1
|
Sacco A, Kazi A, Nzelu D, Jowett V, Pandya P. Feasibility and reproducibility of speckle tracking echocardiography in routine assessment of the fetal heart in a low-risk population. J Perinat Med 2025; 53:509-516. [PMID: 39992190 DOI: 10.1515/jpm-2024-0514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 01/23/2025] [Indexed: 02/25/2025]
Abstract
OBJECTIVES The objective of this study was to evaluate the feasibility and reproducibility of speckle tracking echocardiography (STE) in routine fetal cardiac assessments by non-cardiac experts in an NHS clinical setting. METHODS A prospective longitudinal cohort study was performed from April 2022 to June 2023. During all ultrasound scans between 18 and 40 weeks' gestation a 3 s cineloop of the fetal four chamber view was stored. Parameters of global cardiac function were analysed off-line using STE software by two researchers independently. RESULTS Of 393 ultrasound scans performed in fetuses fulfilling criteria, 50.9 % were able to be analysed using STE. Intraobserver variability was poor to moderate for both operators (Operator 1 correlation coefficient for FAC 0.28, EF 0.17, SV 0.01, SV/kg 0.00, CO 0.74, CO/kg 0.39; Operator two correlation coefficient for FAC 0.58, EF 0.65, SV 0.67, SV/kg 0.02, CO 0.66, CO/kg 0.31). Interobserver variability was also poor to moderate (Operator 1 vs. Operator two correlation coefficient for FAC 0.01, EF 0.00, SV 0.00, SV/kg 0.00, CO 0.64, CO/kg 0.25; Operator 2 vs. Operator 1 correlation coefficient for FAC 0.16, EF 0.06, SV 0.72, SV/kg 0.008, CO 0.70, CO/kg 0.34). CONCLUSIONS Routine speckle tracking echocardiography of global cardiac function by non-cardiac experts in low-risk fetuses has low to moderate feasibility and reproducibility in a real-world NHS setting. A high grade of expertise is likely necessary to use STE in order to achieve high reproducibility. Future research should investigate factors contributing to variability in STE measurements and standardisation of protocols.
Collapse
Affiliation(s)
- Adalina Sacco
- Institute for Women's Health, University College London, London, UK
- University College London Hospitals, London, UK
| | - Ayisha Kazi
- Institute for Women's Health, University College London, London, UK
| | - Diane Nzelu
- University College London Hospitals, London, UK
| | | | - Pranav Pandya
- Institute for Women's Health, University College London, London, UK
- University College London Hospitals, London, UK
| |
Collapse
|
2
|
Bokhari SFH, Faizan Sattar SM, Mehboob U, Umais M, Ahmad M, Malik A, Bakht D, Iqbal A, Dost W. Advancements in prenatal diagnosis and management of hypoplastic left heart syndrome: A multidisciplinary approach and future directions. World J Cardiol 2025; 17:103668. [PMID: 40161566 PMCID: PMC11947948 DOI: 10.4330/wjc.v17.i3.103668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 02/12/2025] [Accepted: 02/27/2025] [Indexed: 03/21/2025] Open
Abstract
Hypoplastic left heart syndrome is a severe congenital defect involving underdeveloped left-sided cardiac structures, leading to significant mortality and morbidity. Prenatal diagnosis using fetal ultrasound and echocardiography enables early detection, family counseling, and improved clinical decision-making. Advanced prenatal interventions, such as fetal aortic valvuloplasty and atrial septostomy, show promise but require careful patient selection. A multidisciplinary approach involving obstetricians, neonatologists, and pediatric cardiologists is vital for effective management. Future directions include refining imaging techniques, such as three-dimensional ultrasound, cardiovascular magnetic resonance imaging, and exploring bioengineering solutions, stem cell therapies, and genetic research. These advancements aim to improve therapeutic options and address current limitations, including transplant scarcity and postoperative complications. Although surgical innovations have improved survival rates, challenges remain, including neurological risks and long-term hemodynamic issues. Ongoing research and technological advancements are essential to enhance outcomes and quality of life for hypoplastic left heart syndrome patients.
Collapse
Affiliation(s)
| | - Syed M Faizan Sattar
- Department of Medicine and Surgery, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Umair Mehboob
- Department of Medicine and Surgery, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Muhammad Umais
- Department of Medicine and Surgery, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Muhammad Ahmad
- Department of Medicine and Surgery, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Ahmad Malik
- Department of Medicine and Surgery, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Danyal Bakht
- Department of Medicine and Surgery, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Asma Iqbal
- Department of Medicine and Surgery, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Wahidullah Dost
- Curative Medicine, Kabul University of Medical Sciences, Kabul 10001, Kābul, Afghanistan.
| |
Collapse
|
3
|
Elekes T, Csermely G, Kádár K, Molnár L, Keszthelyi G, Hozsdora A, Vizer M, Török M, Merkely P, Várbíró S. Learning Curve of First-Trimester Detailed Cardiovascular Ultrasound Screening by Moderately Experienced Obstetricians in 3509 Consecutive Unselected Pregnancies with Fetal Follow-Up. Life (Basel) 2024; 14:1632. [PMID: 39768340 PMCID: PMC11678686 DOI: 10.3390/life14121632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 12/02/2024] [Accepted: 12/07/2024] [Indexed: 01/11/2025] Open
Abstract
Our primary objective was to assess the effectiveness of detailed cardiovascular ultrasound screening during the first trimester, which was performed by obstetricians with intermediate experience. We collected first-trimester fetal cardiac screening data from an unselected pregnant population at RMC-Fetal Medicine Center during a study period spanning from 1 January 2010, to 31 January 2015, in order to analyze our learning curve. A pediatric cardiologist performed a follow-up assessment in cases where the examining obstetrician determined that the fetal cardiac screening results were abnormal or high-risk. Overall, 42 (0.88%) congenital heart abnormalities were discovered prenatally out of 4769 fetuses from 4602 pregnant women who had at least one first-trimester cardiac ultrasonography screening. In total, 89.2% of the major congenital heart abnormalities (27 of 28) in the following fetuses were discovered (or at least highly suspected) at the first-trimester screening and subsequent fetal echocardiography by the pediatric cardiology specialist. Of these, 96.4% were diagnosed prenatally. According to our results, the effectiveness of first-trimester fetal cardiovascular ultrasound screening conducted by moderately experienced obstetricians in an unselected ('routine') pregnant population may reach as high as 90% in terms of major congenital heart defects, provided that equipment, quality assurance, and motivation are appropriate.
Collapse
Affiliation(s)
- Tibor Elekes
- RMC-Fetal Medicine Centre, Gábor Áron Street 74-78, H-1026 Budapest, Hungary; (T.E.); (G.C.); (K.K.); (L.M.); (G.K.); (A.H.)
- Cardiovascular Medicine and Research Division, Semmelweis University, Üllői Street 26, H-1085 Budapest, Hungary
| | - Gyula Csermely
- RMC-Fetal Medicine Centre, Gábor Áron Street 74-78, H-1026 Budapest, Hungary; (T.E.); (G.C.); (K.K.); (L.M.); (G.K.); (A.H.)
| | - Krisztina Kádár
- RMC-Fetal Medicine Centre, Gábor Áron Street 74-78, H-1026 Budapest, Hungary; (T.E.); (G.C.); (K.K.); (L.M.); (G.K.); (A.H.)
| | - László Molnár
- RMC-Fetal Medicine Centre, Gábor Áron Street 74-78, H-1026 Budapest, Hungary; (T.E.); (G.C.); (K.K.); (L.M.); (G.K.); (A.H.)
| | - Gábor Keszthelyi
- RMC-Fetal Medicine Centre, Gábor Áron Street 74-78, H-1026 Budapest, Hungary; (T.E.); (G.C.); (K.K.); (L.M.); (G.K.); (A.H.)
| | - Andrea Hozsdora
- RMC-Fetal Medicine Centre, Gábor Áron Street 74-78, H-1026 Budapest, Hungary; (T.E.); (G.C.); (K.K.); (L.M.); (G.K.); (A.H.)
| | - Miklós Vizer
- DaVinci Private Hospital, Málics Ottó Street 1, H-7635 Pécs, Hungary;
| | - Marianna Török
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői Street 78a, H-1082 Budapest, Hungary; (P.M.); (S.V.)
- Workgroup of Research Management, Doctoral School, Semmelweis University, Üllői Street 22, H-1085 Budapest, Hungary
| | - Petra Merkely
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői Street 78a, H-1082 Budapest, Hungary; (P.M.); (S.V.)
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői Street 78a, H-1082 Budapest, Hungary; (P.M.); (S.V.)
- Workgroup of Research Management, Doctoral School, Semmelweis University, Üllői Street 22, H-1085 Budapest, Hungary
- Department of Obstetrics and Gynecology, University of Szeged, Semmelweis Street 1, H-6725 Szeged, Hungary
| |
Collapse
|
4
|
Avnet H, Thomas S, Erenbourg A, Yagel S, Welsh A. Evaluating fetal tricuspid and mitral annular plane systolic excursion (TAPSE and MAPSE) using spatiotemporal image correlation (STIC) M-mode. J Perinat Med 2024; 52:645-653. [PMID: 38720525 DOI: 10.1515/jpm-2023-0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/28/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVES This study aimed to evaluate the feasibility and reliability of tricuspid and mitral annular plane systolic excursion measurements (TAPSE and MAPSE) applying M-mode spatiotemporal image correlation (STIC) technology in low-risk pregnancies. METHODS An initial retrospective pilot study was carried out to assess repeatability, followed by a larger mixed cross-sectional and prospective longitudinal study, both evaluating low-risk singleton pregnancies between 22+6 and 39+1 weeks. As only annuli capture was necessary, STIC acquisition parameters were set to the minimum volume angle of 15° and acquisition time of 7.5 s. RESULTS A total of 330 volumes were analysed offline applying STIC M-mode. Acquisition rates were 96.9 % for TAPSE and 93.7 % MAPSE in the pilot study (n=32) and 98.0 % for both in the longitudinal study (n=102). Both study designs revealed good repeatability for both sides of the heart, with higher intraclass correlation coefficients (ICCs) for TAPSE (0.84-0.94) compared to MAPSE (0.80-0.88). Good repeatability was demonstrated for both sides of the heart, more so for TAPSE than MAPSE, with ICCs for TAPSE 0.84-0.91 and MAPSE 0.75-0.76, comparable to prior ICCs for STIC repeatability. CONCLUSIONS Modified STIC acquisition settings specifically tailored for capturing the longitudinal annular displacement may improve STIC TAPSE and MAPSE acquisition rates, optimising image quality for precise measurement and potentially bringing these modalities closer to clinical application.
Collapse
Affiliation(s)
- Hagai Avnet
- School of Clinical Medicine, Discipline of Women's Health, Faculty of Medicine, 7800 University of New South Wales , Sydney, NSW, Australia
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, 26744 Sheba Medical Center , TelHashomer, Israel
| | - Samantha Thomas
- School of Clinical Medicine, Discipline of Women's Health, Faculty of Medicine, 7800 University of New South Wales , Sydney, NSW, Australia
| | - Anna Erenbourg
- School of Clinical Medicine, Discipline of Women's Health, Faculty of Medicine, 7800 University of New South Wales , Sydney, NSW, Australia
| | - Simcha Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Alec Welsh
- School of Clinical Medicine, Discipline of Women's Health, Faculty of Medicine, 7800 University of New South Wales , Sydney, NSW, Australia
- Department of Maternal-Fetal Medicine, 7800 Royal Hospital for Women , Sydney, NSW, Australia
| |
Collapse
|
5
|
Weissbach T, Lev S, Haimov A, Massarwa A, Shamay I, Plaschkes R, Assa L, Elkan-Miller T, Weisz B, Nardini G, Armon N, Sharon R, Mazaki Tovi S, Kassif E. The Hard Palate Sweep: a multiplanar 2-dimensional sonographic method for the prenatal detection of cleft palate. Am J Obstet Gynecol 2024; 230:356.e1-356.e10. [PMID: 37741531 DOI: 10.1016/j.ajog.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Prenatal diagnosis of cleft palate is challenging. Numerous 2-dimensional and 3-dimensional methods have been proposed to assess the integrity of the fetal palate, yet detection rates remain relatively low. We propose the "Hard Palate Sweep," a novel 2-dimensional method that enables clear demonstration of the entire fetal palate throughout pregnancy, in a single sweep, avoiding acoustic shadows cast by surrounding bones. OBJECTIVE This study aimed to assess the feasibility and performance of the Hard Palate Sweep, performed throughout pregnancy. STUDY DESIGN This was a prospective cross-sectional study performed between 2018 and 2022 in pregnant patients referred for a routine or targeted anomaly scan between 13 and 40 weeks of gestation. The presence or absence of a cleft palate was determined using the "Hard Palate Sweep." This was compared with the postnatal palate integrity assessment. Test feasibility and performance indices, including sensitivity, specificity, and positive and negative predictive values were calculated. Offline clips were reviewed by 2 investigators for the assessment of inter- and intraoperator agreement, using Cohen's kappa formula. The study protocol was approved by the institutional ethics committee. All participating patients were informed and provided consent. RESULTS A total of 676 fetuses were included in the study. The Hard Palate Sweep was successfully performed in all cases, and 19 cases were determined to have a cleft palate. Of these, 13 cases were excluded because postmortem confirmation was not performed, leaving 663 cases available for analysis. Six cases determined to have a cleft palate were confirmed postnatally. In 655 of 657 cases prenatally determined to have an intact palate, this was confirmed postnatally. In the 2 remaining cases, rare forms of cleft palate were diagnosed postnatally, rendering 75% sensitivity, 100% specificity, 100% positive predictive value, and 99.7% negative predictive value for the Hard Palate Sweep (P<.001). There was complete intra- and interoperator agreement (kappa=1; P<.0001). CONCLUSION The Hard Palate Sweep is a feasible and accurate method for prenatally detecting a cleft palate. It was successfully performed in all attempted cases between 13 and 40 weeks of gestation. This method is reproducible, offering high sensitivity and specificity. Implemented routinely, the Hard Palate Sweep is expected to increase the prenatal detection of cleft palate.
Collapse
Affiliation(s)
- Tal Weissbach
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shir Lev
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adina Haimov
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abeer Massarwa
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Shamay
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Roni Plaschkes
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Assa
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Elkan-Miller
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Nardini
- Department of Plastic Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Noam Armon
- Department of Plastic and Aesthetic Surgery, Hadassah University Medical Center, Jerusalem, Israel
| | - Roni Sharon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Shali Mazaki Tovi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
6
|
Athalye C, van Nisselrooij A, Rizvi S, Haak MC, Moon-Grady AJ, Arnaout R. Deep-learning model for prenatal congenital heart disease screening generalizes to community setting and outperforms clinical detection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:44-52. [PMID: 37774040 PMCID: PMC10841849 DOI: 10.1002/uog.27503] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES Despite nearly universal prenatal ultrasound screening programs, congenital heart defects (CHD) are still missed, which may result in severe morbidity or even death. Deep machine learning (DL) can automate image recognition from ultrasound. The main aim of this study was to assess the performance of a previously developed DL model, trained on images from a tertiary center, using fetal ultrasound images obtained during the second-trimester standard anomaly scan in a low-risk population. A secondary aim was to compare initial screening diagnosis, which made use of live imaging at the point-of-care, with diagnosis by clinicians evaluating only stored images. METHODS All pregnancies with isolated severe CHD in the Northwestern region of The Netherlands between 2015 and 2016 with available stored images were evaluated, as well as a sample of normal fetuses' examinations from the same region and time period. We compared the accuracy of the initial clinical diagnosis (made in real time with access to live imaging) with that of the model (which had only stored imaging available) and with the performance of three blinded human experts who had access only to the stored images (like the model). We analyzed performance according to ultrasound study characteristics, such as duration and quality (scored independently by investigators), number of stored images and availability of screening views. RESULTS A total of 42 normal fetuses and 66 cases of isolated CHD at birth were analyzed. Of the abnormal cases, 31 were missed and 35 were detected at the time of the clinical anatomy scan (sensitivity, 53%). Model sensitivity and specificity were 91% and 78%, respectively. Blinded human experts (n = 3) achieved mean ± SD sensitivity and specificity of 55 ± 10% (range, 47-67%) and 71 ± 13% (range, 57-83%), respectively. There was a statistically significant difference in model correctness according to expert-graded image quality (P = 0.03). The abnormal cases included 19 lesions that the model had not encountered during its training; the model's performance in these cases (16/19 correct) was not statistically significantly different from that for previously encountered lesions (P = 0.41). CONCLUSIONS A previously trained DL algorithm had higher sensitivity than initial clinical assessment in detecting CHD in a cohort in which over 50% of CHD cases were initially missed clinically. Notably, the DL algorithm performed well on community-acquired images in a low-risk population, including lesions to which it had not been exposed previously. Furthermore, when both the model and blinded human experts had access to only stored images and not the full range of images available to a clinician during a live scan, the model outperformed the human experts. Together, these findings support the proposition that use of DL models can improve prenatal detection of CHD. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- C Athalye
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - A van Nisselrooij
- Department of Obstetrics, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - S Rizvi
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - M C Haak
- Department of Obstetrics, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - A J Moon-Grady
- Department of Pediatrics, Division of Cardiology, University of California, San Francisco, San Francisco, CA, USA
| | - R Arnaout
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics, Division of Cardiology, University of California, San Francisco, San Francisco, CA, USA
- Bakar Computational Health Sciences Institute; Department of Radiology; UCSF Berkeley Joint Program in Computational Precision Health; Center for Intelligent Imaging; Biological and Medical Informatics, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
7
|
Regouin M, Mancini J, Lafouge A, Mace P, Fontaine N, Roussin S, Guichard J, Dumont C, Quarello E. The Left Outflow Tract in Fetal Cardiac Screening Examination: Introduction of Quality Criteria Is Not Always Associated With an Improvement of Practice When Supervised by Humans. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2095-2105. [PMID: 37163223 DOI: 10.1002/jum.16231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/11/2023] [Accepted: 04/01/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Since 2016, the French CNEOF included the left ventricular outflow tract (LVOT) in the second and third trimester of pregnancy in addition to the four-chamber view and the parasagittal view of the right outflow tract. The objective of this study was to define quality criteria for fetal LVOT assessment and to perform a human audit of past and current practices, before and after the implementation of those quality criteria at a large scale. METHODS Seven quality criteria were investigated and rated from 0 to 1 during three periods of interest. Files were randomly selected from three centers, and average total and specific scores were calculated. RESULTS LVOT pictures were present in more than 94.3% of reports. The average quality score was 5.49/7 (95% confidence interval [CI]: 5.36-5.62), 5.91/7 (95% CI: 5.80-6.03), and 5.70/7 (95% CI: 5.58-5.82) for the three centers in the three periods of interest. There was no significant difference following the introduction of the quality criteria, 2017 versus 2020, P = .054. CONCLUSION Fetal LVOT images were present in most of ultrasound reports but the introduction of the proposed quality criteria under human supervision seems not associated with a significant change in practice.
Collapse
Affiliation(s)
- Maud Regouin
- Département de Gynécologie Obstétrique, Hôpital Sud de la Réunion, Réunion, France
| | - Julien Mancini
- APHM, INSERM, IRD, SESSTIM, Hop Timone, Public Health Department (BIOSTIC), Aix Marseille University, Marseille, France
| | | | - Pierre Mace
- Institut Méditerranéen d'Imagerie Médicale Appliquée à la Gynécologie, la Grossesse et l'Enfance IMAGE2, Marseille, France
- Hôpital Beauregard, Marseille, France
| | - Nathalie Fontaine
- Département de Gynécologie Obstétrique, Hôpital Sud de la Réunion, Réunion, France
| | | | - Jimmy Guichard
- Cabinet d'Echographie Gynécologique et Obstétricale-Espace 9 Mois, Montreuil, France
| | - Coralie Dumont
- Département de Gynécologie Obstétrique, Hôpital Sud de la Réunion, Réunion, France
| | - Edwin Quarello
- Institut Méditerranéen d'Imagerie Médicale Appliquée à la Gynécologie, la Grossesse et l'Enfance IMAGE2, Marseille, France
- Unité de Dépistage et de Diagnostic Prénatal, Hôpital Saint-Joseph, Marseille, France
| |
Collapse
|
8
|
Kanneganti A, Gosavi AT, Lim MXK, Li WLS, Chia DA, Choolani MA, Chen CK, Biswas A. Fetal congenital heart diseases: Diagnosis by anatomical scans, echocardiography and genetic tests. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:420-431. [PMID: 38920167 DOI: 10.47102/annals-acadmedsg.2022472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Objective To determine the distribution of major fetal congenital heart diseases (CHDs) diagnosed antenatally during routine second-trimester obstetric anatomical scans in an unselected population at a single tertiary centre and to characterise and stratify risk factors, genetic diagnosis and long-term health at 4 years old. Method A single-centre cohort study of all major fetal CHDs detected on routine obstetric fetal anatomical ultrasound scans between January 2014 and December 2017 was performed in an unselected population. Demographic details, fetal echocardiogram reports, genetic test results, delivery outcomes and postnatal progress were stratified by CHD subtype. Results Of 20,031 screened pregnancies, 109 pregnancies (0.53%) had major fetal CHDs. The most common subtypes were coarctation of aorta (17.4%), transposition of great arteries (16.5%), and tetralogy of Fallot and univentricular hearts (13.8% each). Of the 60.5% that underwent confirmatory genetic testing-mostly conventional karyotyping and testing for 22q11 microdeletion-about a quarter had abnormalities, of which 22q microdeletion was the most common. We had complete obstetric data in 85 pregnancies (78%), of which 76.5% progressed to live birth. Among these, 92.1% of postnatal echocardiograms concurred with antenatal ones. At 4 years old, 43.2% of offspring had no medical or developmental issues, 20.0% had mild medical or developmental issues, 21.5% had major medical or developmental issues, and 12.3% had deceased. Conclusion Fetal echocardiograms accurately diagnose CHDs. Future studies should evaluate the roles of chromosomal microarray and next-generation sequencing in diagnosing CHD.
Collapse
Affiliation(s)
- Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Arundhati Tushar Gosavi
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mei Xian Karen Lim
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Wei Ling Sarah Li
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Dawn Ak Chia
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Mahesh Arjandas Choolani
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching Kit Chen
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cardiology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Arijit Biswas
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
9
|
Moon-Grady AJ, Donofrio MT, Gelehrter S, Hornberger L, Kreeger J, Lee W, Michelfelder E, Morris SA, Peyvandi S, Pinto NM, Pruetz J, Sethi N, Simpson J, Srivastava S, Tian Z. Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:679-723. [PMID: 37227365 DOI: 10.1016/j.echo.2023.04.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
| | - Mary T Donofrio
- Children's National Hospital, Washington, District of Columbia
| | | | | | - Joe Kreeger
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Wesley Lee
- Baylor College of Medicine, Houston, Texas
| | | | - Shaine A Morris
- Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Houston, Texas
| | - Shabnam Peyvandi
- University of California, San Francisco, San Francisco, California
| | | | - Jay Pruetz
- Children's Hospital of Los Angeles, Los Angeles, California
| | | | - John Simpson
- Evelina London Children's Hospital, London, United Kingdom
| | | | - Zhiyun Tian
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
10
|
Carvalho JS, Axt-Fliedner R, Chaoui R, Copel JA, Cuneo BF, Goff D, Gordin Kopylov L, Hecher K, Lee W, Moon-Grady AJ, Mousa HA, Munoz H, Paladini D, Prefumo F, Quarello E, Rychik J, Tutschek B, Wiechec M, Yagel S. ISUOG Practice Guidelines (updated): fetal cardiac screening. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:788-803. [PMID: 37267096 DOI: 10.1002/uog.26224] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/04/2023]
Affiliation(s)
- J S Carvalho
- Royal Brompton Hospital, Guy's & St Thomas' NHS Foundation Trust; and Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - R Axt-Fliedner
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, University Hospital Giessen & Marburg, Giessen, Germany
| | - R Chaoui
- Center of Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - J A Copel
- Departments of Obstetrics, Gynecology & Reproductive Sciences, and Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - B F Cuneo
- Children's Hospital Colorado, The Heart Institute, Aurora, CO, USA
| | - D Goff
- Pediatrix Cardiology of Houston and Loma Linda University School of Medicine, Houston, TX, USA
| | - L Gordin Kopylov
- Obstetrical Unit, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - A J Moon-Grady
- Clinical Pediatrics, UC San Francisco, San Francisco, CA, USA
| | - H A Mousa
- Fetal Medicine Unit, University of Leicester, Leicester, UK
| | - H Munoz
- Obstetrics and Gynecology, Universidad de Chile and Clinica Las Condes, Santiago, Chile
| | - D Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - F Prefumo
- Obstetrics and Gynecology Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - E Quarello
- Image 2 Center, Obstetrics and Gynecologic Department, St Joseph Hospital, Marseille, France
| | - J Rychik
- Fetal Heart Program at Children's Hospital of Philadelphia, and Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - B Tutschek
- Pränatal Zürich, Zürich, Switzerland; and Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - M Wiechec
- Department of Gynecology and Obstetrics, Jagiellonian University in Krakow, Krakow, Poland
| | - S Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Mt. Scopus and the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
11
|
Athalye C, van Nisselrooij A, Rizvi S, Haak M, Moon-Grady AJ, Arnaout R. Deep learning model for prenatal congenital heart disease (CHD) screening generalizes to the community setting and outperforms clinical detection. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.10.23287134. [PMID: 38903074 PMCID: PMC11188113 DOI: 10.1101/2023.03.10.23287134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Objective Congenital heart defects (CHD) are still missed despite nearly universal prenatal ultrasound screening programs, which may result in severe morbidity or even death. Deep machine learning (DL) can automate image recognition from ultrasound. The aim of this study was to apply a previously developed DL model trained on images from a tertiary center, to fetal ultrasound images obtained during the second-trimester standard anomaly scan in a low-risk population. Methods All pregnancies with isolated severe CHD in the Northwestern region of the Netherlands between 2015 and 2016 with available stored images were evaluated, as well as a sample of normal fetuses' examinations from the same region. We compared initial clinical diagnostic accuracy (made in real time), model accuracy, and performance of blinded human experts with access only to the stored images (like the model). We analyzed performance by study characteristics such as duration, quality (independently scored by study investigators), number of stored images, and availability of screening views. Results A total of 42 normal fetuses and 66 cases of isolated CHD at birth were analyzed. Of the abnormal cases, 31 were missed and 35 were detected at the time of the clinical anatomy scan (sensitivity 53 percent). Model sensitivity and specificity was 91 and 93 percent, respectively. Blinded human experts (n=3) achieved sensitivity and specificity of 55±10 percent (range 47-67 percent) and 71±13 percent (range 57-83 percent), respectively. There was a statistically significant difference in model correctness by expert-grader quality score (p=0.04). Abnormal cases included 19 lesions the model had not encountered in its training; the model's performance (15/19 correct) was not statistically significantly different on previously encountered vs. never before seen lesions (p=0.07). Conclusions A previously trained DL algorithm out-performed human experts in detecting CHD in a cohort in which over 50 percent of CHD cases were initially missed clinically. Notably, the DL algorithm performed well on community-acquired images in a low-risk population, including lesions it had not been previously exposed to. Furthermore, when both the model and blinded human experts had access to stored images alone, the model outperformed expert humans. Together, these findings support the proposition that use of DL models can improve prenatal detection of CHD.
Collapse
|
12
|
Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Restrepo H. Isolated Balanced Complete Atrioventricular Septal Defects: Prenatal Detection and Outcome in Nevada. Clin Pediatr (Phila) 2023; 62:132-135. [PMID: 35912687 DOI: 10.1177/00099228221114933] [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] [Indexed: 01/11/2023]
Abstract
We analyzed patients with isolated, balanced complete atrioventricular septal defects. We identified 71 patients born in Nevada, between January 2008 and December 2020. We also analyzed prenatal detection rates. Of the 71, 61 (85%) had trisomy 21, 1 (1%) had CHARGE syndrome and 22q.11 deletion, and 10 (14%) had no chromosomal abnormalities. Of the 71, 67 had prenatal care, and 43/67 (64%) were prenatally diagnosed. Prenatal detection rate for 2008-2012 was 9/20 (45%) and 18/21 (86%) for 2018-2020, P = .03. Of the 71, 67 underwent surgical repair with 1 current postpulmonary artery banding and 0 surgical deaths. Of the 67, 3 (4%) had heart block. Only 1 (1.5%) patient had reoperation for a mitral valve replacement. Of the 71, 67 (94%) are alive during a 6-year average (range = 0-12 years) follow-up. In conclusion, surgical and long-term outcomes were excellent. Also, high state-wide, general population prenatal detection rates were achieved.
Collapse
Affiliation(s)
- William N Evans
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, Division of Pediatric Cardiology, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ruben J Acherman
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, Division of Pediatric Cardiology, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Michael L Ciccolo
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Juan Lehoux
- Children's Heart Center Nevada, Las Vegas, NV, USA
| | - Humberto Restrepo
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, Division of Pediatric Cardiology, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| |
Collapse
|
13
|
Gómez O, Nogué L, Soveral I, Guirado L, Izquierdo N, Pérez-Cruz M, Masoller N, Escobar MC, Sanchez-de-Toledo J, Martínez-Crespo JM, Bennasar M, Crispi F. Cord blood cardiovascular biomarkers in tetralogy of fallot and D-transposition of great arteries. Front Pediatr 2023; 11:1151814. [PMID: 37187588 PMCID: PMC10175815 DOI: 10.3389/fped.2023.1151814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Previous reports suggest that cord blood biomarkers could serve as a prognostic tool for conotruncal congenital heart defects (CHD). We aimed to describe the cord blood profile of different cardiovascular biomarkers in a prospective series of fetuses with tetralogy of Fallot (ToF) and D-transposition of great arteries (D-TGA) and to explore their correlation with fetal echocardiography and perinatal outcome. Methods A prospective cohort study (2014-2019), including fetuses with isolated ToF and D-TGA and healthy controls, was conducted at two tertiary referral centers for CHD in Barcelona. Obstetric ultrasound and fetal echocardiography were performed in the third trimester and cord blood was obtained at delivery. Cord blood concentrations of N-terminal precursor of B-type natriuretic peptide, Troponin I, transforming growth factorβ (TGFβ), placental growth factor, and soluble fms-like tyrosine kinase-1 were determined. Results Thirty-four fetuses with conotruncal-CHD (22 ToF and 12 D-TGA) and 36 controls were included. ToF-fetuses showed markedly increased cord blood TGFβ (24.9 ng/ml (15.6-45.3) vs. normal heart 15.7 ng/ml (7.2-24.3) vs. D-TGA 12.6 ng/ml (8.7-37.9); P = 0.012). These results remained statistically significant even after adjusting for maternal body mass index, birth weight and mode of delivery. TGFß levels showed a negative correlation with the pulmonary valve diameter z-score at fetal echocardiography (r = -0.576, P = 0.039). No other differences were found in the rest of cord blood biomarkers among the study populations. Likewise, no other significant correlations were identified between cardiovascular biomarkers, fetal echocardiography and perinatal outcome. Conclusions This study newly describes increased cord blood TGFβ concentrations in ToF compared to D-TGA and normal fetuses. We also demonstrate that TGFβ levels correlate with the severity of right ventricle outflow obstruction. These novel findings open a window of research opportunities on new prognostic and potential preventive strategies.
Collapse
Affiliation(s)
- Olga Gómez
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Fetal Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Correspondence: Olga Gómez
| | - Laura Nogué
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Iris Soveral
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- Department of Obstetrics, Hospital General de Hospitalet, Barcelona, Spain
| | - Laura Guirado
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Nora Izquierdo
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Miriam Pérez-Cruz
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- Sant Joan de Déu Research Institute (IRSJD), Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network, Carlos III Health Institute, Madrid, Spain
| | - Narcís Masoller
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - María Clara Escobar
- Sant Joan de Déu Research Institute (IRSJD), Barcelona, Spain
- Pediatric Cardiology Department, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
| | - Joan Sanchez-de-Toledo
- Sant Joan de Déu Research Institute (IRSJD), Barcelona, Spain
- Pediatric Cardiology Department, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
| | - Josep Maria Martínez-Crespo
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Fetal Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Mar Bennasar
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Fàtima Crispi
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Fetal Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| |
Collapse
|
14
|
Muñoz H, Enríquez G, Ortega X, Pinto M, Hosiasson S, Germain A, Díaz C, Cortés F. Diagnóstico de cardiopatías congénitas: ecografía de cribado, ecocardiografía fetal y medicina de precisión. REVISTA MÉDICA CLÍNICA LAS CONDES 2023. [DOI: 10.1016/j.rmclc.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
|
15
|
Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Berthoty D, Montes A, Mayman GA, Restrepo H. Isolated Vascular Rings Are Common Cardiovascular Malformations. World J Pediatr Congenit Heart Surg 2023; 14:21-23. [PMID: 36847763 DOI: 10.1177/21501351221122972] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE We investigated the prevalence of isolated vascular rings in the general population of Southern Nevada. METHODS We identified those prenatally and postnatally diagnosed with an isolated vascular ring between January 2014 and December 2021. We included only those with vascular or ligamentous structures completely encircling the trachea and esophagus. To investigate the prevalence of isolated vascular rings, we included only those with situs solitus, levocardia, and no significant intracardiac malformations. RESULTS We identified 112 patients. Of the 112, 66 (59%) were female. There were approximately 211,000 total live births in Southern Nevada for the study period, for an overall prevalence of 5.3 isolated vascular rings per 10 000 live births. However, for the years 2014 to 2017, the average prevalence figure was 3.5 per 10 000 live births, and for the years 2018 to 2021, the average prevalence figure was 7.1 (range 6.5-8.0) per 10 000 live births. Simultaneously, the prenatal detection rate rose from 66% to 86%. CONCLUSIONS Isolated vascular rings are common cardiovascular malformations. As prenatal detection rates in the Southern Nevada general population approach 90%, the prevalence figures for isolated vascular rings appear to asymptote at about 7 per 10 000 live births.
Collapse
Affiliation(s)
- William N Evans
- Congenital Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ruben J Acherman
- Congenital Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Michael L Ciccolo
- Congenital Heart Center Nevada, Las Vegas, NV, USA.,Department of Surgery, Kirk Kerkorian School of Medicine at the 14722University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Juan Lehoux
- Congenital Heart Center Nevada, Las Vegas, NV, USA
| | - Dean Berthoty
- 497616Sunrise Children's Hospital, Department of Radiology, Las Vegas, NV, USA
| | - Arthur Montes
- 497616Sunrise Children's Hospital, Department of Radiology, Las Vegas, NV, USA
| | - Gary A Mayman
- Congenital Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Humberto Restrepo
- Congenital Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, NV, USA
| |
Collapse
|
16
|
Swor K, Yeo L, Tarca AL, Jung E, Romero R. Fetal intelligent navigation echocardiography (FINE) has superior performance compared to manual navigation of the fetal heart by non-expert sonologists. J Perinat Med 2022; 51:477-491. [PMID: 36474319 PMCID: PMC10164033 DOI: 10.1515/jpm-2022-0387] [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: 08/09/2022] [Accepted: 10/15/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Manual and intelligent navigation (i.e. fetal intelligent navigation echocardiography or FINE) by the operator are two methods to obtain standard fetal cardiac views from spatiotemporal image correlation (STIC) volumes. The objective was to compare the performance between manual and intelligent navigation (FINE) of the fetal heart by non-expert sonologists. METHODS In this prospective observational study, ten sonologists underwent formal training on both navigational methods. Subsequently, they were tested on their ability to obtain nine cardiac views from five STIC volumes of normal fetal hearts (19-28 gestational weeks) using such methods. The following parameters were determined for both methods: (1) success rate of obtaining nine cardiac views; (2) mean time to obtain nine cardiac views per sonologist; and (3) maximum number of cardiac views successfully obtained for each STIC volume. RESULTS All fetal cardiac images obtained from 100 STIC volumes (50 for each navigational method) were reviewed by an expert in fetal echocardiography. Compared to manual navigation, FINE was associated with a significantly: (1) higher success rate of obtaining eight (excluding the abdomen view) appropriate cardiac views (92-100% vs. 56-88%; all p<0.05); (2) shorter mean time (minute:seconds) to obtain nine cardiac views (2:11 ± 0:37 vs. 15:49 ± 7:44; p<0.0001); and (3) higher success rate of obtaining all nine cardiac views for a given STIC volume (86 vs. 14%; p<0.001). CONCLUSIONS When performed by non-expert sonologists, intelligent navigation (FINE) had a superior performance compared to manual navigation of the normal fetal heart. Specifically, FINE obtained appropriate fetal cardiac views in 92-100% of cases.
Collapse
Affiliation(s)
- Katie Swor
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Adi L Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Computer Science, College of Engineering, Wayne State University, Detroit, MI, USA
| | - Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
| |
Collapse
|
17
|
Achiron RR, Kassif E, Gilboa Y, Salem Y, Jakobson Y, Raviv-Zilka L, Kivilevitch Z. Congenital Aortic Vascular Ring: In-Utero Sonographic Assessment of Tracheal Patency and Postnatal Outcome. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:e112-e117. [PMID: 33091939 DOI: 10.1055/a-1283-6051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Congenital aortic vascular ring may present after birth with variable degrees of respiratory distress due to tracheal compression. The aim of this study was to prospectively evaluate in utero tracheal patency in correlation with postnatal outcome. METHODS During an eight-year period, fetuses with aortic arch abnormality encircling the trachea and forming a complete ring were recruited for the study. Tracheal patency was classified as: no compression, partial compression, or complete compression. Postnatal MRI/CTangio studies were performed and outcome data was retrospectively analyzed from the medical records. RESULTS Among the 46 fetuses recruited to the study, 38 had right aortic arch (RAA), and 8 presented with double aortic arch (DAA). In the RAA group 35 (92.1 %) of the fetuses presented no compression and 34 (97.1 %) of them were asymptomatic in the long-term follow-up. Three fetuses (7.9 %) in this group presented in utero compression: one was terminated at 16 weeks of gestation due to associated ominous findings, and the other two had mild respiratory symptoms around 12 months of age and underwent surgery with a good outcome. In the DAA group, all fetuses presented in utero with tracheal compression. Seven showed partial and one complete compression. Among the seven with partial compression, six were symptomatic and underwent surgery. The case with severe airway occlusion had emergency tube insertion in the delivery room and underwent surgery at 7 days but died from severe respiratory complications. CONCLUSION This is the first study to evaluate in utero tracheal patency in cases with vascular ring. It allows better prenatal and postnatal workup and follow-up including potentially life-threatening respiratory failure.
Collapse
Affiliation(s)
| | - Eran Kassif
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Hospital, Tel Hashomer, Israel
| | - Yinon Gilboa
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishay Salem
- Children Hospital Center Pediatric Cardiology Unit, Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - Yizhak Jakobson
- Pediatric Radiology Unit, Edmond and Lily Safra Children's Hospital Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Lisa Raviv-Zilka
- Pediatric Radiology Unit, Edmond and Lily Safra Children's Hospital Center, The Chaim Sheba Medical Center Tel-Hashomer, Ramat Gan, Israel
| | - Zvi Kivilevitch
- Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat Gan, Israel
| |
Collapse
|
18
|
Carvalho JS. Risk stratification for irregular fetal heart rhythm: practical approach to management. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:717-720. [PMID: 36454638 DOI: 10.1002/uog.26109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 06/17/2023]
Affiliation(s)
- J S Carvalho
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, Guy's and St Thomas's NHS Foundation Trust, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| |
Collapse
|
19
|
Nageswari CS, Vimal Kumar M, Grace NVA, Thiyagarajan J. Tunicate swarm-based grey wolf algorithm for fetal heart chamber segmentation and classification: a heuristic-based optimal feature selection concept. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2022. [DOI: 10.3233/jifs-221654] [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]
Abstract
Ultrasound image quality management and assessment are an important stage in clinical diagnosis. This operation is often carried out manually, which has several issues, including reliance on the operator’s experience, lengthy labor, and considerable intra-observer variance. As a result, automatic quality evaluation of Ultrasound images is particularly desirable in medical applications. This research work plans to perform the fetal heart chamber segmentation and classification using the novel intelligent technology named as hybrid optimization algorithm Tunicate Swarm-based Grey Wolf Algorithm (TS-GWA). Initially, the US fetal images data is collected and data undergoes the preprocessing using the total variation technique. From the preprocessed images, the optimal features are extracted using the TF-IDF approach. Then, Segmentation is processed on optimally selected features using Spatially Regularized Discriminative Correlation Filters (SRDCF) method. In the final step, the classification of fetal images is done using the Modified Long Short-Term Memory (MLSTM) Network. The fitness function behind the optimal feature selection as well as the hidden neuron optimization of MLSTM is the maximization of PSNR and minimization of MSE. The PSNR value is improved from 3.1 to 9.8 in the proposed method and accuracy of the proposed classification algorithm is improved from 1.9 to 12.13 compared to other existing techniques. The generalization ability and the adaptability of proposed TS-GWA method are described by conducting the various performance analysis. Extensive performance result shows that proposed intelligent techniques performs better than the existing segmentation methods.
Collapse
|
20
|
Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Rothman A, Galindo A, Restrepo H. Prenatal diagnosis of hypoplastic aortic arch without intracardiac malformations: The nevada experience. J Card Surg 2022; 37:3705-3710. [PMID: 36047366 DOI: 10.1111/jocs.16834] [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: 04/30/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We reviewed our center's experience with neonatal and infant hypoplastic aortic arch, unassociated with intracardiac malformations, and investigated changes in prenatal detection rates over time for those requiring therapeutic procedures. METHODS We identified all prenatal diagnoses of hypoplastic aortic arch with situs solitus, unassociated with intracardiac malformations, made in Nevada between May 2017 and April 2022. In addition, we identified all those 0-180 days old, with prenatal care, that underwent a surgical or interventional cardiac catheterization aortic arch procedure, whether prenatally or postnatally diagnosed. We excluded those with ventricular septal defects, functionally univentricular hearts, interrupted aortic arches, or any associated malformation requiring an additional surgical or interventional procedure ≤6 months old. Additionally, we calculated prenatal detection rates for those undergoing a surgical or interventional catheterization procedure for each of the 5 years. RESULTS We identified 107 patients prenatally and postnatally. Of the 107 patients, 56 (34 prenatally diagnosed and 22 postnatally diagnosed) underwent an aortic arch procedure, and 51 additionally prenatally diagnosed, live-born infants did not undergo a procedure. Of the 56 procedures, 2 were by interventional catheterization, and 54 underwent a surgical repair. Prenatal detection for those undergoing a procedure statistically significantly increased over the 5 years from 38% to 82%, rho = 0.95 (p = .04). CONCLUSIONS Currently in Nevada, our prenatal detection rate is >80% in the general population for those between 0 and 6 months old who require a therapeutic procedure for aortic arch obstruction without intracardiac malformations.
Collapse
Affiliation(s)
- William N Evans
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ruben J Acherman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Michael L Ciccolo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Juan Lehoux
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA
| | - Abraham Rothman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Alvaro Galindo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Humberto Restrepo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| |
Collapse
|
21
|
Laux D, Derridj N, Stirnemann J, Lucron H, Stos B, Levy M, Houyel L, Bonnet D. Accuracy and impact of prenatal diagnosis of common arterial trunk. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:223-233. [PMID: 35118719 PMCID: PMC9539359 DOI: 10.1002/uog.24873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Outcome of common arterial trunk (CAT) depends mainly on truncal valve function, presence of coronary artery abnormalities and presence of interrupted aortic arch. The main objective of this study was to evaluate the accuracy of prenatal diagnosis of CAT by analyzing prenatal vs postnatal assessment of: (1) anatomic subtypes and (2) truncal valve function. The secondary objective was to assess the potential impact of prenatal diagnosis of CAT on postnatal mortality and morbidity by comparing prenatally vs postnatally diagnosed patients. METHODS This was a retrospective analysis of all CAT patients diagnosed either prenatally, with postnatal or fetopsy confirmation, or postnatally, from 2011 to 2019 in a single tertiary center. Cohen's kappa statistic was used to evaluate agreement between pre- and postnatal assessment of anatomic subtypes according to Van Praagh and of truncal valve function. Mortality and morbidity variables were compared between prenatally vs postnatally diagnosed CAT patients. RESULTS A total of 84 patients (62 liveborn with prenatal diagnosis, 16 liveborn with postnatal diagnosis and six terminations of pregnancy with fetopsy) met the inclusion criteria. The accuracy of prenatal diagnosis of CAT anatomic subtype was 80.3%, and prenatal and postnatal concordance for subtype diagnosis was only moderate (κ = 0.43), with no patient with CAT Type A3 (0/4) and only half of patients with CAT Type A4 (8/17) being diagnosed prenatally. Fetal evaluation of truncal valve function underestimated the presence (no agreement; κ = 0.09) and severity (slight agreement; κ = 0.19) of insufficiency. However, four of five cases of postnatally confirmed significant truncal valve stenosis were diagnosed prenatally, with fair agreement for both presence and severity of stenosis (κ = 0.38 and 0.24, respectively). Mortality was comparable in patients with and those without prenatal diagnosis (log-rank P = 0.87). CAT patients with fetal diagnosis underwent earlier intervention (P < 0.001), had shorter intubation time (P = 0.047) and shorter global hospital stay (P = 0.01). CONCLUSIONS The accuracy of prenatal diagnosis of CAT is insufficient to tailor neonatal management and to predict outcome. Fetal assessment of truncal valve dysfunction appears unreliable due to perinatal transition. Improvement is necessary in the fetal diagnosis of anatomic subtypes of CAT requiring postnatal prostaglandin infusion. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- D Laux
- UE3C-Unité d'Explorations Cardiologiques des Cardiopathies Congénitales, Paris, France
- Service de Cardiologie Congénitale et Pédiatrique, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - N Derridj
- Service de Cardiologie Congénitale et Pédiatrique, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Paris, France
- Université́ de Paris, CRESS, INSERM, INRA, Paris, France
| | - J Stirnemann
- Service de Gynécologie-Obstétrique, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - H Lucron
- Cardiologie Congénitale et Pédiatrique, Centre de Compétence M3C-Antilles-Guyane, CHU de la Martinique, Fort-de-France, Martinique, France
| | - B Stos
- UE3C-Unité d'Explorations Cardiologiques des Cardiopathies Congénitales, Paris, France
- Service de Cardiologie Congénitale et Pédiatrique, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - M Levy
- UE3C-Unité d'Explorations Cardiologiques des Cardiopathies Congénitales, Paris, France
- Service de Cardiologie Congénitale et Pédiatrique, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - L Houyel
- Service de Cardiologie Congénitale et Pédiatrique, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - D Bonnet
- Service de Cardiologie Congénitale et Pédiatrique, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| |
Collapse
|
22
|
Evans WN, Acherman RJ, Restrepo H. Pulmonary Versus Systemic Outflow Obstruction in Functionally Univentricular Hearts with Isomerism: An Observation. Pediatr Cardiol 2022; 43:995-998. [PMID: 34981141 DOI: 10.1007/s00246-021-02810-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Our objective was to review our experience with isomerism associated with univentricular hearts and evaluate the prevalence of pulmonary versus systemic outflow obstruction. We identified those prenatally or postnatally diagnosed, between September 2004 and October 2021, with right and left isomerism and a functionally univentricular heart. We identified 62, 51 prenatally and 11 postnatally. Of the 62, 61 had prenatal care for an 84% (51/61) prenatal detection rate. Of the 62, 36 (58%) had right isomerism. Of the 51 prenatally diagnosed, 36 were live-born, 13 had fetal demise, and two underwent elective termination. Of the total 62, 43 had pulmonary outflow obstruction, 14 had systemic outflow obstruction, three had no outflow obstruction, and two had a common arterial trunk. However, between September 2004 and December 2019, 41 of 52 (79%) had pulmonary outflow obstruction, and between January 2000 and October 2021, 2 of 10 (20%) had pulmonary outflow obstruction (p = 001). We noted a statistically significant temporal change in the prevalence of pulmonary versus systemic outflow obstruction in those with isomeric situs and a functionally univentricular heart. Further, prenatal diagnosis exceeded 80% in the general population of Nevada.
Collapse
Affiliation(s)
- William N Evans
- Congenital Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.
- Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, 2040 W Charleston Blvd 3rd Floor, Las Vegas, NV, 89102, USA.
| | - Ruben J Acherman
- Congenital Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, 2040 W Charleston Blvd 3rd Floor, Las Vegas, NV, 89102, USA
| | - Humberto Restrepo
- Congenital Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, 2040 W Charleston Blvd 3rd Floor, Las Vegas, NV, 89102, USA
| |
Collapse
|
23
|
Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Restrepo H. Decreasing Mortality for STAT 4 and 5 Neonatal Heart Surgeries Concurrent With Improving Prenatal Detection: The Nevada Experience. World J Pediatr Congenit Heart Surg 2022; 13:361-365. [PMID: 35446211 DOI: 10.1177/21501351221087700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Our objective was to investigate whether a relationship existed between our center's STAT 4 and 5 category surgical mortality and general-population prenatal detection rates in Nevada. Methods: We identified patients who underwent STAT 4 and 5 neonatal index cardiovascular surgeries at our center between October 2012 and September 2021. Additionally, we calculated prenatal detection rates for each of the 9 retrospective study years. We used descriptive statistics and nonparametric testing, including the Spearman Rho correlation (R) and the Mann-Whitney U-tests, with a significant P-value set at < .05. Results: We identified 356 patients. We noted a statistically significant increasing trend in prenatal detection percentages (rho = 0.79, P = .01), concurrent with a statistically significant decreasing trend in surgical mortality (rho = -0.82, P = .007). Conclusions: Despite encouraging results, we could not establish a cause-and-effect relationship between concurrent decreased surgical mortality and increased prenatal detection rates for patients undergoing STAT 4 and 5 surgical procedures at our center.
Collapse
Affiliation(s)
- William N Evans
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ruben J Acherman
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Michael L Ciccolo
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Surgery, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Juan Lehoux
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA
| | - Humberto Restrepo
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| |
Collapse
|
24
|
Evans WN, Acherman RJ, Restrepo H. Critical congenital heart disease and maternal comorbidities: An observation. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2021.101433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
25
|
Chen Z, Zhao H, Zhao Y, Han J, Yang X, Throckmorton A, Wei Z, Ge S, He Y. Retrograde flow in aortic isthmus in normal and fetal heart disease by principal component analysis and computational fluid dynamics. Echocardiography 2022; 39:166-177. [PMID: 35026051 DOI: 10.1111/echo.15256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/04/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Reverse flow Retrograde flow (RF) of blood in the aortic isthmus can be observed in different types of fetal heart disease (FHD), including abnormalities in heart structure and function. This study sought to investigate the relationship between RF and blood flow parameters, and develop a computational fluid dynamics (CFD) model to understand the mechanisms underlying this observation. MATERIAL AND METHODS A total of 281 fetuses (gestational age [GA] 26.6±.3 weeks) with FHD and 2803 normal fetuses (GA: 26.1±.1 weeks) by fetal echocardiography collected from May 2016 to December 2018. Principal component analysis (PCA) was performed to find the relationship and the CFD model reconstructed from 3D/4D spatio-temporal image correlation (STIC) images to simulate hemodynamics. RESULTS There was a significant difference in the percentages of RF between the study (80/201 (39%)) and control (29/2803 (1%)) groups (p < 0.05). The RF occur when the aorta flow rate (left heart) is reduced to 60% by CFD stimulation. Pearson correlation analysis showed significant correlations between flow rate and wall shear stress(WSS) (r = .883, p = 0.047) variables at the AI. CONCLUSION Volumetric flow rate of AO or left heart was the main component of the cause of RF. The hemodynamics of the cardiovascular system have highly complex behavior hinge on the turbulent nature of circulating blood flow.
Collapse
Affiliation(s)
- Zhuo Chen
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongkai Zhao
- School of Energy and Power Engineering, Beijing University of Aeronautics and Astronautics, Beijing, China
| | - Ying Zhao
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiancheng Han
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Yang
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Amy Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Zhenglun Wei
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Shuping Ge
- Geisinger Heart and Vascular Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Yihua He
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
26
|
Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Galindo A, Rothman A, Mayman GA, Restrepo H. Stage-1 Hybrid Palliation for High-Risk 2-Ventricle Patients with Ductal-Dependent Systemic Circulation in the Era of High Prenatal Detection. World J Pediatr Congenit Heart Surg 2021; 12:754-759. [PMID: 34846971 DOI: 10.1177/21501351211044417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We reviewed our center's prenatal detection and surgical experience with high-risk, 2-ventricle patients, with complex congenital heart disease that underwent stage-1 hybrid palliation. METHODS We retrospectively identified those born between March 2008 and March 2021 with 2-ventricle hearts, complex congenital cardiovascular malformations, and ductal-dependent systemic circulation that underwent stage-1 hybrid palliation consisting of surgical bilateral pulmonary artery banding and interventional catheterization placed ductus arteriosus stents. RESULTS We identified 30 patients. Of the 30, 19 (63%) were male. For the 30, median gestational age was 35 weeks (29-39 weeks), and median birth weight was 2.2 kg (0.6-4.5 kg). Of the 30, 1 was transferred from an adjacent state, and 29 were born in Nevada. Of the 29 born in Nevada, overall statewide prenatal detection was 18 of 29 (62%); however, for 2008 to 2011 the prenatal detection rate was 3 of 10 (30%) and 15 of 19 (79%) for 2012 to 2021, P = .03. For the last 5 years, prenatal detection for Nevada-born patients was 8 of 8 (100%). Two full-term newborns, without a prenatal diagnosis, presented postnatally in extremis. For the 30 patients, there were 0 stage-1 hybrid palliation mortalities, 1 subsequent repair mortality, and 3 late nonsurgical deaths. CONCLUSIONS Stage-1 hybrid palliation may result in excellent surgical outcomes for high-risk, 2-ventricle patients. Additionally, high rates of population-wide prenatal detection are possible for high-risk congenital heart disease, allowing prenatal planning and possibly reducing postnatal extremis presentations.
Collapse
Affiliation(s)
- William N Evans
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ruben J Acherman
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Michael L Ciccolo
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Juan Lehoux
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA
| | - Alvaro Galindo
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Abraham Rothman
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Gary A Mayman
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Humberto Restrepo
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| |
Collapse
|
27
|
Prenatal and Neonatal Detection of Isomeric Situs and the Association with Maternal Comorbidities. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-021-00325-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
28
|
Evans WN, Acherman RJ, Restrepo H. Prenatal diagnosis of significant congenital heart disease and elective termination of pregnancy in Nevada. J Matern Fetal Neonatal Med 2021; 35:8761-8766. [PMID: 34814797 DOI: 10.1080/14767058.2021.2004115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We investigated the relationship between prenatal detection of significant congenital heart disease and elective termination of pregnancy over time in Nevada. METHODS We identified those prenatally or post-natally diagnosed with significant congenital cardiovascular malformations in Nevada with birth dates or estimated delivery dates between July 2012 and June 2021. RESULTS We identified 1246. Of 1246, 69 underwent fetal demise, 42 had elective termination, and 1135 were live-born. Of the 1135 live-born, 1090 had prenatal care, of which 718 (66%) overall had a prenatal diagnosis of significant congenital heart disease. However, prenatal detection statistically significantly increased over time from 45 to 82%, p = .00001. Termination of pregnancy averaged 10% of those identified within the legal timeframe, and the rate did not statistically significantly increase with increasing prenatal detection rates, p = .56. Of the 42 undergoing elective termination, 23 (55%) had syndromes or comorbidities vs. 280 (25%) of the 1135 live-births, p = .0003. CONCLUSIONS In Nevada, despite a statistically significant increase in prenatal detection of significant congenital heart disease over time, termination of pregnancy rates did not increase. Nevertheless, those undergoing elective termination were more likely to have associated syndromes or comorbidities.
Collapse
Affiliation(s)
- William N Evans
- Congenital Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Ruben J Acherman
- Congenital Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Humberto Restrepo
- Congenital Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| |
Collapse
|
29
|
Aberrant right subclavian artery as soft marker in the diagnosis of trisomy 21 during the first trimester of pregnancy. Arch Gynecol Obstet 2021; 305:1439-1444. [PMID: 34550447 PMCID: PMC9166867 DOI: 10.1007/s00404-021-06221-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Purpose Aberrant right subclavian artery is an anatomical variation with a prevalence of around 0.5–1.5% of the general population, being more frequently found among people with chromosomopathies, especially, trisomy 21. Despite being an anatomical finding, and thus, constant through the whole pregnancy, its value in the diagnosis of aneuploidies during the first trimester of pregnancy has been little studied. The aim of this study is to evaluate the reliability of the first-trimester ultrasound in the diagnosis of ARSA and its utility in the early diagnosis of aneuploidies. Methods This was a descriptive, observational, cross-sectional study that included all fetuses with sonographic diagnosis of ARSA between 2011 and 2018. Results There were 257 cases of ARSA diagnosed. The first-trimester ultrasound showed the following results in the detection of ARSA: sensitivity of 68% (CI 95% 60.8%–74.5%), specificity of 99.9% (CI 95% 99.9%–100%), positive predictive value of 93.7% (CI 95% 88.1%–96.8%), and negative predictive value of 99.6% (CI 95% 99.5%–99.7%). Due to the presence of ARSA, two cases of trisomy 21, that would have been missed in the first trimester, were diagnosed, using ARSA as a soft marker and modifying the risk obtained by the combined screening as part of the genetic sonogram of the first trimester. Conclusions ARSA visualization during the first-trimester ultrasound is trustworthy and it can improve the detection of trisomy 21 in some cases of aneuploidy missed during the combined screening of the first trimester.
Collapse
|
30
|
Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Restrepo H. Prenatal diagnosis in Nevada for patients undergoing cardiovascular surgery in the first six months. J Card Surg 2021; 36:4472-4475. [PMID: 34486772 DOI: 10.1111/jocs.15979] [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: 08/11/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We reviewed our center's experience with prenatal detection in Nevada's general population for young infants undergoing cardiovascular surgery. METHODS We identified patients born in Nevada that underwent an initial cardiovascular surgery between 0 and 6 months old with birth dates between August 2012 and July 2021. Additionally, we calculated prenatal congenital cardiovascular malformation detection rates for each of the 9 years. RESULTS We identified 660 patients. For the 660 patients, 649 (98%) mothers underwent prenatal care, which included at least one anatomical-survey obstetric ultrasound. Of the 649 with prenatal care, 395 (61%) had a prenatal diagnosis overall. However, prenatal diagnosis improved over the 9 years from 44% in 2012 to 79% in 2021 (correlation coefficient of 0.93, p = .00024). CONCLUSIONS Our results demonstrated a progressive rise in prenatal detection rates for young infants undergoing cardiovascular surgery in Nevada.
Collapse
Affiliation(s)
- William N Evans
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ruben J Acherman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Michael L Ciccolo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Juan Lehoux
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA
| | - Humberto Restrepo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| |
Collapse
|
31
|
Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Galindo A, Rothman A, Mayman GA, Restrepo H. Common arterial trunk in the era of high prenatal detection rates: Results of neonatal palliation and primary repair. J Card Surg 2021; 36:4090-4094. [PMID: 34462970 DOI: 10.1111/jocs.15964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We reviewed our center's experience with common arterial trunk. METHODS We included those with common arterial trunk in Nevada with estimated delivery dates or birth dates between June 2006 and May 2021. We excluded patients with functionally univentricular hearts. RESULTS We identified a total of 39: 32 prenatally and 7 postnatally. Of the 32 prenatally detected, 2 had elective termination, 2 had fetal demise, and 28 were live-born. Of the 7 postnatally diagnosed, 6 had prenatal care without a fetal echocardiogram, and 1 had no prenatal care. Overall, live-born prenatal detection was 28/34 (82%). Prenatal detection for 2006-2009 was 2/6 (33%) and for 2010-2021 was 26/28 (93%) p = .049. Of the 35 live-born infants, 1 died preoperatively, and 34 underwent neonatal surgery. Of the 34, 8 had palliation (birth weight 1.9±0.7 kg, range 0.8-2.6 kg), and 26 had a primary repair (birth weight 3.0±0.3 kg, range 2.6-4.0 kg) p = .0004. For all 34 neonatal surgical procedures, there were 2 (5.9%) deaths; however, there were no subsequent surgical or interventional catheterization mortalities. CONCLUSIONS In Nevada, current state-wide, general population prenatal detection of the common arterial trunk was more than 90%. By employing a combination of neonatal palliation and primary repair, surgical mortality was less than 6% in a cohort that included those with birth weights less than 2.5 kg, truncal valve surgery, and interrupted aortic arches.
Collapse
Affiliation(s)
- William N Evans
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ruben J Acherman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Michael L Ciccolo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Juan Lehoux
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA
| | - Alvaro Galindo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Abraham Rothman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Gary A Mayman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Humberto Restrepo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| |
Collapse
|
32
|
|
33
|
Abel JS, Berg C, Geipel A, Gembruch U, Herberg U, Breuer J, Brockmeier K, Gottschalk I. Prenatal diagnosis, associated findings and postnatal outcome of fetuses with truncus arteriosus communis (TAC). Arch Gynecol Obstet 2021:10.1007/s00404-021-06157-w. [PMID: 34453587 DOI: 10.1007/s00404-021-06157-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess the spectrum of associated anomalies, the intrauterine course, postnatal outcome and management of fetuses with truncus arteriosus communis (TAC) METHODS: All cases of TAC diagnosed prenatally over a period of 8 years were retrospectively collected in two tertiary referral centers. All additional prenatal findings were assessed and correlated with the outcome. The accuracy of prenatal diagnosis was assessed. RESULTS 39 cases of TAC were diagnosed prenatally. Mean gestational age at first diagnosis was 22 weeks (range, 13-38). Two cases were lost follow-up. Correct prenatal diagnosis of TAC was made in 21 of 24 (87.5%) cases and of TAC subtype in 19 of 21 (90.5%) cases. Prenatal diagnosis of TAC was incorrect in three cases: one newborn had aortic atresia with ventricular septal defect postnatally, one had hypoplastic right ventricle with dextro Transposition of the Great Arteries with coartation of the aorta and a third newborn had Tetralogy of Fallot with abnormal origin of the left pulmonary artery arising from the ascending aorta postnatally. These three cases were excluded from further analysis. In 9 of 34 (26.5%) cases, TAC was an isolated finding. 13 (38.2%) fetuses had additional chromosomal anomalies. Among them, microdeletion 22q11.2 was most common with a prevalence of 17.6% in our cohort. Another 3 fetuses were highly suspicious for non-chromosomal genetic syndromes due to their additional extra-cardiac anomalies, but molecular diagnosis could not be provided. Major cardiac and extra-cardiac anomalies occurred in 3 (8.8%) and in 20 (58.8%) cases, respectively. Predominantly, extra-cardiac anomalies occurred in association with chromosomal anomalies. Additionally, severe IUGR occurred in 6 (17.6%) cases. There were 14 terminations of pregnancy (41.2%), 1 (2.9%) intrauterine fetal death, 5 postnatal deaths (14.7%) and 14 (41.2%) infants were alive at last follow-up. Intention-to-treat survival rate was 70%. Mean follow-up among survivors was 42 months (range, 6-104). Postoperative health status among survivors was excellent in 11 (78.6%) infants, but 5 (46.2%) of them needed repeated re-interventions due to recurrent pulmonary artery or conduit stenosis. The other 3 (21.4%) survivors were significantly impaired due to non-cardiac problems. CONCLUSION TAC is a rare and complex cardiac anomaly that can be diagnosed prenatally with high precision. TAC is frequently associated with chromosomal and extra-cardiac anomalies, leading to a high intrauterine and postnatal loss rate due to terminations and perioperative mortality. Without severe extra-cardiac anomalies, postoperative short- and medium-term health status is excellent, independent of the subtype of TAC, but the prevalence of repeated interventions due to recurrent stenosis is high.
Collapse
Affiliation(s)
- J S Abel
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
| | - C Berg
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - U Herberg
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - J Breuer
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - K Brockmeier
- Department of Pediatric Cardiology, University of Cologne, Cologne, Germany
| | - I Gottschalk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
| |
Collapse
|
34
|
Ultrasound Patterns in the First Trimester Diagnosis of Congenital Heart Disease. J Clin Med 2021; 10:jcm10153206. [PMID: 34361992 PMCID: PMC8347903 DOI: 10.3390/jcm10153206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/21/2022] Open
Abstract
Congenital heart disease (CHD) is the most common birth defect, with a reported prevalence of 5–12 per 1000 live births. Very recently, the American Institute of Ultrasound in Medicine published a guideline recommending the use of the four-chamber and the three-vessel and trachea views to screen for CHD in the first trimester of pregnancy. Our aim is to present abnormal image patterns that are seen in the four-chamber, three-vessel, and trachea views of the fetal heart in the first trimester and to describe their association with specific CHD types. We used a total of 29 cases of CHD from the archives of Filantropia Hospital and the Maternal and Child Health Institute (INSMC) fetal medicine units. We selected cases with a clear and well-documented diagnosis of the CHD type. We identified a series of repeating color doppler flow patterns seen in the four-chamber, three-vessel, and trachea views of the studied cases. Our observations could be developed into a diagnosis algorithm to orientate the examiner to the most likely type of CHD in individual cases.
Collapse
|
35
|
Key Features on the 3-Vessel View and 3-Vessel Tracheal View of Isolated Right Aortic Arch Anomalies. Ultrasound Q 2021; 36:235-239. [PMID: 32890326 DOI: 10.1097/ruq.0000000000000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Right aortic arch anomalies are a spectrum of malformations that include right aortic arch with mirror image branching, right aortic arch with an aberrant left subclavian artery, and double aortic arch. Although these are rare anomalies, they are of importance as they form vascular rings, which can cause symptoms in the newborn period. These anomalies are not detected with routine cardiac views, and it is only with the 3-vessel, and the 3-vessel tracheal view that they can be identified and characterized. We describe specific sonographic findings of these anomalies on the 3-vessel and the 3-vessel tracheal view.
Collapse
|
36
|
The multiform sonographic spectrum of arterial duct in right aortic arch. Int J Cardiovasc Imaging 2021; 37:3385-3395. [PMID: 34236571 PMCID: PMC8604842 DOI: 10.1007/s10554-021-02325-w] [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: 04/19/2021] [Accepted: 06/23/2021] [Indexed: 11/22/2022]
Abstract
To study the different characteristics of arterial duct (AD) in a series of prenatally detected right aortic arch (RAA). Out of 832 congenital heart diseases (CHD) referred to a tertiary center, 98 cases had RAA. Based on anatomical landmarks we identified 7 types of AD: type 1 left-sided, transverse; type 2 left-sided, vertical; type 3 from the underside of aortic arch (AA), vertical; type 4 right-sided, mirror-image “V”, transverse; type 5 right-sided, “H” shaped, transverse; type 6 bilateral; type 7 absent or unidentifiable. For each type of AD the incidence of associated major CHD was calculated and chi-square test was applied to verify the null hypothesis with significance level of p < 0.05. Type 1 occurred in 43% of cases including 4 with CHD and no cases with pulmonary outflow obstruction (POO). Symptoms of vascular ring were present in 41% of survivors. Type 2, 3 and 7 AD were associated with tetralogy of Fallot (TOF) or equivalents. No type 5 AD with CHD had POO and 3 isolated cases had asymptomatic hypoplasia of left pulmonary artery (LPA). Two type 6 AD had disconnection of LPA. Type 1 occurred more often as an isolated finding (p < 0.001), whereas types 2 (p = 0.0026), 3 (p = 0.0045), 4 (p = 0.0325) and 7 (p = 0.0001) were frequently associated with major CHD. In RAA, type 1 (U-shaped) is usually an isolated finding (p < 0.001) which includes all symptomatic vascular rings. POO is always present when the AD is vertical or absent but not when it lies on a transverse plane. Bilateral AD is rare and brings the risk of functionary loss of left lung if not identified.
Collapse
|
37
|
Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Restrepo H. Prenatal diagnosis of isolated perimembranous ventricular septal defects undergoing primary surgical repair in infancy. J Matern Fetal Neonatal Med 2021; 35:8001-8005. [PMID: 34139939 DOI: 10.1080/14767058.2021.1940933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We retrospectively analyzed our center's experience with the prenatal diagnosis of isolated perimembranous ventricular septal defects that underwent primary surgical repair in infancy. METHODS We identified patients born in Southern Nevada, between October 2012 and October 2020, with prenatal care that underwent surgical closure of an isolated large perimembranous ventricular septal defect between 1 and 12 months of age. The description at surgery defined ventricular septal defect morphology. We included only those with situs solitus, levocardia without dextroposition, and without any other cardiovascular abnormality. We analyzed prenatal detection rates for each of the eight years. RESULTS We identified 81 patients. Of the 81, 35 (43%) had trisomy 21. We identified no other aneuploidies in those that underwent surgical repair; however, 1 had a 15q13.3 deletion syndrome, and 1 had a 22 q11.2 deletion syndrome. Of the 81, 27 (33%) overall were prenatally diagnosed. Increasing prenatal detection rates strongly correlated with time (R = 0.92, p = .002). CONCLUSIONS Trisomy 21 is common in isolated perimembranous ventricular septal defects undergoing primary repair in infancy. Further, prenatal detection rates significantly improved over time, up to 65% detection in the current years.
Collapse
Affiliation(s)
- William N Evans
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Ruben J Acherman
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Michael L Ciccolo
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Department of Surgery, School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Juan Lehoux
- Children's Heart Center Nevada, Las Vegas, NV, USA
| | - Humberto Restrepo
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
| |
Collapse
|
38
|
Vorisek CN, Enzensberger C, Willomeit S, Kurkevych A, Stessig R, Ritgen J, Degenhardt J, Mielke G, Bosselmann S, Krapp M, Slodki M, Respondek-Liberska M, Wolter A, Kawecki A, Goette M, Axt-Fliedner R. Prenatal Diagnosis and Outcome of Congenital Corrected Transposition of the Great Arteries - A Multicenter Report of 69 Cases. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:291-296. [PMID: 31995816 DOI: 10.1055/a-1069-7698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Congenital corrected transposition of the great arteries (ccTGA) is a rare congenital cardiac anomaly which remains difficult to diagnose prenatally. We aim to investigate the natural history, associated anomalies and the outcome of patients in prenatally diagnosed ccTGA. METHOD This was an international multicenter retrospective analysis of fetuses with a diagnosis of ccTGA from 2002 to 2017. We reviewed clinical and echocardiographic databases of seven centers. Anatomic survey and fetal echocardiography were performed according to international guidelines of ISUOG. RESULTS We considered 69 fetuses with prenatally suspected ccTGA. There was an overall survival rate of 91 % among 54 patients with a confirmed diagnosis. Survival to live birth was 96 % (52/54) and survival on an intention-to-treat basis was 94 % (49/52). The mean gestational age at the time of diagnosis was 25.6 ± 5.9 weeks of gestation. In 7 out of 54 fetuses (13 %), ccTGA was an isolated finding. Dextro/mesocardia was present in 15 cases (27.8 %). Intracardiac anomalies were present in 46/54 cases (85.2 %) with the most frequent anomaly being a ventricular septal defect present in 41 fetuses (75.9 %). Complete heart block was diagnosed in 10 cases (18.5 %). Extracardiac anomalies were observed in 9 out of 54 cases (16.7 %). Prenatal karyotyping of the fetus was available in 30/54 (55.6 %) cases with chromosomal anomalies in 4/30 (13.3 %). CONCLUSION ccTGA is a rare cardiac anomaly often accompanied by a variable spectrum of further intracardiac abnormalities. Accurate diagnosis of ccTGA, which can be integrated into parental counselling, is feasible with a favorable short-term outcome for affected neonates.
Collapse
Affiliation(s)
- Carina Nina Vorisek
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
| | - Christian Enzensberger
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
| | - Steven Willomeit
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
| | - Andrii Kurkevych
- Fetal Cardiology Unit, Ukrainian Children's Hospital, Kyiv, UA, Kyiv, Ukraine
| | | | - Jochen Ritgen
- Prenatal Plus, Prenatal Care Center Cologne, Germany
| | | | - Gunther Mielke
- Prenatal Medicine, Prenatal Care Center Stuttgart, Germany
| | | | | | - Maciej Slodki
- Fetal Cardiology, Polish Mother Memorial Hospital Research Institute, Lodz, Poland
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Aline Wolter
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
| | - Andrea Kawecki
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
| | - Malena Goette
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
| | - Roland Axt-Fliedner
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
| |
Collapse
|
39
|
Arnaout R, Curran L, Zhao Y, Levine JC, Chinn E, Moon-Grady AJ. An ensemble of neural networks provides expert-level prenatal detection of complex congenital heart disease. Nat Med 2021; 27:882-891. [PMID: 33990806 DOI: 10.1038/s41591-021-01342-5] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
Congenital heart disease (CHD) is the most common birth defect. Fetal screening ultrasound provides five views of the heart that together can detect 90% of complex CHD, but in practice, sensitivity is as low as 30%. Here, using 107,823 images from 1,326 retrospective echocardiograms and screening ultrasounds from 18- to 24-week fetuses, we trained an ensemble of neural networks to identify recommended cardiac views and distinguish between normal hearts and complex CHD. We also used segmentation models to calculate standard fetal cardiothoracic measurements. In an internal test set of 4,108 fetal surveys (0.9% CHD, >4.4 million images), the model achieved an area under the curve (AUC) of 0.99, 95% sensitivity (95% confidence interval (CI), 84-99%), 96% specificity (95% CI, 95-97%) and 100% negative predictive value in distinguishing normal from abnormal hearts. Model sensitivity was comparable to that of clinicians and remained robust on outside-hospital and lower-quality images. The model's decisions were based on clinically relevant features. Cardiac measurements correlated with reported measures for normal and abnormal hearts. Applied to guideline-recommended imaging, ensemble learning models could significantly improve detection of fetal CHD, a critical and global diagnostic challenge.
Collapse
Affiliation(s)
- Rima Arnaout
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. .,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA. .,Center for Intelligent Imaging, University of California, San Francisco, San Francisco, CA, USA. .,Biological and Medical Informatics, University of California, San Francisco, San Francisco, CA, USA. .,Chan Zuckerberg Biohub, University of California, San Francisco, San Francisco, CA, USA.
| | - Lara Curran
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Yili Zhao
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco,, San Francisco, CA, USA
| | - Jami C Levine
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard School of Medicine, Boston, MA, USA
| | - Erin Chinn
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Anita J Moon-Grady
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco,, San Francisco, CA, USA
| |
Collapse
|
40
|
Ctori E, Crucean A, Pinkey B, McGuirk SP, Anderson RH, Stickley J, Jones TJ, Seale AN. Morphology of vascular ring arch anomalies influences prognosis and management. Arch Dis Child 2021; 106:477-483. [PMID: 33106229 DOI: 10.1136/archdischild-2020-319388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/23/2020] [Accepted: 09/14/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study aimed to explore the anatomical features of aortic arch anomalies associated with vascular rings, hoping to identify those which may increase the risk of symptomatic presentation and surgical intervention. METHODS This was a retrospective observational study at a single cardiac unit. Individuals diagnosed with an aortic arch anomaly, either isolated or non-isolated, between June 2014 and September 2018 were included. The morphology of the aortic arch was established via analysis of postnatal echocardiography, CT or MRI scans. CT and magnetic resonance studies were evaluated for the presence of a Kommerell diverticulum in those with aberrant vessels. Case notes were reviewed for relevant clinical data. RESULTS Of those with aberrant subclavian arteries, 24/79 (30.4%) were shown to have a Kommerell diverticulum. Additional forms of congenital heart disease were present in 133/227 (58.6%) individuals. Surgical division of the vascular ring was performed in 30/227 (13.2%), most commonly in the setting of a double aortic arch (70.8%). In those with aberrant subclavian arteries, no children without a Kommerell diverticulum were referred for surgery. In those with a Kommerell diverticulum confirmed on imaging, 11/24 underwent surgery. CONCLUSION Individuals with a double aortic arch, or an aberrant subclavian artery arising from a Kommerell diverticulum, have the highest requirement for surgical intervention, especially in isolated anomalies. These individuals should remain under monitoring. The subjective nature of symptoms remains problematic. Longitudinal research is required further to understand the natural history of vascular rings and how it links to morphology.
Collapse
Affiliation(s)
- Elena Ctori
- College of Medical and Dental Science, University of Birmingham, Birmingham, UK
| | - Adrian Crucean
- College of Medical and Dental Science, University of Birmingham, Birmingham, UK
- Heart Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Benjamin Pinkey
- Department of Radiology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Simon P McGuirk
- Department of Radiology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert H Anderson
- Heart Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
- Institute of Genetics, Newcastle, UK
| | - John Stickley
- Heart Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Timothy J Jones
- Heart Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Anna N Seale
- College of Medical and Dental Science, University of Birmingham, Birmingham, UK
- Heart Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
41
|
Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Berthoty D, Mayman GA, Restrepo H. Isolated vascular rings in the era of high prenatal detection rates: Demographics, diagnosis, risk factors, and outcome. J Card Surg 2021; 36:1381-1388. [PMID: 33586208 DOI: 10.1111/jocs.15414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We reviewed our center's isolated vascular ring data. METHODS Inclusion criteria were patients born in Nevada between June 2015 and July 2020 with situs solitus, levocardia, atrioventricular and ventriculoarterial concordance, and no significant intracardiac malformations. RESULTS We identified 95 patients. Of the 95, 56 (59%) were female (p = .033). For the study period, there were approximately 180,000 live births, for a prevalence of 5.3 isolated vascular rings per 10,000 live births. Of the 95, 78 (82%) were prenatally diagnosed. Of the 95, 63 (66%) were products of high-risk pregnancies (p = .0001). Additionally, we found advanced maternal age was an isolated vascular ring risk factor (relative risk ratio, 2.7; 95% confidence interval, 1.8, 4.1; p < .00001). CONCLUSIONS Isolated vascular rings are relatively common cardiovascular malformations and more common in females. High prenatal detection rates are achievable. Further, the majority with isolated vascular rings are products of high-risk pregnancies, and advanced maternal age is a statistically significant occurrence risk factor.
Collapse
Affiliation(s)
- William N Evans
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, School of Medicine, Division of Pediatric Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ruben J Acherman
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, School of Medicine, Division of Pediatric Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Michael L Ciccolo
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Surgery, School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Juan Lehoux
- Children's Heart Center Nevada, Las Vegas, Nevada, USA
| | - Dean Berthoty
- Department of Radiology, Sunrise Children's Hospital, Las Vegas, Nevada, USA
| | - Gary A Mayman
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, School of Medicine, Division of Pediatric Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Humberto Restrepo
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, School of Medicine, Division of Pediatric Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| |
Collapse
|
42
|
He X, Chen J, Li G. Study on the views and methods of ultrasonic screening and diagnosis for abnormal aortic arch in infants. Cardiovasc Ultrasound 2021; 19:8. [PMID: 33446185 PMCID: PMC7809778 DOI: 10.1186/s12947-021-00237-2] [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: 04/29/2020] [Accepted: 01/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to explore echocardiographic views and methods of aortic arch anomalies in infants, so as to improve the screening sensitivity and diagnostic accuracy. METHODS 140 children with abnormal aortic arch diagnosed by ultrasound in Children's Hospital of Hebei Province from January 2014 to December 2019 were selected for retrospective analysis. All were confirmed by surgery or/and computerized tomography angiography. Series of views for aortic arch (the three-vessel and tracheal view, aortic arch short axis view, left aortic arch long axis view, aortic arch long axis continuous scan views) were performed in all cases on the basis of the routine views of echocardiography. The screening sensitivity and diagnostic coincidence rate of different echocardiographic views for aortic arch anomalies were analyzed. RESULTS Among the 140 infants, right aortic arch were 21 cases (6/21 were accompanied by mirror branch and 15/21 were with aberrant left subclavian artery). Left aortic arch with aberrant right subclavian artery were 2 cases, and double aortic arch with both arches open were 20 cases. Double aortic arch with left arch atresia were 2 cases, and atresia of the proximal aorta with aortic arch dysplasia was 1 case. Coarctation of the aorta were 67 cases, and interruption of aortic arch were 27 cases. All the patients were correctly diagnosed except that 2 infants with interruption of aortic arch were incorrectly diagnosed as coarctation of the aorta, and 1 infant with coarctation of the aorta was misdiagnosed as interruption of aortic arch by echocardiography. The screening sensitivities of four views and four-view combination for abnormal aortic arch were 99.3, 73.6, 87.1, 99.3, and 100%; the diagnostic coincidence rates were 85.7, 27.1,66.4, 95.0%, and 97.9% respectively. On the basis of traditional left aortic long axis view, other three views had their own advantages. The screening sensitivity and diagnostic coincidence rate of four-view combination were significantly improved. CONCLUSIONS The three-vessel trachea view is simple and feasible, which is suitable for screening abnormal aortic arch. The combination of four views conduces to improving screening sensitivity and diagnostic accuracy of aortic arch abnormalities.
Collapse
Affiliation(s)
- Xinjian He
- Department of Ultrasoud Diagnosis, Children's Hospital of Hebei Province, Hebei Medical University, Shijiazhuang, China.
| | - Jiaoyang Chen
- Department of Ultrasoud Diagnosis, Children's Hospital of Hebei Province, Hebei Medical University, Shijiazhuang, China
| | - Gaoyang Li
- Department of Ultrasoud Diagnosis, Children's Hospital of Hebei Province, Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
43
|
Yagel S. Integration of nuchal translucency screening into the first-trimester fetal anatomy scan: the time has come. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:29-31. [PMID: 33387407 DOI: 10.1002/uog.23552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/22/2020] [Indexed: 06/12/2023]
Affiliation(s)
- S Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
44
|
Prenatal diagnosis, associated findings and postnatal outcome in fetuses with congenitally corrected transposition of the great arteries. Arch Gynecol Obstet 2020; 303:1469-1481. [PMID: 33219483 PMCID: PMC8087597 DOI: 10.1007/s00404-020-05886-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/05/2020] [Indexed: 01/03/2023]
Abstract
Purpose To analyze anatomic features and associated malformations in 37 prenatally detected cases of congenitally corrected transposition of the great arteries (ccTGA) and to evaluate the prenatal course, neonatal outcome and mid-term follow-up. Methods Retrospective analysis of prenatal ultrasound of 37 patients with ccTGA in two tertiary centers between 1999 and 2019. All fetuses received fetal echocardiography and a detailed anomaly scan. Postnatal outcome and follow-up data were retrieved from pediatric reports. Results Isolated ccTGA without associated cardiac anomalies was found in 13.5% (5/37), in all other fetuses additional defects such as VSD (73.0%), pulmonary obstruction (35.1%), tricuspid valve anomalies (18.9%), aortic arch anomalies (13.5%), ventricular hypoplasia (5.4%) or atrioventricular block (5.4%) were present. The rate of extracardiac malformations or chromosomal aberrations was low. There were 91.9% (34/37) live births and postnatal survival rates reached 91.2% in a mean follow-up time of 4.98 years. The prenatal diagnosis of ccTGA was confirmed postnatally in all but one documented live birth and the prenatal counselling regarding the expected treatment after birth (uni- versus biventricular repair) was reassured in the majority of cases. The postnatal intervention rate was high, 64.7% (22/34) received surgery, the intervention-free survival was 36.7%, 35.0% and 25.0% at 1 month, 1 year and 10 years, respectively. Conclusions ccTGA is a rare heart defect often associated with additional heterogeneous cardiac anomalies that can be diagnosed prenatally. The presented study demonstrates a favorable outcome in most cases but the majority of patients require surgical treatment early in life.
Collapse
|
45
|
Martínez-Payo C, Suanzes E, Nieto-Jiménez Y, Ruiz de Azúa M, Siles A, Usano AI, Pérez-Medina T. Is it useful to evaluate the presence of aberrant right subclavian artery in prenatal diagnosis ultrasounds? J Obstet Gynaecol Res 2020; 47:359-367. [PMID: 33059391 DOI: 10.1111/jog.14533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/08/2020] [Accepted: 09/30/2020] [Indexed: 12/01/2022]
Abstract
AIM Analyze if the evaluation of aberrant right subclavian artery in the prenatal echography has improved the detection of chromosomal, genetic and/or morphological abnormalities in our population. METHODS Descriptive, observational, cross-sectional study of the cases of aberrant right subclavian artery diagnosed in our Prenatal Diagnosis Unit between January of 2011 and December of 2018. RESULTS Two hundred and fifty-seven cases of aberrant right subclavian artery were diagnosed and among them, 179 were considered isolated cases and thus were confirmed after birth. The detection of aberrant right subclavian artery did not improve itself neither the diagnosis of trisomy 21 in the second trimester of pregnancy nor other chromosomal or genetic abnormalities, including the not isolated cases. There were two cases of trisomy 21 diagnosed in the second trimester that presented major sonographic disorders and an inadequate examination during the first trimester. When aberrant right subclavian artery was associated with soft markers of aneuploidy in the second trimester, any case was a trisomy 21. Aberrant right subclavian artery seems to be associated with some minor and major heart defects, especially ventriculoseptal defect and aneurismatic ductus, and in some cases, also with clubfeet. CONCLUSION When an adequate screening of aneuploidies and a thorough ultrasound have been performed during the first trimester, aberrant right subclavian artery hardly helps to perform other diagnosis in the second trimester.
Collapse
Affiliation(s)
- Cristina Martínez-Payo
- Unidad de Diagnóstico Prenatal, Servicio de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Elena Suanzes
- Unidad de Diagnóstico Prenatal, Servicio de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Yolanda Nieto-Jiménez
- Unidad de Diagnóstico Prenatal, Servicio de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Miguel Ruiz de Azúa
- Unidad de Diagnóstico Prenatal, Servicio de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ana Siles
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ana Isabel Usano
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Tirso Pérez-Medina
- Jefe de Servicio, Servicio de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| |
Collapse
|
46
|
Gottschalk I, Strizek B, Jehle C, Stressig R, Herberg U, Breuer J, Brockmeier K, Hellmund A, Geipel A, Gembruch U, Berg C. Prenatal Diagnosis and Postnatal Outcome of Fetuses with Pulmonary Atresia and Ventricular Septal Defect. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:514-525. [PMID: 30616264 DOI: 10.1055/a-0770-2832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To assess the intrauterine course, associated conditions and postnatal outcome of fetuses with pulmonary atresia with ventricular septal defect (PAVSD). METHODS All cases of PAVSD diagnosed prenatally over a period of 10 years with a minimum follow-up of 6.5 years were retrospectively collected in 3 tertiary referral centers. RESULTS 50 cases of PAVSD were diagnosed prenatally. 44.0 % of fetuses had isolated PAVSD, 4.0 % had associated cardiac anomalies, 10.0 % had extra-cardiac anomalies, 38.0 % had chromosomal anomalies, 4.0 % had non-chromosomal syndromes. Among the 32 liveborn children, 56.3 % had reverse flow in the patent arterial duct, 25.0 % had major aortopulmonary collateral arteries (MAPCAs) with ductal agenesis and 18.7 % had a double supply. 17 pregnancies were terminated (34.0 %), there was 1 intrauterine fetal death (2.0 %), 1 neonatal death (2.0 %), and 6 deaths (12.0 %) in infancy. 25 of 30 (83.3 %) liveborn children with an intention to treat were alive at the latest follow-up. The mean follow-up among survivors was 10.0 years (range 6.5-15.1). 56.0 % of infants underwent staged repair, 44.0 % had one-stage complete repair. After exclusion of infants with additional chromosomal or syndromal anomalies, 88.9 % were healthy, and 11.1 % had mild limitations. The presence of MAPCAs did not differ significantly between survivors and non-survivors (p = 0.360), between one-stage or staged repair (p = 0.656) and healthy and impaired infants (p = 0.319). CONCLUSION The prognosis in cases without chromosomal or syndromal anomalies is good. MAPCAs did not influence prognosis or postoperative health. The incidence of repeat interventions due to recurrent stenoses is significantly higher after staged compared with single-stage repair.
Collapse
Affiliation(s)
- Ingo Gottschalk
- Division of Prenatal Medicine, University-Hospital of Cologne, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University-Hospital of Bonn, Germany
| | - Christel Jehle
- Division of Prenatal Medicine, University-Hospital of Cologne, Germany
| | - Rüdiger Stressig
- Praenatal.plus Prenatal Medicine and Genetics, praenatal.plus Cologne, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University-Hospital of Bonn, Germany
| | - Johannes Breuer
- Department of Pediatric Cardiology, University-Hospital of Bonn, Germany
| | - Konrad Brockmeier
- Department of Pediatric Cardiology, University-Hospital of Cologne, Germany
| | - Astrid Hellmund
- Department of Obstetrics and Prenatal Medicine, University-Hospital of Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University-Hospital of Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University-Hospital of Bonn, Germany
| | - Christoph Berg
- Division of Prenatal Medicine, University-Hospital of Cologne, Germany
| |
Collapse
|
47
|
Kassif E, Tsur A, Shust-Barequet S, Raviv O, Kushnir A, Abu Snenh S, Achiron R, Mazaki-Tovi S, Weisz B, Salem Y, Weissbach T. The “No ARSA” Sign: A Novel Method of Prenatal Screening for Aberrant Right Subclavian Artery. J Clin Med 2020; 9:jcm9082658. [PMID: 32824459 PMCID: PMC7463697 DOI: 10.3390/jcm9082658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022] Open
Abstract
An aberrant right subclavian artery (ARSA) can be overlooked by the conventional method as described by Chaoui et al., due to acoustic shadowing. The aim of this study was to evaluate the feasibility and accuracy of a novel screening method for ARSA by demonstrating the brachiocephalic artery bifurcation, referred to as the “No ARSA” sign. A prospective study conducted at a tertiary care center between 2018 and 2019 included unselected pregnant patients at a median gestational age of 15.1 (14.2–22.1; IQR (inter-quartile range)) weeks, who had been referred for a routine or targeted anomaly scan. All participants were scanned for the presence or absence of ARSA using both the conventional and the novel “No ARSA” methods for validation purposes. A total of 226 unselected patients were enrolled in the study. The “No ARSA” sign was visualized in 218 fetuses (96.5%). In the remaining 8 cases (3.5%), the “No ARSA” sign was not demonstrated. In these fetuses, an ARSA was visualized by the conventional method. The new method exhibited 100% feasibility and was in complete agreement with the conventional method. Intra- and inter-observer agreement was excellent (κ = 1). The results of the study suggest that the “No ARSA” sign is an efficient and reliable screening tool for ARSA.
Collapse
Affiliation(s)
- Eran Kassif
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Abraham Tsur
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Shir Shust-Barequet
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Oshrat Raviv
- Departments of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Anya Kushnir
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Samar Abu Snenh
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Reuven Achiron
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Shali Mazaki-Tovi
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Boaz Weisz
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Yishay Salem
- Pediatric Cardiology Unit, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: (Y.S.); (T.W.); Tel.: +972-546-250-299 (T.W.)
| | - Tal Weissbach
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
- Correspondence: (Y.S.); (T.W.); Tel.: +972-546-250-299 (T.W.)
| |
Collapse
|
48
|
Yagel S, Moon-Grady AJ. Fetal cardiac evaluation services for low-risk pregnancies: how can we improve? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:726-727. [PMID: 32478982 DOI: 10.1002/uog.22052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
Linked Comment: Ultrasound Obstet Gynecol 2020; 55:747-757.
Collapse
Affiliation(s)
- S Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A J Moon-Grady
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
49
|
Yang ZJ, DeVore GR, Pei QY, Yan YN, Li YT, Wang Y. The construction and application of an ultrasound and anatomical cross-sectional database of structural malformations of the fetal heart. Prenat Diagn 2020; 40:892-904. [PMID: 32279335 DOI: 10.1002/pd.5708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Establish a fetal heart anatomical cross-sectional database that correlates with screening transverse ultrasound images suggested by international professional organizations to detect congenital heart defects. METHODS Fetuses with suspected congenital heart defects identified using the following cardiac image sequences obtained from transverse slices beginning from the upper abdomen and ending in the upper thorax were the subjects of this study: (1) four-chamber view, (2) left ventricular outflow tract view, (3) three-vessel right ventricular outflow tract view, and (4) the three-vessel tracheal view. A database of digital two-dimensional images of the transverse sweep was created for fetuses with confirmed congenital heart defects. In addition, using four-dimensional ultrasound spatial-temporal image correlation, selected transverse ultrasound images were acquired as part of the database. Ultrasound-detected congenital heart defects were confirmed postnatally from pathological specimens of the heart and lungs using a cross-sectional technique that mirrored the ultrasound images described above. When anatomical specimens were not available, prenatal ultrasound-detected congenital heart defects were confirmed using postnatal echocardiography and/or following surgery. RESULTS The four screening views described in the Methods section identified 160 fetuses that comprised the database. Forty-five datasets consisted of both ultrasound and anatomical cross-sectional images. Thirteen percent (6/45) only had abnormalities of the four-chamber view (eg, endocardial cushion defects). Twenty-four percent (11/45) had abnormalities of the four-chamber view as well as right and left outflow tracts (eg, complex malformations). Of these, 10 of 11 had an abnormal tracheal view. Sixteen percent (7/45) had an abnormal four-chamber view and abnormal right outflow tract (eg, pulmonary stenosis). Thirty-three percent (15/45) had a normal four-chamber view but had abnormal right and left outflow tracts as well as an abnormal tracheal view (eg, tetralogy of Fallot, D-transposition of the great arteries). CONCLUSIONS Combining both ultrasound and anatomical imaging may be of assistance in training imagers to recognize cardiovascular pathology when performing the screening examination of the fetal heart.
Collapse
Affiliation(s)
- Zhen-Juan Yang
- Division of Obstetric Ultrasonography, Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, P.R. China
| | - Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Qiu-Yan Pei
- Division of Obstetric Ultrasonography, Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, P.R. China
| | - Ya-Ni Yan
- Division of Obstetric Ultrasonography, Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, P.R. China
| | - Yun-Tao Li
- Division of Obstetric Ultrasonography, Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, P.R. China
| | - Yan Wang
- Division of Obstetric Ultrasonography, Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, P.R. China
| |
Collapse
|
50
|
Guirado L, Crispi F, Soveral I, Valenzuela-Alcaraz B, Rodriguez-López M, García-Otero L, Torres X, Sepúlveda-Martínez Á, Escobar-Diaz MC, Martínez JM, Friedberg MK, Gratacós E, Gómez O. Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography. Fetal Diagn Ther 2019; 47:399-410. [PMID: 31822009 DOI: 10.1159/000503228] [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] [Received: 04/10/2019] [Accepted: 09/06/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Fetal right ventricular (RV) function assessment is challenging due to the RV geometry and limitations of in utero assessment. Postnatally, 2D echocardiographic RV fractional area change (FAC) is used to assess RV global systolic function by calculating the percentage of change in RV area from systole to diastole. Reports on FAC are scarce in prenatal life, and nomograms throughout pregnancy are not available. Our aims were (1) to study prenatal RV FAC feasibility and reproducibility and (2) to construct nomograms for RV FAC and end-diastolic (ED) and end-systolic (ES) RV areas from 18 to 41 weeks of gestation. METHODS Prospective cohort study including 602 low-risk singleton pregnancies undergoing a fetal echocardiography from 18 to 41 weeks of gestation. RV ED and ES areas were measured following standard recommendations for ventricular dimensions and establishing strict landmarks to identify the different phases of the cardiac cycle. RV FAC was calculated as: ([ED area - ES area]/ED area) × 100. RV FAC intra- and inter-observer reproducibility was evaluated in 45 fetuses by calculating the intraclass correlation coefficient (ICC). Parametric regressions were tested to model each parameter against gestational age (GA) and estimated fetal weight (EFW). RESULTS RV areas and FAC were successfully obtained in ∼99% of fetuses with acceptable reproducibility throughout gestation (RV ED area inter-observer ICC [95% CI] 0.96 [0.93-0.98], RV ES area 0.97 [0.94-0.98], and FAC 0.69 [0.44-0.83]). Nomograms were constructed for RV ED and ES areas and FAC. RV areas showed a quadratic and logarithmic increase with GA and EFW, respectively. In contrast, RV FAC showed a slight quadratic decrease throughout gestation (mean RV FAC ranged from 36% at 18 weeks of gestation [10-90th centiles: 25-47%, respectively] to 29% at 41 weeks [10-90th centiles: 18-40%, respectively]). The best models for RV areas and FAC were a second-degree polynomial. CONCLUSIONS RV FAC is a feasible and reproducible parameter to assess RV global systolic function in fetal life. We provide reference ranges adjusted by GA and EFW that can be used as normal references for the assessment of RV function in prenatal conditions.
Collapse
Affiliation(s)
- Laura Guirado
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Fàtima Crispi
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain,
| | - Iris Soveral
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Brenda Valenzuela-Alcaraz
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Mérida Rodriguez-López
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.,Pontificia Universidad Javeriana seccional Cali, Cali, Colombia
| | - Laura García-Otero
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Ximena Torres
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Álvaro Sepúlveda-Martínez
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.,Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | | | - Josep María Martínez
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Mark K Friedberg
- The Labatt Family Heart Center, Division of Cardiology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Eduard Gratacós
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Olga Gómez
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| |
Collapse
|