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Pasieczna M, Kuran-Ohde J, Grzyb A, Bokiniec R, Wójcik-Sęp A, Czajkowski K, Szymkiewicz-Dangel J. Value of fetal echocardiographic examination in pregnancies complicated by preterm premature rupture of membranes. J Perinat Med 2024; 0:jpm-2023-0448. [PMID: 38639637 DOI: 10.1515/jpm-2023-0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/10/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES Cardiopulmonary and infectious complications are more common in preterm newborns after preterm premature rupture of membranes (pPROM). Fetal echocardiography may be helpful in predicting neonatal condition. Our aim was to assess the cardiovascular changes in fetuses from pregnancies complicated by pPROM and possible utility in predicting the intrauterine or neonatal infection, and neonatal heart failure (HF). METHODS It was a prospective study enrolling 46 women with singleton pregnancies complicated by pPROM between 18+0 and 33+6 weeks of gestation and followed until delivery. 46 women with uncomplicated pregnancies served as a control group. Fetal echocardiographic examinations with the assessment of cardiac structure and function (including pulmonary circulation) were performed in all patients. RESULTS Mean gestational age of pPROM patients was 26 weeks. Parameters suggesting impaired cardiac function in fetuses from pPROM were: higher right ventricle Tei index (0.48 vs. 0.42 p<0.001), lower blood flow velocity in Ao z-score (0.14 vs. 0.84 p=0.005), lower cardiovascular profile score (CVPS), higher rate of tricuspid regurgitation (18.2 % vs. 4.4 % p=0.04) and pericardial effusion (32.6 vs. 0 %). Intrauterine infection was diagnosed in 18 patients (39 %). 4 (8.7 %) newborns met the criteria of early onset sepsis (EOS). HF was diagnosed in 9 newborns. In fetal echocardiographic examination HF group had shorter mitral valve inflow time and higher left ventricle Tei index (0.58 vs. 0.49 p=0.007). CONCLUSIONS Worse cardiac function was observed in fetuses from pPROM compared to fetuses from uncomplicated pregnancies.
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Affiliation(s)
- Monika Pasieczna
- 2nd Department of Obstetrics and Gynecology, 37803 Medical University of Warsaw , Warsaw, Poland
| | - Joanna Kuran-Ohde
- 2nd Department of Obstetrics and Gynecology, 37803 Medical University of Warsaw , Warsaw, Poland
- Department of Perinatal Cardiology and Congenital Defects, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Agnieszka Grzyb
- Department of Perinatal Cardiology and Congenital Defects, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Cardiology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Renata Bokiniec
- Department of Neonatology and Neonatal Intensive Care, 37803 Medical University of Warsaw , Warsaw, Poland
| | - Agata Wójcik-Sęp
- Department of Neonatology and Neonatal Intensive Care, 37803 Medical University of Warsaw , Warsaw, Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynecology, 37803 Medical University of Warsaw , Warsaw, Poland
| | - Joanna Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Defects, Centre of Postgraduate Medical Education, Warsaw, Poland
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Kosinski P, Borowski D, Brawura-Biskupski-Samaha R, Cnota W, Debska M, Drews K, Grzesiak M, Jaczynska R, Janiak K, Kaczmarek P, Lipa M, Litwinska M, Luterek K, Olejek A, Polczynska-Kaniak E, Preis K, Szaflik K, Szymkiewicz-Dangel J, Swiatkowska-Freund M, Wegrzyn P, Wielgos M, Wloch A, Zamlynski J, Zamlynski M, Sieroszewski P. Fetal therapy guidelines of the Polish Society of Gynecologists and Obstetricians - Fetal Therapy Section. Ginekol Pol 2024; 95:285-315. [PMID: 38632880 DOI: 10.5603/gpl.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Przemyslaw Kosinski
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, Poland.
| | - Dariusz Borowski
- Clinic of Obstetrics and Gynecology, Provincial Combined Hospital, Kielce, Poland
| | | | - Wojciech Cnota
- Chair and Department of Gynecology and Obstetrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marzena Debska
- National Medical Institute of the Ministry of the Interior and Administration in Warsaw, Poland
| | - Krzysztof Drews
- Department of Perinatology and Women's Diseases, Poznan University of Medical Sciences, Poland
| | - Mariusz Grzesiak
- Department of Perinatology, Obstetrics and Gynecology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- 2nd Chair and Department of Gynecology and Obstetrics, Medical University of Lodz, Poland
| | - Renata Jaczynska
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, Poland
| | - Katarzyna Janiak
- Department of Gynecology, Reproductive, Fetal Therapy and Infertility Diagnosis and Treatment, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Piotr Kaczmarek
- Department of Gynecology, Reproductive, Fetal Therapy and Infertility Diagnosis and Treatment, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Michal Lipa
- National Medical Institute of the Ministry of the Interior and Administration in Warsaw, Poland
| | - Magdalena Litwinska
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Katarzyna Luterek
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, Poland
| | - Anita Olejek
- Department of Gynecology, Obstetrics and Oncological Gynecology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | - Krzysztof Preis
- Department of Gynecology and Obstetrics, Medical University of Gdansk, Poland
- Department of Obstetrics, Gynecology and Gynecological Oncology, Provincial Multi-specialist Hospital in Torun, Poland
| | - Krzysztof Szaflik
- Department of Gynecology, Reproductive, Fetal Therapy and Infertility Diagnosis and Treatment, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Joanna Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Defects, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Piotr Wegrzyn
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, Poland
| | - Miroslaw Wielgos
- National Medical Institute of the Ministry of the Interior and Administration in Warsaw, Poland
- Medical Faculty, Lazarski University, Warsaw, Poland
| | - Agata Wloch
- Chair and Department of Gynecology and Obstetrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jacek Zamlynski
- Department of Gynecology, Obstetrics and Oncological Gynecology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mateusz Zamlynski
- Department of Gynecology, Obstetrics and Oncological Gynecology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Piotr Sieroszewski
- 1st Department of the Gynecology and Obstetrics, Medical University of Lodz, Poland
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3
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Grzyb A, Szymkiewicz-Dangel J. Cerebroplacental hemodynamics in fetuses with transposition of the great arteries and usefulness in predicting neonatal condition. Ultrasound Obstet Gynecol 2023; 62:414-421. [PMID: 37021693 DOI: 10.1002/uog.26211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Literature on cerebroplacental hemodynamics in fetuses with transposition of the great arteries (TGA) is scarce and provides conflicting results regarding the presence of a brain-sparing effect. The aims of this study were to examine Doppler parameters in the middle cerebral artery (MCA) and umbilical artery (UA) in a large cohort of fetuses with TGA, and to assess their possible utility in predicting the need for urgent balloon atrial septostomy (BAS) in the neonate. METHODS This was a retrospective observational study of fetuses diagnosed with TGA between 2008 and 2022 and an age-matched cohort of normal fetuses, conducted in a single tertiary fetal cardiology center. Medical records and echocardiographic examinations were reviewed to collect demographic, sonographic and follow-up data. Selected Doppler parameters were compared between fetuses with TGA and normal fetuses, as well as between TGA fetuses with and those without an associated ventricular septal defect (VSD), to assess the impact of this congenital heart defect on cerebroplacental circulation. Additionally, Doppler indices in patients with a restrictive foramen ovale (FO) were analyzed to identify potential predictors of the need for urgent BAS. RESULTS A total of 541 examinations of 159 fetuses with TGA performed between 19 and 40 weeks' gestation and 1300 examinations of 1215 age-matched normal fetuses were included in the study. MCA pulsatility index (PI) and UA-PI followed expected trends throughout pregnancy, with slightly higher values observed in TGA fetuses, albeit within the limits for the normal population. Cerebroplacental ratio (CPR) values were similar in normal and TGA fetuses. The presence of a small VSD did not have a clinically significant impact on Doppler parameters. Peak systolic velocity (PSV) in the MCA increased gradually after 35 weeks' gestation, especially in fetuses that did not develop restriction of the FO after birth. MCA-PSV values below 1.16 multiples of the median measured at 38 weeks or later predicted the need for urgent BAS with 81.4% sensitivity and 52.4% specificity. CONCLUSIONS MCA-PI, UA-PI and CPR values in fetuses with TGA usually fall within normal limits throughout pregnancy. The presence of a small VSD does not affect the Doppler parameters significantly. MCA-PSV increases in TGA fetuses after 35 weeks, and its value measured at the last prenatal examination (ideally after 37 weeks) may serve as an additional predictive factor for the need for urgent BAS. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Grzyb
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Cardiology, The Children's Memorial Health Institute, Warsaw, Poland
| | - J Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
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Bekiesinska-Figatowska M, Sobieraj P, Pasieczna M, Szymkiewicz-Dangel J. Early Diagnosis of Tuberous Sclerosis Complex: Prenatal Diagnosis. AJNR Am J Neuroradiol 2023; 44:1070-1076. [PMID: 37536734 PMCID: PMC10494953 DOI: 10.3174/ajnr.a7952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/25/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND PURPOSE Strong emphasis has been placed recently on early (4 postnatal months) detection of tuberous sclerosis complex and the introduction of antiepileptic treatment before seizure onset. This objective can be achieved prenatally: Cardiac rhabdomyomas and the major diagnostic tuberous sclerosis complex sign are detected during fetal ultrasound, and prenatal MR imaging allows detection of cerebral major manifestations: cortical tubers, subependymal nodules, and subependymal giant cell astrocytomas. MATERIALS AND METHODS We retrospectively reviewed 50 fetuses with ultrasound-detected cardiac tumors at 19-36 gestational weeks (median, 31 weeks). MR imaging with the use of 1.5T scanners was performed at 24-37 gestational weeks (median, 34 weeks). RESULTS In 11 fetuses (22%), cardiac tumors remained the only criterion. In remaining 39 fetuses (78%), MR imaging revealed a prenatal diagnosis of tuberous sclerosis complex, having shown an additional 1-3 major criteria: subependymal nodules in all cases (39/39 = 100.0%), subependymal giant cell astrocytomas in 6 (6/39 = 15.4%), and cortical tubers in 24 (24/39 = 61.5%). Radial migration lines and cerebellar tuber, not published so far, were shown in 1 case each. CONCLUSIONS A schedule of proper care of children with tuberous sclerosis complex can be established during the perinatal period due to education of women to report for mandatory ultrasound examinations during pregnancy, the good quality of ultrasound, and referral to MR imaging if a cardiac tumor is depicted on ultrasound. Gynecologists and pediatric cardiologists performing fetal ultrasound and radiologists performing prenatal MR imaging are a key to early diagnosis of tuberous sclerosis complex in many cases.
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Affiliation(s)
- M Bekiesinska-Figatowska
- From the Department of Diagnostic Imaging (M.B.-F., P.S.), Institute of Mother and Child, Warsaw, Poland
| | - P Sobieraj
- From the Department of Diagnostic Imaging (M.B.-F., P.S.), Institute of Mother and Child, Warsaw, Poland
| | - M Pasieczna
- Second Department of Obstetrics and Gynecology (M.P.), Medical University of Warsaw, Warsaw, Poland
| | - J Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Anomalies (J.S.-D.), Centre of Postgraduate Medical Education, Warsaw, Poland
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Feduniw S, Muzyka-Placzyńska K, Kajdy A, Wrona M, Sys D, Szymkiewicz-Dangel J. Intrapartum cardiotocography in pregnancies with and without fetal CHD. J Perinat Med 2022; 50:961-969. [PMID: 35534874 DOI: 10.1515/jpm-2021-0139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/24/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Congenital heart defects (CHD) are the most common inherited abnormalities. Intrapartum cardiotocography (CTG) is still considered a "gold standard" during labor. However, there is a lack of evidence regarding the interpretation of intrapartum CTG in fetuses with CHD. Therefore, the study aimed to compare intrapartum CTG in normal fetuses and fetuses with CHD and describe the association between CTG and neonatal outcomes. METHODS The present study is a retrospective analysis of the CTG of 395 fetuses. There were three study groups: Group 1: 185 pregnancies with a prenatal diagnosis of CHD, Group 2: 132 high-risk pregnancies without CHD, and Group 3: 78 low-risk pregnancies without CHD. RESULTS Abnormal CTG was present statistically OR=3.4 (95%CI: 1.61-6.95) more often in Group 1. The rate of the emergency CS was higher in this group OR=3 (95%CI: 1.3-3.1). Fetuses with CHD and abnormal CTG were more often scored ≤7 Apgar, with no difference in acidemia. The multivariate regression model for Group 1 does not show clinical differences between Apgar scores or CTG assessment in neonatal acidemia prediction. CONCLUSIONS CTG in fetuses with CHD should be interpreted individually according to the type of CHD and conduction abnormalities. Observed abnormalities in CTG are associated with the fetal heart defect itself. Preterm delivery and rapid cesarean delivery lead to a higher rate of neonatal complications. Health practitioners should consider this fact during decision-making regarding delivery in cases complicated with fetal cardiac problems.
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Affiliation(s)
- Stepan Feduniw
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marcin Wrona
- Department of Gynecological Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Joanna Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
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6
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Grzyb A, Koleśnik A, Bokiniec R, Szymkiewicz-Dangel J. Tetralogy of Fallot in the fetus - from diagnosis to delivery. 18-year experience of a tertiary Fetal Cardiology Center. Kardiol Pol 2022; 80:834-841. [PMID: 35579022 DOI: 10.33963/kp.a2022.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Tetralogy of Fallot (TOF) is a common congenital heart disease but very heterogeneous in terms of detailed cardiac anatomy, associated malformations, and genetic anomalies, especially when assessed prenatally. AIMS We aimed to analyze the clinical spectrum of TOF in the prenatal period, including detailed cardiac morphology, coexisting anomalies, and their impact on short-term neonatal outcome. We also assessed changing trends in the prenatal diagnostic workup of TOF. METHODS A retrospective cohort study including fetuses diagnosed with TOF between 2002 and 2019 was conducted in a tertiary Fetal Cardiology Center. Medical records and echocardiographic examinations were reviewed to collect demographic, sonographic, and genetic data. RESULTS Among 326 TOF fetuses, 237 (73%) had pulmonary stenosis (TOF-PS), 72 (22%) pulmonary atresia (TOF-PA), and 17 (5%) absent pulmonary valve (TOF-APV). The yearly number of diagnoses increased during the study period, with decreasing fetal age at the time of diagnosis. Extracardiac malformations were found in 172 (53%) fetuses, cardiovascular malformations in 159 (49%), and genetic anomalies in 99 (39% of the tested group). Hypoplastic thymus, right aortic arch, and polyhydramnios were sonographic markers of microdeletion 22q11. Left-to-right ductal flow was predictive of postnatal ductal dependency. The perinatal outcome was dependent on the presence of associated anomalies and disease subtype, with TOF-APV having the worst prognosis. CONCLUSIONS Extracardiac and genetic anomalies are common in fetuses with TOF, and, together with disease subtype and ductal flow assessment, they impact the perinatal management and outcomes. Genetic testing with array comparative genomic hybridization should be offered in all cases.
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Affiliation(s)
- Agnieszka Grzyb
- Department of Perinatal Cardiology and Congenital Anomalies, Center of Postgraduate Medical Education, Warszawa, Poland.,Department of Cardiology, The Children's Memorial Health Institute, Warszawa, Poland
| | - Adam Koleśnik
- Cardiovascular Interventions Laboratory, The Children's Memorial Health Institute, Warszawa, Poland.,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warszawa, Poland
| | - Renata Bokiniec
- Department of Neonatology and Intensive Care, Medical University of Warsaw, Warszawa, Poland
| | - Joanna Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Center of Postgraduate Medical Education, Warszawa, Poland.
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Szymkiewicz-Dangel J, Hussey MM. Liver herniation into the pericardium mimicking a pericardial tumor: unusual presentation of trisomy 13. J Ultrason 2021; 21:e353-e356. [PMID: 34970448 PMCID: PMC8678639 DOI: 10.15557/jou.2021.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/06/2021] [Indexed: 11/22/2022] Open
Abstract
Aim of the study: Trisomy 13 is the third most common autosomal trisomy. The following case report shows an atypical case of trisomy 13, highlighting the usefulness of 3D volume storage and reconstruction, and the necessity of careful interpretation of the first trimester screening results. Case description: The results of the first trimester screening tests were interpreted as normal, and invasive tests were not recommended. At 21 weeks, a bright spot in the left ventricle was noted, and fetal echocardiography was performed at 33 weeks. The scan showed a massive pericardial effusion and a pericardial tumor located in front of the right ventricle. Conclusions: The final diagnosis, made postnatally, revealed an atypical right-sided diaphragmatic hernia. Part of the liver was displaced to the pericardial cavity, mimicking a pericardial tumor in a baby with trisomy 13. Following the diagnosis of the lethal disorder, the baby was discharged under a home-based palliative care program and died on the 49th day of life.
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Affiliation(s)
- Joanna Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
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Rebizant B, Koleśnik A, Grzyb A, Chaberek K, Sękowska A, Witwicki J, Szymkiewicz-Dangel J, Dębska M. Fetal Cardiac Interventions-Are They Safe for the Mothers? J Clin Med 2021; 10:jcm10040851. [PMID: 33669554 PMCID: PMC7922873 DOI: 10.3390/jcm10040851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 12/28/2022] Open
Abstract
The aim of fetal cardiac interventions (FCI), as other prenatal therapeutic procedures, is to bring benefit to the fetus. However, the safety of the mother is of utmost importance. The objective of our study was to evaluate the impact of FCI on maternal condition, course of pregnancy, and delivery. 113 mothers underwent intrauterine treatment of their fetuses with critical heart defects. 128 percutaneous ultrasound-guided FCI were performed and analyzed. The patients were divided into four groups according to the type of FCI: balloon aortic valvuloplasty (fBAV), balloon pulmonary valvuloplasty (fBPV), interatrial stent placement (IAS), and balloon atrioseptoplasty (BAS). Various factors: maternal parameters, perioperative data, and pregnancy complications, were analyzed. There was only one major complication—procedure-related placental abruption (without need for blood products transfusion). There were no cases of: procedure-related preterm prelabor rupture of membranes (pPROM), chorioamnionitis, wound infection, and anesthesia associated complications. Tocolysis was only necessary only in two cases, and it was effective in both. None of the patients required intensive care unit admission. The procedure was effective in treating polyhydramnios associated with fetal heart failure in six out of nine cases. Deliveries occurred at term in 89%, 54% were vaginal. The results showed that FCI had a negligible impact on a further course of pregnancy and delivery.
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Affiliation(s)
- Beata Rebizant
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (K.C.); (A.S.)
- Correspondence: Correspondence: (B.R.); (M.D.); Tel.: +48-508130737 (B.R.); +48-607449302 (M.D.)
| | - Adam Koleśnik
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, US Clinic Agatowa, 03-680 Warsaw, Poland; (A.K.); (A.G.); (J.S.-D.)
- Cardiovascular Interventions Laboratory, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, 02-004 Warsaw, Poland
| | - Agnieszka Grzyb
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, US Clinic Agatowa, 03-680 Warsaw, Poland; (A.K.); (A.G.); (J.S.-D.)
- Department of Cardiology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
| | - Katarzyna Chaberek
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (K.C.); (A.S.)
| | - Agnieszka Sękowska
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (K.C.); (A.S.)
- Pain Clinic, Department of Anesthesiology and Intensive Care, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland
| | - Jacek Witwicki
- Department of Neonatology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland;
| | - Joanna Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, US Clinic Agatowa, 03-680 Warsaw, Poland; (A.K.); (A.G.); (J.S.-D.)
| | - Marzena Dębska
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (K.C.); (A.S.)
- Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland
- Correspondence: Correspondence: (B.R.); (M.D.); Tel.: +48-508130737 (B.R.); +48-607449302 (M.D.)
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9
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Pasieczna M, Kuran-Ohde J, Kajdy A, Filipecka-Tyczka D, Świątek N, Szymkiewicz-Dangel J. Monoamniotic twins pregnancy complicated by a fetal congenital heart defect – a challenge for perinatal decisions. Case Reports in Perinatal Medicine 2020. [DOI: 10.1515/crpm-2020-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
To analyze pregnancy management and postnatal follow-up in monochorionic monoamniotic (MCMA) pregnancies complicated by a congenital heart defect (CHD) in one twin and to compare the results with current recommendations concerning time and mode of delivery in MCMA pregnancies.
Cases presentation
Perinatal medical records of five pairs of monoamniotic twins referred to Fetal Cardiology Department were analyzed. 5 out of 23 MCMA pregnancies (21.7%) were complicated by CHD in one fetus. Cesarean section (CS) was performed between 32 and 35 weeks of gestation (WoG). 9 out of 10 neonates had respiratory failure, including all patients with CHD. Twins without congenital abnormalities spent median 21 days (range 10–40 days) in neonatal units. Patients with CHD were transferred to cardiology departments on average 6th day of life. All were operated on later than term-born neonates, 4 out of 5 required stage surgery and their median stay in the hospital was 75 days (range 48–106 days).
Conclusions
According to current recommendations, delivery in MCMA pregnancies should be scheduled at 32–34 weeks. In cases complicated by CHD in one twin, such early delivery complicates surgical treatment and may affect the final outcome. Low body weight and respiratory disorders increase the risk of complications in the perioperative period and prolong hospitalization.
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Affiliation(s)
- Monika Pasieczna
- 2nd Department of Obstetrics and Gynecology , Medical University of Warsaw , Warsaw , Poland
| | - Joanna Kuran-Ohde
- 2nd Department of Obstetrics and Gynecology , Medical University of Warsaw , Warsaw , Poland
- Department of Perinatal Cardiology and Congenital Anomalies , Centre of Postgraduate Medical Education , Warsaw , Poland
| | - Anna Kajdy
- Department of Reproductive Health , Centre of Postgraduate Medical Education , Warsaw , Poland
| | | | - Natalia Świątek
- Scientific Students’ Club of Fetal Cardiology, Medical University of Warsaw , Warsaw , Poland
| | - Joanna Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Anomalies , Centre of Postgraduate Medical Education , Warsaw , Poland
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Pasieczna M, Koleśnik A, Królicki L, Duczkowski M, Bekiesińska-Figatowska M, Szymkiewicz-Dangel J. Fetal echocardiography gives a clue for the maternal diagnosis of tuberous sclerosis complex. J Clin Ultrasound 2019; 47:555-557. [PMID: 31297820 DOI: 10.1002/jcu.22754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 06/03/2019] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
The detection of multiple cardiac tumors during fetal echocardiography allowed us to make the diagnosis of tuberous sclerosis complex in the mother and establish the reason of her first epileptic seizures.
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Affiliation(s)
- Monika Pasieczna
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Warszawa, Poland
| | - Adam Koleśnik
- Department of Perinatal Cardiology and Congenital Anomalies, The Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Leszek Królicki
- Department of Nuclear Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marek Duczkowski
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
| | | | - Joanna Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, The Centre of Postgraduate Medical Education, Warsaw, Poland
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Kajdy A, Materny A, Modzelewski J, Baszczeska J, Rabijewski M, Szymkiewicz-Dangel J. Spontaneous resolution of prenatally diagnosed isolated pleural effusion: An unusual early sign of a newborn disease. J Obstet Gynaecol Res 2019; 45:2466-2469. [PMID: 31478277 DOI: 10.1111/jog.14113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022]
Abstract
We present a case report of a fetus with a diagnosed pleural effusion in the first trimester on nuchal translucency scan. The effusion resolved spontaneously by 17 weeks of pregnancy. Toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH) - negative. Array comparative genomic hybridization (aCGH) - normal. Serial Doppler scans normal - no prenatal signs of anemia. Maternal antibodies against red cell antigens - negative. Delivery at term by cesarean section because of macrosomia. Neonate suffered from prolonged jaundice. At 3 weeks of life diagnosed with hereditary spherocytosis. Literature review shows that this may be the first connection between this disease and prenatal life.
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Affiliation(s)
- Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Neonatology, Saint Sophia Hospital, Warsaw, Poland
| | - Anna Materny
- Department of Neonatology, Saint Sophia Hospital, Warsaw, Poland
| | - Jan Modzelewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Neonatology, Saint Sophia Hospital, Warsaw, Poland
| | | | - Michał Rabijewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Joanna Szymkiewicz-Dangel
- Department of Prenatal Cardiology and Congenital Defects, Center of Postgraduate Medical Education, Warsaw, Poland
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Bokiniec R, Własienko P, Szymkiewicz-Dangel J, Borszewska-Kornacka MK. Echocardiographic analysis of left ventricular function in term and preterm neonates at week 40 of postconceptional life. Kardiol Pol 2019; 77:445-450. [PMID: 30835331 DOI: 10.5603/kp.a2019.0040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Both gestational and chronological age of the neonate may influence and impair the function of the delicate and immature myocardium. However, the transition from fetal to neonatal circulation in preterm neonates is poorly understood. AIMS This study aimed to compare left ventricular (LV) systolic and diastolic function between premature neonates at expected term and term neonates during the postnatal cardiovascular transitional period. METHODS Using echocardiography, we assessed systolic and diastolic function of the LV in 89 preterm neonates at week 40 of postconceptional age and 29 term neonates after closure of the patent ductus arteriosus (PDA) and on the 28th day of life. Based on M‑mode images, we measured myocardial thickness and fractional shortening (FS%). Using pulsed‑wave Doppler echocardiography, we estimated cardiac output, myocardial performance index (MPI), and LV diastolic function (E and A waves, E/A ratio). Systolic and diastolic function was also assessed by tissue Doppler imaging. RESULTS Compared with term neonates on the 28th day of life, preterm neonates had reduced myocardial thickness (P ≤0.04), FS% (P = 0.002), and cardiac output (P = 0.01). However, preterm neonates had a lower MPI than term neonates after PDA closure (P <0.001) and on the 28th day of life (P = 0.02). The E/A ratio and S' wave values were similar in preterm and term neonates (P >0.05). CONCLUSIONS Preterm neonates at 40 weeks of postconceptional age have preserved systolic and diastolic function of the LV.
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Affiliation(s)
- Renata Bokiniec
- Neonatal and Intensive Care Department, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Własienko
- Perinatal Cardiology Unit, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
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Bokiniec R, Własienko P, Borszewska-Kornacka M, Szymkiewicz-Dangel J. Evaluation of left ventricular function in preterm infants with bronchopulmonary dysplasia using various echocardiographic techniques. Echocardiography 2017; 34:567-576. [DOI: 10.1111/echo.13488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Renata Bokiniec
- Neonatal and Intensive Care Department; Medical University of Warsaw; Warsaw Poland
| | - Paweł Własienko
- Perinatal Cardiology Unit; Medical University of Warsaw; Warsaw Poland
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Bokiniec R, Własienko P, Borszewska-Kornacka M, Szymkiewicz-Dangel J. Echocardiographic evaluation of right ventricular function in preterm infants with bronchopulmonary dysplasia. Echocardiography 2017; 34:577-586. [PMID: 28229480 DOI: 10.1111/echo.13489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM To evaluate right ventricular function in preterm infants with and without bronchopulmonary dysplasia. METHODS Eighty-nine preterm infants (<32 weeks) were divided into three groups: (1) no-bronchopulmonary dysplasia (n=32); (2) mild-bronchopulmonary dysplasia (n=35); (3) severe-bronchopulmonary dysplasia (n=15). Right ventricular echocardiographic parameters included the following: (1) pulsed-wave Doppler through the tricuspid valve (E/A ratio), pulmonary artery acceleration time, right ventricular ejection time, right ventricular velocity-time integral; (2) tissue Doppler measurements of myocardial velocities and atrioventricular conduction times; (3) pulsed-wave Doppler and tissue Doppler evaluation of myocardial performance index and E/E' ratio; and (4) M-mode detection of right ventricular end-diastolic wall diameter. RESULTS The severe-bronchopulmonary dysplasia group had higher mean right ventricular myocardial performance index (on the 28th day of life by pulsed-wave Doppler) than the no-bronchopulmonary dysplasia (P=.014) or mild-bronchopulmonary dysplasia (P=.031) groups; no differences were found between no-bronchopulmonary dysplasia and mild-bronchopulmonary dysplasia groups (P=.919). A reduction in right ventricular myocardial performance index at later time points was observed in all three groups (P<.05). We found no differences between preterm infants with differing bronchopulmonary dysplasia severity in other right ventricular echocardiographic parameters. CONCLUSION Right ventricular myocardial performance index measured by pulsed-wave Doppler indicates impaired right ventricular function in preterm infants with severe bronchopulmonary dysplasia.
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Affiliation(s)
- Renata Bokiniec
- Neonatal and Intensive Care Department, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Własienko
- Perinatal Cardiology Unit, Medical University of Warsaw, Warsaw, Poland
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Bokiniec R, Własienko P, Borszewska-Kornacka MK, Madajczak D, Szymkiewicz-Dangel J. Myocardial performance index (Tei index) in term and preterm neonates during the neonatal period. Kardiol Pol 2016; 74:1002-9. [PMID: 27112943 DOI: 10.5603/kp.a2016.0056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/25/2016] [Accepted: 03/22/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND The myocardial performance index (MPI) is a noninvasive method to measure global systolic and diastolic myocardial function. In both term and premature neonates, changes in the systolic and diastolic function of the left ventricle (LV) and right ventricle (RV) reflect the degree of neonatal myocardial immaturity and the co-existence of foetal circulation. AIM To assess MPI (or Tei indices) of both ventricles in term and preterm newborns, and to observe MPI trends throughout the neonatal period. METHODS Heart ultrasound imaging was performed on the first day of life (DOL), after patent ductus arteriosus (PDA) closure, and on the 28th DOL, in 29 term and 29 preterm newborns. RVMPI and LVMPI were measured within the preterm group at 40 weeks of post-conception age (PCA). RESULTS A statistically significant reduction in RVMPI was observed in both term and preterm newborns. In term newborns, the RVMPI value on the first DOL was 0.42 ± 14, dropping to 0.29 ± 0.09 after PDA closure, and finally reaching 0.22 ± 0.09 on the 28th DOL. The respective RVMPI values for the preterm newborns were 0.44 ± 0.15, 0.30 ± 0.12, and 0.21 ± 0.08. Little variability in the mean values of LVMPI was observed in both groups throughout the neonatal period. The LVMPI for term neonates in successive measurements was 0.37 ± 0.10, 0.39 ± 0.07, and 0.37 ± 0.11, respectively, and for the preterm neonates it was 0.37 ± 0.10, 0.35 ± 0.09, and 0.36 ± 0.10, respectively. The MPI values from preterm newborns taken at 40 weeks PCA (RVMPI = 0.28 ± 0.09; LVMPI = 0.37 ± 0.05) were comparable to those measured in term newborns after PDA closure. CONCLUSIONS Observed postnatal changes in RVMPI correspond to changes in ventricular function, reflecting the haemodynamic changes of the transitional circulation. The relatively small postnatal changes in LVMPI in term and preterm newborns may reflect an immature myocardium. The RVMPI and LVMPI values at 40 weeks PCA in preterm newborns correlate best with MPI values in term newborns just after PDA closure.
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Sołowiej P, Kowalczyk M, Szymkiewicz-Dangel J. [Coarctation of the aorta--perinatal evolution of the defect]. Kardiol Pol 2016; 74:304. [PMID: 27004548 DOI: 10.5603/kp.2016.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 11/25/2022]
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Dębska M, Szymkiewicz-Dangel J, Koleśnik A, Kretowicz P, Rebizant B, Witwicki J, Dębski R. [Fetal cardiac interventions - are we ready for them?]. Ginekol Pol 2015; 86:280-6. [PMID: 26117987 DOI: 10.17772/gp/2074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of the study was to analyze types and methods of intrauterine fetal cardiac interventions performed between June 2011 and December 2013, and to assess the perinatal management of the neonates. METHODS The program was developed after analysis of the available literature, practical individual training in Linz, Austria, and simulation of the procedure in a dissecting-room. The rules for anesthesia in pregnant women and their fetuses were developed. The interventions were performed in fetuses with critical cardiac defects, in the operating room, under ultrasonographic control. The protocol was approved by the Local Bioethics Committee at the Centre of Postgraduate Medical Education. MATERIAL We included fetuses with critical aortic stenosis (n=29), critical pulmonary stenosis (n=2), and closed or extremely restricted foramen ovale (n=7). Between June 2011 and December 2013, the team comprised of JD, MD and AK conducted 42 interventions in 35 fetuses, including 32 balloon aortic valvuloplasties (in 29 fetuses), 2 pulmonary valvuloplasties, 4 balloon atrial septostomies and 4 atrial septal stent placement. Three fetuses required both, aortic valvuloplasty and fenestration of the atrial septum. RESULTS Out of the 42 procedures, 41 (97%) were technically successful. We recorded 3 cases of fetal demise associated with the intervention. We modulated the protocol of anesthesia given to pregnant women, switching from general to local anesthesia with intravenous sedation. We always provided additional fetal anesthesia with fentanyl and atracurium via the umbilical vein. CONCLUSIONS Based on our 2.5-year experience, it seems safe to conclude that all types of fetal cardiac interventions may be successfully conducted at Polish centers. The procedures are safe for the pregnant women and improve fetal status. Most of the neonates treated prenatally were referred in good general condition to a tertiary pediatric cardiology and cardiac surgery center
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Bokiniec R, Kufel K, Borszewska-Kornacka MK, Szymkiewicz-Dangel J. A Neonate With TGA and Restrictive Foramen Ovale: How to Apply Ordinary Catheterization Through the Umbilical Vein to Rescue the Neonate, a Case Report. J Med Cases 2014. [DOI: 10.14740/jmc1853w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Bokiniec R, Własienko P, Szymkiewicz-Dangel J, Borszewska-Kornacka MK. Doppler tissue imaging assessment of myocardial velocities and atrioventricular time intervals in term newborn infants during the neonatal period. Kardiol Pol 2013; 71:1154-60. [DOI: 10.5603/kp.2013.0296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 11/25/2022]
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Slodki M, Szymkiewicz-Dangel J, Tobota Z, Seligman NS, Weiner S, Respondek-Liberska M. The Polish National Registry for Fetal Cardiac Pathology: organization, diagnoses, management, educational aspects and telemedicine endeavors. Prenat Diagn 2012; 32:456-60. [PMID: 22495926 DOI: 10.1002/pd.3838] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We describe the National Registry for Fetal Cardiac Pathology, a program under the Polish Ministry of Health aimed at improving the prenatal diagnosis, care, and management of congenital heart disease (CHD). METHODS An online database was created to prospectively record diagnosis, prenatal care, delivery, follow-up, and still images and video for fetuses with CHD. A certification program in fetal cardiac ultrasound was also implemented. Optimal screening and referral centers were identified by number of fetuses entered in the Registry yearly by each center. RESULTS From 2004 to 2009, 2910 fetuses with CHD were registered (2473 structural, 437 functional anomalies). The most common reasons for referral for fetal echocardiography were abnormal four-chamber view (56.0%) and extra-cardiac anomalies (8.2% ), while the most common diagnoses were atrioventricular septal defects (10.2%) and hypoplastic left heart syndrome (9.7%). Prenatal diagnosis increased yearly, from 10.0% of neonatal diagnoses in 2003 to 38.0% in 2008. CONCLUSION From inception of the registry up to 2009 there has been a fourfold increase in the number of neonates referred for cardiac surgery in whom the condition was prenatally diagnosed. Equally important achievements include the establishment of a certification program for fetal echocardiography and the organization of prenatal and neonatal management.
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Affiliation(s)
- Maciej Slodki
- Fetal Cardiology Center Type C, Department for Diagnosis and Prevention of Congenital Malformations, Medical University of Lodz and Polish Mother's Memorial Hospital, Lodz, Poland.
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Hamela-Olkowska A, Szymkiewicz-Dangel J, Własienko P, Majewska U, Bokiniec R. [Right ventricular hypertrophic cardiomyopathy in the fetus --may it be caused by chronic oral tocolysis with fenoterol?]. Ginekol Pol 2012; 83:145-148. [PMID: 22568362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
The use of fenoterol in the treatment of preterm labor is associated with the risk of many complications in the mother and the fetus. We present a case of a multipara treated with oral fenoterol due to threatening preterm labor 14 weeks. At 35 weeks of gestation the fetus was diagnosed with hypertrophic cardiomyopathy with severe impairment of the right ventricle. The only factor that might have caused such a state of the fetal circulatory system was fenoterol, used from 21 weeks of gestation. After the withdrawal of the fenoterol the fetal right ventricular function improved gradually. However fetal cardiac hypertrophy persisted until the birth at 39 weeks of gestation. Concentric hypertrophy of the right ventricular wall and interventricular septum were confirmed in the newborn.
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Affiliation(s)
- Anita Hamela-Olkowska
- Poradnia Perinatologii i Kardiologii Perinatalnej, II Katedra i Klinika Połoznictwa i Ginekologii, Warszawski Uniwersytet Medyczny, Warszawa, Polska.
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Jóźwiak S, Kotulska K, Domańska-Pakieła D, Lojszczyk B, Syczewska M, Chmielewski D, Dunin-Wąsowicz D, Kmieć T, Szymkiewicz-Dangel J, Kornacka M, Kawalec W, Kuczyński D, Borkowska J, Tomaszek K, Jurkiewicz E, Respondek-Liberska M. Antiepileptic treatment before the onset of seizures reduces epilepsy severity and risk of mental retardation in infants with tuberous sclerosis complex. Eur J Paediatr Neurol 2011; 15:424-31. [PMID: 21507691 DOI: 10.1016/j.ejpn.2011.03.010] [Citation(s) in RCA: 208] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 03/25/2011] [Accepted: 03/28/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epilepsy appears in 70-80% of patients with tuberous sclerosis complex, most commonly in the first year of age. Early manifestation of epilepsy is associated with drug-resistant epilepsy and mental retardation in more than 80% of patients. Clinical epileptic seizures are preceded by deterioration of EEG recording thus infants with high risk of epilepsy can be identified. AIMS We hypothesized that preventative antiepileptic treatment of infants with multifocal activity on EEG might lower the incidence of drug-resistant epilepsy and mental retardation. METHODS Forty-five infants with early diagnosis of tuberous sclerosis complex were included in the open-label study. They were divided in two groups: standard (n=31) and preventative one (n=14). In standard group the antiepileptic treatment was launched early, but after the onset of seizures. In preventative group medication was commenced when active epileptic discharges were seen on EEG, but before the onset of clinical seizures. Children were followed till the end of 2 years of age. RESULTS At 24 months of age mental retardation was significantly more frequent and severe in "standard" vs "preventative" group (48% vs 14%; p=0.031; mean IQ score 68.7 vs 92.3; p<0.05). The "preventative" group was characterized by higher ratio of seizure-free patients (93% vs 35%; p=0.004), lower incidence of drug-resistant epilepsy (7% vs 42%; p=0.021) and lower number of patients requiring polytherapy (21% vs 55%; 0.039) than the "standard group. CONCLUSIONS Preventative antiepileptic treatment of infants with tuberous sclerosis complex and high risk of epilepsy markedly improves their neurodevelopmental outcome and reduces the incidence of drug-resistant seizures.
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Affiliation(s)
- Sergiusz Jóźwiak
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland.
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Hamela-Olkowska A, Szymkiewicz-Dangel J. [Quantitative assessment of the right and the left ventricular function using pulsed Doppler myocardial performance index in normal fetuses at 18 to 40 weeks of gestation]. Ginekol Pol 2011; 82:108-113. [PMID: 21574482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE To establish the values of the pulsed Doppler myocardial performance index (MPI, Tei index) for the left and the right ventricle in normal fetuses at 18 to 40 weeks gestation. MATERIAL AND METHODS Echocardiography exams were performed in 140 normal fetuses at 18 to 40 weeks gestation at the tertiary centre for fetal cardiology MPI was calculated in pulsed Doppler using formula: (a-b)/b. The time a was measured from a closure click to the subsequent opening click of the mitral/tricuspid valve and time b from opening to the closure clicks of the aortic/pulmonary valve. RESULTS The mean MPI for the LV was 0.47 +/- 0.07 and for RV 0.48 +/- 0.1. There was no difference between the Tei index LV and the Tei index RV (p = 0.41). We observed a linear correlation between the Tei index LV and the Tei index RV (p = 0.008; r = 0.22). Fetal heart rate and gestational age had no effect on the MPI for both ventricles. CONCLUSIONS The assessed normal values of Tei index for the left and the right ventricles in fetuses may be used in comparison of myocardial performance in various clinical settings.
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Affiliation(s)
- Anita Hamela-Olkowska
- Poradnia Perinatologii i Kardiologii Perinatalnej, II Katedra i Klinika Poloinictwa i Ginekologii Warszawski Uniwersytet Medyczny, Warszawa, Polska.
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Hamela-Olkowska A, Szymkiewicz-Dangel J. [Fetal tachyarrhythmia--current state of knowledge]. Ginekol Pol 2010; 81:844-850. [PMID: 21365901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Fetal tachyarrhythmia occurs in approximately 10% of all fetal arrhythmias. The majority of fetal tachyarrhythmias occur due to atrioventricular reentrant type of supraventricular tachycardia. A fetal tachycardic heart is at risk of developing low cardiac output, hydrops and ultimately fetal death or significant neurological morbidity. Reliable diagnosis of fetal tachyarrhythmia is possible by echocardiography and is crucial for a managed therapeutic approach. The goals of therapy for fetal tachyarrhythmias are to restore sinus rhythm, resolve heart failure and postpone delivery before term. A review of fetal tachyarrhythmias has been reported in our work.
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Affiliation(s)
- Anita Hamela-Olkowska
- Poradnia Perinatologii i Kardiologii Perinatalnej, II Katedra i Klinika Połoznictwa i Ginekologii, Warszawski Uniwersytet Medyczny.
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Hamela-Olkowska A, Szymkiewicz-Dangel J, Romejko-Wolniewicz E, Teliga-Czajkowska J, Czajkowski K. [Cardiotocography in fetal heart arrhythmia--analysis of cases]. Ginekol Pol 2010; 81:622-628. [PMID: 20873126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Cardiotocography (CTG) is routinely used in obstetric units to monitor fetal well-being during pregnancy and labor Nevertheless the use of CTG is limited in cases of fetal arrhythmia, because it truncates the FHR if faster than 210 bpm and slower than 50 bpm. In fetal arrhythmias, with the heart rate between 50 bpm and 210 bpm, CTG may be nonconclusive, difficult to interpret and should not be taken into consideration when making the decision to end the pregnancy especially when it is premature. Until now the usefulness of CTG in the fetal arrhythmia has not been sufficiently described. The following study evaluates typical cases of fetal arrhythmia diagnosed by fetal echocardiography with corresponding cardiotocography and reviews the decision that had been made in each case.
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Affiliation(s)
- Anita Hamela-Olkowska
- II Katedra i Klinika Połoznictwa i Ginekologii, Warszawski Uniwersytet Medyczny, Warszawa.
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Niszczota C, Koleśnik A, Szymkiewicz-Dangel J. [Post-mortem stereomicroscopic examination of embryonic and fetal hearts in the 1st trimester of pregnancy]. Ginekol Pol 2010; 81:197-202. [PMID: 20486541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
UNLABELLED Post-mortem examination of embryos and fetuses becomes increasingly important due to the development of prenatal diagnostic methods. Possibilities of visualization of embryonic and fetal heart in echocardiography and autopsy develops rapidly and due to learning curve there is a need for confirmation of results. There are different methods for visualization of cardiac anatomy. Some morphologists prefer classical histology while others use stereomicroscopy OBJECTIVES To develop our own autopsy routine for embryonic and small fetal hearts. MATERIAL AND METHODS Twenty five normal and malformed fetal hearts aged from 7 to 12 weeks, fixed and unfixed, were submerged in saline solution and dissected using microsurgical instruments. nikon SMZ 1500 microscope, Nikon DS-Fi1 camera and NIS-Elements 3.00 software were used for observation and documentation. The chest was opened by median sternotomy the heart was dissected in situ and sequential segmental analysis was applied. RESULTS Detailed anatomy of atriums, interatrial septum, pulmonary and systemic veins drainage were examined. In all cases it was possible to assess morphology of chambers, atrioventricular and ventriculoarterial connections. Congenital heart defect was diagnosed in only 3 out of 25 cases: one in the 10th week of gestation (complete atrioventricular septal defect--CAVSD) and two in the 12th week of gestation (1 case of CAVSD with trisomy 21 confirmed cytogenetically and one of tetralogy of Fallot). CONCLUSION Microautopsy of fetal heart in the 1st trimester of pregnancy is possible using stereomicroscopy and allows us to diagnose congenital heart diseases. Detailed structures are best visible when specimen is unfixed and submerged in saline solution.
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Affiliation(s)
- Cezary Niszczota
- Zaklad Anatomii Prawidłowej i Klinicznej, Centrum Biostruktury, Warszawski Uniwersytet Medyczny, Warszawa
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Szymkiewicz-Dangel J, Hamela-Olkowska A, Własienko P, Jalinik K, Czajkowski K. [The possibility of evaluation of the myocardial performance index in fetuses at 11,0 to 13,6 week of gestation]. Ginekol Pol 2007; 78:218-22. [PMID: 17650904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES To assess myocardial performance index (Tei index) for left and right ventricle in fetuses at 11.0 to 13.6 week of gestation. MATERIAL AND METHODS Flow velocity waveforms of mitral, tricuspid, aortic and pulmonary valves were obtained. The Tei index for the left ventricle (Tei LV) was calculated in 55, and for the right ventricle (Tei RV) in 27 fetuses. RESULTS The value of Tei LV ranged from 0.28 to 0.59, mean 0.41 +/- 0.08, and for Tei RV from 0.23 to 0.56, mean 0.37 +/- 0.11. There was no statistically important correlation either between Tei index and both ventricles or gestational age and fetal heart rate. The possibility to measure Tei index increased with the progress of the pregnancy. There remains a significant correlation between Tei LV and Tei RV values. CONCLUSIONS Tei index may be useful for the assessment of fetal myocardial performance in the first trimester of pregnancy. Tei index is independent of gestational age and fetal heart rate. It is easier to measure the Tei index for the left ventricle than for the right one.
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Affiliation(s)
- Joanna Szymkiewicz-Dangel
- Poradnia Perinatologii i Kardiologii Perinatalnej, II Katedra i Klinika Połoznictwa i Ginekologii AM w Warszawie.
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Szymkiewicz-Dangel J, Hamela-Olkowska A, Strzyzewski W, Lipiński T, Czajkowski K. [Evaluation of fetal heart anatomy at the end of the first trimester and the beginning of the mid-trimester]. Ginekol Pol 2003; 74:1294-301. [PMID: 14669433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
OBJECTIVE To evaluate fetal heart anatomy in the late first and in the early second trimester. MATERIALS AND METHODS The study included 75 fetuses between 11 and 19 weeks' gestation. Exams were performed using transabdominal or transvaginal probes. RESULTS The proportion of cases successfully visualized to all cases in particular week of pregnancy was following: 11 week--0/1 (0%), 12--1/1 (100%), 13 week--1/1 (100%), 14--18/23 (79%), 15--6/9 (67%), 16--23/27 (86%), 17--4/5 (80%), 18--6/6 (100%), 19--2/2 (100%). In 11 weeks' gestation two ventricles and two atrias could be imaged. Anatomy was seen from 12 weeks' gestation with transvaginal and from 13 weeks' gestation with transabdominal transducers. Two tricuspid regurgitations were detected. The interventricular septum was the most difficult structure to visualize in all cases. The grey scale alone was not sufficient for accurate examination of the heart and it was necessary to use colour Doppler to confirm normal forward flow to both ventricles and to identify outflow tracts. CONCLUSIONS 1. Successful visualization of the heart in early pregnancy is possible from 12 weeks' gestation with transvaginal and from 13 weeks' gestation with transabdominal probe. 2. Fetal echocardiography between first and second trimester should lead to better understanding of fetal hemodynamics in normal and abnormal fetuses and help to introduce new therapeutic treatment in some cases.
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Szymkiewicz-Dangel J. [Fetal arrhythmia--own experience]. Med Wieku Rozwoj 2003; 7:241-54. [PMID: 15537269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Experience in diagnosis and treatment of fetal arrhythmia of Prenatal Cardiology Clinic in the Children's Memorial Health Institute (until 2001), and then the Perinatology and Perinatal Cardiology Clinic of the 2nd Department of Obstetrics and Gynecology in the Medical University of Warsaw are discussed. The author described physiology and pathophysiology of the fetal conduction system, diagnostic and therapeutic methods of fetal arrhythmia. We retrospectively analyzed 130 fetuses with arrhythmia. Median time of diagnosis was 30 weeks, median maternal age 28 years. Extrasystole was the most common type of fetal arrhythmia (83 fetuses). 19 of them had to be closely followed up, because there were structural anomalies in 6 (7.2%) of them, and progression of arrhythmia (bradycardia, supraventricular tachycardia or atrial flutter) in 17. Supraventricular tachycardia was diagnosed in 17 fetuses (12--SVT, 5--atrial flutter AF), and all of them were treated in utero. Transplacental therapy with digoxin, flecainide, sotalol and amiodarone was used, and transumbilical emergency treatment with adenosine was introduced in 2 fetuses with severe hydrops. Complete heart block (CHB) was in 12 fetuses, in 8 with severe heart defects, in 4 was caused by anti-Ro antibodies. We concluded that extrasystole, although in majority were benign condition, in 15% fetuses needed to be followed up, due to heart defect or more serious arrhythmia. Type of rhythm disturbances can change during pregnancy. SVT and AF could be successfully treated transplacentally. All cases with CHB and heart defect died in utero or shortly after birth. Follow up of fetuses with CHB without heart defect seemed to be much better.
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Affiliation(s)
- Joanna Szymkiewicz-Dangel
- II Katedra i Klinika Połoznictwa i Ginekologii, Akademii Medycznej w Warszawie, Szpital Kliniczny im. Ksieznej Anny Mazowieckiej.
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Ksiazyk J, Szymkiewicz-Dangel J, Bieganowska K. [Echocardiography versus angiocardiography of congenital heart defects]. Pol Przegl Radiol 1986; 50:279-84. [PMID: 3302974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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