1
|
Patel SR, Michelfelder E. Prenatal Diagnosis of Congenital Heart Disease: The Crucial Role of Perinatal and Delivery Planning. J Cardiovasc Dev Dis 2024; 11:108. [PMID: 38667726 PMCID: PMC11050606 DOI: 10.3390/jcdd11040108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Although most congenital heart defects (CHDs) are asymptomatic at birth, certain CHD lesions are at significant risk of severe hemodynamic instability and death if emergent cardiac interventions are not performed in a timely fashion. Therefore, accurate identification of at-risk fetuses and appropriate delivery resource planning according to the degree of anticipated hemodynamic instability is crucial. Fetal echocardiography has increased prenatal CHD detection in recent years due to advancements in ultrasound techniques and improved obstetrical cardiac screening protocols, enabling the prediction of newborns' hemodynamic status. This assessment can guide multidisciplinary resource planning for postnatal care, including selection of delivery site, delivery room management, and transport to a cardiac center based on CHD risk severity. This review will discuss fetal cardiovascular physiology and the circulatory changes that occur at the time of and immediately following birth, outline fetal echocardiographic findings used to risk-stratify newborns with CHDs, and outline principles for neonatal resuscitation and initial transitional care in neonates with these complex CHD lesions.
Collapse
Affiliation(s)
- Sheetal R. Patel
- Ann & Robert H Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Erik Michelfelder
- Children’s Healthcare of Atlanta, Emory School of Medicine, Emory University, Atlanta, GA 30265, USA
| |
Collapse
|
2
|
Vepa S, Alavi M, Wu W, Schmittdiel J, Herrinton LJ, Desai K. Prenatal detection rates for congenital heart disease using abnormal obstetrical screening ultrasound alone as indication for fetal echocardiography. Prenat Diagn 2024. [PMID: 38489018 DOI: 10.1002/pd.6544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/20/2023] [Accepted: 02/11/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To determine the live born prenatal detection rate of significant congenital heart disease (CHD) in a large, integrated, multi-center community-based health system using a strategy of referral only of patients with significant cardiac abnormalities on obstetrical screening ultrasound for fetal echocardiography. Detection rates were assessed for screening in both radiology and maternal fetal medicine (MFM). The impact on fetal echocardiography utilization was also assessed. METHODS This was a retrospective cohort study using an electronic health record, outside claims databases and chart review to determine all live births between 2016 and 2020 with postnatally confirmed sCHD that were prenatally detectable and resulted in cardiac surgery, intervention, or death within 1 year. RESULTS There were 214,486 pregnancies resulting in live births. Prenatally detectable significant CHD was confirmed in 294 infants. Of those 183 were detected for an overall live-born detection rate of 62%. Detection rates in MFM were 75% and in radiology were 52%. The number of fetal echocardiograms needed to detect (NND) sCHD was 7. CONCLUSIONS A focus on quality and standardization of obstetrical screening ultrasound with referral to fetal echocardiography for cardiac abnormalities alone achieves benchmark targets for live-born detection of significant CHD requiring fewer fetal echocardiograms.
Collapse
Affiliation(s)
- Sanjay Vepa
- Department of Pediatric Cardiology, Kaiser Permanente, Oakland, California, USA
| | - Mubarika Alavi
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Weilu Wu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Julie Schmittdiel
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lisa J Herrinton
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Kavin Desai
- Department of Pediatric Cardiology, Kaiser Permanente, Oakland, California, USA
| |
Collapse
|
3
|
Portela Dias J, Guedes-Martins L. Fetal Pulmonary Venous Return: From Basic Research to the Clinical Value of Doppler Assessment. Pediatr Cardiol 2023; 44:1419-1437. [PMID: 37505268 PMCID: PMC10435640 DOI: 10.1007/s00246-023-03244-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
The fetal pulmonary circulation represents less than 25% of the fetal cardiac output. In comparison with the pulmonary arteries, studies on pulmonary veins are few and limited, and many questions remain to be answered. The literature reports that pulmonary veins play an important role in regulating vascular flow, forming an active segment of the pulmonary circulation. The development of more sophisticated ultrasonography technology has allowed the investigation of the extraparenchymal pulmonary veins and their waveform. The recognition of the pulmonary vein anatomy in echocardiography is important for the diagnosis of anomalous pulmonary venous connections, with a significant impact on prognosis. On the other hand, the identification of the normal pulmonary vein waveform seems to be a reliable way to study left heart function, with potential applicability in fetal and maternal pathology. Thus, the goal of this narrative review was to provide a clinically oriented perspective of the available literature on this topic.
Collapse
Affiliation(s)
- J Portela Dias
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313, Porto, Portugal.
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar e Universitário de Santo António, Largo da Maternidade Júlio Dinis 45, 4050-651, Porto, Portugal.
- Unidade de Investigação e Formação - Centro Materno Infantil do Norte, 4050-651, Porto, Portugal.
| | - L Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313, Porto, Portugal
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar e Universitário de Santo António, Largo da Maternidade Júlio Dinis 45, 4050-651, Porto, Portugal
- Unidade de Investigação e Formação - Centro Materno Infantil do Norte, 4050-651, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal
| |
Collapse
|
4
|
Huang J, Tang J, Fan Y, Wang D, Ye L. Risk factors associated with prolonged intensive care unit stay following surgery for total anomalous pulmonary venous connection: a retrospective study. J Cardiothorac Surg 2023; 18:257. [PMID: 37689705 PMCID: PMC10492368 DOI: 10.1186/s13019-023-02356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/09/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Prolonged intensive care unit (ICU) stays consume medical resources and increase medical costs. This study identified risk factors associated with prolonged postoperative intensive care unit (ICU) stay in children with total anomalous pulmonary venous connection (TAPVC). METHODS The medical records of 85 patients who underwent surgical repair of TAPVC were retrospectively analyzed. The patients were divided into prolonged-stay and standard-stay groups. The prolonged stay group included all patients who exceeded the 75th percentile of the ICU stay duration, and the standard stay group included all remaining patients. The effects of patient variables on ICU stay duration were investigated using univariate and logistic regression analyses. RESULTS Patient median age was 41 (18-103) days, and median weight was 3.80 (3.30-5.35) kg.Postoperative duration of ICU stay was 11-68 days in the prolonged stay group (n = 23) and 2-10 days in the standard stay group (n = 62). Lower preoperative pulse oximetry saturation (SpO2), higher intraoperative plasma lactate levels, and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay. Preoperative SpO2 < 88.5%, highest plasma lactate value > 4.15 mmol/L, and postoperative mechanical ventilation duration was longer than 53.5 h, were associated with increased risk of prolonged ICU stay. Young age, low body weight, subcardiac type, need for vasoactive drug support, emergency surgery, long anesthesia time, low SpO2 after anesthesia induction, long cardiopulmonary bypass (CPB) and aortic clamp times, high lactate level, low temperature, large volume of ultrafiltration during CPB, large amounts of chest drainage, large red blood cells (RBCs) and plasma transfusion, and postoperative cardiac dysfunction may be associated with prolonged ICU stay. CONCLUSIONS Lower preoperative SpO2, higher intraoperative plasma lactate levels, and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay in children with TAPVC. When SpO2 was lower than 88.5%, the highest plasma lactate value was more than 4.15 mmol/L, and the postoperative mechanical ventilator duration was longer than 53.5 h, the risk of prolonged ICU stay increased. Improved clinical management, including early diagnosis and timely surgical intervention to reduce hypoxia time and protect intraoperative cardiac function, may reduce ICU stay time.
Collapse
Affiliation(s)
- Jinjin Huang
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jian Tang
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yong Fan
- Department of Extracorporeal Life Support, Heart Institute, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Dongpi Wang
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lifen Ye
- Department of Extracorporeal Life Support, Heart Institute, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| |
Collapse
|
5
|
Xue X, Wu Q, Xiong M, Ling W, Guo S, Ma H, Huang B, Liu M, Qiu X, Weng Z. Prenatal diagnosis and postnatal verification in fetuses with total anomalous pulmonary venous connection. Front Pediatr 2023; 11:1206032. [PMID: 37351315 PMCID: PMC10282755 DOI: 10.3389/fped.2023.1206032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
Objective To systematically verify the accuracy of a four-step prenatal ultrasonography in diagnosing fetal total anomalous pulmonary venous connection (TAPVC). Methods A total of 62 TAPVC fetuses received prenatal ultrasonography and were confirmed by postnatal echocardiography, surgery, or postabortion autopsy. The suspected TAPVC fetuses were further screened by a four-step prenatal ultrasonography for TAPVC classification, pulmonary venous obstruction, and the associated malformations, and followed postpartum. The sonographic features, clinical data, and prognosis of the TAPVC fetuses were retrospectively analyzed. Results Of the 62 TAPVC fetuses, supracardiac TAPVC was found in 20 cases, intracardiac TAPVC in 12, infracardiac TAPVC in 21, and mixed TAPVC in 9. A total of 30 cases with right atrium isomerism were correctly diagnosed. Of the 11 cases with other intracardiac and extracardiac malformations, 1 case was missed to be diagnosed. Of the 21 isolated TAPVC cases, 6 were missed prenatally and 1 case was prenatally diagnosed as intracardiac and postnatally proved to be mixed (intracardiac type + supracardiac type) by echocardiography. Of the 13 TAPVC live births, 4 infants died in the neonatal period without operation. Of the nine infants undergoing the operation, five recuperated and survived; one survived but had complications with superior vena cava obstruction and collateral circulation formation, and three died postoperatively. Conclusion The four-step prenatal ultrasound procedure can comprehensively and systematically evaluate fetal TAPVC, detailing the classification, potential obstruction, and associated malformations. It provides substantial support for subsequent prenatal counseling and neonatal assessment. The retrospective analysis also reveals that isolated TAPVC is more prone to be missed in diagnosis.
Collapse
Affiliation(s)
- Xiaoying Xue
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiumei Wu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Mingtao Xiong
- Department of Ultrasound, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Ling
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shan Guo
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hong Ma
- Department of Pathology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Biying Huang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Min Liu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiuqing Qiu
- Department of Obstetrics & Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zongjie Weng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| |
Collapse
|
6
|
Mamalis M, Koehler T, Bedei I, Wolter A, Schenk J, Widriani E, Axt-Fliedner R. Comparison of the Results of Prenatal and Postnatal Echocardiography and Postnatal Cardiac MRI in Children with a Congenital Heart Defect. J Clin Med 2023; 12:jcm12103508. [PMID: 37240614 DOI: 10.3390/jcm12103508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE In fetuses with suspicion of congenital heart disease (CHD), assessment by segmental fetal echocardiography is of great importance. This study sought to examine the concordance of expert fetal echocardiography and postnatal MRI of the heart at a high-volume paediatric heart centre. METHODS The data of two hundred forty-two fetuses have been gathered under the condition of full pre- and postnatal and the presence of a pre- and postnatal diagnosis of CHD. The haemodynamically leading diagnosis was determined for each test person and was then sorted into diagnostic groups. The diagnoses and diagnostic groups were used for the comparison of diagnostic accuracy in fetal echocardiography. RESULTS All comparisons between the diagnostic methods for detection of congenital heart disease showed an "almost perfect" (Cohen's Kappa > 0.9) strength of agreement for the diagnostic groups. The diagnosis made by prenatal echocardiography showed a sensitivity of 90-100%, a specificity and a negative predictive value of 97-100%, and a positive predictive value of 85-100%. The diagnostic congruence resulted in an "almost perfect" strength of agreement for all evaluated diagnoses (transposition of great arteries, double outlet right ventricle, hypoplastic left heart, tetralogy of Fallot, atrioventricular septal defect). An agreement of Cohen's Kappa > 0.9 was achieved for all groups, with exception of the diagnosis of double outlet right ventricle (0.8) in prenatal echocardiography compared to postnatal echocardiography. This study came to the result of a sensitivity of 88-100%, a specificity and negative predictive value of 97-100%, and a positive predictive value of 84-100%. The performance of cardiac magnetic resonance imaging (MRI) as an additional measure to echocardiography had an added value in the description of the malposition of the great arteries when diagnosed with double outlet right ventricle and in the detailed description of the anatomy of the lung circulation. CONCLUSIONS Prenatal echocardiography could be shown to be a reliable method for detection of congenital heart disease when regarding the slightly lower accuracy of diagnosis for double outlet right ventricle and right heart anomalies. Furthermore, the impact of examiner experience and the consideration of follow-up examinations for further improvement of diagnosis accuracy may not be underestimated. The main advantage of an additional MRI is the possibility to obtain a detailed anatomic description of the blood vessels of the lung and the outflow tract. The conduction of further studies that include false-negative and false-positive cases, and studies that are not set within the high-risk-group, as well as studies in a less specialized setting, would allow the completion and investigation of possible differences and discrepancies when comparing the results that have been obtained in this study.
Collapse
Affiliation(s)
- Marios Mamalis
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Tamara Koehler
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Ivonne Bedei
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Aline Wolter
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Johanna Schenk
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Ellyda Widriani
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Roland Axt-Fliedner
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| |
Collapse
|
7
|
Pu L, Liu H, Liu D, Zhao F, Dai X, Chen J. Novel marker for diagnosis of supracardiac total anomalous pulmonary venous connection in first trimester. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:653-655. [PMID: 36349882 DOI: 10.1002/uog.26112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 05/04/2023]
Affiliation(s)
- L Pu
- Department of Ultrasonic Medicine, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - H Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Pediatric Pulmonology and Immunology, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China
- NHC Key Laboratory of Chronobiology (Sichuan University), Chengdu, Sichuan, China
| | - D Liu
- Department of Ultrasonic Medicine, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - F Zhao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Radiology, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China
| | - X Dai
- Department of Ultrasonic Medicine, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - J Chen
- Department of Ultrasonic Medicine, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| |
Collapse
|
8
|
Krishna MR, Sennaiyan UN. Three-dimensional spatiotemporal imaging correlation in the diagnosis of isolated infracardiac total anomalous pulmonary venous connection in fetal life. Ann Pediatr Cardiol 2023; 16:226-228. [PMID: 37876945 PMCID: PMC10593278 DOI: 10.4103/apc.apc_34_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 10/26/2023] Open
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a critical congenital heart disease which is often missed on prenatal echocardiography because of the decreased pulmonary blood flow in fetal life. Improvement in technology has resulted in increasing prenatal diagnosis of this condition. We report a foetus with infra cardiac TAPVC in whom prenatal diagnosis was facilitated by the use of STIC technology.
Collapse
Affiliation(s)
- Mani Ram Krishna
- Tiny Hearts Fetal and Pediatric Cardiac Clinic, Thanjavur, Tamil Nadu, India
| | | |
Collapse
|
9
|
Anuwutnavin S, Unalome V, Rekhawasin T, Tongprasert F, Thongkloung P. Fetal left-atrial posterior-space-to-diagonal ratio at 17-37 weeks' gestation for prediction of total anomalous pulmonary venous connection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:488-496. [PMID: 36099492 DOI: 10.1002/uog.26072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To develop normative data for the left-atrial posterior-space-to-diagonal (LAPSD) ratio and post-left atrium space (PLAS) index in fetuses from 17 to 37 weeks' gestation, and determine the optimal cut-offs of the LAPSD ratio and PLAS index to discriminate between normal fetuses and those with total anomalous pulmonary venous connection (TAPVC). METHODS This was a prospective cross-sectional assessment of 428 structurally normal fetuses between 17 and 37 weeks' gestation and a retrospective study of 27 TAPVC fetuses. The fetal LAPSD ratio was calculated by dividing the left atrium-descending aorta distance (LDD) by the left atrial diagonal diameter (LA). The PLAS index was calculated as the ratio of the LDD to the descending aorta diameter (DA). Pearson's correlation analysis was used to examine the correlation of cardiac parameters with gestational age (GA) and fetal somatic growth. The PLAS index and LAPSD ratio were compared between the normal and TAPVC groups to assess their usefulness in the prenatal diagnosis of TAPVC. RESULTS LDD, LA and DA measures showed moderate to strong positive correlation, whereas both the LAPSD ratio and PLAS index showed a slight decrease with increasing GA and biometric variables. The fetal LAPSD ratio and PLAS index in TAPVC cases were significantly greater compared with those of fetuses with a normal heart (both P < 0.001). There were no significant differences in the PLAS index and LAPSD ratio between the isolated and complex TAPVC groups (both P = 1). No significant associations of the PLAS index and LAPSD ratio with fetal gender, four-chamber view type (apical, basal or lateral) or TAPVC type were found. Using values of ≥ 0.35 for the LAPSD ratio and of ≥ 1 for the PLAS index exhibited similar excellent diagnostic performance, with a sensitivity of 100% and specificity of 97.0% or 95.1% for detecting TAPVC. CONCLUSIONS Our study demonstrates that the LAPSD ratio is a practical and effective screening tool for diagnosing fetal TAPVC, similar to the PLAS index. Incorporating these parameters into routine cardiac scanning may enhance the prenatal detection of TAPVC. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- S Anuwutnavin
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - V Unalome
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - T Rekhawasin
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - F Tongprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - P Thongkloung
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
10
|
Wang X, Yang TY, Zhang YY, Liu XW, Zhang Y, Sun L, Gu XY, Chen Z, Guo Y, Xue C, Han JC, Zhu HG, He YH. Diagnosis of fetal total anomalous pulmonary venous connection based on the post-left atrium space ratio using artificial intelligence. Prenat Diagn 2022; 42:1323-1331. [PMID: 35938586 DOI: 10.1002/pd.6220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/08/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To explore whether the post-left atrium space (PLAS) ratio would be useful for prenatal diagnosis of total anomalous pulmonary venous connection (TAPVC) using echocardiography and artificial intelligence. METHODS We retrospectively included 642 frames of four-chamber view from 319 fetuses (32 with TAPVC and 287 without TAPVC) in end-systolic and end-diastolic periods with multiple apex directions. The average gestational age was 25.6±2.7 weeks. No other cardiac or extracardiac malformations were observed. The dataset was divided into a training set (n=540; 48 with TAPVC and 492 without TAPVC) and test set (n=102; 20 with TAPVC and 82 without TAPVC). The PLAS ratio was defined as the ratio of the epicardium-descending aortic distance to the center of the heart-descending aortic distance. Supervised learning was used in DeepLabv3+, FastFCN, PSPNet, and DenseASPP segmentation models. The area under the curve (AUC) was used on the test set. RESULTS Expert annotations showed that this ratio was not related to the period or apex direction. It was higher in the TAPVC group than in the control group detected by expert and the four models. The AUC of expert annotations, DeepLabv3+, FastFCN, PSPNet, and DenseASPP were 0.977, 0.941, 0.925, 0.856, and 0.887, respectively. CONCLUSION Segmentation models achieve good diagnostic accuracy for TAPVC based on the PLAS ratio. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Xin Wang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Ting-Yang Yang
- State Key Laboratory of Software Development Environment, Beihang University, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Ying-Ying Zhang
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China.,School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiao-Wei Liu
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Ye Zhang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Lin Sun
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Xiao-Yan Gu
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Zhuo Chen
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Yong Guo
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Chao Xue
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Jian-Cheng Han
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Hao-Gang Zhu
- State Key Laboratory of Software Development Environment, Beihang University, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Yi-Hua He
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China
| |
Collapse
|
11
|
Lin DM, Zhu YX, Tan Y, Huang YJ, Yuan K, Liu WF, Xu ZF. Feasibility of Transabdominal Real-time CDFI and HDFI Techniques for Fetal Pulmonary Vein Display in the First Trimester. Curr Med Sci 2022; 42:635-641. [PMID: 35511413 DOI: 10.1007/s11596-022-2569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to assess the feasibility and usefulness of transabdominal color Doppler flow imaging (CDFI) technology and the high-definition flow imaging (HDFI) technique in detecting fetal pulmonary veins (PVs) in the first trimester (11-13+6 weeks). METHODS From December 2018 to October 2019, 328 pregnant women with 328 normal singleton fetuses (crown-rump length: 45-84 mm) who had undergone CDFI and HDFI scans for fetal heart and vessel examination were enrolled in this study. The cases were divided into three groups according to the gestational age: group A, 11+0 -11+6 weeks; group B, 12+0 -12+6 weeks; and group C, 13+0 -13+6 weeks. Baseline sonograms and CDFI and HDFI images were analyzed by two senior radiologists independently and blindly. The abilities of CDFI and HDFI to display PVs were compared. RESULTS Successful PV display rates via CDFI and HDFI were 2.3% and 68.2% (P<0.01), 22.4% and 82.4% (P<0.01), 41.5% and 91.2% (P<0.01) for group A, group B, and group C, respectively. The total successful display rates for the two methods were 28.9% (CDFI) and 84.8% (HDFI) (P<0.01). CONCLUSIONS The HDFI technique is more valuable than CDFI for detecting PVs in early pregnancy (11-13+6 weeks). HDFI can detect at least one PV in all cases and may be used to detect pulmonary venous anomalies early.
Collapse
Affiliation(s)
- Dong-Mei Lin
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, China.,Department of Medical Ultrasonics, South China Hospital of Shenzhen University, Shenzhen, 518000, China
| | - Yun-Xiao Zhu
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, China
| | - Ying Tan
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, China
| | - Yu-Jun Huang
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, China
| | - Kun Yuan
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, China
| | - Wen-Fen Liu
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, China
| | - Zuo-Feng Xu
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, China.
| |
Collapse
|
12
|
Pereira SS, Meinerikandathevan S. Infracardiac Total Anomalous Pulmonary Venous Drainage: A Case Report. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221091258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anomalous pulmonary venous drainage is a rare cause of congenital heart disease with varied clinical presentation. Symptoms can differ depending on the degree of venous obstruction. An 8-day-old term baby presented with tachypnea and was subsequently found to have an unobstructed infracardiac total anomalous pulmonary venous drainage. She underwent an uneventful surgical repair. The diagnosis of total anomalous pulmonary venous drainage can be delayed or missed, and a high index of suspicion is necessary.
Collapse
Affiliation(s)
- Sujith S. Pereira
- Neonatal Unit, Homerton Hospital, London, UK
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | | |
Collapse
|
13
|
Memon D, Vaidyanathan B. Prenatal diagnosis of obstructed supracardiac total anomalous pulmonary venous connection at 23 weeks with successful immediate postnatal surgical correction. Ann Pediatr Cardiol 2021; 14:432-436. [PMID: 34667423 PMCID: PMC8457286 DOI: 10.4103/apc.apc_197_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/20/2020] [Accepted: 12/13/2020] [Indexed: 11/08/2022] Open
Abstract
Diagnosis of isolated total anomalous pulmonary venous connections (TAPVCs) is relatively rare in fetal life, especially in early gestation. We report a case of a fetus diagnosed with the supracardiac type of TAPVC at 23 weeks gestation, with evidence of obstruction to connection of the common vertical vein to the superior vena cava. The neonate had a critical presentation at birth and underwent an emergency surgical repair immediately after birth with excellent outcome on short term follow-up with the resolution of pulmonary artery hypertension.
Collapse
Affiliation(s)
- Danish Memon
- Department of Paediatric Cardiology, Division of Fetal Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Balu Vaidyanathan
- Department of Paediatric Cardiology, Division of Fetal Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| |
Collapse
|
14
|
Utility of a modified vascular corrosion casting technique in the diagnosis of fetal total anomalous pulmonary venous connection. Sci Rep 2021; 11:11281. [PMID: 34050234 PMCID: PMC8163765 DOI: 10.1038/s41598-021-90681-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/04/2021] [Indexed: 12/30/2022] Open
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiac malformation, and prenatal detection of TAPVC malformation remains a challenging. TAPVC can be easily missed or misdiagnosed in prenatal examinations. This study was aimed to use the modified vascular corrosion casting technique to prepare fetal cardiovascular casts with TAPVC and investigate the utility of cardiovascular casting for the demonstration of fetal TAPVC. The retrospective study enrolled twenty fetuses (22 to 29 + 4 gestational weeks) with TAPVC diagnosed by prenatal echocardiography and casting technique from May 2015 to May 2020. Pre- and postnatal medical records, including results obtained by prenatal ultrasound, postpartum computed tomography angiography, as well as anatomic and cardiovascular casting findings were carefully reviewed and analyzed. In twenty cases, 80% (16/20) had intra- or extracardiac malformations. The TAPVC types were supracardiac (n = 8), cardiac (n = 6), infracardiac (n = 4), and mixed (n = 2). The diagnosis of 1 case each of supracardiac and cardiac TAPVC was modified to partial anomalous pulmonary venous connection; additionally, 4 malformations were missed and 2 were misdiagnosed, including an anomalous left brachiocephalic vein in supracardiac TAPVC, abnormal inflow of the hepatic vein and a double inferior vena cava in infracardiac TAPVC; and bilateral ductus arteriosus in infracardiac TAPVC; a tetralogy of Fallot in cardiac TAPVC that was corrected to right ventricular double outlet; and an absence of ductus arteriosus that was misdiagnosed as slim ductus arteriosus. Comparing with ultrasound, casting technique has its own superiority in exhibiting TAPVC abnormalities, especially in certain types such as course, origin and absence abnormalities of ductus. Postpartum cardiovascular casts can accurately depict the branch structure of the heart's larger vessels, and may be used as a clinical assessment and teaching method in complex cardiac malformations.
Collapse
|
15
|
Bravo-Valenzuela NJM, Peixoto AB, Araujo Júnior E. Prenatal diagnosis of total anomalous pulmonary venous connection: 2D and 3D echocardiographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:240-247. [PMID: 33398887 DOI: 10.1002/jcu.22973] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/14/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a rare cyanotic congenital heart disease that accounts for less than 1% of all congenital heart diseases. TAPVC is characterized by the absence of pulmonary venous drainage into the left atrium. It is underdiagnosed in utero, with prenatal detection rates of less than 1.4%. The prenatal diagnosis of TAPVC affects the postnatal outcome, particularly in obstructive forms (critical TAPVC), since planned delivery and perinatal management are mandatory. Thus, identifying the ultrasound key markers of TAPVC is important for the prenatal diagnosis and perinatal assistance. The ventricular size discrepancy (right ventricle > left ventricle) can be a useful marker. Furthermore, the increased retroatrial distance between the left atrium and the aorta could be a diagnostic marker for prenatal TAPVC, especially when the left atrium is small. Three- (3D) and four-dimensional ultrasonography may improve the prenatal diagnosis of TAPVC. This study reviews the two (2D) and 3D ultrasonographic markers used in the antenatal diagnosis of TAPVC, with a focus on the tools that can be used by sonographers, obstetricians, and fetal medicine specialists to improve the prenatal diagnosis of TAPVC, and when to refer the case to a fetal cardiac specialist.
Collapse
Affiliation(s)
| | - Alberto Borges Peixoto
- Mario Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| |
Collapse
|
16
|
Momoki K, Matsui H. Impact of Novel Fetal Cardiac Screening Detecting Fetal Isolated Partial Anomalous Pulmonary Venous Connections. Circ Rep 2021; 3:182-183. [PMID: 33738352 PMCID: PMC7956875 DOI: 10.1253/circrep.cr-20-0108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kodai Momoki
- Department of Pediatric Cardiology, Nagano Children's Hospital Nagano Japan
| | - Hikoro Matsui
- Department of Pediatric Cardiology, Nagano Children's Hospital Nagano Japan.,Department of Pediatrics, The School of Medicine, The University of Tokyo Tokyo Japan
| |
Collapse
|
17
|
Kurosaki K, Kitano M, Sakaguchi H, Shiraishi I, Iwanaga N, Yoshimatsu J, Hoashi T, Ichikawa H, Yasuda S. Discrepancy Between Pre- and Postnatal Diagnoses of Congenital Heart Disease and Impact on Neonatal Clinical Course - A Retrospective Study at a Japanese Tertiary Institution. Circ J 2020; 84:2275-2285. [PMID: 33148938 DOI: 10.1253/circj.cj-20-0316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is often diagnosed prenatally using fetal echocardiography, but few studies have evaluated the accuracy of these fetal cardiac diagnoses in detail. We investigated the discrepancy between pre- and postnatal diagnoses of CHD and the impact of discrepant diagnoses.Methods and Results:This retrospective study at a tertiary institution included data from the medical records of 207 neonates with prenatally diagnosed CHD admitted to the cardiac neonatal intensive care unit between January 2011 and December 2016. Pre- and postnatal diagnoses of CHD differed in 12% of neonates. Coarctation of the aorta and ventricular septal defects were the most frequent causes of discrepant diagnosis. Unexpected treatments were added to 38% of discrepant diagnostic cases. However, discrepant diagnoses did not adversely affect the clinical course. The 9% of the 207 neonates who required invasive intervention within 24 h of delivery were accurately diagnosed prenatally. CONCLUSIONS Pre- and postnatal diagnoses differed in only a few neonates, with differences not adversely affecting the clinical course. Neonates who required invasive intervention immediately after delivery were accurately diagnosed prenatally. Prenatal diagnosis thus seems to contribute to improved prognosis in neonates with CHD.
Collapse
Affiliation(s)
- Kenichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center.,Department of Advanced Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
| | - Masataka Kitano
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Naoko Iwanaga
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Jun Yoshimatsu
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Takaya Hoashi
- Department of Pediatric Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Hajime Ichikawa
- Department of Pediatric Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center.,Department of Advanced Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
| |
Collapse
|
18
|
Guo Y, Gao S, Kang L, Han J, Zhang Y, Weng Z, Shang J, Hao X, Zhao Y, Ge S, He Y. Comparison of prenatal ultrasound and postmortem findings in fetuses with common pulmonary vein atresia. Echocardiography 2019; 36:1153-1158. [PMID: 31116443 DOI: 10.1111/echo.14363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/26/2019] [Accepted: 04/17/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The previous literature on common pulmonary vein atresia (CPVA) mainly consists of neonatal case reports. There is a lack of research on the prenatal diagnosis of CPVA. METHODS We conducted a retrospective study of all fetuses with CPVA confirmed by autopsy between August 2010 and May 2018. Prenatal echocardiographic features, autopsy findings, and genetic test results were analyzed. We compared fetal CPVA with total anomalous pulmonary venous return (TAPVR) and neonatal CPVA. RESULTS During the study period, fetal echocardiography was performed on 31 617 fetuses. Six cases of CPVA were identified by autopsies, including 1 case performed with a cardiovascular cast. All 6 cases (100%) had asplenia syndrome (AS) and bilateral superior vena cava (BSVC). In 1 case (16.7%), the prenatal ultrasound results were in complete agreement with the postmortem findings. Four cases (66.7%) were misdiagnosed as TAPVR by prenatal echocardiography. For the remaining case (16.7%), no pulmonary venous anomalies were detected on prenatal echocardiography. No aneuploidy was identified in any of the cases. There were no statistically significant differences among the proportions of associated complex anomalies and AS between the fetal CPVA and TAPVR groups. The proportion of associated complex anomalies and AS in the fetal CPVA group was higher than that in the neonatal group (P < 0.05). CONCLUSIONS Prenatal diagnosis of fetal CPVA is difficult and challenging even for experts. Our study showed that fetal CPVA is often combined with AS, complex cardiac malformations, and BSVC. These findings may help in the diagnosis of fetal CPVA.
Collapse
Affiliation(s)
- Yong Guo
- Department of Echocardiography, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuang Gao
- Department of Echocardiography, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Kang
- Department of Neurology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Jiancheng Han
- Department of Echocardiography, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ye Zhang
- Department of Echocardiography, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zongjie Weng
- Department of Ultrasound, Maternity and Child Care Centers in Fujian Province, Fuzhou, China
| | - Jianfeng Shang
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Hao
- Department of Echocardiography, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ying Zhao
- Department of Echocardiography, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuping Ge
- The Heart Center, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Yihua He
- Department of Echocardiography, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
19
|
Lloyd DFA, Pushparajah K, Simpson JM, van Amerom JFP, van Poppel MPM, Schulz A, Kainz B, Deprez M, Lohezic M, Allsop J, Mathur S, Bellsham-Revell H, Vigneswaran T, Charakida M, Miller O, Zidere V, Sharland G, Rutherford M, Hajnal JV, Razavi R. Three-dimensional visualisation of the fetal heart using prenatal MRI with motion-corrected slice-volume registration: a prospective, single-centre cohort study. Lancet 2019; 393:1619-1627. [PMID: 30910324 PMCID: PMC6484696 DOI: 10.1016/s0140-6736(18)32490-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/13/2018] [Accepted: 10/02/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Two-dimensional (2D) ultrasound echocardiography is the primary technique used to diagnose congenital heart disease before birth. There is, however, a longstanding need for a reliable form of secondary imaging, particularly in cases when more detailed three-dimensional (3D) vascular imaging is required, or when ultrasound windows are of poor diagnostic quality. Fetal MRI, which is well established for other organ systems, is highly susceptible to fetal movement, particularly for 3D imaging. The objective of this study was to investigate the combination of prenatal MRI with novel, motion-corrected 3D image registration software, as an adjunct to fetal echocardiography in the diagnosis of congenital heart disease. METHODS Pregnant women carrying a fetus with known or suspected congenital heart disease were recruited via a tertiary fetal cardiology unit. After initial validation experiments to assess the general reliability of the approach, MRI data were acquired in 85 consecutive fetuses, as overlapping stacks of 2D images. These images were then processed with a bespoke open-source reconstruction algorithm to produce a super-resolution 3D volume of the fetal thorax. These datasets were assessed with measurement comparison with paired 2D ultrasound, structured anatomical assessment of the 2D and 3D data, and contemporaneous, archived clinical fetal MRI reports, which were compared with postnatal findings after delivery. FINDINGS Between Oct 8, 2015, and June 30, 2017, 101 patients were referred for MRI, of whom 85 were eligible and had fetal MRI. The mean gestational age at the time of MRI was 32 weeks (range 24-36). High-resolution (0·50-0·75 mm isotropic) 3D datasets of the fetal thorax were generated in all 85 cases. Vascular measurements showed good overall agreement with 2D echocardiography in 51 cases with paired data (intra-class correlation coefficient 0·78, 95% CI 0·68-0·84), with fetal vascular structures more effectively visualised with 3D MRI than with uncorrected 2D MRI (657 [97%] of 680 anatomical areas identified vs 358 [53%] of 680 areas; p<0·0001). When a structure of interest was visualised in both 2D and 3D data (n=358), observers gave a higher diagnostic quality score for 3D data in 321 (90%) of cases, with 37 (10%) scores tied with 2D data, and no lower scores than for 2D data (Wilcoxon signed rank test p<0·0001). Additional anatomical features were described in ten cases, of which all were confirmed postnatally. INTERPRETATION Standard fetal MRI with open-source image processing software is a reliable method of generating high-resolution 3D imaging of the fetal vasculature. The 3D volumes produced show good spatial agreement with ultrasound, and significantly improved visualisation and diagnostic quality compared with source 2D MRI data. This freely available combination requires minimal infrastructure, and provides safe, powerful, and highly complementary imaging of the fetal cardiovascular system. FUNDING Wellcome Trust/EPSRC Centre for Medical Engineering, National Institute for Health Research.
Collapse
Affiliation(s)
- David F A Lloyd
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kuberan Pushparajah
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joshua F P van Amerom
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Milou P M van Poppel
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Alexander Schulz
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Bernard Kainz
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK; Department of Computing (BioMedIA), Imperial College London, London, UK
| | - Maria Deprez
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Maelene Lohezic
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Joanna Allsop
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Sujeev Mathur
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hannah Bellsham-Revell
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Trisha Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marietta Charakida
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gurleen Sharland
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mary Rutherford
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Joseph V Hajnal
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Reza Razavi
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| |
Collapse
|
20
|
Krasoń A, Płużańska J, Łukaszewski M, Moll J, Respondek-Liberska M. Prenatal Detection and Postnatal Verification of Unusual Intracardiac Total Anomolous Pulmonary Venous Connection (Tapvc) in Complex Heart Defect with Dextrocardia - Case Report. PRENATAL CARDIOLOGY 2018. [DOI: 10.1515/pcard-2018-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Prenatal diagnosis of total anomolous pulmonary venous connection (intracardiac) was diagnosed in fetus with dextrocardia and complex heart defect, which allowed fetal echocardiography monitoring, planning the time and place for delivery as well as early cardiac surgery. The differences between prenatal and postnatal evaluations were underlined. Despite life treathening condition neonate was asymptomatic without any heart murmur for the first 3 days after delivery.
Collapse
Affiliation(s)
- Aneta Krasoń
- Prenatal Cardiology Department, Polish Mother’s Memorial Hospital Research Institute, Lodz , Poland
| | - Joanna Płużańska
- Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital Research Institute, Lodz , Poland
| | - Maciej Łukaszewski
- Department of Medical Imaging, Polish Mother’s Memorial Hospital Research Institute, Lodz , Poland
| | - Jadwiga Moll
- Department of Cardiology, Polish Mother’s Memorial Hospital Research Institute, Lodz , Poland
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital Research Institute, Lodz , Poland
- Medical University of Lodz, Department of Diagnoses and Prevention Fetal Malformations, Lodz , Poland
| |
Collapse
|
21
|
Hancock HS, Romano JC, Armstrong A, Yu S, Lowery R, Gelehrter S. Single Ventricle and Total Anomalous Pulmonary Venous Connection: Implications of Prenatal Diagnosis. World J Pediatr Congenit Heart Surg 2018; 9:434-439. [PMID: 29945508 DOI: 10.1177/2150135118771344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Single ventricle (SV) patients with total anomalous pulmonary venous connection (TAPVC) are at high risk. Given the limited published data available, we examined outcomes and the implications of a prenatal diagnosis of SV/TAPVC. METHODS A single-center, retrospective review was performed in neonates with SV/TAPVC from 1998 to 2014, identified through institutional databases. Patient demographic, perioperative, and follow-up data were collected. RESULTS Thirty-four eligible infants with SV/TAPVC were identified (mean birth weight: 3.0 kg). The TAPVC types were supracardiac (59%), infracardiac (21%), mixed (12%), and cardiac (9%). Heterotaxy syndrome was present in 25 (74%) infants. A prenatal diagnosis of SV was made in 26 (76%) infants, with TAPVC identified in 12 (35%). Seventeen (50%) had obstructed TAPVC within the first 48 hours of life; 7 of these patients had obstructed TAPVC identified prenatally. There were two preoperative deaths. Overall survival for the cohort was 65% at 1 year and 50% at 3 years. Survival in the obstructed group was significantly worse compared to the unobstructed group (47% vs 81% at 1 year; 27% vs 73% at 3 years, P = .01). Obstructed TAPVC and a prenatal prediction of obstructed TAPVC were significantly associated with postoperative mortality ( P = .01 and .03, respectively). CONCLUSIONS Patients with SV/TAPVC remain a high-risk group, with obstructed TAPVC a significant risk factor for mortality. Prenatal diagnosis of TAPVC in SV patients is challenging, but given those with obstructed TAPVC are especially at high risk, improved prenatal diagnostic techniques in this group may enhance counseling/delivery planning.
Collapse
Affiliation(s)
- Hayley S Hancock
- 1 Division of Pediatric Cardiology, Department of Pediatrics, Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Jennifer C Romano
- 2 Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.,3 Section of Pediatric Cardiac Surgery, Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Aimee Armstrong
- 4 Division of Pediatric Cardiology, Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sunkyung Yu
- 2 Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Ray Lowery
- 2 Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Gelehrter
- 2 Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
22
|
Domadia S, Kumar SR, Votava-Smith JK, Pruetz JD. Neonatal Outcomes in Total Anomalous Pulmonary Venous Return: The Role of Prenatal Diagnosis and Pulmonary Venous Obstruction. Pediatr Cardiol 2018; 39:1346-1354. [PMID: 29796693 DOI: 10.1007/s00246-018-1901-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/08/2018] [Indexed: 11/28/2022]
Abstract
The objective of this study is to evaluate neonatal outcomes of total anomalous pulmonary venous return (TAPVR) and identify fetal echocardiography findings associated with preoperative pulmonary venous obstruction (PPVO). This retrospective study evaluated TAPVR cases from 2005 to 2014 for preoperative and postoperative outcomes based on prenatal diagnosis, PPVO, and heterotaxy syndrome. Fetal pulmonary and vertical vein Dopplers were analyzed as predictors of PPVO. Of 137 TAPVR cases, 12% were prenatally diagnosed; 60% had PPVO, and 21% had heterotaxy. Of the prenatally diagnosed patients, 63% also had heterotaxy. TAPVR repair was performed in 135 cases and survival to discharge was 82% (112/137). Heterotaxy was the only independent predictor of mortality on multiple regression analysis [OR 5.5 (CI 1.3-16.7), p = 0.02]. PPVO was associated with preoperative acidosis, need for inhaled nitric oxide, and more emergent surgery, but not postoperative mortality. Fetal vertical vein Doppler peak velocity > 0.74 m/s mmHg predicted PPVO (93% sensitivity; 83% specificity) while pulmonary vein Doppler did not. TAPVR has severe neonatal morbidity and mortality with low prenatal diagnosis rates in the absence of heterotaxy. Patients with obstructed TAPVR had greater preoperative morbidity, but only heterotaxy was independently associated with increased postoperative mortality. Vertical vein velocity helped prenatally identify those at risk of PPVO.
Collapse
Affiliation(s)
- Shelly Domadia
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - S Ram Kumar
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Cardiothoracic Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jodie K Votava-Smith
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. Mailstop #34, Los Angeles, CA, 90027, USA
| | - Jay D Pruetz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. Mailstop #34, Los Angeles, CA, 90027, USA. .,Department of Obstetrics & Gynecology, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
23
|
Paladini D, Pistorio A, Wu LH, Meccariello G, Lei T, Tuo G, Donarini G, Marasini M, Xie HN. Prenatal diagnosis of total and partial anomalous pulmonary venous connection: multicenter cohort study and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:24-34. [PMID: 28926132 DOI: 10.1002/uog.18907] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/31/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aims of this study were to review systematically literature on and describe the sonographic features and associated anomalies of total (TAPVC) and partial (PAPVC) anomalous pulmonary venous connection and scimitar syndrome (SS). METHODS A retrospective cohort study was carried out of cases of TAPVC, PAPVC and SS that underwent comprehensive ultrasound examination, seen over a 20-year period at two tertiary referral centers. Assessed variables included TAPVC subtype, gestational age at diagnosis, area behind the left atrium, ventricular disproportion, vertical vein, pulmonary venous obstruction, mode of diagnosis, association with cardiac and extracardiac conditions, and pregnancy and fetoneonatal outcomes. The outcome was considered favorable if the individual was alive and well (no functional impairment from surgery or cardiac or extracardiac conditions). Cases associated with right isomerism were excluded from the analysis, as TAPVC in these cases was only one of several major cardiac anomalies affecting sonographic signs. A systematic review was performed in order to obtain a synthesis of characteristics associated with TAPVC, PAPVC and SS. The literature search of PubMed and EMBASE (1970-2016) included reviews, case series and case reports. A meta-analysis was conducted only for TAPVC. Random-effects models were used to obtain pooled estimates of the frequencies of clinical characteristics and sonographic features. RESULTS For TAPVC, a total of 15 studies involving 71 patients (including 13 from the current cohort study) were included in the systematic review and meta-analysis. The pooled estimate for the association of TAPVC with congenital heart disease was 28.3% (95% CI, 18.1-41.3%) and with extracardiac anomalies it was 18.5% (95% CI, 10.5-30.6%). Of TAPVC cases, obstructed venous return was observed in 34.1% (95% CI, 22.7-47.7%), a favorable outcome in 43.8% (95% CI, 24.0-65.8%), ventricular disproportion in 59.2% (95% CI, 45.1-72.0%), increased area behind the left atrium in 58.1% (95% CI, 41.1-73.5%) and a vertical vein in 59.3% (95% CI, 41.1-75.3%). Diagnosis was established by using color or power Doppler in 84.9% (95% CI, 67.3-93.9%) of cases. For SS, there were only three studies describing eight cases, to which the current study added another five. Ventricular disproportion was present in three out of nine SS cases for which data were available, but for two of these, there was a concurrent heart anomaly. Color Doppler was used for all SS diagnoses, and four-dimensional echocardiography was useful in two out of six cases in which it was used. Outcome for SS cases was generally good. For PAPVC, there were only five studies describing five cases, to which the current study added another two. Major cardiac anomalies were associated in four out of seven of these cases, and extracardiac anomalies in three out of six cases for which data were available. CONCLUSIONS TAPVC can be associated with other cardiac and extracardiac anomalies in a significant percentage of cases. Leading sonographic signs are ventricular disproportion, increased area behind the left atrium and the finding of a vertical vein. Color/power Doppler is the key mode for diagnosis of TAPVC. Obstructed venous return can be expected in roughly one-third of cases of TAPVC and outcome is favorable in less than half of cases. Data for SS and PAPVC are too few to synthesize. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- D Paladini
- Fetal Medicine & Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - A Pistorio
- Unit of Epidemiology and Biostatistics, Istituto Giannina Gaslini, Genoa, Italy
| | - L H Wu
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - G Meccariello
- Fetal Medicine & Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - T Lei
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - G Tuo
- Department of Pediatric Cardiology and Cardiac Surgery, Istituto Giannina Gaslini, Genoa, Italy
| | - G Donarini
- Fetal Medicine & Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - M Marasini
- Department of Pediatric Cardiology and Cardiac Surgery, Istituto Giannina Gaslini, Genoa, Italy
| | - H-N Xie
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
24
|
Abstract
The development of fetal echocardiography and success in prenatal cardiac screening programs over the past 30 years has been driven by technical innovation and influenced by the different approaches of the various specialties practicing it. Screening for congenital heart defects no longer focuses on examining a limited number of pregnant women thought to be at increased risk, but instead forms an integrated part of a high-quality anatomical ultrasound performed in the second trimester using the 'five-transverse view' protocol. A prenatal diagnosis is feasible in almost all cardiac lesions and the advantages to parents and to health professionals are well recognized. Prenatal evaluation can usually determine the level of care required at delivery, thereby reducing perinatal morbidity. However, only half of the babies undergoing surgery within the first year of life have a prenatal detection, and practical training programs to support and provide feedback to sonographers remain essential for continued improvement.
Collapse
Affiliation(s)
- Helena M Gardiner
- The Fetal Center at Children's Memorial Hermann Hospital, McGovern Medical School at UTHealth, The University of Texas Health Sciences Center at Houston, Houston TX, USA.
| |
Collapse
|
25
|
Atik-Ugan S, Saltik İL. Prenatally diagnosed infracardiac total anomalous pulmonary venous connection: from the two sides of the spectrum. J OBSTET GYNAECOL 2018. [DOI: 10.1080/01443615.2017.1414775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sezen Atik-Ugan
- Department of Pediatric Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, İstanbul, Turkey
| | - İrfan Levent Saltik
- Department of Pediatric Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, İstanbul, Turkey
| |
Collapse
|
26
|
Fernandes P, Mantagou L, Ramaraj R, Agarwal U, Lim JSL. Antenatal diagnosis of total anomalous pulmonary venous connection in functional single ventricle hearts: Outcomes over 13-year period. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 26:42-48. [PMID: 29456581 DOI: 10.1177/1742271x17751256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/03/2017] [Indexed: 11/17/2022]
Abstract
Introduction A functionally single cardiac ventricle seen on foetal ultrasound scan carries a guarded prognosis. The antenatal diagnosis of anomalous pulmonary venous connection (APVC) remains challenging, if there is no associated structural cardiac abnormality. Antenatally, a combination of complex cardiac anomaly with suspected isomerism should raise the possibility of associated total anomalous pulmonary venous connection (TAPVC). There needs to be a high index of suspicion for TAPVC, in functional single ventricle and suspected isomerism, as this carries a very grim outcome postnatally. We illustrate foetal echocardiographic findings of suspected TAPVC and review outcomes of antenatal versus postnatal diagnosis of TAPVC with functional single ventricle. Methods We retrospectively reviewed our database over 13 years, focusing on foetal cardiac diagnosis, pregnancy outcomes, management and outcomes of livebirths with diagnosis of TAPVC with functional single ventricle. Results Thirteen patients were included in the review. For the nine antenatal patients, three pregnancies were terminated and six babies were born alive (four babies had compassionate care, two babies had cardiac surgery). One baby is alive at 8.5 years, after Fontan surgery. For the four postnatal patients, three babies had compassionate care (one alive at age 8.1 years) and one baby had cardiac surgery (died age nine weeks). Ten of the 13 patients have right atrial isomerism. Of these 10 patients, only two are alive. For the three non-isomeric babies, only one baby is still alive. There is heterogeneity of the type of TAPVC diagnosed with no particular group that offered better survival. Conclusion Antenatal diagnosis of TAPVC, even in the context of functional single ventricle remains challenging. If isomerism is suspected, targeted evaluation of pulmonary venous connection should be done. This combination of cardiac lesion carries a very grim outcome. The ability to make this diagnosis antenatally will add to the information and counselling given to these parents.
Collapse
Affiliation(s)
| | - Lito Mantagou
- 1Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Ram Ramaraj
- 1Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Umber Agarwal
- 2Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | | |
Collapse
|
27
|
Sanapo L, Pruetz JD, Słodki M, Goens MB, Moon-Grady AJ, Donofrio MT. Fetal echocardiography for planning perinatal and delivery room care of neonates with congenital heart disease. Echocardiography 2017; 34:1804-1821. [DOI: 10.1111/echo.13672] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Laura Sanapo
- Division of Fetal and Transitional Medicine; Children's National Health System; George Washington University; Washington DC USA
| | - Jay D. Pruetz
- Division of Cardiology; Children's Hospital Los Angeles; Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Maciej Słodki
- Department of Prenatal Cardiology; Polish Mother's Memorial Hospital Research Institute; Lodz Poland
- Faculty of Health Sciences; The State University of Applied Sciences; Plock Poland
| | - M. Beth Goens
- Special Delivery Service; Pediatric Cardiology; University of New Mexico; Albuquerque NM USA
| | - Anita J. Moon-Grady
- Division of Cardiology; Department of Pediatrics; UCSF Benioff Children's Hospital; San Francisco CA USA
| | - Mary T. Donofrio
- Division of Fetal and Transitional Medicine; Children's National Health System; George Washington University; Washington DC USA
- Fetal Heart Program; Division of Cardiology; Children's National Health System; Washington DC USA
| |
Collapse
|
28
|
Zhang Y, Shao Q, Sun L, Ge S, He Y. Prenatal diagnosis of total anomalous pulmonary venous connection by 2D and 3D fetal echocardiography. Echocardiography 2017; 34:1852-1857. [PMID: 29287134 DOI: 10.1111/echo.13698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ye Zhang
- Department of Echocardiography; Beijing Anzhen Hospital; Capital Medical University; Beijing China
| | - Qin Shao
- Department of Echocardiography; Beijing Anzhen Hospital; Capital Medical University; Beijing China
| | - Lin Sun
- Department of Echocardiography; Beijing Anzhen Hospital; Capital Medical University; Beijing China
| | - Shuping Ge
- Section of Cardiology; St. Christopher's Hospital for Children and Drexel University College of Medicine; Philadelphia PA USA
| | - Yihua He
- Department of Echocardiography; Beijing Anzhen Hospital; Capital Medical University; Beijing China
| |
Collapse
|
29
|
van Velzen CL, Ket JCF, van de Ven PM, Blom NA, Haak MC. Systematic review and meta-analysis of the performance of second-trimester screening for prenatal detection of congenital heart defects. Int J Gynaecol Obstet 2017; 140:137-145. [PMID: 29094357 DOI: 10.1002/ijgo.12373] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/11/2017] [Accepted: 10/31/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prenatal detection rate of congenital heart defects (CHDs) is increasing, but reported rates vary. OBJECTIVES To determine the performance of the second-trimester anomaly scan to detect CHD. SEARCH STRATEGY PubMed and Embase were searched for relevant studies in any language from inception to February 3, 2017. The search terms included "prenatal diagnosis" or "pregnancy," "cardiovascular diseases" or "cardiac defects," "congenital," and "specificity," or "sensitivity," or "cohort study." SELECTION CRITERIA Cohort studies assessing the detection rate of CHD during population-based prenatal screening from 1995 were eligible for inclusion. DATA COLLECTION AND ANALYSIS Data were collected from identified studies; authors were approached for additional data when necessary. A review and meta-analysis were performed. When possible, separate analyses were undertaken for isolated CHD cases. MAIN RESULTS Meta-analysis of seven studies showed the pooled detection rate of CHD in unselected populations as 45.1% (95% confidence interval 33.5%-57.0%). However, the rate of detection of univentricular defects and heterotaxy was above 85%. Similar rates were found among cases of isolated CHD. CONCLUSIONS Prenatal detection showed a strong correlation with CHD severity. The detection of conotruncal anomalies needs to improve. A thoroughly organized screening program will be essential to achieve a higher detection rate.
Collapse
Affiliation(s)
- Christine L van Velzen
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, Netherlands
| | | | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands.,Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique C Haak
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
30
|
Krupickova S, Rigby ML, Jicinska H, Marais G, Rubens M, Carvalho JS. Total anomalous pulmonary venous connection to unroofed coronary sinus diagnosed in a fetus with spinal muscular atrophy Type I. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:657-658. [PMID: 28170121 DOI: 10.1002/uog.17432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/06/2017] [Accepted: 02/01/2017] [Indexed: 06/06/2023]
Affiliation(s)
- S Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
| | - M L Rigby
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
| | - H Jicinska
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
- Fetal Medicine Unit, St George's Hospital, London, UK
| | - G Marais
- Department of Paediatrics, Croydon Hospital, Croydon, UK
| | - M Rubens
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
- Department of Radiology, Royal Brompton Hospital, London, UK
| | - J S Carvalho
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
- Fetal Medicine Unit, St George's Hospital, London, UK
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| |
Collapse
|
31
|
Kao CC, Hsieh CC, Cheng PJ, Chiang CH, Huang SY. Total Anomalous Pulmonary Venous Connection: From Embryology to a Prenatal Ultrasound Diagnostic Update. J Med Ultrasound 2017; 25:130-137. [PMID: 30065477 PMCID: PMC6029298 DOI: 10.1016/j.jmu.2017.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/02/2017] [Indexed: 01/03/2023] Open
Affiliation(s)
- Chuan-Chi Kao
- Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ching-Chang Hsieh
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Po-Jen Cheng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Chi-Hsin Chiang
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Shih-Yin Huang
- Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| |
Collapse
|
32
|
Acevedo JM, Lee S, Gotteiner N, Lay AS, Patel A. Total anomalous pulmonary venous connection (TAPVC): A familial cluster of 3 siblings. Echocardiography 2017; 34:1531-1535. [DOI: 10.1111/echo.13665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Jennifer M. Acevedo
- Department of Pediatrics-Cardiology; Ann and Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Simon Lee
- Department of Pediatrics-Cardiology; Ann and Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Nina Gotteiner
- Department of Pediatrics-Cardiology; Ann and Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Amy S. Lay
- Department of Pediatrics-Cardiology; Children's Mercy; University of Missouri-Kansas City School of Medicine; Kansas MO USA
| | - Angira Patel
- Department of Pediatrics-Cardiology; Ann and Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine; Chicago IL USA
| |
Collapse
|
33
|
Mao YK, Zhao BW, Zheng FH, Wang B, Peng XH, Chen R, Pan M. Z
-scores for fetal left atrial size and left atrium-descending aorta distance in fetuses with isolated total anomalous pulmonary venous connection. Prenat Diagn 2017; 37:992-1000. [PMID: 28753739 DOI: 10.1002/pd.5119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/18/2017] [Accepted: 07/21/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Yan Kai Mao
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital; Zhejiang University College of Medicine; Hangzhou China
| | - Bo Wen Zhao
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital; Zhejiang University College of Medicine; Hangzhou China
| | - Feng Hua Zheng
- Department of Ultrasonic Medicine; The First People's Hospital of Yuhang District; Hangzhou China
| | - Bei Wang
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital; Zhejiang University College of Medicine; Hangzhou China
| | - Xiao Hui Peng
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital; Zhejiang University College of Medicine; Hangzhou China
| | - Ran Chen
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital; Zhejiang University College of Medicine; Hangzhou China
| | - Mei Pan
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital; Zhejiang University College of Medicine; Hangzhou China
| |
Collapse
|
34
|
Abstract
OBJECTIVES The aim of this study was to determine the probability of intervention at birth after prenatal diagnosis of CHD. METHODS A 10-year retrospective study including all foetuses with a prenatally diagnosed CHD and those delivered in a tertiary-care cardiac centre between January, 2002 and December, 2011 was carried out. Patients were classified into eight groups according to the anticipated risk of neonatal intervention. RESULTS The need for urgent intervention and/or PGE1 infusion within the first 48 hours of life was 47% (n=507/1080): 72% (n=248) for CHD at risk for a Rashkind procedure, 77% (n=72) for CHD with ductal-dependent pulmonary flow, 13% (n=22) for CHD with potentially ductal-dependent pulmonary flow, 94% (n=62) for CHD with ductal-dependent systemic flow, 29% (n=88) for CHD with potentially ductal-dependant systemic flow, 50% (n=4) for total anomalous pulmonary venous connection, and 17% (n=1) for CHD with atrio-ventricular block. In all, 34% of the patients received PGE1 infusion and 21.4% underwent urgent catheter-based or surgical interventions; 10% of patients without anticipated risk (n=10) underwent an early intervention; 6.7% (n=73) of the patients died; and 55% (n=589) had an intervention before discharge from hospital. CONCLUSION Half of the neonates with foetal CHD benefited from an urgent intervention or PGE1 infusion at birth. We recommend scheduled delivery and in utero transfer for transposition of the great arteries, double-outlet right ventricle with sub-pulmonary ventricular septal defect, total anomalous pulmonary venous connection, CHD with atrio-ventricular block with heart rate <50, all ductal-dependant lesions, and CHD with potentially ductal-dependant systemic flow.
Collapse
|
35
|
Muntean I, Mărginean C, Stanca R, Togănel R, Pop M, Gozar L. Prenatal diagnoses of an uncommon isolated obstructed supracardiac total anomalous pulmonary venous connection: Case report and review of the literature (CARE compliant). Medicine (Baltimore) 2017; 96:e6061. [PMID: 28151919 PMCID: PMC5293482 DOI: 10.1097/md.0000000000006061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Total anomalous pulmonary venous connection is an uncommon congenital heart disease. Four types are described based on the site of pulmonary venous drainage: supracardiac, cardiac, infradiaphragmathic, and mixed connection. In most cases of supracardiac type, the common venous confluence drains through an ascending left vertical vein into the brachiocephalic vein, right superior vena cava, and then into the right atrium. Anomalous connection of the pulmonary venous confluence directly to the right SVC, especially the obstructed form is an unusual and severe supracardiac variant. The prenatal diagnosis is challenging. PATIENT CONCERNS We present a case report of a fetus diagnosed with TAPVC at 23 gestational weeks. DIAGNOSIS INTERVENTIONS The 4-chamber view showed a small left atrium, with a "smooth" posterior wall and the absence of pulmonary vein connection. This is the first case of prenatally diagnosed isolated, obstructed supracardiac type with drainage directly into the right superior vena cava. CONCLUSION The obstetrician and fetal cardiologist should be cautious at the direct and indirect echocardiographic signs of this condition. A prenatal diagnose of isolated, obstructed form is important for adequate planning of delivery and postnatal surgery in a tertiary center.
Collapse
Affiliation(s)
- Iolanda Muntean
- Department of Pediatric Cardiology, University of Medicine and Pharmacy
| | - Claudiu Mărginean
- Department of Obstetric and Gynecology I, University of Medicine and Pharmacy, Tirgu-Mures
| | | | - Rodica Togănel
- Department of Pediatric Cardiology, University of Medicine and Pharmacy
| | - Marian Pop
- County Emergency Hospital, Tîrgu-Mureş, România
| | - Liliana Gozar
- Department of Pediatric Cardiology, University of Medicine and Pharmacy
| |
Collapse
|
36
|
Files MD, Morray B. Total Anomalous Pulmonary Venous Connection: Preoperative Anatomy, Physiology, Imaging, and Interventional Management of Postoperative Pulmonary Venous Obstruction. Semin Cardiothorac Vasc Anesth 2016; 21:123-131. [PMID: 27831520 DOI: 10.1177/1089253216672442] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Total anomalous pulmonary venous connection refers to a spectrum of cardiac anomalies where the pulmonary veins fail to return to the left atrium and the pulmonary venous blood returns through a systemic vein or directly to the right atrium. There is a wide anatomical variety of venous connections and degrees of pulmonary venous obstruction that affect the presentation, surgical repair, and outcomes. In this review, we explore the preoperative physiology, echocardiographic diagnosis, and approach to postoperative complications.
Collapse
|
37
|
Ross FJ, Joffe D, Latham GJ. Perioperative and Anesthetic Considerations in Total Anomalous Pulmonary Venous Connection. Semin Cardiothorac Vasc Anesth 2016; 21:138-144. [PMID: 27694572 DOI: 10.1177/1089253216672012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a potentially devastating form of congenital heart disease in which all pulmonary blood flow returns to the systemic venous circulation rather than the left atrium. Anomalous pulmonary venous flow may be obstructed at birth, and affected infants present with severe cyanosis and poor cardiac output unresponsive to standard resuscitation with prostaglandin. Obstructed TAPVC remains one of the few indications for emergent neonatal cardiac surgery. This review will discuss the physiology and perioperative management of isolated TAPVC without associated cardiac lesions.
Collapse
Affiliation(s)
- Faith J Ross
- 1 Seattle Children's Hospital, Seattle, WA, USA.,2 University of Washington School of Medicine, Seattle, WA, USA
| | - Denise Joffe
- 1 Seattle Children's Hospital, Seattle, WA, USA.,2 University of Washington School of Medicine, Seattle, WA, USA
| | - Gregory J Latham
- 1 Seattle Children's Hospital, Seattle, WA, USA.,2 University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
38
|
Respondek-Liberska M, Sokołowski Ł, Słodki M, Zych-Krekora K, Strzelecka I, Krekora M, Maroszyńska I, Moll J, Moll J. Prenatal Diagnosis of TAPVC on Monday, Delivery of Tuesday and Cardiac Surgery at Wednesday - A Model of Perinatal Care in 3rd Trimester in Case of Fetal/Neonatal Critical Heart Defect in Tertiary Center. PRENATAL CARDIOLOGY 2016. [DOI: 10.1515/pcard-2016-0005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a congenital heart defect (CHD), in which all pulmonary veins connect to the systemic veins or to the right atrium/coronary sinus instead of the left atrium. We present a case report of fetus with prenatally diagnosed isolated infracardiac type of TAPVC in 38th week of gestation. In fetal echocardiographic examination performed in the Department of Prenatal Cardiology, the fetus presented lack of visible pulmonary veins connection to left atrium, abnormal venous confluence behind left atrium, additional vein leading from abdominal cavity to mediastinum and abnormal smooth Doppler blood flow in pulmonary confluence. The accurate prenatal diagnosis allowed to deliver the neonate at term, in tertiary center one day after diagnosis, and to perform surgical reposition of pulmonary veins the following day. The neonate was referred home in a good condition after 28 days of hospitalization. This case is a good example of the value of the 3rd trimester echocardiography.
Collapse
Affiliation(s)
- Maria Respondek-Liberska
- 1. Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital Research Institute
- 2. Medical University of Lodz, Department of Diagnoses and Prevention Fetal Malformations Lodz, Poland
| | - Łukasz Sokołowski
- 3. Medical University of Lodz, Students Research Circle Prenatal Cardiology
| | - Maciej Słodki
- 1. Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital Research Institute
- 4. Institute of Health Sciences, The State School of Higher Professional Education in Płock, Poland
| | - Katarzyna Zych-Krekora
- 2. Medical University of Lodz, Department of Diagnoses and Prevention Fetal Malformations Lodz, Poland
| | - Iwona Strzelecka
- 2. Medical University of Lodz, Department of Diagnoses and Prevention Fetal Malformations Lodz, Poland
- 5. Department of Nursing, Medical
| | - Michał Krekora
- 6. University of Lodz Department of Obstetrics & Gynecology Research Institute of Lodz
| | - Iwona Maroszyńska
- 7. Department of Intensive Care of Neonates and Congenital Malformations, Research Institute Polish Mother's Memorial Hospital
| | - Jadwiga Moll
- 8. Department of Pediatric Cardiology, Research Institute Polish Mother's Memorial Hospital
| | - Jacek Moll
- 9. Department of Pediatric Cardiac Surgery, Research Instiute Polish Mother's Memorial Hospital
| |
Collapse
|
39
|
Lloyd DFA, van Amerom JFP, Pushparajah K, Simpson JM, Zidere V, Miller O, Sharland G, Allsop J, Fox M, Lohezic M, Murgasova M, Malamateniou C, Hajnal JV, Rutherford M, Razavi R. An exploration of the potential utility of fetal cardiovascular MRI as an adjunct to fetal echocardiography. Prenat Diagn 2016; 36:916-925. [PMID: 27521762 PMCID: PMC5082528 DOI: 10.1002/pd.4912] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/01/2016] [Accepted: 08/09/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Fetal cardiovascular magnetic resonance imaging (MRI) offers a potential alternative to echocardiography, although in practice, its use has been limited. We sought to explore the need for additional imaging in a tertiary fetal cardiology unit and the usefulness of standard MRI sequences. METHODS Cases where the diagnosis was not fully resolved using echocardiography were referred for MRI. Following a three-plane localiser, fetal movement was assessed with a balanced steady-state free precession (bSSFP) cine. Single-shot fast spin echo and bSSFP sequences were used for diagnostic imaging. RESULTS Twenty-two fetal cardiac MRIs were performed over 12 months, at mean gestation of 32 weeks (26-38 weeks). The majority of referrals were for suspected vascular abnormalities (17/22), particularly involving the aortic arch (n = 10) and pulmonary vessels (n = 4). Single-shot fast spin echo sequences produced 'black-blood' images, useful for examining the extracardiac vasculature in these cases. BSSFP sequences were more useful for intracardiac structures. Real-time SSFP allowed for dynamic assessment of structures such as cardiac masses, with enhancement patterns also allowing for tissue characterisation in these cases. CONCLUSIONS Fetal vascular abnormalities such as coarctation can be difficult to diagnose by using ultrasound. Fetal MRI may have an adjunctive role in the evaluation of the extracardiac vascular anatomy and tissue characterisation. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- David F A Lloyd
- Evelina Children's Hospital, London, UK. .,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
| | - Joshua F P van Amerom
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Kuberan Pushparajah
- Evelina Children's Hospital, London, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | | | | | | | | | - Joanna Allsop
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Matthew Fox
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Maelene Lohezic
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Maria Murgasova
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Christina Malamateniou
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Jo V Hajnal
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Mary Rutherford
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Reza Razavi
- Evelina Children's Hospital, London, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| |
Collapse
|
40
|
Akkurt MO, Yavuz A, Akkurt I, Karakoc G, Sezik M. Reliability of posterior-left atrium space index measurements during 20-24 weeks of gestation in structurally normal fetuses. J Perinat Med 2016; 44:613-7. [PMID: 26352074 DOI: 10.1515/jpm-2015-0147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/29/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We aimed to evaluate the correlation between clinical parameters and the post-left atrium (LA) space index, which is a candidate screening marker for total anomalous pulmonary venous connection (TAPVC). We also calculated the inter- and intra-observer variabilities of measurements for this parameter. METHODS The LA-descending aorta distance/descending aorta diameter ratios (post-LA space index) were obtained from 165 fetuses between 20 and 24 weeks of gestation. Regression analyses were utilized to evaluate the correlations across clinical parameters and the post-LA space index. Intraclass correlations coefficients were calculated for the intra- and inter-observer agreements of three examiners with different sonographic experience. RESULTS The mean (±SD) maternal and gestational age (GA) was 28.6±4.9 years and 21.7±0.9 weeks of gestation, respectively. In multivariate analyses, there was no correlation between post-LA space index and maternal age, fetal gender, or GA at cardiac scan. There were moderate to strong correlations across the measurements by different examiners, indicating good inter- and intra-observer agreements. CONCLUSION The post-LA space index during 20-24 weeks of gestation is a simple and reliable marker that is not affected by GA. However, its potential as a screening tool for TAPVC warrants further clinical investigation.
Collapse
|
41
|
Fetal cardiology: changing the definition of critical heart disease in the newborn. J Perinatol 2016; 36:575-80. [PMID: 26963427 DOI: 10.1038/jp.2016.20] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 01/14/2023]
Abstract
Infants born with congenital heart disease (CHD) may require emergent treatment in the newborn period. These infants are likely to benefit the most from a prenatal diagnosis, which allows for optimal perinatal planning. Several cardiac centers have created guidelines for the management of these high-risk patients with CHD. This paper will review and compare several prenatal CHD classification systems with a particular focus on the most critical forms of CHD in the fetus and newborn. A contemporary definition of critical CHD is one which requires urgent intervention in the first 24 h of life to prevent death. Such cardiac interventions may be not only life saving for the infant but also decrease subsequent morbidity. Critical CHD cases may require delivery at specialized centers that can provide perinatal, obstetric, cardiology and cardiothoracic surgery care. Fetuses diagnosed in mid-gestation require detailed fetal diagnostics and serial monitoring during the prenatal period, in order to assess for ongoing changes and identify progression to a more severe cardiac status. Critical CHD may progress in utero and there is still much to be learned about how to best predict those who will require urgent neonatal interventions. Despite improved therapeutic capabilities, newborns with critical CHD continue to have significant morbidity and mortality due to compromise that begins in the delivery room. Fetal echocardiography is the best way to predict the need for specialized care at birth to improve outcome. Once the diagnosis is made of critical CHD, delivery at the proper time and in appropriate institution with specific care protocols should be initiated. More work needs to be done to better delineate the risk factors for progression of critical CHD and to determine which newborns will require specialized care. The most frequently described forms of critical CHD requiring immediate intervention include hypoplastic left heart syndrome with intact or severely restricted atrial septum, obstructed total anomalous pulmonary venous return and transposition of the great arteries with restrictive atrial septum.
Collapse
|
42
|
Bensemlali M, Stirnemann J, Le Bidois J, Lévy M, Raimondi F, Hery E, Stos B, Bessières B, Boudjemline Y, Bonnet D. Discordances Between Pre-Natal and Post-Natal Diagnoses of Congenital Heart Diseases and Impact on Care Strategies. J Am Coll Cardiol 2016; 68:921-30. [DOI: 10.1016/j.jacc.2016.05.087] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/18/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
|
43
|
Tongsong T, Luewan S, Jatavan P, Tongprasert F, Sukpan K. A Simple Rule for Prenatal Diagnosis of Total Anomalous Pulmonary Venous Return. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1601-1607. [PMID: 27269000 DOI: 10.7863/ultra.15.08016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 10/21/2015] [Indexed: 06/06/2023]
Abstract
The objective of this series was to describe a simple rule for prenatal diagnosis of total anomalous pulmonary venous return (TAPVR). Fourteen fetuses had a prenatal diagnosis of TAPVR by the simple rule, including the following components: (1) the major criterion, which was the absence of a connection between the pulmonary vein and the left atrium; and (2) at least 1 of the following minor criteria: (a) the presence of a vascular confluence behind the atria, (b) abnormal spectral Doppler waveforms in the pulmonary veins, (c) a smooth posterior wall of the left atrium, (d) increased retroatrial space, (e) a dilated coronary sinus (cardiac type), (f) a dilated superior vena cava or brachiocephalic vein, and (g) an additional vessel on the 3-vessel/3-vessel and trachea view or a vertical descending vein. All were accurately diagnosed, and none were missed by the diagnosis. In summary, the simple rule described is helpful in increasing the number of accurate prenatal diagnoses of TAPVR.
Collapse
Affiliation(s)
- Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suchaya Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phudit Jatavan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Fuanglada Tongprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kornkanok Sukpan
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
44
|
Hayashi T, Ozawa K, Sugibayashi R, Wada S, Ono H. Functional total anomalous pulmonary venous connection via levoatriocardinal vein. Pediatr Int 2016; 58:656-9. [PMID: 27460400 DOI: 10.1111/ped.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/15/2015] [Accepted: 01/12/2016] [Indexed: 11/30/2022]
Abstract
We report a fetal case of double outlet right ventricle, mitral atresia, and intact atrial septum. Although the pulmonary veins were connected to the left atrium, pulmonary venous blood drained into the right superior vena cava via the stenotic levoatriocardinal vein (LACV), which resulted in a circulation resembling total anomalous pulmonary venous connection (TAPVC) with pulmonary venous obstruction. Since the pulmonary veins were connected to both the stenotic LACV and the "dead-end" left atrium, the pulmonary venous flow had a to-and-fro pattern along with atrial relaxation and contraction. Postnatal echocardiography and computed tomography confirmed the diagnosis of normally connected but anomalously draining pulmonary veins via the LACV. Surgical creation of an atrial septal defect on the day of birth successfully relieved pulmonary venous obstruction. Normally connected but anomalously draining pulmonary veins via the LACV should be considered for TAPVC differential diagnosis in fetuses with a left-side heart obstruction.
Collapse
Affiliation(s)
- Taiyu Hayashi
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | - Katsusuke Ozawa
- Division of Fetal Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Rika Sugibayashi
- Division of Fetal Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Seiji Wada
- Division of Fetal Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
45
|
Olsen R, Doyle Z, Levy D, Anton T, Molkara D, Tarsa M, Sklansky M, Pretorius DH. Anomalous Pulmonary Venous Return: Insights Into Prenatal Detection. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1193-1206. [PMID: 27126401 DOI: 10.7863/ultra.15.04041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/08/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To review all cases of total anomalous pulmonary venous return (TAPVR) or partial anomalous pulmonary venous return (PAPVR) identified prenatally or postnatally at a single institution and to identify factors that may lead to a correct or missed diagnosis in both high- and low-risk fetuses on screening examinations. METHODS Fetal images from 16 cases of prenatally or postnatally diagnosed T/PAPVR were retrospectively reviewed to analyze factors that influenced interpretations and diagnoses. RESULTS Sixteen diagnoses of T/PAPVR were made, with a final number of 10 confirmed cases, 1 of which was PAPVR. Ten fetuses with a presumptive diagnosis of T/PAPVR before delivery were at an average gestational age of 24.7 weeks, with 5 cases diagnosed postnatally. None of the diagnoses of isolated TAPVR were made during a screening examination. Twelve of the pregnancies were complicated by complex cardiac defects, including 6 with heterotaxy syndromes. Of the 5 abnormal cases identified in the postpartum period, 3 had isolated TAPVR. In the 3 patients with isolated defects, prenatal echocardiography was not performed; the anatomy scan interpretations were confounded by multiple factors. In retrospect, there was no obvious sonographic evidence of TAPVR in these patients; however, color flow Doppler imaging of the pulmonary veins was not performed on any of them. CONCLUSIONS Although fetal echocardiography has improved the overall detection of TAPVR or PAPVR, this abnormality continues to elude prenatal diagnosis during screening in both low- and high-risk patients. We hypothesize that the use of color flow Doppler imaging in the 4-chamber view may assist in diagnosing TAPVR in screening low-risk patients, especially in those with difficult scans.
Collapse
Affiliation(s)
- Richelle Olsen
- Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Reproductive Medicine, University of California San Diego, San Diego, California USA
| | - Zoe Doyle
- University of California San Diego Medical School, La Jolla, California USA
| | - Denis Levy
- Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADivision of Cardiology, Department of Pediatrics, Southern California Permanente Medical Group, Kaiser Permanente, San Diego, California USA
| | - Tracy Anton
- Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Reproductive Medicine, University of California San Diego, San Diego, California USA
| | - Delaram Molkara
- Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Pediatrics, University of California San Diego, San Diego, California USA
| | - Maryam Tarsa
- Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Reproductive Medicine, University of California San Diego, San Diego, California USA
| | - Mark Sklansky
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California USA
| | - Dolores H Pretorius
- Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Radiology, University of California San Diego, San Diego, California USA
| |
Collapse
|
46
|
Ishido H, Masutani S, Hishitani T, Taketadu M, Senzaki H. Re: 'Post-LA space index' as a potential novel marker for the prenatal diagnosis of isolated total anomalous pulmonary venous connection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:747-748. [PMID: 26627926 DOI: 10.1002/uog.15756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- H Ishido
- Departments of Pediatrics and Pediatric Cardiology, Staff Office Building 110, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - S Masutani
- Departments of Pediatrics and Pediatric Cardiology, Staff Office Building 110, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - T Hishitani
- Pediatric Cardiology, Saitama Children's Medical Center, Saitama, Japan
| | - M Taketadu
- Departments of Pediatrics and Pediatric Cardiology, Staff Office Building 110, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - H Senzaki
- Departments of Pediatrics and Pediatric Cardiology, Staff Office Building 110, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| |
Collapse
|
47
|
Abstract
VACTERL association and Scimitar syndrome are rare congenital diseases. In this study, we report on a neonate with prenatal suspicion of VACTERL association and small left-sided cardiac structures, which, only on postnatal angiography, could be revealed to be part of a Scimitar syndrome. As this is the second reported case of VACTERL association and Scimitar syndrome, the presence of Scimitar syndrome should be considered in the prenatal and postnatal evaluation of VACTERL association.
Collapse
|
48
|
Neurocognitive outcomes at kindergarten entry after surgical repair of total anomalous pulmonary venous connection in early infancy. Pediatr Cardiol 2015; 36:350-7. [PMID: 25208496 DOI: 10.1007/s00246-014-1013-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Abstract
The objective of this study was to determine neurocognitive outcomes 4.5 years after surgery for TAPVC in infancy and predictors of these outcomes. A cohort having TAPVC repair at age ≤6 weeks between 1998 and 2007 were followed by the Complex Pediatric Therapies Follow-up Program at 4.5 years. Outcomes include mortality, full-scale intelligence quotient (FSIQ), verbal IQ (VIQ), performance IQ (PIQ), visual motor integration (VMI), and general adaptive composite of the Adaptive Behavior Assessment System (GAC). There were 51 infants with simple TAPVC [4 year mortality 4 (8%)], and 16 with complex TAPVC [4 year mortality 7 (44%)], hazard ratio (HR) 7.02 (95% CI 2.05-24.07, p = 0.002). Of the 47 survivors after simple TAPVC, FSIQ (SD) was 92 (17), VIQ 92 (17), PIQ 94 (15), VMI 92 (15), and GAC 92 (15). Independent predictors of neurocognitive outcome included father's socioeconomic status, mother's years of schooling, gender, post-operative base deficit, and deep hypothermic circulatory arrest (DHCA) time. Complex TAPVC was associated on univariate analysis only with PIQ [81.9 (10.2) vs. 93.6 (15.4); p = 0.012] and FSIQ [80.7 (10.1) vs. 92.0 (17.7); p = 0.017]. Original peoples accounted for 25/51 (49%) of simple and 3/16 (19%) of complex TAPVC. Original peoples race was associated with 4-year mortality [HR 6.85 (95% CI 2.15, 21.76, p = 0.001)]. Survivors of TAPVC repair in early infancy have encouraging neurocognitive outcomes. Few independent predictors of neurocognitive outcome were found, with post-operative acidosis and DHCA time being potentially modifiable. Original peoples account for an unexpected proportion of patients (42%) and have a higher mortality.
Collapse
|
49
|
Evans W, Castillo W, Rollins R, Luna C, Kip K, Ludwick J, Madan N, Ciccolo M, Galindo A, Rothman A, Mayman G, Cass K, Thomas V, Restrepo H, Acherman R. Moving towards universal prenatal detection of critical congenital heart disease in southern Nevada: a community-wide program. Pediatr Cardiol 2015; 36:281-8. [PMID: 25103855 DOI: 10.1007/s00246-014-0996-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/23/2014] [Indexed: 11/26/2022]
Abstract
This study compares the current, prenatal detection rate for critical congenital heart disease in Southern Nevada with the previously reported rate, after developing and expanding a comprehensive, community-wide fetal cardiology program. For the current-period analysis, we inquired our database and electronic health records for patients born in Clark County, Nevada, with critical congenital heart disease between May 2012 and April 2014, and we compared the results with the previous period between May 2003 and April 2006. The major components of the community-wide program include fetal congenital heart disease screening via general obstetric ultrasound studies performed in obstetrician's offices, radiology imaging centers, or maternal-fetal medicine specialty practices; subsequent referral for comprehensive fetal echocardiography performed in maternal-fetal medicine offices under the on-site supervision by fetal cardiologists; and recurring community educational programs teaching the 5-axial plane, fetal echocardiographic screening protocol to general obstetric sonographers and instructing perinatal sonographers in advanced imaging topics. For the current period, the prenatal detection rate for critical congenital heart disease in Southern Nevada was 71 versus 36% for the previous period (p < 0.001). The temporal improvement in prenatal detection of critical congenital heart disease may be related to our expanded decentralized, community-wide fetal cardiology program, and our experiences may be applicable to other metropolitan areas.
Collapse
Affiliation(s)
- William Evans
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Kim HS, Jeong K, Cho HJ, Choi WY, Choi YE, Ma JS, Cho YK. Total anomalous pulmonary venous return in siblings. J Cardiovasc Ultrasound 2014; 22:213-9. [PMID: 25580197 PMCID: PMC4286644 DOI: 10.4250/jcu.2014.22.4.213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/12/2014] [Accepted: 11/27/2014] [Indexed: 12/03/2022] Open
Abstract
Total anomalous pulmonary venous return (TAPVR) is a rare and critical congenital vascular anomaly that requires an early operation. However, initial symptoms of TAPVR may be non-specific, and cardiovascular findings may be minimal. The heart may not be enlarged and there is often no cardiac murmur. Without cardiac murmur, these symptoms are similar to those of respiratory distress syndrome in newborns. Therefore, a high degree of suspicion and an early diagnosis of TAPVR are important. This condition generally occurs without a family history and has a low recurrence rate, but several familial cases, including siblings, have been reported worldwide. Additionally, several chromosomal or gene abnormalities associated with TAPVR have been reported. In the case presented here, two brothers with a 6-year age gap were diagnosed with TAPVR. Surgery was performed without cardiac or neurological complications. This is the first report on TAPVR in siblings in Korea.
Collapse
Affiliation(s)
- Ho-Sung Kim
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Kumi Jeong
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Hwa-Jin Cho
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Woo-Yeon Choi
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Young Earl Choi
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Sook Ma
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Young Kuk Cho
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| |
Collapse
|