The Application of Crown-Chin Length to Crown-Rump Length Ratio in Predicting Fetal Skeletal Dysplasia at First Trimester

OBJECTIVE

To examine the feasibility of using crown-chin length (CCL) to crown-rump length (CRL) ratio in screening for skeletal dysplasia in the first trimester.

METHODS

Four hundred and eighteen singleton pregnant women were recruited and the ratio of CCL to CRL was calculated according to gestational age. Fetuses with skeletal dysplasia were collected from database in the last 10 years. The CCL/CRL ratios were then calculated and the unpaired Student's t-test was to determine the significance of differences between normal fetuses and fetuses with skeletal dysplasia. Receiver operating characteristic curve was used to show the clinical sensitivity and specificity.

RESULTS

In 418 normal fetuses, CCL increased linearly with gestation from a mean of 20 mm at 11⁺⁰ weeks to 37 mm at 13⁺⁶ weeks (CCL [mm] = 0.51-4 CRL, R²  = 0.824, P = .000). There was also a significant linear association between fetal CCL/CRL ratio and CRL, from a mean of 0.48 at 11⁺⁰ weeks to 0.41 at 13⁺⁶ weeks (CCL/CRL = 0.63-3 CRL, R²  = 0.108, P = .000). In 154 skeletal dysplasia cases, early pregnancy ultrasound images were available in only 16 cases. The CCL/CRL ratio in 10 of 16 fetuses with skeletal dysplasia was above the 95th percentile. Using the 95th percentile as a cut-off, the detection rate, specificity, false-positive rate, and positive likelihood ratio are 62.5, 72.6, 5, and 17.5%, respectively.

CONCLUSIONS

Increased fetal CCL/CRL ratio at 11-14 weeks' gestation is associated with an increased risk of skeletal dysplasia and may be useful in first-trimester screening for this condition.

Evaluation of the Z-score accuracy of noninvasive prenatal testing for fetal trisomies 13, 18 and 21 at a single center

OBJECTIVE

To assess the correlation between Z-scores of positive noninvasive prenatal testing (NIPT) results and the positive predictive value (PPV) of NIPT.

METHODS

Pregnancies with positive NIPT results at Guangzhou Women and Children's Medical Centre between July 2017 and May 2020 were included in this study. Fetal karyotyping or microarray analysis was provided to patients with abnormal NIPT results for confirmatory testing. Logistic regression analyses was applied to study the relationship between the Z scores and the PPV performance. The optimal cutoff values for indicating fetal common trisomies were obtained based on receiver operating characteristic (ROC) curve analysis, and then the PPV were calculated in pregnancies with positive NIPT results at Z-score greater than or equal to cutoff value and in patients with a Z-score between 3 and cutoff value respectively.

RESULTS

A total of 214 pregnancies with positive NIPT results for fetal common trisomies were validated by invasive prenatal diagnosis and follow up in this study. Of these, NIPT indicated trisomy 13 in 25 cases, trisomy 18 in 54 cases and trisomy 21 in 135 patients. Logistic regression analyses showed a significant association (p < 0.05) between the Z-scores and true positive results for T21 and T18. For T13, the significant association was not observed (p > 0.05). The ROC curve analysis showed that the optimal cutoff Z-score for indicating fetal trisomies 13, 18, and 21 were 6.889, 7.574 and 6.612 respectively, and the corresponding area under curve were 0.706, 0.916, and 0.954. In this cohort with abnormal NIPT results, the cutoff values revealed a sensitivity of 96.8% and a specificity of 90% for indicating trisomies 21, and a sensitivity of 88.9% and a specificity of 92.6% for trisomies 18. However, probably due to the sample size, the sensitivity and specificity for indicating trisomy 13 were lower (85.7% and 61.1%) than that for trisomies 21 and 18. The PPVs in pregnancies with positive NIPT results at Z-score greater than or equal to cutoff value were 99.18% (121/122) for trisomy 21, 92.31% (24/26) for trisomy 18 and 46.15% (6/13) for trisomy 13. In patients with a Z-score between 3 and cutoff Z-score, the PPV of NIPT for trisomies 21, 18, and 13 were 30.77% (4/13), 10.71% (3/28), and 8.33% (1/12) respectively. Moreover, by classifying Z scores as 3 ≤ Z < 5, 5 ≤ Z < 10, and Z ≥ 10, the majority of Z scores were above 10 with a PPV of 99% for T21 and just 5.2% were between 3 and 5 with a PPV of 14.3%. In contrast for T18, over a third of tests had Z scores between 3 and 5. The PPV in this group is just over 5%.

CONCLUSIONS

The present results show that the PPV performance of NIPT for fetal trisomies 13, 18, and 21 are closely associated with Z-score. The higher the Z-score, the greater the likelihood that the aneuploidy result is correct. Our experience in evaluating the Z-score accuracy of NIPT in this study could be of use in similar work.

P650 A rare form of cardiac mass: primary cardiac lymphoma

Funding Acknowledgements

We declare no conflict of interest and no financial support

A rare form of cardiac mass

primary cardiac lymphoma

Introduction

Primary tumors of the heart are rare and constitute 5% of all cardiac masses. Primary cardiac lymphoma is a curable form of cancer that responds well to early diagnosis and chemotherapy.

Case report

56 year old male patient presented to our outpatient clinic with abdominal swelling. Echocardiography revealed a mass lesion that surrounded the right ventricle and restricted ventricular diastolic function. The mass lesion was poorly discernable from normal myocardial tissue. Magnetic resonance imaging (MRI) showed an infiltrative mass lesion that filled the right pericardial space, and that surrounded the junction between vena cava superior and the right atrium, as well as the root of the aorta. Subxyphoidal biopsy revealed diffuse large B cell lymphoma. Patient died on the 10th day of chemotherapy.

Discussion

Primary cardiac lymphoma constitutes only 2% of all primary cardiac tumors. Cardiac lymphomas are curable in early stages with chemotherapy without the need for surgical excision. Cardiac lymphoma should be kept in mind when faced with a cardiac mass lesion and imaging modalities such as MRI and PET scanning and tissue biopsy should be utilized before planning surgical interventions since these lesions respond well to chemotherapy

Abstract P650 Figure.

Chromosomal microarray analysis in the prenatal diagnosis of orofacial clefts: Experience from a single medical center in mainland China

The aim of this study was to investigate the value of chromosomal microarray analysis (CMA) for the prenatal diagnosis of orofacial clefts.A total of 143 fetuses with oral clefts were detected by ultrasound during prenatal exam between 2012 and 2017 in our center. We categorized the cases into 4 groups: isolated cleft lip (CL) (CL only), isolated cleft palate (CP only), isolated cleft lip and palate (CLP) (CLP only), and syndromic CLP (combined with other malformations). The CMA was performed in all cases, while 139 fetuses were referred for G-banded chromosome analysis.There were 42 male and 10 female fetuses were born, with a sex ratio of 4.2:1. The isolated CLP group accounted for 74.1% (106/143) of cases, while the isolated CL, isolated CP, and syndromic CP groups accounted for 13.9% (20/143), 2% (3/143), and 10% (14/143), respectively. A total of 11 fetuses had pathogenic copy number variants (CNVs, 7.7%), including isolated CP (1/143, 0.7%), isolated CLP (5/143, 3.5%), and syndromic CLP (5/143, 3.5%). Compared with the CMA results, 5 fetuses were found to have an abnormal karyotype (5/139, 3.6%). However, no abnormalities were found in either karyotype analysis or CMA in the isolated CL group.CMA is a valuable tool for identifying submicroscopic chromosomal abnormalities in the prenatal diagnosis of oral clefts. An excellent outcome can be expected for fetuses with isolated CL that are negative for chromosomal abnormalities.

The effect of myocardial surgical revascularization on left ventricular late potentials

BACKGROUND

The presence of ventricular late potentials (LP) is an important indicator for the development of ventricular tachyarrhythmias due to ischemic heart disease. The effect of myocardial revascularization on LP has remained controversial. The purpose of this study was to determine whether complete myocardial surgical revascularization (CABG) documented by myocardial perfusion scintigraphy might alter the substrate responsible for LP.

METHODS

Prospectively, enrolled patients undergoing elective CABG were evaluated with thallium-201 myocardial perfusion scintigraphy and signal- averaged ECG pre- and postoperatively. SAECG recordings were obtained serially: before, 48-72 hours and 3 months after CABG. LPS were defined as positive if SAECG met at least two of Gomes criteria. Scintigraphies were performed pre- and 3 months postoperatively for determination of the success of revascularization. Changes observed in SAECG recordings after CABG were compared between those with and without successful revascularization.

RESULTS

CABG resulted in successful revascularization in 23 patients and was unsuccessful in 17 (no change or deterioration of the perfusion defects). Preoperative SAECG values were not different between groups except for RMS values. The incidence of LP decreased significantly postoperatively in patients with improved myocardial perfusion, whereas there were no changes in patients who did not have postoperative perfusion improvement (McNemar test, P < 0.05).

CONCLUSIONS

LPs disappear following the elimination of myocardial ischemia by complete surgical revascularization. Persistence of ischemia following CABG usually results in the persistence of late potentials. The incidence of ventricular arrhythmias is expected to be unchanged in these patients and they should be reevaluated for reinterventions.

Soluble P-selectin and the success of thrombolysis in acute myocardial infarction

BACKGROUND

P-Selectin mediates adhesive interactions between platelets, leukocytes and endothelium to form thrombi. Our purpose was to investigate plasma soluble(s) P-selectin levels in patients with acute myocardial infarction (aMI) and the effect of thrombolysis on P-selectin levels.

METHODS

Patients with aMI within the first 6 h of chest pain were enrolled prospectively. sP-selectin levels were determined by ELISA in the plasma of patients with aMI (n=32), stable angina (n=18), and healthy controls (n=15). Samples were obtained before, 3 and 24 h after reperfusion therapy with tissue plasminogen activator. Seven patients showed recurrent angina or failure to reperfuse.

RESULTS

sP-selectin levels were significantly higher in aMI group than other groups (86.7+/-8.7 ng/ml, P<0.05). sP-selectin levels were similar in stable angina and control groups (28.8+/-4.4 vs. 25.4+/-7.3 ng/ml, P=NS). A significant increase in sP-selectin levels was observed 3 h after successful thrombolysis and this was followed by a decrease to near the baseline level late after reperfusion. But patients with failed reperfusion showed sustained high sP-selectin levels after 24 h of thrombolysis (P<0.05).

CONCLUSION

The plasma sP-selectin level is elevated in aMI and it increases further following thrombolytic therapy. This increase is probably induced by activation of endothelial cells or platelets after myocardial ischemia and reperfusion during aMI. As the elevated levels are sustained in patients with failed reperfusion, serial P-selectin levels may be used as a non-invasive indicator of successful thrombolysis in aMI.

Diagnosis and treatment of concomitant aortic and coronary disease: a retrospective study and brief review

Coronary arteriosclerosis seriously complicates the surgical treatment of aortic diseases. The aim of our retrospective study was to determine the incidence of coronary artery disease among our surgical patients in treatment for aortic dissection or aneurysm, and to determine whether coronary intervention before aortic surgery appears to affect outcomes. Between 1 January 1993 and 1 March 1998, our center treated 253 patients for aortic dissection or aneurysm. We examined these cases retrospectively for information on diagnostic and treatment methods, both for the aortic lesions and for concomitant coronary arteriosclerosis. Aortic dissection had been detected in 86 (33.9%) patients and aortic aneurysm in 167 (66.1%). Coronary angiography was performed to search for concomitant coronary artery disease in 29 (33.8%) patients with dissection and in 112 (67.1%) patients with aneurysm; of these, 11 (12. 7%) and 54 (32.3%), respectively, were found to have coronary disease. Among 43 patients with abdominal aortic aneurysm in whom coronary angiography was performed, concomitant coronary disease was detected in 36 (83.7%). Coronary artery bypass surgery was performed in 10 patients who had dissection and in 30 patients who had aneurysm; percutaneous transluminal coronary angioplasty was performed in 7 patients who had aneurysm. Perioperative mortality rates in the dissection and aneurysm groups, overall, were 23.2% and 13.8%, respectively Unfortunately, the prospective, random clinical study that would be necessary to prove the case for or against preoperative coronary angiography among subsets of patients in need of aortic repair would raise ethical questions, given the strength of the information already in our possession, gathered by less formal methods. Our study reinforces existing evidence that preoperative angiography can reduce mortality and morbidity in the elective repair of aortic aneurysm, especially thoracic or abdominal aneurysm. However, angiography should not be performed routinely in cases of aortic dissection and should be withheld in cases of type A dissection.

Aortopulmonary artery fistula. Presenting with congestive heart failure in a patient with aortic dissection

Although it is a rare occurrence, aortic dissections can rupture into the cardiac chambers or great vessels. A review of the English literature revealed only 3 cases of fistula between an aortic false lumen and the main pulmonary artery that were repaired successfully. In this article, we report the case of a chronic type I aortic dissection with an aortopulmonary artery fistula. The patient presented with congestive heart failure. One year earlier he had undergone aortic valve replacement. To our knowledge, this is the 4th case of a successfully repaired type I aortic dissection with rupture into the pulmonary artery and the 1st such case involving a patient who had undergone a previous cardiac operation.

Takayasu arteritis in Turkey

Takayasu arteritis is a non-specific inflammatory process of unknown etiology affecting the aorta and its branches. A retrospective study was done in 14 patients diagnosed as Takayasu arteritis. Eleven patients were female and three were male. Ages ranged from 12 to 30 years. Seven patients had type I arteritis, three patients type II arteritis, and four patients type III Takayasu arteritis. Successful angioplasty was performed in five cases.

A rare indication for stenting: persistent coronary artery spasm

A 34-year-old man presenting with angina both at rest and on exertion was investigated. He developed severe ST segment elevation and a brief period of ventricular tachycardia during an exercise tolerance test. On coronary angiography, 60% fixed luminal narrowing was observed in the proximal left anterior descending coronary artery and a severe spasm developed at this site, leading to temporary total occlusion of the vessel. Successful coronary angioplasty (PTCA) was performed on this lesion, with a residual 15% narrowing. However, the patient had a recurrence of angina 3 weeks later, despite being administered high doses of nitrate and calcium antagonist. During control angiography, the lesion severity was unchanged, but spasm developed again following contrast injection. At this time, a Palmaz-Schatz stent was implanted. Calcium antagonist, nitrate, Ticlopidine and low molecular weight heparin therapy was started. There was no recurrence of symptoms during a 3-month follow-up. The exercise tolerance test, and myocardial perfusion scintigraphy findings were normal and the stent was patent without restenosis at the end of the 3-month follow-up. Intracoronary stent implantation for persistent coronary spasm refractory to conventional medical therapy can be considered a feasible and attractive treatment modality for the control of symptoms.