1
|
Villalaín C, Moon-Grady AJ, Herberg U, Strainic J, Cohen JL, Shah A, Levi DS, Gómez-Montes E, Herraiz I, Galindo A. Prediction of postnatal circulation in pulmonary atresia/critical stenosis with intact ventricular septum: systematic review and external validation of models. Ultrasound Obstet Gynecol 2023; 62:14-22. [PMID: 36776132 DOI: 10.1002/uog.26176] [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: 10/27/2022] [Revised: 01/12/2023] [Accepted: 01/23/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE A favorable postnatal prognosis in cases of pulmonary atresia/critical stenosis with intact ventricular septum (PA/CS-IVS) is generally equated with the possibility of achieving biventricular (BV) repair. Identification of fetuses that will have postnatal univentricular (UV) circulation is key for prenatal counseling, optimization of perinatal care and decision-making regarding fetal therapy. We aimed to evaluate the accuracy of published models for predicting postnatal circulation in PA/CS-IVS using a large internationally derived validation cohort. METHODS This was a systematic review of published uni- and multiparametric models for the prediction of postnatal circulation based on echocardiographic findings at between 20 and 28 weeks of gestation. Models were externally validated using data from the International Fetal Cardiac Intervention Registry. Sensitivity, specificity, predictive values, area under the receiver-operating-characteristics curves (AUCs) and proportion of cases with true vs predicted outcome were calculated. RESULTS Eleven published studies that reported prognostic parameters of postnatal circulation were identified. Models varied widely in terms of the main outcome (UV (n = 3), non-BV (n = 3), BV (n = 3), right-ventricle-dependent coronary circulation (n = 1) or tricuspid valve size at birth (n = 1)) and in terms of the included predictors (single parameters only (n = 6), multiparametric score (n = 4) or both (n = 1)), and were developed on small sample sizes (range, 15-38). Nine models were validated externally given the availability of the required parameters in the validation cohort. Tricuspid valve diameter Z-score, tricuspid regurgitation, ratios between right and left cardiac structures and the presence of ventriculocoronary connections (VCC) were the most commonly evaluated parameters. Multiparametric models including up to four variables (ratios between right and left structures, right ventricular inflow duration, presence of VCC and tricuspid regurgitation) had the best performance (AUC, 0.80-0.89). Overall, the risk of UV outcome was underestimated and that of BV outcome was overestimated by most models. CONCLUSIONS Current prenatal models for the prediction of postnatal outcome in PA/CS-IVS are heterogeneous. Multiparametric models for predicting UV and non-BV circulation perform well in identifying BV patients but have low sensitivity, underestimating the rate of fetuses that will ultimately have UV circulation. Until better discrimination can be achieved, fetal interventions may need to be limited to only those cases in which non-BV postnatal circulation is certain. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- C Villalaín
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University, Madrid, Spain
- Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - A J Moon-Grady
- Department of Pediatrics, Division of Cardiology, University of California San Francisco, UCSF Benioff Children's Hospital, CA, USA
| | - U Herberg
- Klinik für Kinderkardiologie Universitätsklinikum, Aachen, Germany
| | - J Strainic
- Department of Pediatrics, Division of Pediatric Cardiology, The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, University Hospitals of Cleveland Medical Center, Case Western University, Cleveland, OH, USA
| | - J L Cohen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Shah
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Irving Medical Center, New York, NY, USA
| | - D S Levi
- Division of Cardiology, UCLA Mattel Children's Hospital, University of California Los Angeles Medical School, Los Angeles, CA, USA
| | - E Gómez-Montes
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University, Madrid, Spain
- Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - I Herraiz
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University, Madrid, Spain
- Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - A Galindo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University, Madrid, Spain
- Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| |
Collapse
|
2
|
Müller N, Herberg U, Breuer J, Kratz T, Härtel JA. Fitness to fly for children and adolescents after Fontan palliation. Front Cardiovasc Med 2023; 10:1170275. [PMID: 37424899 PMCID: PMC10326614 DOI: 10.3389/fcvm.2023.1170275] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/02/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction At cruising altitude, the cabin pressure of passenger aircraft needs to be adjusted and, therefore, the oxygen content is equivalent to ambient air at 2,500 masl, causing mild desaturation and a rising pulmonary vascular resistance (PVR) in healthy subjects. For Fontan patients with passive pulmonary perfusion, a rising PVR can cause serious medical problems. The purpose of this fitness to fly investigation (FTF) is to assess the risk of air travel for children and adolescents after Fontan palliation. Methods We investigated 21 Fontan patients [3-14y] in a normobaric hypoxic chamber at a simulated altitude of 2,500 m for 3 h. Oxygen saturation, heart rate, and regional tissue saturation in the forehead (NIRS) were measured continuously. Before entering the chamber, after 90 and 180 min in the hypoxic environment, blood gas analysis and echocardiography were performed. Results Heart rate and blood pressure did not show significant intraindividual changes. Capillary oxygen saturation (SaO2) decreased significantly after 90 min by a mean of 5.6 ± 2.87% without further decline. Lactate, pH, base excess, and tissue saturation in the frontal brain did not reach any critical values. In the case of open fenestration between the tunnel and the atrium delta, P did not increase, indicating stable pulmonary artery pressure. Conclusion All 21 children finished the investigation successfully without any adverse events, so flying short distance seems to be safe for most Fontan patients with good current health status. As the baseline oxygen saturation does not allow prediction of the maximum extent of desaturation and adaption to a hypoxic environment takes up to 180 min, the so-called hypoxic challenge test is not sufficient for these patients. Performing an FTF examination over a period of 180 min allows for risk assessment and provides safety to the patients and their families, as well as the airline companies.
Collapse
Affiliation(s)
- N. Müller
- Department for Pediatric Cardiology, Children’s Heart Center UK Bonn, University Hospital Bonn, Bonn, Germany
| | - U. Herberg
- Department for Pediatric Cardiology, Children’s Heart Center UK Bonn, University Hospital Bonn, Bonn, Germany
- Department for Pediatric Cardiology, University Hospital Aachen, Aachen, Germany
| | - J. Breuer
- Department for Pediatric Cardiology, Children’s Heart Center UK Bonn, University Hospital Bonn, Bonn, Germany
| | - T. Kratz
- Department for Pediatric Cardiology, Children’s Heart Center UK Bonn, University Hospital Bonn, Bonn, Germany
| | - J. A. Härtel
- Department for Pediatric Cardiology, Children’s Heart Center UK Bonn, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
3
|
Vollbrecht T, Hart C, Herberg U, Katemann C, Zhang S, Isaak A, Mesropyan N, Kravchenko D, Bischoff ML, Pieper CC, Kütting D, Faridi B, Attenberger U, Geipel A, Luetkens AJ. Doppler-Ultraschall (DUS)-getriggerte fetale Herz-MRT zur Diagnose komplexer Herzfehler bei 3 Tesla: Klinische Etablierung und diagnostische Wertigkeit. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749889] [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] [Indexed: 11/07/2022]
Affiliation(s)
- T Vollbrecht
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - C Hart
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - U Herberg
- Uniklinikum Bonn, Abteilung für Kinderkardiologie, Bonn
| | | | - S Zhang
- Philips GmbH Market DACH, Hamburg
| | - A Isaak
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - N Mesropyan
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - D Kravchenko
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - M L Bischoff
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - C C Pieper
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - D Kütting
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - B Faridi
- Uniklinikum Bonn, Abteilung für Geburtshilfe und Pränatalmedizin, Bonn
| | - U Attenberger
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - A Geipel
- Uniklinikum Bonn, Abteilung für Geburtshilfe und Pränatalmedizin, Bonn
| | - A J Luetkens
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| |
Collapse
|
4
|
Linden K, Otte F, Winkler C, Laser K, Goldschmidt F, Breuer J, Herberg U. Atrioventricular coupling in infants and children assessed by three-dimensional echocardiography. J Am Soc Echocardiogr 2022; 35:976-984. [DOI: 10.1016/j.echo.2022.04.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
|
5
|
Neidlin M, Grünwald A, Korte J, Wilmanns N, Winkler C, Gross-Hardt S, Steinseifer U, Linden K, Herberg U. Intraventricular Flow Dynamics in Single Right Ventricle Patients with Real-Time Echocardiography and Computational Modeling Provide Additional Insight into Cardiac Function. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742954] [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] [Indexed: 10/18/2022]
Affiliation(s)
- M. Neidlin
- Institute of Applied Medical Engineering, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - A. Grünwald
- Institute of Applied Medical Engineering, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J. Korte
- Institute of Applied Medical Engineering, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - N. Wilmanns
- Institute of General Mechanics, RWTH Aachen University, Aachen, Deutschland
| | - C. Winkler
- Department of Pediatric Cardiology, Uniklinik Bonn, Bonn, Deutschland
| | - S. Gross-Hardt
- Institute of Applied Medical Engineering, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - U. Steinseifer
- Institute of Applied Medical Engineering, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - K. Linden
- Department of Pediatric Cardiology, Uniklinik Bonn, Bonn, Deutschland
| | - U. Herberg
- Department of Pediatric Cardiology, Uniklinik Bonn, Bonn, Deutschland
| |
Collapse
|
6
|
Abel JS, Berg C, Geipel A, Gembruch U, Herberg U, Breuer J, Brockmeier K, Gottschalk I. Prenatal diagnosis, associated findings and postnatal outcome of fetuses with truncus arteriosus communis (TAC). Arch Gynecol Obstet 2021:10.1007/s00404-021-06157-w. [PMID: 34453587 DOI: 10.1007/s00404-021-06157-w] [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: 01/30/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess the spectrum of associated anomalies, the intrauterine course, postnatal outcome and management of fetuses with truncus arteriosus communis (TAC) METHODS: All cases of TAC diagnosed prenatally over a period of 8 years were retrospectively collected in two tertiary referral centers. All additional prenatal findings were assessed and correlated with the outcome. The accuracy of prenatal diagnosis was assessed. RESULTS 39 cases of TAC were diagnosed prenatally. Mean gestational age at first diagnosis was 22 weeks (range, 13-38). Two cases were lost follow-up. Correct prenatal diagnosis of TAC was made in 21 of 24 (87.5%) cases and of TAC subtype in 19 of 21 (90.5%) cases. Prenatal diagnosis of TAC was incorrect in three cases: one newborn had aortic atresia with ventricular septal defect postnatally, one had hypoplastic right ventricle with dextro Transposition of the Great Arteries with coartation of the aorta and a third newborn had Tetralogy of Fallot with abnormal origin of the left pulmonary artery arising from the ascending aorta postnatally. These three cases were excluded from further analysis. In 9 of 34 (26.5%) cases, TAC was an isolated finding. 13 (38.2%) fetuses had additional chromosomal anomalies. Among them, microdeletion 22q11.2 was most common with a prevalence of 17.6% in our cohort. Another 3 fetuses were highly suspicious for non-chromosomal genetic syndromes due to their additional extra-cardiac anomalies, but molecular diagnosis could not be provided. Major cardiac and extra-cardiac anomalies occurred in 3 (8.8%) and in 20 (58.8%) cases, respectively. Predominantly, extra-cardiac anomalies occurred in association with chromosomal anomalies. Additionally, severe IUGR occurred in 6 (17.6%) cases. There were 14 terminations of pregnancy (41.2%), 1 (2.9%) intrauterine fetal death, 5 postnatal deaths (14.7%) and 14 (41.2%) infants were alive at last follow-up. Intention-to-treat survival rate was 70%. Mean follow-up among survivors was 42 months (range, 6-104). Postoperative health status among survivors was excellent in 11 (78.6%) infants, but 5 (46.2%) of them needed repeated re-interventions due to recurrent pulmonary artery or conduit stenosis. The other 3 (21.4%) survivors were significantly impaired due to non-cardiac problems. CONCLUSION TAC is a rare and complex cardiac anomaly that can be diagnosed prenatally with high precision. TAC is frequently associated with chromosomal and extra-cardiac anomalies, leading to a high intrauterine and postnatal loss rate due to terminations and perioperative mortality. Without severe extra-cardiac anomalies, postoperative short- and medium-term health status is excellent, independent of the subtype of TAC, but the prevalence of repeated interventions due to recurrent stenosis is high.
Collapse
Affiliation(s)
- J S Abel
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
| | - C Berg
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - U Herberg
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - J Breuer
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - K Brockmeier
- Department of Pediatric Cardiology, University of Cologne, Cologne, Germany
| | - I Gottschalk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
| |
Collapse
|
7
|
Abel JS, Berg C, Geipel A, Gembruch U, Herberg U, Breuer J, Brockmeier K, Gottschalk I. Prenatal diagnosis, associated findings and postnatal outcome of fetuses with truncus arteriosus communis (TAC). Arch Gynecol Obstet 2021; 304:1455-1466. [PMID: 34028563 PMCID: PMC8553718 DOI: 10.1007/s00404-021-06067-x] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/09/2021] [Indexed: 11/18/2022]
Abstract
Purpose To assess the spectrum of associated anomalies, the intrauterine course, postnatal outcome and management of fetuses with truncus arteriosus communis (TAC) Methods All cases of TAC diagnosed prenatally over a period of 8 years were retrospectively collected in two tertiary referral centers. All additional prenatal findings were assessed and correlated with the outcome. The accuracy of prenatal diagnosis was assessed. Results Thirty nine cases of TAC were diagnosed prenatally. Mean gestational age at first diagnosis was 22 weeks (range 13–38). Two cases were lost follow-up. Correct prenatal diagnosis of TAC was made in 87.5% and of TAC subtype in 90.5%. Prenatal diagnosis was incorrect in three cases: one newborn had aortic atresia with ventricular septal defect (VSD) postnatally, one had hypo-plastic right ventricle with dextro transposition of the great arteries (d-TGA) with coarctation of the aorta and a third newborn had tetralogy of fallot (TOF) with abnormal origin of the left pulmonary artery arising from the ascending aorta postnatally. These 3 cases were excluded from further analysis. In 26.5% of cases, TAC was an isolated finding. 38.2% of fetuses had additional chromosomal anomalies. Among them, microdeletion 22q11.2 was most common with a prevalence of 17.6% in our cohort. Another 3 fetuses were highly suspicious for non-chromosomal genetic syndromes due to their additional extra-cardiac anomalies, but molecular diagnosis could not be provided. Major cardiac and extra-cardiac anomalies occurred in between 8.8% and 58.8%, respectively. Predominantly, extra-cardiac anomalies occurred in association with chromosomal anomalies. Additionally, severe IUGR occurred in 17.6%. There were 14 terminations of pregnancy (41.2%), 1 (2.9%) intrauterine fetal death, 5 postnatal deaths (14.7%) and 14 (41.2%) infants were alive at last follow-up. Intention-to-treat survival rate was 70%. Mean follow-up among survivors was 42 months (range 6–104). Postoperative health status among survivors was excellent in 78.6%, but 46.2% needed repeated re-interventions due to recurrent pulmonary artery or conduit stenosis. The other 21.4% of survivors were significantly impaired due to non-cardiac problems. Conclusion Truncus arteriosus communis is a rare and complex cardiac anomaly that can be diagnosed prenatally with high precision. TAC is frequently associated with chromosomal and extra-cardiac anomalies, leading to a high intrauterine and postnatal loss rate due to terminations and perioperative mortality. Without severe extra-cardiac anomalies, postoperative health status is excellent, independent of the subtype of TAC, but the prevalence of repeated interventions due to recurrent stenosis is high.
Collapse
Affiliation(s)
- J S Abel
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Kerpenerstr. 34, 50931, Cologne, Germany
| | - C Berg
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Kerpenerstr. 34, 50931, Cologne, Germany.,Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - U Herberg
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - J Breuer
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - K Brockmeier
- Department of Pediatric Cardiology, University of Cologne, Cologne, Germany
| | - I Gottschalk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Kerpenerstr. 34, 50931, Cologne, Germany.
| |
Collapse
|
8
|
Härtel JA, Müller N, Manunzio U, Manunzio C, De Marées M, Wolber M, Leibold D, Jung T, Breuer J, Herberg U. Erratum to: Physical Exercise Is Safe for Fontan Patients in Hypoxia. Thorac Cardiovasc Surg 2019. [PMID: 30986865 DOI: 10.1055/s-0039-1685202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J A Härtel
- Department of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany
| | - N Müller
- Department of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany
| | - U Manunzio
- Department of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany
- Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - C Manunzio
- Department of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany
- Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - M De Marées
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - M Wolber
- Department of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany
| | - D Leibold
- Department of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany
| | - T Jung
- Department of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany
| | - J Breuer
- Department of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany
| | - U Herberg
- Department of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany
| |
Collapse
|
9
|
Gottschalk I, Abel JS, Menzel T, Herberg U, Breuer J, Gembruch U, Geipel A, Brockmeier K, Berg C. Prenatal diagnosis and postnatal outcome of fetuses with double outlet right ventricle (DORV) in a single center. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671112] [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] [Indexed: 10/28/2022] Open
Affiliation(s)
- I Gottschalk
- Universitätsfrauenklinik Köln, Bereich für Pränatalmedizin und Gynäkologische Sonografie, Köln, Deutschland
| | - JS Abel
- Universitätsfrauenklinik Köln, Bereich für Pränatalmedizin und Gynäkologische Sonografie, Köln, Deutschland
| | - T Menzel
- Universitätsfrauenklinik Köln, Bereich für Pränatalmedizin und Gynäkologische Sonografie, Köln, Deutschland
| | - U Herberg
- Universitätsklinikum Bonn, Abteilung für Kinderkardiologie, Bonn, Deutschland
| | - J Breuer
- Universitätsklinikum Bonn, Abteilung für Kinderkardiologie, Bonn, Deutschland
| | - U Gembruch
- Universitätsklinikum Bonn, Abteilung für Geburtshilfe und Pränatalmedizin, Bonn, Deutschland
| | - A Geipel
- Universitätsklinikum Bonn, Abteilung für Geburtshilfe und Pränatalmedizin, Bonn, Deutschland
| | - K Brockmeier
- Universitätsklinik Köln, Klinik und Poliklinik für Kinderkardiologie, Köln, Deutschland
| | - C Berg
- Universitätsfrauenklinik Köln, Bereich für Pränatalmedizin und Gynäkologische Sonografie, Köln, Deutschland
- Universitätsklinikum Bonn, Abteilung für Geburtshilfe und Pränatalmedizin, Bonn, Deutschland
| |
Collapse
|
10
|
Kovacevic A, Öhman A, Tulzer G, Herberg U, Dangel J, Carvalho JS, Fesslova V, Jicinska H, Sarkola T, Pedroza C, Averiss IE, Mellander M, Gardiner HM. Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study. Ultrasound Obstet Gynecol 2018; 52:221-229. [PMID: 28976617 DOI: 10.1002/uog.18913] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 05/31/2017] [Revised: 08/15/2017] [Accepted: 09/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Fetal aortic stenosis may progress to hypoplastic left heart syndrome. Fetal valvuloplasty (FV) has been proposed to improve left heart hemodynamics and maintain biventricular (BV) circulation. The aim of this study was to assess FV efficacy by comparing survival and postnatal circulation between fetuses that underwent FV and those that did not. METHODS This was a retrospective multicenter study of fetuses with aortic stenosis that underwent FV between 2005 and 2012, compared with contemporaneously enrolled natural history (NH) cases sharing similar characteristics at presentation but not undergoing FV. Main outcome measures were overall survival, BV-circulation survival and survival after birth. Secondary outcomes were hemodynamic change and left heart growth. A propensity score model was created including 54/67 FV and 60/147 NH fetuses. Analyses were performed using logistic, Cox or linear regression models with inverse probability of treatment weighting (IPTW) restricted to fetuses with a propensity score of 0.14-0.9, to create a final cohort for analysis of 42 FV and 29 NH cases. RESULTS FV was technically successful in 59/67 fetuses at a median age of 26 (21-34) weeks. There were 7/72 (10%) procedure-related losses, and 22/53 (42%) FV babies were delivered at < 37 weeks. IPTW demonstrated improved survival of liveborn infants following FV (hazard ratio, 0.38; 95% CI, 0.23-0.64; P = 0.0001), after adjusting for circulation and postnatal surgical center. Similar proportions had BV circulation (36% for the FV cohort and 38% for the NH cohort) and survival was similar between final circulations. Successful FV cases showed improved hemodynamic response and less deterioration of left heart growth compared with NH cases (P ≤ 0.01). CONCLUSIONS We report improvements in fetal hemodynamics and preservation of left heart growth following successful FV compared with NH. While the proportion of those achieving a BV circulation outcome was similar in both cohorts, FV survivors showed improved survival independent of final circulation to 10 years' follow-up. However, FV is associated with a 10% procedure-related loss and increased prematurity compared with the NH cohort, and therefore the risk-to-benefit ratio remains uncertain. We recommend a carefully designed trial incorporating appropriate and integrated fetal and postnatal management strategies to account for center-specific practices, so that the benefits achieved by fetal therapy vs surgical strategy can be demonstrated clearly. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- A Kovacevic
- Royal Brompton NHS Foundation Trust, London, UK; and Department of General Paediatrics, Neonatology and Paediatric Cardiology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - A Öhman
- Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - G Tulzer
- Department of Paediatric Cardiology, Children's Heart Center Linz, Kepler University Hospital, Linz, Austria
| | - U Herberg
- Department of Paediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - J Dangel
- Perinatal Cardiology Department, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - J S Carvalho
- Brompton Centre for Fetal Cardiology, Royal Brompton NHS Foundation Trust, London, UK; and Fetal Medicine Unit, St George's University Hospital NHS Trust and Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | - V Fesslova
- Center of Fetal Cardiology, Policlinico San Donato IRCSS, Milan, Italy
| | - H Jicinska
- University Hospital Brno, Faculty of Medicine, Masaryk University Brno, Czech Republic
| | - T Sarkola
- University of Helsinki and Helsinki University Central Hospital/Children's Hospital, Helsinki, Finland
| | - C Pedroza
- Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - I E Averiss
- The Fetal Center, McGovern Medical School at University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - M Mellander
- Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H M Gardiner
- The Fetal Center, McGovern Medical School at University of Texas Health Sciences Center at Houston, Houston, TX, USA
| |
Collapse
|
11
|
Gottschalk I, Strizek B, Jehle C, Stressig R, Herberg U, Breuer J, Brockmeier K, Hellmund A, Geipel A, Gembruch U, Berg C. Pränatale Diagnose und postnatales Outcome von Feten mit Pulmonalatresia und Ventrikelseptumdefekt. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1660603] [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] [Indexed: 10/28/2022] Open
Affiliation(s)
- I Gottschalk
- Bereich für Pränatale Medizin und Gynäkologische Sonografie, Universitätsfrauenklinik Köln, Deutschland
| | - B Strizek
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinik Bonn, Deutschland
| | - C Jehle
- Bereich für Pränatale Medizin und Gynäkologische Sonografie, Universitätsfrauenklinik Köln, Deutschland
| | - R Stressig
- praenatal.de, Pränatale Medizin und Genetik, Köln, Deutschland
| | - U Herberg
- Abteilung für Kinderkardiologie, Universitätsklinik Bonn, Deutschland
| | - J Breuer
- Abteilung für Kinderkardiologie, Universitätsklinik Bonn, Deutschland
| | - K Brockmeier
- Klinik und Poliklinik für Kinderkardiologie, Universitätsklinik Köln, Deutschland
| | - A Hellmund
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinik Bonn, Deutschland
| | - A Geipel
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinik Bonn, Deutschland
| | - U Gembruch
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinik Bonn, Deutschland
| | - C Berg
- Bereich für Pränatale Medizin und Gynäkologische Sonografie, Universitätsfrauenklinik Köln, Deutschland
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinik Bonn, Deutschland
| |
Collapse
|
12
|
Linden K, Winkler C, Breuer J, Herberg U. Pressure-Volume Relations in Patients with Single Ventricle: Feasibility and Comparison of Obtainment by 3D-Real Time Echocardiography and Mini Pressure-Wire with Conductance Technology. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628311] [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] [Indexed: 10/28/2022]
Affiliation(s)
- K. Linden
- Kinderkardiologie, Universitätsklinikum Bonn, Bonn, Germany
| | - C. Winkler
- Kinderkardiologie, Universitätsklinikum Bonn, Bonn, Germany
| | - J. Breuer
- Kinderkardiologie, Universitätsklinikum Bonn, Bonn, Germany
| | - U. Herberg
- Kinderkardiologie, Universitätsklinikum Bonn, Bonn, Germany
| |
Collapse
|
13
|
Glezou S, Herberg U, Körperich H, Barth P, Burchert W, Kececioglu D, Dalla R, Laser K. Pediatric Left Ventricular Volumetry Using Real-time Three-dimensional Echocardiography: Validation and Multicenter Reference Values Based on High Sample Size. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628332] [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] [Indexed: 10/28/2022]
Affiliation(s)
- S. Glezou
- Department of Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - U. Herberg
- Department of Pediatric Cardiology, Children’s Hospital, University of Bonn, Bonn, Germany
| | - H. Körperich
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - P. Barth
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - W. Burchert
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - D. Kececioglu
- Department of Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - R. Dalla
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University, Medical Hospital of the University of Munich, Munich, Germany
| | - K.T. Laser
- Department of Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
14
|
Gottschalk I, Jehle C, Herberg U, Breuer J, Brockmeier K, Bennink G, Hellmund A, Strizek B, Gembruch U, Geipel A, Berg C. Prenatal diagnosis of absent pulmonary valve syndrome from first trimester onwards: novel insights into pathophysiology, associated conditions and outcome. Ultrasound Obstet Gynecol 2017; 49:637-642. [PMID: 27240926 DOI: 10.1002/uog.15977] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 03/01/2016] [Revised: 05/04/2016] [Accepted: 05/24/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess the spectrum of associated anomalies, intrauterine course and outcome in fetuses with absent pulmonary valve syndrome (APVS). METHODS All cases with a prenatal diagnosis of APVS at two centers over a period of 13 years were analyzed retrospectively. APVS was diagnosed in the presence of rudimentary or dysplastic pulmonary valve leaflets with to-and-fro blood flow in the pulmonary trunk on color and pulsed-wave Doppler ultrasound. Data on demographic characteristics, presence of associated conditions, Doppler studies and pregnancy outcome were reviewed. RESULTS During the study period, 40 cases of APVS were diagnosed prenatally. Thirty-seven (92.5%) cases were associated with tetralogy of Fallot (TOF) and three (7.5%) had an intact ventricular septum. Patency of the ductus arteriosus (DA) was found in 17/37 (45.9%) TOF cases and in all three cases with an intact ventricular septum. Mean gestational age at diagnosis was 19.7 (range, 12-34) weeks with 10 (25.0%) cases (all with TOF) diagnosed in the first trimester. TOF was an isolated finding in 15 (37.5%) cases. Chromosomal anomalies, cardiac defects and extracardiac anomalies were present in 18 (45.0%), four (10.0%) and three (7.5%) cases, respectively. Among the 40 cases, there were 19 (47.5%) terminations of pregnancy, six (15.0%) intrauterine deaths, four (10.0%) neonatal deaths and 11 (27.5%) survivors. Patency of the DA, reversed flow during atrial contraction in the ductus venosus, umbilical artery or fetal middle cerebral artery, and hydrops/increased nuchal translucency thickness were significantly associated with non-survival. All 10 cases diagnosed in the first trimester had a patent DA and abnormal Doppler parameters, eight had hydrops and/or increased nuchal translucency, six were associated with trisomy 13 or 18 and none survived. CONCLUSION APVS diagnosed in the first trimester is significantly associated with TOF, patency of the DA, abnormal Doppler parameters, lethal trisomies and intrauterine mortality. Cases of APVS with isolated TOF and agenesis of the DA have a better outcome than those with additional anomalies, with > 80% survival. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- I Gottschalk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - C Jehle
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - U Herberg
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - J Breuer
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - K Brockmeier
- Heart Center, University Hospital of Cologne, Cologne, Germany
| | - G Bennink
- Heart Center, University Hospital of Cologne, Cologne, Germany
| | - A Hellmund
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - B Strizek
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - C Berg
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| |
Collapse
|
15
|
Goldschmidt F, Linden K, Winkler C, Laser K, Dalla-Pozza R, Herberg U. Left Atrial Pediatric Reference Volumes Using Real-Time 3D-Echocardiography. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1599002] [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] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | - K.T. Laser
- Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | | | | |
Collapse
|
16
|
Winkler C, Linden K, Schultz T, Breuer J, Herberg U. Data-Driven Decision Support for the Diagnosis and Prognosis of Critical Heart Failures Based on 3D Echocardiography Data. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598980] [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] [Indexed: 10/20/2022]
Affiliation(s)
- C. Winkler
- Department of Pediatric Cardiology, Universitätskinderklinik Bonn, Bonn, Germany
| | - K. Linden
- Department of Pediatric Cardiology, Universitätskinderklinik Bonn, Bonn, Germany
| | - T. Schultz
- Institute of Computer Science II, University of Bonn, Bonn, Germany
| | - J. Breuer
- Department of Pediatric Cardiology, Universitätskinderklinik Bonn, Bonn, Germany
| | - U. Herberg
- Department of Pediatric Cardiology, Universitätskinderklinik Bonn, Bonn, Germany
| |
Collapse
|
17
|
Wollens K, Laser K, Dalla-Pozza R, Breuer J, Herberg U. Real-Time 3D Echocardiography in Pediatric Cardiology: Head-to-Head Comparison of 3D Quantification Software (QLab and TomTec) and CMRI. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1599021] [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] [Indexed: 10/20/2022]
Affiliation(s)
- K. Wollens
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - K.T. Laser
- Department of Cong. Heart Diseases, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - R. Dalla-Pozza
- Department of Pediatric Cardiology, Ludwig Maximilian Universität, München, Germany
| | - J. Breuer
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - U. Herberg
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
18
|
Gardiner HM, Kovacevic A, Tulzer G, Sarkola T, Herberg U, Dangel J, Öhman A, Bartrons J, Carvalho JS, Jicinska H, Fesslova V, Averiss I, Mellander M. Natural history of 107 cases of fetal aortic stenosis from a European multicenter retrospective study. Ultrasound Obstet Gynecol 2016; 48:373-381. [PMID: 26843026 DOI: 10.1002/uog.15876] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 12/22/2015] [Revised: 01/22/2016] [Accepted: 01/30/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Fetal aortic valvuloplasty (FV) aims to prevent fetal aortic valve stenosis progressing into hypoplastic left heart syndrome (HLHS), which results in postnatal univentricular (UV) circulation. Despite increasing numbers of FVs performed worldwide, the natural history of the disease in fetal life remains poorly defined. The primary aim of this study was to describe the natural history of fetal aortic stenosis, and a secondary aim was to test previously published criteria designed to identify cases of emerging HLHS with the potential for a biventricular (BV) outcome after FV. METHODS From a European multicenter retrospective study of 214 fetuses with aortic stenosis (2005-2012), 107 fetuses in ongoing pregnancies that did not undergo FV were included in this study and their natural history was reported. We examined longitudinal changes in Z-scores of aortic and mitral valve and left ventricular dimensions and documented direction of flow across the foramen ovale and aortic arch, and mitral valve inflow pattern and any gestational changes. Data were used to identify fetuses satisfying the Boston criteria for emerging HLHS and estimate the proportion of these that would have been ideal FV candidates. We applied the threshold score whereby a score of 1 was assigned to fetuses for each Z-score meeting the following criteria: left ventricular length and width > 0; mitral valve diameter > -2; aortic valve diameter > -3.5; and pressure gradient across either the mitral or aortic valve > 20 mmHg. We compared the predicted circulation with known survival and final postnatal circulation (BV, UV or conversion from BV to UV). RESULTS Among the 107 ongoing pregnancies there were eight spontaneous fetal deaths and 99 livebirths. Five were lost to follow-up, five had comfort care and four had mild aortic stenosis not requiring intervention. There was intention-to-treat in these 85 newborns but five died prior to surgery, before circulation could be determined, and thus 80 underwent postnatal procedures with 44 BV, 29 UV and seven BV-to-UV circulatory outcomes. Of newborns with intention-to-treat, 69/85 (81%) survived ≥ 30 days. Survival at median 6 years was superior in cases with BV circulation (P = 0.041). Those with a postnatal UV circulation showed a trend towards smaller aortic valve diameters at first scan than did the BV cohort (P = 0.076), but aortic valve growth velocities were similar in both cohorts to term. In contrast, the mitral valve diameter was significantly smaller at first scan in those with postnatal UV outcomes (P = 0.004) and its growth velocity (P = 0.008), in common with the left ventricular inlet length (P = 0.004) and width (P = 0.002), were reduced significantly by term in fetuses with UV compared with BV outcome. Fetal data, recorded before 30 completed gestational weeks, from 70 treated neonates were evaluated to identify emerging HLHS. Forty-four had moderate or severe left ventricular depression and 38 of these had retrograde flow in the aortic arch and two had left-to-right flow at atrial level and reversed a-waves in the pulmonary veins. Thus 40 neonates met the criteria for emerging HLHS and BV circulation was documented in 13 (33%). Of these 40 cases, 12 (30%) had a threshold score of 4 or 5, of which five (42%) had BV circulation without fetal intervention. CONCLUSIONS The natural history in our cohort of fetuses with aortic stenosis and known outcomes shows that a substantial proportion of fetuses meeting the criteria for emerging HLHS, with or without favorable selection criteria for FV, had a sustained BV circulation without fetal intervention. This indicates that further work is needed to refine the selection criteria to offer appropriate therapy to fetuses with aortic stenosis. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- H M Gardiner
- The Fetal Center at Children's Memorial Hermann Hospital, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), TX, USA
| | - A Kovacevic
- Department of Paediatric and Congenital Cardiology, University of Heidelberg, Heidelberg, Germany
| | - G Tulzer
- Department of Paediatric Cardiology, Children's Heart Centre, Linz, Austria
| | - T Sarkola
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - U Herberg
- Department of Paediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - J Dangel
- Perinatal Cardiology Clinic, 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - A Öhman
- Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Bartrons
- Department of Paediatric Cardiology, Sant Joan de Déu, Barcelona, Spain
| | - J S Carvalho
- Department of Paediatric and Congenital Cardiology, Royal Brompton and Harefield Hospital, NHS Trust, and Fetal Medicine Unit, St George's Hospital NHS Trust, London, UK
| | - H Jicinska
- University Hospital and Masaryk University Brno, Brno, Czech Republic
| | - V Fesslova
- Center of Fetal Cardiology, Policlinico San Donato IRCSS, Milan, Italy
| | - I Averiss
- The Fetal Center at Children's Memorial Hermann Hospital, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), TX, USA
| | - M Mellander
- Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
19
|
Abstract
OBJECTIVE A considerable proportion of unexplained intrauterine fetal deaths are attributed to long QT syndrome (LQTS) susceptibility. Additionally, the estimated prevalence of LQTS in newborns is 1 in 2000. Still, prenatal diagnosis of LQTS is very rare. The aim of this study was to assess the frequency of prenatal diagnosis of LQTS at our institution, present the cases, compare our findings with the existing literature and propose a possible screening approach. METHODS We searched our fetal database between 2006 and 2013 for cases with suspected diagnosis of LQTS. RESULTS During the investigation period around 26 000 fetuses were evaluated and three cases of suspected fetal LQTS identified. Two cases of familial LQTS had no or mild intrauterine manifestation of the condition, the third fetus had a de-novo mutation with severe, early-onset disease. CONCLUSIONS LQTS continues to be a challenging prenatal diagnosis. In fetuses who present with complex arrhythmias, a high degree of suspicion is required, and close surveillance and timely delivery in the presence of a multidisciplinary team are necessary. For asymptomatic cases or screening purposes, routine fetal heart rate registration and detailed assessment of cases with a low for gestational age baseline may be an option.
Collapse
|
20
|
Gottschalk I, Stressig R, Ritgen J, Herberg U, Breuer J, Vorndamme A, Strizek B, Willruth A, Geipel A, Gembruch U, Berg C. Extracardiac anomalies in prenatally diagnosed heterotaxy syndrome. Ultrasound Obstet Gynecol 2016; 47:443-449. [PMID: 25847110 DOI: 10.1002/uog.14871] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 01/30/2015] [Revised: 03/29/2015] [Accepted: 03/31/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess the incidence and impact of extracardiac anomalies on the prognosis of fetuses with heterotaxy syndrome. METHODS All fetuses diagnosed with heterotaxy syndrome by three experienced examiners over a period of 14 years (1999-2013) were reviewed retrospectively. RESULTS In total, 165 fetuses with heterotaxy syndrome were diagnosed in the study period. One hundred and fifty (90.9%) had cardiac defects; extracardiac anomalies that did not involve the spleen were present in 26/165 (15.8%) cases. Of the total study cohort, termination of pregnancy was performed in 49 (29.7%) cases, intrauterine death occurred in 11 (6.7%), postnatal death occurred in 38 (23.0%) and 67 (40.6%) were alive at the latest follow-up, resulting in a total perinatal and pediatric mortality of 59.4%. Among the 105 liveborn neonates, 15 (14.3%) had extracardiac anomalies with significant impact on the postnatal course: one neonate died following repair of an encephalocele, six had successful treatment for various types of intestinal malrotation and/or atresia and one underwent hiatal hernia repair; the remaining seven had biliary atresia, of which five died and the two survivors are awaiting liver transplantation. The status of the spleen was assessed in 93/105 liveborn children and was found to be abnormal in 84/93 (90.3%). There were three cases of lethal sepsis, all associated with asplenia. Of the 38 postnatal deaths, 29 (76.3%) had a cardiac cause, seven (18.4%) had an extracardiac cause and in two (5.2%) the reason was uncertain. CONCLUSIONS Although the leading causes of death in fetuses and children with heterotaxy syndrome are cardiac, a small subset of fetuses have extracardiac anomalies with significant impact on outcome. These anomalies often escape prenatal detection, and therefore neonates at risk should be monitored for bowel obstruction, biliary atresia and immune dysfunction in order to allow timely intervention through a multidisciplinary approach. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- I Gottschalk
- Division of Prenatal Medicine and Gynecologic Sonography, Department of Gynecology and Obstetrics, University of Köln, Köln, Germany
| | - R Stressig
- praenatal.de, Prenatal Medicine and Genetics, Köln, Germany
- Congenital Cardiac Center ('Deutsches Kinderherzzentrum'), Sankt Augustin, Germany
| | - J Ritgen
- praenatal.de, Prenatal Medicine and Genetics, Köln, Germany
| | - U Herberg
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - J Breuer
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - A Vorndamme
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - B Strizek
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Willruth
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - C Berg
- Division of Prenatal Medicine and Gynecologic Sonography, Department of Gynecology and Obstetrics, University of Köln, Köln, Germany
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| |
Collapse
|
21
|
Udink ten Cate F, Lagies R, Herberg U, Schmidt B, Hannes T, Nazzal R, Sreeram N. Rigid Body Rotation Is a Robust and Highly Reproducible Marker of Cardiac Dysfunction in Children and Young Adults with Heart Disease. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571922] [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: 10/22/2022]
|
22
|
Horst J, Karabiyik A, Körperich H, Fischer M, Klusmeier E, Haas N, Kececioglu D, Herberg U, Laser K. Comprehensive Quantification of the Right Ventricle: Pediatric Reference Values from 0 to 18 Years. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571916] [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: 10/22/2022]
|
23
|
Strizek B, Gottschalk I, Herberg U, Geipel A, Berg C, Gembruch U. Flecainid ist die effektivste Therapie bei fetaler supraventrikulärer Tachykardie. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566505] [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: 10/22/2022]
|
24
|
Gottschalk I, Jehle C, Stressig R, Herberg U, Breuer J, Gembruch U, Geipel A, Berg C. Pränatale Diagnose und postnataler Verlauf komplexer Fallot'scher Tetralogien. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0034-1375707] [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: 10/23/2022]
|
25
|
Linden K, Ladage D, Gatzweiler E, Dewald O, Duerr G, Seehase M, Breuer J, Herberg U. Messung kleiner Herzvolumina mit Transpulmonaler Thermodilution und 3D-Echokardiographie im Tiermodell. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1555973] [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: 10/23/2022]
|
26
|
Smit F, Laser K, Dalla Pozza R, Hildebrand U, Peters B, Breuer J, Kececioglu D, Herberg U. Real-Time 3D-Echocardiography of the Right Ventricle - Pediatric Reference-Values for Right Ventricular Volumes using Knowledge Based Reconstruction. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1555970] [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: 10/23/2022]
|
27
|
Herberg U, Ladage D, Dürr G, Linden K, Gatzweiler E, Seehase M, Dörner J, Breuer J, Dewald O. Validation of Pressure Volume Relations Derived from 3D Real-Time Echocardiography and Mini Pressure Wire in Piglets. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544404] [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: 10/20/2022]
|
28
|
Dewald O, Esmailzadeh B, Dürr G, Knies R, Herberg U, Breuer J. Modification of the Norwood Procedure for an Unusual Anatomy of Heart and Supraaortic Blood Vessels. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544527] [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: 10/24/2022]
|
29
|
Herberg U, Breuer J, Gembruch U, Willruth A. Imaging in fetal cardiology. Minerva Pediatr 2014; 66:453-471. [PMID: 25253189] [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: 06/03/2023]
Abstract
Early detection and accurate diagnosis of fetal cardiac disease is a central approach in perinatal medicine. The purpose of this review is to evaluate current imaging modalities for the assessment of the fetal heart and its function. Conventional fetal 2D- and color-Doppler echocardiography as a screening tool as well as a diagnostic modality has been proven to be safe, easy and cost-effective for the diagnosis of structural heart disease. Cardiac function can be assessed by M-mode and intra- and extra-cardiac Doppler-echocardiography on a routine basis, but remains challenging in subclinical pathology. Tissue-Doppler, speckle tracking, dynamic three-dimensional (4D) echocardiography, and fetal cardiac magnetic resonance imaging are advanced modalities for the assessment of cardiac structure and function. Implementation of these new technologies is far from routine, but these approaches have already shown promising results and may allow a more detailed evaluation of cardiac function. In this review, we provide a brief overview of currently available techniques, and their benefits and limitations in the clinical assessment of the fetal heart.
Collapse
Affiliation(s)
- U Herberg
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany -
| | | | | | | |
Collapse
|
30
|
Kock L, Bertram H, Boekenkamp R, DeWolf D, Ditkivsky I, Freund M, Gewillig M, Happel C, Herberg U, Kampmann C, Karthasyan E, Kozlik-Feldmann R, Kretschmar O, Kuzmenko Y, Milanesi O, Mueller G, Pongiglione G, Schubert S, Tarusinov G, Haas N. Interventional VSD-closure with the Nit-Occlud® Lé VSD-coil in 111 patients - results of the EUREVECO-registry. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1393981] [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: 10/24/2022]
|
31
|
Goltz D, Lunkenheimer JM, Abedini M, Herberg U, Berg C, Fischer HP. Third-trimester pulmonary maturation is significantly disturbed in patients with intact inter-atrial septum combined with mitral atresia, hypoplastic left heart syndrome or critical aortic stenosis. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1394018] [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: 10/24/2022]
|
32
|
Flöck A, Herberg U, Gembruch U, Merz WM. Fetales Long-QT-Syndrom: Befund und Verlauf anhand dreier Fallbeispiele. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388194] [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: 10/24/2022] Open
|
33
|
Gottschalk I, Jehle C, Stressig R, Herberg U, Breuer J, Gembruch U, Geipel A, Berg C. Pränatale Diagnose und postnataler Verlauf komplexer Fallot'scher Tetralogien. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388073] [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: 10/24/2022] Open
|
34
|
Herberg U, Klebach C, Faller J, Trier HG, Breuer J. Spatiotemporal accuracy of real-time 3D echocardiography in the neonatal and pediatric setting--validation studies using small dynamic test objects. Ultraschall Med 2013; 34:580-589. [PMID: 24338695 DOI: 10.1055/s-0033-1355764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED The precision of real-time 3D-echocardiography (RT3DE) is not sufficiently validated for small, fast-moving structures such as the neonatal and pediatric heart. PURPOSE To assess the spatiotemporal accuracy of RT3DE in small, moving test objects. MATERIALS AND METHODS Small, calibrated test objects in the size of neonatal and pediatric heart chambers were made from polyurethane foam or metal wire mesh and moved in a water bath through a calibrated dynamic test system. Using matrix transducers (X7-2, ie33 and X4-1, Sonos 7500, Philips, Andover, USA), 2 D and live 3 D datasets under variation of the motion speed (0.033 - 0.133 m/s corresponding to 50 - 200 heart cycles/minute), the volume rate and transducer position were recorded and analyzed (QLab 7.0, Philips). RESULTS 3 D datasets of the moving test objects showed relevant spatial distortion, which was obviously related to the sequential scanning technology of the matrix transducer. Different segments of a test object were not recorded simultaneously, but rather row-by-row, so that there was a time delay between the first and the last-recorded voxel of a single 3 D volume (mean±SD: 28.9 ± 7.82 m/s or 80 ± 7 % of the time duration of a 3 D volume). With increasing motion speed of the test object and reduced 3 D volume rate, the distortion artifacts increased significantly. CONCLUSION 3 D acquisitions using matrix technology demonstrate relevant spatiotemporal inaccuracies. This may lead to misinterpretations during the evaluation of the synchronicity of valvular or ventricular motion and incorrect definition of volume estimations. In particular, at higher heart rates and higher rates of movement, these limitations have to be taken into account in clinical practice.
Collapse
Affiliation(s)
- U Herberg
- Department of Pediatric Cardiology, University of Bonn
| | - C Klebach
- Department of Pediatric Cardiology, University of Bonn
| | - J Faller
- Department of Pediatric Cardiology, University of Bonn
| | - H G Trier
- Technology in Medicine and Public Health, TIMUG e. V., Bonn
| | - J Breuer
- Department of Pediatric Cardiology, University of Bonn
| |
Collapse
|
35
|
Herberg U, Geipel A, Tatcheva C, Mallmann M, Esmailzadeh B, Gembruch U, Breuer J, Berg C. Fetale Kritische Aortenstenose - Follow-up von Pränataler Diagnose und Intrauteriner sowie Postnataler Therapie. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354458] [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: 10/26/2022]
|
36
|
Herberg U, Ladage D, Linden K, Seehase M, Dürr D, Dewald O, Breuer J. Assessment of Pressure Volume Relation under Various Pharmacological Conditions Using Mini-Pressure Wire and 3D-Echocardiography - Comparative Study with Conductance Technology in Piglets. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354464] [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: 10/26/2022]
|
37
|
Gatzweiler E, Breuer T, Breuer J, Herberg U. Ventricular Pressure-Volume Loops Obtained by 3D Real-Time Echocardiography and Mini-Pressure Wire. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354453] [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: 10/26/2022]
|
38
|
Herberg U, Linden K, Dörner J, Nähle C, Seehase M, Dewald O, Breuer J. Vergleich der Herzvolumenmessung kleiner Herzen mittels 3D-Echtzeit-Echokardiografie und MRT im Tiermodell. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354465] [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: 10/26/2022]
|
39
|
Abstract
Fetal cardiac interventions are being performed with growing success by a minimally invasive percutaneous and transthoracic approach. The primary aim of these interventions is to minimise postnatal morbidity and mortality, rarely also to achieve intrauterine survival. Valvuloplasty in utero for severe aortic stenosis is performed in order to achieve sufficient growth of the left ventricle and to make a later biventricular repair possible. In rare cases with hydrops secondary to massive left ventricular dilatation and mitral insufficiency it is used as a salvage therapy. Premature obstruction of the foramen ovale can be treated by balloon atrioseptoplasty or stenting of the atrial septum with the aim to attain a decompression of the left atrium and consequently of the pulmonary veins. This might reduce the extent of pulmonary hypertension and the resulting vascular and parenchymal changes in affected infants. Intrauterine valvuloplasty of a highly stenotic pulmonary valve or a pulmonary atresia with intact ventricular septum in order to prevent hypoplasia of the right ventricle and to enable postnatal biventricular repair is only rarely justified. Currently these intrauterine cardiac interventions are limited to a small group of fetuses with cardiac defects. However, with enhanced imaging modalities and equipment and with growing experience, fetal cardiac interventions are likely to increase in the next years.
Collapse
Affiliation(s)
- U Gembruch
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn.
| | | | | | | |
Collapse
|
40
|
Herberg U, Hövels-Gürich H. [Neurological and psychomotor development of foetuses and children with congenital heart disease--causes and prevalence of disorders and long-term prognosis]. Z Geburtshilfe Neonatol 2012; 216:132-40. [PMID: 22825761 DOI: 10.1055/s-0032-1312670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Children with severe congenital heart defects (CHD) requiring open heart surgery in the first year of life are at high risk for developing neurological and psychomotor abnormalities. Depending on the type and severity of the CHD, between 15 and over 50% of these children have deficits, which are usually confined to distinct domains of development, although formal intelligence tends to be normal. Children with mild CHD, who comprise the majority of congenital heart defects, have a far better developmental prognosis than those with complex CHD. This review concentrates on the impact of severe CHD on the developing brain of the foetus and infant. It also provides a summary of recent clinical and neuroimaging studies, and an overview of the long-term neurological prognosis. Advanced neuroimaging modalities indicate that, related to altered cerebral blood flow and oxygenation, foetuses with severe CHD show delayed third trimester brain maturation and increased vulnerability for hypoxic injury. Morphological and neurological abnormalities are present before surgery, commonly affecting the white matter. In the long-term, impaired neurological and developmental outcomes are related to the combination of prenatal, perinatal and additional perioperative risk factors. Therefore, new therapeutic approaches aim to optimise the intra- and perinatal management of foetuses and newborns with congenital heart defects. Identification and avoidance of risk factors, early neurodevelopmental assessment and therapy may optimise the long-term outcome in this high-risk population.
Collapse
Affiliation(s)
- U Herberg
- Abteilung für Kinderkardiologie, Zentrum für Kinderheilkunde, Universitätsklinikum Bonn.
| | | |
Collapse
|
41
|
Mallmann MR, Geipel A, Herberg U, Breuer J, Gembruch U, Berg C. Case Report - Intrauterine Aortenklappensprengung und atriale Stenteinlage bei kritischer fetaler Aortenklappenstenose mit intaktem interatrialem Septum. Z Geburtshilfe Neonatol 2012. [DOI: 10.1055/s-0032-1309116] [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: 10/28/2022]
|
42
|
Endlich M, Mellert F, Breuer J, Herberg U, Heinze I, Welz A, Schiller W. Transapical mitral valve in valve implantation. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297817] [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: 10/14/2022]
|
43
|
Herberg U, Steinweg B, Berg C, Breuer J. Echocardiography in the fetus--a systematic comparative analysis of standard cardiac views with 2D, 3D reconstructive and 3D real-time echocardiography. Ultraschall Med 2011; 32:293-301. [PMID: 20425686 DOI: 10.1055/s-0029-1245281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE The aim of our study was to assess the feasibility and reliability of fetal three-dimensional reconstructive echocardiography using freehand technique (3DR) and 3D real-time echocardiography using matrix technology (RT-3D) in consecutive series of pregnancies and to compare the findings with the gold standard 2D ultrasound, as well as postnatal findings. MATERIALS AND METHODS Fifty consecutive pregnant women (gestational age 19+3 to 37+0) including 10 fetuses with cardiac malformations were scanned prospectively with 2D, 3DR and RT-3D. 3D data sets were evaluated by a blinded independent examiner. The visualization rates for standard cardiac views and structures were determined and the quality and diagnostic accuracy of each modality were calculated. RESULTS In RT-3D, the visualization rate of fetal cardiac views was equivalent to 2D, but was significantly lower for 3DR (4cv: 2D 98%, RT-3D 100%, 3DR 96% RVOT: 2D 96%, RT-3D 98%, 3DR 84%). Short-axis views or views of the complete aortic or ductal arch were more readily identified in RT-3D than in 2D (2D 70%, RT-3D 82%). 3DR was more susceptible than RT-3D to artifacts during acquisition and post-processing. The sensitivity and overall accuracy were significantly higher for 2D and RT-3D than for 3DR, when prenatal data was compared with postnatal findings. CONCLUSION 3D freehand reconstruction has significantly lower visualization rates and overall accuracy compared to 2D and RT-3D. RT-3D echo is a feasible and reliable method for imaging the fetal heart. Offering the opportunity of data post-processing and evaluation, RT-3D is a promising method for improving the accuracy of sonographic analysis of fetal cardiac morphology and function.
Collapse
Affiliation(s)
- U Herberg
- Department of Pediatric Cardiology, Universitätsklinikum Bonn, Bonn, Germany.
| | | | | | | |
Collapse
|
44
|
Herberg U, Lück S, Steinweg B, Brand M, Knies R, Geipel A, Trier HG, Breuer J. Volumetry of fetal hearts using 3D real-time matrix echocardiography - in vitro validation experiments and 3D echocardiographic studies in fetuses. Ultraschall Med 2011; 32:46-53. [PMID: 20614413 DOI: 10.1055/s-0029-1245428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE The aim of this study was to assess the feasibility, accuracy and reliability of 3D real-time echocardiography for fetal heart volumetry. MATERIALS AND METHODS Fifty unselected and consecutive fetuses, including 14 with cardiac malformations, were scanned prospectively using real-time 3D matrix technology and 2D echocardiography to determine ventricular volumes. Small phantoms as well as modified balloons (0.5 - 20 ml) were used to assess the validity of 2D and 3D distance, area and volume calculations and to study potential sources of error during data acquisition and analysis. The data was evaluated by two blinded observers. RESULTS In vitro, real-time 3D and 2D underestimated the actual volumes by -5.49 % (3D) and -6.86 % (2D). The intraobserver and interobserver variability were excellent. In vivo, real-time 3D was superior to 2D with regard to intraobserver and interobserver variability (mean coefficient of variation 8.28 % (3D) versus 13.96 % (2D), and mean intraclass correlation coefficient 0.997 (3D) versus 0.885 (2D) for left ventricular volumes). Similar to in vitro, in vivo 2D volumes were calculated smaller than 3D volumes (mean difference -0.39 to -0.94 ml). The ventricular volumes and stroke volumes increased exponentially with gestation. Secondary to poor imaging windows in advanced gestation or inadequate delineation of endocardial borders in small hearts at less than 19 weeks, 3D data could not be analyzed sufficiently in 6 / 50 fetuses. CONCLUSION Real-time 3D using a matrix transducer is a feasible, reliable and valid method for volume determination in the fetus beyond 19 weeks of gestation. If compared to 2D, real-time 3D echocardiography provides improved accuracy of cardiac volumetry, decreases intraobserver and interobserver variability and is a promising tool for the accurate assessment of cardiac size and function.
Collapse
Affiliation(s)
- U Herberg
- Department of Pediatric Cardiology, University of Bonn, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Dewald O, Vlajnic D, Bernhardt C, Herberg U, Doll U, Schirrmeister J, Esmailzadeh B, Probst C, Heinze I, Thees C, Schmitz C, Welz A, Breuer J. Norwood operation with a RV-PA conduit preserves growth of pulmonary arteries. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246873] [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: 10/19/2022]
|
46
|
Berg C, Lachmann R, Kaiser C, Kozlowski P, Stressig R, Schneider M, Asfour B, Herberg U, Breuer J, Gembruch U, Geipel A. Prenatal diagnosis of tricuspid atresia: intrauterine course and outcome. Ultrasound Obstet Gynecol 2010; 35:183-190. [PMID: 20101636 DOI: 10.1002/uog.7499] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the intrauterine course and outcome of tricuspid atresia detected in the fetus. METHODS This was a retrospective review of all confirmed cases of tricuspid atresia detected prenatally between 1998 and 2006 in three tertiary referral centers in Germany. RESULTS Fifty-four cases of tricuspid atresia were detected prenatally during the study period and confirmed postnatally: 28 (51.9%) cases had a concordant ventriculoarterial connection of which 14 also had pulmonary outflow obstruction; 25 (46.3%) cases had a discordant ventriculoarterial connection of which 14 also had aortic outflow obstruction, six had pulmonary outflow tract obstruction and two had other associated intracardiac anomalies; and one (1.9%) had a common arterial trunk. The peak velocity index for veins in the ductus venosus was significantly elevated in 19 of the 37 (51.4%) cases assessed; however, this finding did not correlate with adverse intrauterine outcome. There were associated extracardiac anomalies in 12 cases: five with chromosomal anomalies, two with VACTERL association, one with unilateral renal agenesis, one with hypospadia, one with hydrothorax, one with megacystis and one with agenesis of the ductus venosus. Seventeen of the 54 (31.5%) cases underwent termination of pregnancy, two (3.7%) died in utero, two (3.7%) died in infancy and 33 (61.1%) children survived with a median follow-up of 26 (range, 12-120) months. Prenatal echocardiography correctly anticipated the postnatal course and the need for neonatal intervention in 29/35 (82.9%) continued pregnancies; in the remaining six (17.1%) cases the right outflow tract obstruction had been underestimated. CONCLUSIONS Tricuspid atresia and the frequently associated intracardiac anomalies can be diagnosed in the fetus with considerable accuracy. A thorough search for extracardiac malformations should be performed in order to rule out chromosomal anomalies and multiple malformation syndromes. Elevated pulsatility in the ductus venosus does not indicate cardiac failure. The short-term overall survival in continued pregnancies in our study exceeded 89%, with the greatest rate of loss being in the first year of postnatal life.
Collapse
Affiliation(s)
- C Berg
- Department of Obstetrics and Prenatal Medicine University of Bonn, Bonn, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Berg C, Kaiser C, Bender F, Geipel A, Kohl T, Axt-Fliedner R, Krapp M, Knöpfle G, Herberg U, Breuer J, Schmitz C, Gembruch U. Atrioventricular septal defect in the fetus--associated conditions and outcome in 246 cases. Ultraschall Med 2009; 30:25-32. [PMID: 18491259 DOI: 10.1055/s-2008-1027438] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To evaluate the associated conditions and the outcome of atrioventricular septal defects (AVSD) detected in fetal life. MATERIALS AND METHODS Retrospective review of all cases of AVSD detected prenatally between 1998 and 2006 in two tertiary referral centers in Germany. RESULTS 246 cases of AVSD were detected in the study period: 129 (52.4 %) chromosomal anomalies; 72 (29.3 %) heterotaxy syndromes; 17 (6.9 %) non-chromosomal malformation syndromes; 16 (6.5 %) isolated complex cardiac malformations; 5 (2.0 %) singular extracardiac malformations; 7 (2.8 %) isolated AVSD. Chromosomal anomalies were detected significantly earlier in pregnancy (p < 0.01). Associated intracardiac malformations were present in 109/246 (44.3 %) cases. Fetuses with trisomy 21 were significantly associated with balanced ventricular morphology and isolated AVSD (p < 0.01). Among the 246 cases, 144 (58.5 %) underwent termination of pregnancy, 18 (7.3 %) died in utero, 17 (6.9 %) in the neonatal period and 19 (7.7 %) in infancy. Forty-eight children (19.5 %) survived with a mean follow-up of 34.94 +/- 18.6 months. After exclusion of lethal malformations, the survival rate among live births was 64.9 % (48 / 74). Fetuses with trisomy 21 had significantly better survival rates among continued pregnancies (p < 0.01) and significantly higher rates of successful biventricular repair among survivors who received their final corrective procedure (p < 0.01) than fetuses with normal karyotypes. CONCLUSION Among fetuses with AVSD, those with trisomy 21 are detected earlier in pregnancy, have less distorted cardiac anatomy, higher rates of biventricular repair and better survival rates. Due to the limited sample size in euploid fetuses, it remains unclear whether this apparent protection afforded to Down syndrome accounts also for cohorts with isolated and balanced AVSD.
Collapse
Affiliation(s)
- C Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Schmitz C, Schirrmeister J, Herberg U, Kozlik-Feldmann R, Stüber F, Welz A, Breuer J. "Rapid two-stage" Norwood operation in a child with multiorgan failure. Pediatr Cardiol 2009; 30:77-9. [PMID: 18626682 DOI: 10.1007/s00246-008-9261-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 12/26/2007] [Revised: 04/07/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
Abstract
The Norwood I operation continues to be a procedure with significant operative mortality. One well-accepted risk factor for death after the first step of the Norwood operation is critical preoperative status. We describe herein a new concept for the treatment of patients with hypoplastic left heart syndrome (HLHS) in very poor preoperative condition. This is a case report of a child who was born in a rural hospital. On the second day of life he was referred to our center in multiorgan failure. There were signs of liver dysfunction and the child was anuric. Therapy was started immediately with prostaglandin and vasodilators as well as diuretics, milrinone, and dobutamine. However, systemic perfusion continued to be insufficient. Finally, the child was placed on a ventilator. On the fourth day of life, bilateral pulmonary artery (PA) banding was performed and circulation stabilized immediately. Two hours after the operation urine output started. Liver function stabilized over the next couple of days. Two days after PA banding the child was weaned from the ventilator. On the 12th day of life a Norwood operation with PA debanding and a right ventricle-PA conduit was performed, and 2 days postoperatively the child was weaned from the ventilator. Twenty days after the operation he was discharged home. When the boy was 4 months old a bidirectional cavopulmonary anastomosis was performed. In selected cases of patients with HLHS with very poor hemodynamic conditions, a rapid two-stage approach with bilateral banding followed by a Norwood operation after cardiac stabilization can be recommended.
Collapse
Affiliation(s)
- C Schmitz
- Department of Cardiac Surgery, University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
| | | | | | | | | | | | | |
Collapse
|
49
|
Schmitz C, Esmailzadeh B, Herberg U, Lang N, Sodian R, Kozlik-Feldmann R, Welz A, Breuer J. Hybrid procedures can reduce the risk of congenital cardiovascular surgery. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191322] [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: 10/21/2022]
|
50
|
Kleppe S, Herberg U, Bernhardt C, Breuer J. Barth-Syndrom bei einem männlichen Neugeborenen mit dilatativer Kardiomyopathie. Z Geburtshilfe Neonatol 2008. [DOI: 10.1055/s-2008-1078955] [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: 10/21/2022]
|