: 33990806 DOI: 10.1038/s41591-021-01342-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
Congenital heart disease (CHD) is the most common birth defect. Fetal screening ultrasound provides five views of the heart that together can detect 90% of complex CHD, but in practice, sensitivity is as low as 30%. Here, using 107,823 images from 1,326 retrospective echocardiograms and screening ultrasounds from 18- to 24-week fetuses, we trained an ensemble of neural networks to identify recommended cardiac views and distinguish between normal hearts and complex CHD. We also used segmentation models to calculate standard fetal cardiothoracic measurements. In an internal test set of 4,108 fetal surveys (0.9% CHD, >4.4 million images), the model achieved an area under the curve (AUC) of 0.99, 95% sensitivity (95% confidence interval (CI), 84-99%), 96% specificity (95% CI, 95-97%) and 100% negative predictive value in distinguishing normal from abnormal hearts. Model sensitivity was comparable to that of clinicians and remained robust on outside-hospital and lower-quality images. The model's decisions were based on clinically relevant features. Cardiac measurements correlated with reported measures for normal and abnormal hearts. Applied to guideline-recommended imaging, ensemble learning models could significantly improve detection of fetal CHD, a critical and global diagnostic challenge.
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Affiliation(s)
- Rima Arnaout
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. .,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA. .,Center for Intelligent Imaging, University of California, San Francisco, San Francisco, CA, USA. .,Biological and Medical Informatics, University of California, San Francisco, San Francisco, CA, USA. .,Chan Zuckerberg Biohub, University of California, San Francisco, San Francisco, CA, USA.
| | - Lara Curran
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Yili Zhao
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco,, San Francisco, CA, USA
| | - Jami C Levine
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard School of Medicine, Boston, MA, USA
| | - Erin Chinn
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Anita J Moon-Grady
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco,, San Francisco, CA, USA
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17
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Weichert J, Weichert A. A "holistic" sonographic view on congenital heart disease: How automatic reconstruction using fetal intelligent navigation echocardiography eases unveiling of abnormal cardiac anatomy part II-Left heart anomalies. Echocardiography 2021; 38:777-789. [PMID: 33778977 DOI: 10.1111/echo.15037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/27/2021] [Accepted: 03/06/2021] [Indexed: 12/19/2022] Open
Abstract
Volume ultrasound has been shown to provide valid complementary information on fetal anatomy. Four-dimensional assessment (4D) of the fetal cardiovascular system using spatial-temporal image correlation (STIC) allows for detailed examination of a highly complex organ from the early second trimester onward. There is compelling evidence that this technique harbors quite a number of diagnostic opportunities, but manual navigation through STIC volume datasets is highly operator dependent. In fact, STIC is not incorporated yet into daily practice. Application of the novel fetal intelligent navigation echocardiography (FINE) considerably simplifies fetal cardiac volumetric examinations. This automatic technique applied on cardiac volume datasets reportedly has both high sensitivity and specificity for the detection of congenital heart defects (CHDs). Part I reviewed current data regarding detection rates of CHDs and illustrated the additional value of an automatic approach in delineating cardiac anatomy exemplified by congenital lesions of the right heart. In part II of this pictorial essay, we focused on left heart anomalies and aimed to tabulate recent findings on the quantification of normal and abnormal cardiac anatomy.
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Affiliation(s)
- Jan Weichert
- Division of Prenatal Medicine, Department of Gynecology and Obstetrics, University Hospital of Schleswig-Holstein, Luebeck, Germany.,Elbe Center of Prenatal Medicine and Human Genetics, Hamburg, Germany
| | - Alexander Weichert
- Department of Obstetrics, Charité-Universitätsmedizin Berlin - CCM, Berlin, Germany.,Prenatal Medicine Bergmannstrasse, Berlin, Germany
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18
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Simpson L, Maturen KE, Feldstein VA, Oliver ER, Poder L, Strachowski LM, Sussman BL, Weber TM, Winter T, Zelop CM, Glanc P. ACR Appropriateness Criteria® Nuchal Translucency Evaluation at 11 to 14 Weeks of Gestation. J Am Coll Radiol 2020; 17:S447-S458. [PMID: 33153556 DOI: 10.1016/j.jacr.2020.09.007] [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] [Received: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 11/20/2022]
Abstract
A fetus with an increased nuchal translucency at 11 to 14 weeks gestation is at risk for aneuploidy, genetic syndromes, structural anomalies, and intrauterine fetal demise in both single and twin gestations. In addition to referral to genetics for counseling and consideration of diagnostic genetic testing, a detailed anatomic survey and fetal echocardiogram are indicated in the second trimester to screen for congenital malformations and major heart defects. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Lynn Simpson
- Columbia University, New York, New York; American College of Obstetricians and Gynecologists.
| | | | | | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Liina Poder
- University of California San Francisco, San Francisco, California
| | | | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | | | - Tom Winter
- University of Utah, Salt Lake City, Utah
| | - Carolyn M Zelop
- Valley Hospital, Ridgewood, New Jersey and NYU School of Medicine, New York, New York; American College of Obstetricians and Gynecologists
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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19
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Bak GS, Shaffer BL, Madriago E, Allen A, Kelly B, Caughey AB, Pereira L. Impact of maternal obesity on fetal cardiac screening: which follow-up strategy is cost-effective? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:705-716. [PMID: 31614030 DOI: 10.1002/uog.21895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To perform a cost-effectiveness analysis of different follow-up strategies for non-obese and obese women who had incomplete fetal cardiac screening for major congenital heart disease (CHD). METHODS Three decision-analytic models, one each for non-obese, obese and Class-III-obese women, were developed to compare five follow-up strategies for initial suboptimal fetal cardiac screening. The five strategies were: (1) no follow-up ultrasound (US) examination but direct referral to fetal echocardiography (FE); (2) one follow-up US, then FE if fetal cardiac views were still suboptimal; (3) up to two follow-up US, then FE if fetal cardiac views were still suboptimal; (4) one follow-up US and no FE; and (5) up to two follow-up US and no FE. The models were designed to identify fetuses with major CHD in a theoretical cohort of 4 000 000 births in the USA. Outcomes related to neonatal mortality and neurodevelopmental disability were evaluated. A cost-effectiveness willingness-to-pay threshold was set at US$100 000 per quality-adjusted life year (QALY). Base-case and sensitivity analysis and Monte-Carlo simulation were performed. RESULTS In our base-case models for all body mass index (BMI) groups, no follow-up US, but direct referral to FE led to the best outcomes, detecting 7%, 25% and 82% more fetuses with CHD in non-obese, obese and Class-III-obese women, respectively, compared with the baseline strategy of one follow-up US and no FE. However, no follow-up US, but direct referral to FE was above the US$100 000/QALY threshold and therefore not cost-effective. The cost-effective strategy for all BMI groups was one follow-up US and no FE. Both up to two follow-up US with no FE and up to two follow-up US with FE were dominated (being more costly and less effective), while one follow-up US with FE was over the cost-effectiveness threshold. One follow-up US and no FE was the optimal strategy in 97%, 93% and 86% of trials in Monte-Carlo simulation for non-obese, obese and Class-III-obese models, respectively. CONCLUSION For both non-obese and obese women with incomplete fetal cardiac screening, the optimal CHD follow-up screening strategy is no further US and immediate referral to FE; however, this strategy is not cost-effective. Considering costs, one follow-up US and no FE is the preferred strategy. For both obese and non-obese women, Monte-Carlo simulations showed clearly that one follow-up US and no FE was the optimal strategy. Both non-obese and obese women with initial incomplete cardiac screening examination should therefore be offered one follow-up US. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G S Bak
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - B L Shaffer
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - E Madriago
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - A Allen
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - B Kelly
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - A B Caughey
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - L Pereira
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
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20
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Abstract
There is a growing interest in neonatologists to train in echocardiography. Recommendations for training have been published by medical societies and working groups, but concerns exist on their feasibility in the face of limited resources. Simulators are increasingly used for training in medicine, including echocardiography. They have the potential to help overcome the shortage of training opportunities. We describe the currently available 2 echocardiography simulators designed for neonatology. Both systems are based on real 3-dimensional echocardiographic data and use an electromagnetic tracking system. Although limited data exist proving their effectiveness, deduction from other disciplines support this assumption.
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Affiliation(s)
- Michael Weidenbach
- Department of Pediatric Cardiology, Heart Center Leipzig, University of Leipzig, Struempellstr. 39, Leipzig 04289, Germany.
| | - Christian Paech
- Department of Pediatric Cardiology, Heart Center Leipzig, University of Leipzig, Struempellstr. 39, Leipzig 04289, Germany
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21
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Bak GS, Shaffer BL, Madriago E, Allen A, Kelly B, Caughey AB, Pereira L. Detection of fetal cardiac anomalies: cost-effectiveness of increased number of cardiac views. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:758-767. [PMID: 31945242 DOI: 10.1002/uog.21977] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 12/22/2019] [Accepted: 12/31/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the recommended three-view fetal heart screening method to detect major congenital heart disease (CHD) with more elaborate screening strategies to determine the cost-effective strategy in unselected (low-risk) pregnancies. METHODS A decision-analytic model was designed to compare four screening strategies to identify fetuses with major CHD in a theoretical cohort of 4 000 000 births in the USA. The four strategies were: (1) three views: four-chamber view (4CV) and views of the left (LVOT) and right (RVOT) ventricular outflow tracts; (2) five views: 4CV, LVOT, RVOT and longitudinal views of the ductal arch and aortic arch; (3) five axial views: 4CV, LVOT, RVOT, three-vessel (3V) view and three-vessels-and-trachea view; and (4) six views: 4CV, LVOT, RVOT and 3V views and longitudinal views of the ductal arch and aortic arch. Outcomes related to neonatal mortality and neurodevelopmental disability were evaluated. The analysis was performed from a healthcare-system perspective, with a cost-effectiveness willingness-to-pay threshold set at $100 000 per quality-adjusted life year (QALY). Baseline analysis, one-way sensitivity analysis and Monte-Carlo simulation were performed. RESULTS In our baseline model, screening with five axial views was the optimal strategy, detecting 3520 more CHDs, and resulting in 259 fewer children with neurodevelopmental disability, 40 fewer neonatal deaths and only slightly higher costs, compared with screening with the currently recommended three views. Screening with six views was more effective, but also cost considerably more, compared with screening with five axial views, and had an incremental cost of $490 023/QALY, which was over the willingness-to-pay threshold. The five-view strategy was dominated by the other three strategies, i.e. it was more costly and less effective in comparison. The data were robust when tested with Monte-Carlo and one-way sensitivity analysis. CONCLUSION Although current guidelines recommend a minimum of three views for detecting CHD during the mid-trimester anatomy scan, screening with five axial views is a cost-effective strategy that may lead to improved outcome compared with three-view screening. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G S Bak
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - B L Shaffer
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - E Madriago
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - A Allen
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - B Kelly
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - A B Caughey
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - L Pereira
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
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22
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Shub A, Lappas M. Pregestational diabetes in pregnancy: Complications, management, surveillance, and mechanisms of disease-A review. Prenat Diagn 2020; 40:1092-1098. [PMID: 32333803 DOI: 10.1002/pd.5718] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/12/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022]
Abstract
Diabetes is an increasingly common diagnosis among pregnant women. Pregestational diabetes is associated with an increase in many adverse pregnancy outcomes, which impact both on the woman and her fetus. The models of pregnancy care for women with diabetes are based largely on observational data or consensus opinion. Strategies for aneuploidy screening and monitoring for fetal well-being should be modified in women with diabetes. There is an increasing understanding of the mechanisms by which congenital anomalies and disorders of fetal growth occur, involving epigenetic modifications, changes in gene expression in critical developmental pathways, and oxidative stress. This knowledge may lead to pathways for improved care for these high-risk pregnancies.
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Affiliation(s)
- Alexis Shub
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Australia.,Perinatal Department, Mercy Hospital for Women, Heidelberg, Australia
| | - Martha Lappas
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Australia
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23
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Yu D, Sui L, Zhang N. Performance of First-Trimester Fetal Echocardiography in Diagnosing Fetal Heart Defects: Meta-analysis and Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:471-480. [PMID: 31463979 DOI: 10.1002/jum.15123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/20/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Early fetal echocardiography is becoming increasing common during the nuchal translucency scan period. The aim of this meta-analysis was to assess the accuracy of first-trimester fetal echocardiography in diagnosing congenital heart defects (CHDs). METHODS The databases of PubMed, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature were systematically searched for the candidate articles, and the references of included studies were also examined. We recorded the characteristics of the included studies and assessed the quality of each study by the Quality Assessment of Diagnostic Accuracy Studies tool. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated with Meta-Disc version 1.4 software (Ramón y Cajal Hospital, Madrid, Spain). We also evaluated the publication bias by using Stata version 12.0 software (StataCorp, College Station, TX). RESULTS This meta-analysis included 18 studies with 26,201 fetal hearts. The overall pooled sensitivity, specificity, PLR, and NLR were 0.750, 0.999, 392.95, and 0.277, respectively. The DOR and AUC were 1736.0 and 0.9331. The pooled sensitivity, specificity, PLR, NLR, DOR, and AUC for major CHDs were 0.838, 1.000, 725.69, 0.203, 5084.8, and 0.9617. CONCLUSIONS First-trimester fetal echocardiography had high value in diagnosing CHDs, especially major CHDs.
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Affiliation(s)
- Dongmei Yu
- Department of Special Examinations, Qingdao Women and Children's Hospital, Qingdao, China
| | - Lun Sui
- Department of Special Examinations, Qingdao Women and Children's Hospital, Qingdao, China
| | - Nan Zhang
- Department of Special Examinations, Qingdao Women and Children's Hospital, Qingdao, China
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24
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Rinaldi B, Race V, Corveleyn A, Van Hoof E, Bauters M, Van Den Bogaert K, Denayer E, de Ravel T, Legius E, Baldewijns M, Aertsen M, Lewi L, De Catte L, Breckpot J, Devriendt K. Next-generation sequencing in prenatal setting: Some examples of unexpected variant association. Eur J Med Genet 2020; 63:103875. [PMID: 32058062 DOI: 10.1016/j.ejmg.2020.103875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 11/28/2019] [Accepted: 02/01/2020] [Indexed: 01/08/2023]
Abstract
The application of next-generation sequencing to fetal pathology has proved to increase the diagnostic yield in fetuses with abnormal ultrasounds. We retrospectively reviewed genetic data of 30 selected cases studied through targeted resequencing of OMIM genes. In our experience, clinical data proved to be essential to support diagnostic reasoning and enhance variants' assessment. The molecular diagnosis was reached in 19/30 (63%) cases. Only in 7/19 cases the molecular diagnosis confirmed the initial diagnostic hypothesis, showing the relevance of the genotype-first approach. According to the genotype-phenotype correlation, we were able to divide the solved cases into three groups: i) the correlation is well established but it was missed due to lack of specificity, unusual presentation or recent description; ii) the clinical presentation is much more severe than currently known for the underlying condition; iii) the correlation does not recapitulate the entire phenotype, possibly due to the fetal presentation or multiple coexisting conditions. Moreover, we found a higher proportion of recessive diagnosis in abnormal fetuses compared to cohorts of individuals with developmental delay. Our findings suggest that fetal pathology may be enriched in rare alleles and/or in unusual combinations, counter-selected in postnatal genomes and thus contributing to both phenotypic extremeness and atypical presentation.
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Affiliation(s)
| | - Valerie Race
- Center for Human Genetics, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium
| | - Anniek Corveleyn
- Center for Human Genetics, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium
| | - Evelien Van Hoof
- Center for Human Genetics, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium
| | - Marijke Bauters
- Center for Human Genetics, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium
| | - Kris Van Den Bogaert
- Center for Human Genetics, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium
| | - Ellen Denayer
- Center for Human Genetics, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium
| | - Thomy de Ravel
- Centre for Medical Genetics, Reproduction and Genetics, University Hospital Brussels, Brussels, Belgium
| | - Eric Legius
- Center for Human Genetics, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium
| | - Marcella Baldewijns
- Department of Pathological Anatomy, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium
| | - Michael Aertsen
- Department of Radiology, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium
| | - Liesbeth Lewi
- Department of Obstetrics & Gynaecology, Fetal Medicine, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium
| | - Luc De Catte
- Department of Obstetrics & Gynaecology, Fetal Medicine, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium
| | - Jeroen Breckpot
- Center for Human Genetics, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium
| | - Koenraad Devriendt
- Center for Human Genetics, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium.
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Gao S, Han J, Yu S, Guo Y, Ruan Y, Fu Y, Hao X, Wang X, Wang S, Zhou X, Shang J, Zhang Y, Li T, Hao X, He Y. Comparison of fetal echocardiogram with fetal cardiac autopsy findings in fetuses with congenital heart disease. J Matern Fetal Neonatal Med 2019; 34:3844-3850. [PMID: 31791182 DOI: 10.1080/14767058.2019.1700498] [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
Objective: Although studies have compared fetal echo results with autopsy findings, investigations that compared multiple categories of congenital heart disease (CHD) are lacking. This study, therefore, aimed to compare fetal echocardiographic diagnoses with cardiac autopsy findings and evaluate the diagnostic accuracy of fetal echocardiography (FE).Methods: One hundred seventy-one specimens from fetuses diagnosed with CHD were collected after termination of pregnancy, and fetal autopsies were performed. FE and autopsy diagnoses were compared and the degree of their correspondence was categorized as "complete agreement" (FE results were in accordance with autopsy findings), "minor discrepancies" (autopsies verified the main FE diagnoses but added and/or revised some minor information), or "discordance" (autopsy findings were different from the primary diagnoses of FE).Results: The "complete agreement" group accounted for 87.1% (149/171) of the total specimens. In 11.7% (20/171) of cases, autopsies disclosed new deformities and/or revised some echo results (minor discrepancies group). Minor abnormalities were frequently embodied in small septal defects and vascular malformations. A rare malformation of common pulmonary vein atresia was confirmed by autopsy in two fetuses, but both were misdiagnosed by FE (discordance group).Conclusions: Fetal echocardiographic diagnoses were mostly consistent with autopsy findings. The diagnostic discrepancies mainly consisted of rare cases and minor abnormalities missed or misdiagnosed by FE. Autopsies may help confirm, modify, or add information to prenatal echo results. They may also help sonographers have a better understanding of the anatomic structures of CHD, especially for rare lesions, which could further improve the diagnostic accuracy and integrity of FE.
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Affiliation(s)
- Shuang Gao
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiancheng Han
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shaomei Yu
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yong Guo
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yanping Ruan
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuwei Fu
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Xiaoyan Hao
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Wang
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Siyu Wang
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoxue Zhou
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianfeng Shang
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ye Zhang
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tianjing Li
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiuxiu Hao
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yihua He
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Rakha S, El Marsafawy H. Sensitivity, specificity, and accuracy of fetal echocardiography for high-risk pregnancies in a tertiary center in Egypt. Arch Pediatr 2019; 26:337-341. [PMID: 31519455 DOI: 10.1016/j.arcped.2019.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/24/2019] [Accepted: 08/02/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Advances in fetal echocardiography training among pediatric cardiologists have led to substantial improvements in prenatal detection of congenital heart diseases (CHDs). Nevertheless, diagnostic accuracy varies among centers. Moreover, this subspecialty continues to evolve in developing countries, with limited studies assessing fetal echocardiography sensitivity, specificity, and accuracy in developing countries such as Egypt. SUBJECT AND METHODS High-risk pregnancies referred for fetal echocardiography from January 2011 to January 2019 were analyzed retrospectively. All of the cases included had one of the high-risk indications for fetal echocardiography. Maternal age and gestational age at the prenatal diagnosis were determined, and detailed fetal and neonatal echocardiograms were documented. The results of fetal and postnatal echocardiography were compared to assess the sensitivity, specificity, and accuracy of fetal echocardiography. A minor lesion was defined when no postnatal intervention was needed and a major anomaly when postnatal cardiac therapy, surgery, or intervention was required. RESULTS Out of 615 pregnant patients referred, comparisons between fetal and neonatal echocardiography were possible in 458 fetuses, with 157 patients excluded from the study. The mean maternal age in the study was 26.97±5.871 years and the mean gestational age at referral was 27.24±5.407 weeks. The most common indication for prenatal echocardiography in this cohort was a family history of CHD (142; 31%) followed by nonimmune hydrops (97; 21.18%) and abnormal obstetrical ultrasound screening (64; 13.97%). We had three false-positive minor diagnoses and four false-negative cases with only one requiring intervention. Prenatal diagnosis in this study was accurate in 98.47% of cases. The sensitivity, specificity, and accuracy of fetal echocardiography in the current work were 97.03%, 99.07%, and 98.47, respectively. CONCLUSION Fetal echocardiography is considered a highly sensitive specific tool for prenatal detection of congenital heart diseases in high-risk pregnancies even in developing countries. However, minor fetal cardiac disorders are challenging to diagnose and family counseling should emphasize the difficulty of excluding or confirming such lesions.
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Affiliation(s)
- S Rakha
- Pediatric Cardiology Unit, Mansoura University Children's Hospital, El Gomhouria St, 35516 Mansoura, Dakahlia Governorate, Egypt.
| | - H El Marsafawy
- Pediatric Cardiology Unit, Mansoura University Children's Hospital, El Gomhouria St, 35516 Mansoura, Dakahlia Governorate, Egypt
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Huang C, Zhao B, Lv S, Mao Y, Guo Q, Pan M, Wang B, Peng X, Chen R. Smart-planes fetal heart (S-planes FH) software to quantitative evaluate the fetal great arteries. J Matern Fetal Neonatal Med 2019; 34:1932-1940. [PMID: 31402727 DOI: 10.1080/14767058.2019.1651279] [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: 10/26/2022]
Abstract
OBJECTIVES To explore the feasibility of applying smart-planes fetal heart (S-Planes FH) to 3D volumes to generate and display the outflow tract views (OFTVs) and evaluate its agreement and reliability in determining fetal vessel dimensions. METHODS A total of 147 normal fetuses in the second or third trimester were enrolled. Once conventional 2D sonographic examination was finished, one or more 3D static volumes were then acquired in the 4-chamber view (4CV). The OFTVs automatically generated and displayed via a simple offline operation using S-Planes FH software. Per fetus, a single qualified S-Planes FH image was selected by an expert. The inner diameters of the aorta (AO) and pulmonary artery (PA) were measured in 2D and S-Planes FH images, respectively. The agreement and reliability of the two methods were verified by the Bland-Altman method and the intraclass correlation coefficient (ICC), respectively. RESULTS A total of 515 3D static volumes were successfully acquired in 147 fetuses. The OFTVs were generated and displayed using S-Planes FH in 138 (93.9%) cases. S-Planes FH had good agreement in measuring the diameters of great arteries (95% CI of limits, -0.9419 to 1.1464 for AO diameter, -0.8871 to 1.7007 for PA diameter). The intraobserver and interobserver ICCs in this study were greater than 0.81, indicating almost perfect reliability of the two methods with regard to observers. CONCLUSIONS S-Planes FH software is a feasible method for generating OFTVs as well as determining vessel dimensions in the second and third trimesters and had good agreement with 2D examination. Therefore, it possesses clinical value in screening for CHD and can be operated by different sonographers.
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Affiliation(s)
- Chao Huang
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, PR China
| | - Bowen Zhao
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, PR China
| | - Shuyi Lv
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, PR China
| | - Yankai Mao
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, PR China
| | - Qiaoqiao Guo
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, PR China
| | - Mei Pan
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, PR China
| | - Bei Wang
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, PR China
| | - Xiaohui Peng
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, PR China
| | - Ran Chen
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, PR China
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Cruz-Lemini M, Nieto-Castro B, Luna-Garcia J, Juarez-Martinez I, Martínez-Rivera M, Bermudez-Rojas MDLL, Rebolledo-Fernández C, Cruz-Martinez R. Prenatal diagnosis of congenital heart defects: experience of the first Fetal Cardiology Unit in Mexico. J Matern Fetal Neonatal Med 2019; 34:1529-1534. [PMID: 31257961 DOI: 10.1080/14767058.2019.1638905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The purpose of this article was to describe our experience with the prenatal diagnosis of CHD in patients referred to our Fetal Cardiology Unit. METHODS Prospective cohort study of consecutive fetuses referred for advanced fetal echocardiography to our Fetal Cardiology Unit during a 3-year period (September 2015-September 2018). RESULTS Totally 809 fetuses were evaluated, with 1263 fetal advanced echocardiographies performed. Suspected cardiac abnormality was the most common indication for referral (62.2%). Only 7.3% of patients had known morbidities or risk factors for CHD. Mean gestational age at first examination was 25.6 ± 6.4 weeks. A total of 528 (65.3%) fetuses were found to have a cardiac defect: 40.7% had isolated CHD while 24.6% had associated anomalies. The most common defects found were ventricular septal defects (20.3%), followed by conotruncal defects (9.7%), hypoplastic left heart syndrome (9.3%), fetal arrhythmias (8.9%), and venous anomalies (8.7%). 31.6% presented abnormal genetic studies, the most frequent being Down syndrome (23/212, 10.8%), followed by DiGeorge syndrome (11/212, 5.2%). CONCLUSIONS Prenatal screening and diagnosis of CHD in Mexico are feasible, with suspected cardiac abnormality being the main reason for referral to a specialized Fetal Cardiology Unit. Efforts must be made to make screening available to the general population in the first and second trimesters of pregnancy by fetal medicine or trained specialists, in order to identify fetal CHD and offer advanced echocardiography, genetic studies, timely fetal cardiac intervention in selected cases, and delivery in tertiary centers, to improve overall survival.
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Affiliation(s)
- Monica Cruz-Lemini
- Fetal Medicine Mexico, Fetal Surgery Unit, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
| | - Belen Nieto-Castro
- Fetal Medicine Mexico, Fetal Surgery Unit, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
| | - Jonahtan Luna-Garcia
- Fetal Medicine Mexico, Fetal Surgery Unit, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
| | - Israel Juarez-Martinez
- Fetal Medicine Mexico, Fetal Surgery Unit, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
| | | | | | - Carlos Rebolledo-Fernández
- Fetal Medicine Mexico, Fetal Surgery Unit, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
| | - Rogelio Cruz-Martinez
- Fetal Medicine Mexico, Fetal Surgery Unit, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
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29
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Style CC, Olutoye OO, Verla MA, Lopez KN, Vogel AM, Lau PE, Cruz SM, Espinoza J, Fernandes CJ, Keswani SG, Lee TC. Fetal echocardiography (ECHO) in assessment of structural heart defects in congenital diaphragmatic hernia patients: Is early postnatal ECHO necessary for ECMO candidacy? J Pediatr Surg 2019; 54:920-924. [PMID: 30954228 PMCID: PMC6709683 DOI: 10.1016/j.jpedsurg.2019.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/27/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to determine the accuracy of fetal echocardiogram (ECHO) for detecting cardiac structural anomalies that may impact Extracorporeal Membrane Oxygenation (ECMO) candidacy in infants with Congenital Diaphragmatic Hernia (CDH). METHODS A retrospective review was performed on fetuses with CDH (January 2007-June 2017). Inclusion criteria were inborn and at least one prenatal and postnatal ECHO. ECHOs were evaluated for structural heart defects. Primary outcomes were accuracy of prenatal fetal ECHO and identify differences between prenatal and postnatal ECHO. Descriptive statistics and Chi-square analysis were performed. RESULTS 131 inborn patients were identified. Mean gestational age of fetal ECHO was 26.6 ± 5.5 weeks. The median time to postnatal ECHO was DOL 1 [0-30]. Fetal ECHO had 92% accuracy, 83% sensitivity, 93% specificity, PPV of 95%, NPV of 92%, and a 90% accuracy for visualization of at least one pulmonary vein into the left atrium on the contralateral (non-CDH) side. Thirty-five percent of patients received ECMO, and 26% had an associated cardiac anomaly. All ECMO patients had an accurate structural fetal ECHO. CONCLUSION Fetal ECHO is sufficient for identifying major structural heart defects at large volume centers with trained pediatric cardiologists and may be used to guide clinical management, particularly in regards to ECMO candidacy. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Candace C Style
- Michael E. DeBakey Department of Surgery-Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Oluyinka O Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; Michael E. DeBakey Department of Surgery-Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; Department of Obstetrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; Department of Gynecology-Maternal Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Mariatu A Verla
- Michael E. DeBakey Department of Surgery-Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Keila N Lopez
- Cardiology-Pediatrics Division, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Adam M Vogel
- Michael E. DeBakey Department of Surgery-Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Patricio E Lau
- Michael E. DeBakey Department of Surgery-Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Stephanie M Cruz
- Michael E. DeBakey Department of Surgery-Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Jimmy Espinoza
- Texas Children's Fetal Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; Department of Obstetrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; Department of Gynecology-Maternal Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Caraciolo J Fernandes
- Pediatrics-Newborn Section, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Sundeep G Keswani
- Texas Children's Fetal Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; Michael E. DeBakey Department of Surgery-Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Timothy C Lee
- Texas Children's Fetal Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; Michael E. DeBakey Department of Surgery-Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
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Qasim A, Johnson CB, Aly MA, Aly AM. Prenatal Diagnosis and Successful Palliation of Absent Aortic Valve with Hypoplastic Left Heart Syndrome: A Case Report and Review of Literature. AJP Rep 2019; 9:e121-e126. [PMID: 30972226 PMCID: PMC6456327 DOI: 10.1055/s-0038-1677480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/02/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Congenital absence of the aortic valve leaflets is a rare association with hypoplastic left heart syndrome (HLHS). Case A 37-year-old pregnant woman was referred for fetal evaluation of possible HLHS at 22 weeks of gestation. The fetal echocardiogram (ECHO) was remarkable for a hypoplastic left atrium, nearly atretic mitral valve, small left ventricle, and a hypoplastic aortic valve with severe aortic insufficiency. A female infant was born at term and postnatal ECHO confirmed the above findings. In addition, there was complete absence of the aortic valve leaflets. The patient underwent Norwood's procedure at day 5 of life with atrial septectomy, over-sewing of the aortic valve annulus, and a 4 mm Sano's shunt between the right ventricle and the main pulmonary artery. She tolerated this surgery well and subsequently underwent a bidirectional Glenn's procedure at 8 months of life. Conclusion Prenatal diagnosis of absent aortic valve should be suspected in the presence of severe aortic insufficiency in the fetal ECHO. Early postnatal intervention is critical as those patients are likely to deteriorate quickly. The over-sewing of the aortic valve may be important to prevent coronary steal and myocardial hypoperfusion which could potentially be detrimental.
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Affiliation(s)
- Amna Qasim
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas
| | - Chelsea B Johnson
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas
| | - Muhammad A Aly
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas
| | - Ashraf M Aly
- Division of Pediatric Cardiology, University of Texas Medical Branch, Galveston, Texas
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31
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Noël C, Gagnon MH, Cardinal MP, Guertin O, Déry A, Têtu C, Vanasse A, Roy-Lacroix MÈ, Poder TG, Marelli AJ, Cavallé-Garrido T, Vaujois L, Bigras JL, Dallaire F. Rationale and Design of the FREQUENCY Study: The Fetal Cardiac Registry of Québec to Improve Resource Utilization in Fetal Cardiology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:459-465.e12. [PMID: 30591407 DOI: 10.1016/j.jogc.2018.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/05/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Prenatal detection of congenital heart diseases (CHD) decreases morbidity and cost. To improve detections rates, most physicians refer pregnant women with high-risk pregnancies to fetal cardiologists even when there is no suspicion of CHD at the second trimester screening. This paper presents the rationale and detailed method of the Fetal Cardiac Registry of Québec to Improve Resource Utilization in Fetal Cardiology (FREQUENCY) study. The overall objective is to assess the impact of second trimester ultrasound screening (U/S) and referral pattern in fetal cardiology on detection rates, health care costs, and resource utilization, as well as perinatal morbidity and mortality. METHODS This multicentre retrospective population-based cohort study will link fetal echocardiography data from all centres performing fetal echocardiography in Québec with administrative health care data. This data linking will allow the determination of a true denominator (all women in Québec who underwent second trimester U/S) with complete follow-up of up to 2 years for offspring. This protocol meets Canadian Task Force Classification II-2. RESULTS The study investigators have collected and cleaned fetal echocardiography data for 24 259 eligible pregnancies referred to fetal cardiology. These data will be matched to approximately 860 000 pregnancies between 2007 and 2015. CONCLUSION The results of the FREQUENCY study will shed light on the impact of the current prenatal CHD screening strategy in Canada.
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Affiliation(s)
- Camille Noël
- Division of Pediatric and Fetal Cardiology, Department of Pediatrics, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
| | - Marie-Hélène Gagnon
- Department of Pediatrics, Montréal Children's Hospital, McGill University, Montréal, QC
| | - Mikhail-Paul Cardinal
- Division of Pediatric and Fetal Cardiology, Department of Pediatrics, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
| | - Olivier Guertin
- Division of Pediatric and Fetal Cardiology, Department of Pediatrics, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
| | - Antoine Déry
- Division of Pediatric and Fetal Cardiology, Department of Pediatrics, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
| | - Cassandre Têtu
- Department of Pediatrics, Montréal Children's Hospital, McGill University, Montréal, QC
| | - Alain Vanasse
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC; Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC
| | - Marie-Ève Roy-Lacroix
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC; Division of Fetal-Maternal Medicine, Department of Obstetrics and Gynecology, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC
| | - Thomas G Poder
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC; Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC; Unité D'évaluation des Technologies et des Modes d'Intervention en Santé, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke Sherbrooke, QC
| | - Ariane J Marelli
- MAUDE Unit (McGill Adult Unit for Congenital Heart Disease Excellence), McGill University, Montréal, QC
| | - Tiscar Cavallé-Garrido
- Division of Pediatric Cardiology, Montréal Children's Hospital, McGill University, Montréal, QC
| | - Laurence Vaujois
- Division of Pediatric and Congenital Cardiology, Department of Pediatrics, Laval University Hospital, Faculty of Medicine, Laval University, Québec City, QC
| | - Jean-Luc Bigras
- Department of Pediatric Cardiology, University Hospital Sainte-Justine, University of Montréal, Montréal, QC
| | - Frédéric Dallaire
- Division of Pediatric and Fetal Cardiology, Department of Pediatrics, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC.
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Kondo M, Ohishi A, Baba T, Fujita T, Iijima S. Can echocardiographic screening in the early days of life detect critical congenital heart disease among apparently healthy newborns? BMC Pediatr 2018; 18:359. [PMID: 30453920 PMCID: PMC6241044 DOI: 10.1186/s12887-018-1344-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/12/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Delayed diagnosis of critical congenital heart disease (CCHD) carries a serious risk of mortality, morbidity, and handicap. As echocardiography is commonly used to diagnose congenital heart disease (CHD), echocardiographic investigations in newborns may be helpful in detecting CCHD earlier and with higher sensitivity than when using other screening methods. The present study aimed to evaluate the effectiveness of echocardiographic screening for CCHD in a tertiary care center. METHODS A retrospective chart review was conducted among newborns delivered at Hamamatsu University Hospital between June 2009 and May 2016. The study included consecutive newborns who underwent early echocardiographic screening (within the first 5 days of life) performed by pediatric cardiologists, were born at ≥36 weeks of gestation, had a birthweight ≥2300 g, and were cared for in the well-baby nursery. Newborns admitted to the neonatal intensive care unit, as well as those with prenatal diagnosis of CHD and/or clinical symptoms or signs of CHD were excluded. Four CHD outcome categories were defined: critical, serious, clinically significant, and clinically non-significant. RESULTS A total of 4082 live newborns were delivered during the study period. Of 3434 newborns who met the inclusion criteria and had complete echocardiography data, 104 (3.0%) were diagnosed as having CHD. Among these, none was initially diagnosed as having critical or serious CHD. Of the 95 newborns who continued follow-up with a cardiologist, 61 (64%) were determined to have non-significant CHDs that resolved within 6 months of life. Review of excluded newborns revealed nine cases of critical or serious CHD; among these newborns, six were diagnosed prenatally and three had some clinical signs of CHD prior to hospital discharge. CONCLUSIONS In our tertiary care center, echocardiography screening within the first 5 days of life did not help improve CCHD detection rate in newborns without prenatal diagnosis or clinical signs of CHD. Echocardiographic screening may be associated with increased rate of false-positives (defects resulting in clinically non-significant CHDs) in newborns without prenatal diagnosis or suspicion of CHD.
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Affiliation(s)
- Miyuki Kondo
- Department of Pediatrics, Hamamatsu University School of Medicine, 1 - 20 - 1 Handayama, Hamamatsu, Shizuoka, 431 - 3192, Japan.
| | - Akira Ohishi
- Department of Pediatrics, Hamamatsu University School of Medicine, 1 - 20 - 1 Handayama, Hamamatsu, Shizuoka, 431 - 3192, Japan
| | - Toru Baba
- Department of Pediatrics, Hamamatsu University School of Medicine, 1 - 20 - 1 Handayama, Hamamatsu, Shizuoka, 431 - 3192, Japan
| | - Tomoka Fujita
- Department of Pediatrics, Hamamatsu University School of Medicine, 1 - 20 - 1 Handayama, Hamamatsu, Shizuoka, 431 - 3192, Japan
| | - Shigeo Iijima
- Department of Pediatrics, Hamamatsu University School of Medicine, 1 - 20 - 1 Handayama, Hamamatsu, Shizuoka, 431 - 3192, Japan
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AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:E13-E24. [PMID: 30308091 DOI: 10.1002/jum.14831] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Congenital Critical Heart Defect Screening in a Health Area of the Community of Valencia (Spain): A Prospective Observational Study. Int J Neonatal Screen 2018; 4:3. [PMID: 33072929 PMCID: PMC7548888 DOI: 10.3390/ijns4010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/02/2018] [Indexed: 11/17/2022] Open
Abstract
Despite the progress in the fetal echocardiographic detection of congenital critical heart defects and neonatal physical examination, a significant number of newborn infants are discharged and readmitted to the hospital in severe condition due to cardiac failure or collapse. The aim of this study was to assess the incidence of undetected critical congenital heart disease (CCHD) by a pulse oximetry-screening program in the maternity wards of hospitals with Perinatal Services in a specific geographic area. This is a prospective observational study performed in in the health area corresponding to the city of Valencia. Eligible infants were consecutively admitted newborn infants in the maternities of the participating hospitals with negative fetal echocardiography after normal physical examination in the delivery room. All patients were screened following a specific pulse oximetry protocol before discharge. A total of 8856 newborn infants were screened. A total of three babies presented with severe congenital cardiac malformation and two babies presented with early onset sepsis. Sensitivity was 100% and specificity was 99.97%, with a positive predictive value of 60% and negative predictive value of 100%. Pulse oximetry screening programs in the early neonatal period constitute a valuable tool to avoid inadvertent hospital discharge of severe cardiac malformations and the subsequent life-threatening complications derived.
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Sánchez Luna M, Pérez Muñuzuri A, Sanz López E, Leante Castellanos JL, Benavente Fernández I, Ruiz Campillo CW, Sánchez Redondo MD, Vento Torres M, Rite Gracia S. Pulse oximetry screening of critical congenital heart defects in the neonatal period. The Spanish National Neonatal Society recommendation. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sánchez Luna M, Pérez Muñuzuri A, Sanz López E, Leante Castellanos JL, Benavente Fernández I, Ruiz Campillo CW, Sánchez Redondo MD, Vento Torres M, Rite Gracia S. Cribado de cardiopatías congénitas críticas en el periodo neonatal. Recomendación de la Sociedad Española de Neonatología. An Pediatr (Barc) 2018; 88:112.e1-112.e6. [DOI: 10.1016/j.anpedi.2017.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/30/2017] [Indexed: 10/18/2022] Open
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Abstract
Fast magnetic resonance imaging (MRI) led to the emergence of 'cine MRI' techniques, which enable the visualization of the beating heart and the assessment of cardiac morphology and dynamics. However, established cine MRI methods are not suitable for fetal heart imaging in utero, where anatomical structures are considerably smaller and recording an electrocardiogram signal for synchronizing MRI data acquisition is difficult. Here we present a framework to overcome these challenges. We use methods for image acquisition and reconstruction that robustly produce images with sufficient spatial and temporal resolution to detect the heart contractions of the fetus, enabling a retrospective gating of the images and thus the generation of images of the beating heart. To underline the potential of our approach, we acquired in utero images in six pregnant patients and compared these with their echocardiograms. We found good agreement in terms of diameter and area measurements, and low inter- and intra- observer variability. These results establish MRI as a reliable modality for fetal cardiac imaging, with a substantial potential for prenatal evaluation of congenital heart defects.
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Ismail AQT, Cawsey M, Ewer AK. Newborn pulse oximetry screening in practice. Arch Dis Child Educ Pract Ed 2017; 102:155-161. [PMID: 27530240 DOI: 10.1136/archdischild-2016-311047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/24/2016] [Accepted: 07/26/2016] [Indexed: 11/04/2022]
Abstract
The concept of using pulse oximetry (PO) as a screening test to identify newborn babies with critical congenital heart defects (CCHD) before life-threatening collapse occurs has been debated for some time now. Several recent large studies have consistently shown that PO screening adds value to existing screening techniques with over 90% of CCHDs detected. It can also help identify newborn babies with low oxygen saturations due to infection, respiratory disease and non-critical CCHD. Many countries have now introduced PO screening as routine practice, and as screening gains more widespread acceptance in the UK, we have focused more on the practical aspects of screening in this article. This includes case reports to demonstrate how the different screening modalities for CCHD work together and the experience of hospitals that have already introduced PO screening programmes (Birmingham Women's Hospital and others). Issues discussed include how and when to screen babies in hospital, what to do with a positive screen and how to screen babies born at home. The UK National Screening Committee is currently investigating the potential feasibility of routine PO screening in the UK, and so it is perhaps a suitable time for individual hospitals to consider the possibility of introducing such screening in their maternity units.
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Affiliation(s)
| | - Matt Cawsey
- Neonatal Unit, Birmingham Women's Hospital, Birmingham, UK
| | - Andrew K Ewer
- Neonatal Unit, Birmingham Women's Hospital, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK
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Xie WQ, Zhou L, Chen Y, Ni B. Circulating microRNAs as potential biomarkers for diagnosis of congenital heart defects. World J Emerg Med 2016; 7:85-9. [PMID: 27313801 DOI: 10.5847/wjem.j.1920-8642.2016.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND MicroRNAs are small non-coding RNAs of approximately 22 nucleotides in length, and play important regulatory roles in normal heart development and the pathogenesis of heart diseases. Recently, a few prospective studies have implicated the diagnostic role of microRNAs in congenital heart defects (CHD). DATA RESOURCES This review retrieved the research articles in PubMed focusing on the altered microRNAs in cardiac tissue or serum of patients with CHD versus healthy normal controls, as well as the studies exploring circulating microRNAs as potential biomarkers for (fetal) CHD. RESULTS Most of the studies of interest were conducted in recent years, implicating that the topic in this review is a newly emerging field and is drawing much attention. Moreover, a number of differentially expressed microRNAs between CHD specimens and normal controls have been reported. CONCLUSION Circulating microRNAs may serve as potential biomarkers for diagnosis of CHD in the future, with more efforts paving the road to the aim.
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Affiliation(s)
- Wan-Qin Xie
- Family Planning Research Institute of Hunan Province, Changsha 410126, China
| | - Lin Zhou
- Family Planning Research Institute of Hunan Province, Changsha 410126, China
| | - Yong Chen
- Family Planning Research Institute of Hunan Province, Changsha 410126, China
| | - Bin Ni
- Family Planning Research Institute of Hunan Province, Changsha 410126, China
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Wang Y, Cao HY, Xie MX, He L, Han W, Hong L, Peng Y, Hu YF, Song BC, Wang J, Wang B, Deng C. Cardiovascular cast model fabrication and casting effectiveness evaluation in fetus with severe congenital heart disease or normal heart. ACTA ACUST UNITED AC 2016; 36:259-264. [DOI: 10.1007/s11596-016-1577-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/01/2016] [Indexed: 11/28/2022]
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