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Carrasco D, Guedes-Martins L. Cardiac Axis in Early Gestation and Congenital Heart Disease. Curr Cardiol Rev 2024; 20:CCR-EPUB-137797. [PMID: 38279755 PMCID: PMC11071675 DOI: 10.2174/011573403x264660231210162041] [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: 07/07/2023] [Revised: 09/06/2023] [Accepted: 10/17/2023] [Indexed: 01/28/2024] Open
Abstract
Congenital heart defects represent the most common structural anomalies observed in the fetal population, and they are often associated with significant morbidity and mortality. The fetal cardiac axis, which indicates the orientation of the heart in relation to the chest wall, is formed by the angle between the anteroposterior axis of the chest and the interventricular septum of the heart. Studies conducted during the first trimester have demonstrated promising outcomes with respect to the applicability of cardiac axis measurement in fetuses with congenital heart defects as well as fetuses with extracardiac and chromosomal anomalies, which may result in improved health outcomes and reduced healthcare costs. The main aim of this review article was to highlight the cardiac axis as a reliable and powerful marker for the detection of congenital heart defects during early gestation, including defects that would otherwise remain undetectable through the conventional four-chamber view.
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Affiliation(s)
- D. Carrasco
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto, Serviço de Obstetrícia - Centro Materno Infantil do Norte, Porto 4099-001, Portugal
| | - L. Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto, Serviço de Obstetrícia - Centro Materno Infantil do Norte, Porto 4099-001, Portugal
- Centro Hospitalar Universitário do Porto EPE, Centro Materno Infantil do Norte, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
- Unidade de Investigação e Formação-Centro Materno Infantil do Norte, 4099-001 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, 4200-319, Portugal
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Fazea M, Alhameli M, Ahmed F, Askarpour MR, Murshed W, Jarwsh A, Alkbous A. Pentalogy of Cantrell Associated with Ectopia Cordis: A Case Report. Pediatric Health Med Ther 2022; 13:283-287. [PMID: 35996555 PMCID: PMC9391988 DOI: 10.2147/phmt.s374289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
Pentalogy of Cantrell is a congenital anomaly of the median mesodermal constructions with a poor prognosis. It is characterized by defects of the anterior diaphragm, the lower sternum, the abdominal wall, pericardium, and various congenital heart malformations. We present a case of ectopia cordis and Pentalogy of Cantrell in a newborn of a healthy 35-year-old woman with no history of embryotoxic exposure or smoking. The infant was first diagnosed with the anomaly in the second trimester of pregnancy and was delivered at 35 weeks of gestational age via a caesarian section. Shortly after birth, he was transferred to the neonatal intensive care unit (NICU) due to progressive respiratory failure, which ultimately, along with septicemia, led to infant death on the second day. In conclusion, the Pentalogy of Cantrell should be appropriately assessed for effective prenatal counseling and postnatal management with a multidisciplinary team; since infant survival assessment and early diagnosis give the parents the option of terminating the pregnancy.
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Affiliation(s)
- Muneer Fazea
- Department of Radiology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen.,Department of Radiology, Al-Ma'amon Diagnostic Center, Sana'a, Yemen
| | - Mansour Alhameli
- Department of Radiology, Al-Ma'amon Diagnostic Center, Sana'a, Yemen.,Department of Radiology, Faculty of Medicine, Sana'a University of Medical Sciences, Sana'a, Yemen
| | - Faisal Ahmed
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
| | - Mohammad Reza Askarpour
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Wafa Murshed
- Department of Radiology, Al-Ma'amon Diagnostic Center, Sana'a, Yemen
| | - Azizh Jarwsh
- Department of Radiology, Al-Ma'amon Diagnostic Center, Sana'a, Yemen
| | - Amal Alkbous
- Department of Radiology, Al-Ma'amon Diagnostic Center, Sana'a, Yemen
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3
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NAN J, MENG S, TIAN YL, ZHANG T, WANG R, WEI SB, JIN ZN. Guiding extension catheter facilitated percutaneous coronary intervention for a dextrocardia patient with acute left anterior descending artery occlusion: a case report. J Geriatr Cardiol 2020; 17:790-792. [PMID: 33424948 PMCID: PMC7762699 DOI: 10.11909/j.issn.1671-5411.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jing NAN
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai MENG
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ya-Li TIAN
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tong ZHANG
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui WANG
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shao-Bin WEI
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ze-Ning JIN
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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4
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Sterrett ME, Chang EY, Kumar N, Willan KB, Zyblewski SC. D-transposition of the great arteries with right-sided pulmonary hypoplasia. Ann Pediatr Cardiol 2020; 13:361-363. [PMID: 33311930 PMCID: PMC7727913 DOI: 10.4103/apc.apc_183_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022] Open
Abstract
Unilateral pulmonary agenesis or aplasia (UPA) in combination with congenital heart defects is rare and has not been reported in connection with transposition of the great arteries. This case demonstrated dextroposition of the fetal heart, and subsequent scans could not clearly visualize the right pulmonary artery. UPA should be considered in the workup and counseling for a family in the setting of fetal heart malposition, as there is a significant clinical impact.
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Affiliation(s)
- Mary E Sterrett
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Eugene Y Chang
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Neha Kumar
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Keith B Willan
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Sinai C Zyblewski
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
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5
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García Delgado R, García Rodríguez R, Segura González J, de Luis Alvarado M, Medina Castellano M, García Hernández JÁ. Características ecocardiográficas de la mesocardia fetal: un corazón diferente. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Smith BJ, Flyer JN, Edwards EM, Soll RF, Horbar JD, Yeager SB. Outcomes for Ectopia Cordis. J Pediatr 2020; 216:67-72. [PMID: 31668886 DOI: 10.1016/j.jpeds.2019.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/15/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To utilize a large multicenter neonatal cohort to describe survival and clinical outcomes of very low birth weight (VLBW) or preterm infants with ectopia cordis. STUDY DESIGN Data were prospectively collected on 2 211 262 infants (born 2000-2017) from 845 US centers. Both VLBW (401-1500 g or 22-29 weeks of gestation) and non-VLBW (>1500 g and >29 weeks) infants had diagnoses or anatomic descriptors consistent with ectopia cordis and/or pentalogy of Cantrell. The primary outcome was neonatal survival, defined as hospital discharge or initial length of stay of ≥12 months. RESULTS In total, 180 infants had ectopia cordis, 135 (76%) with findings of pentalogy of Cantrell. VLBW infants comprised 52% of the population. VLBW mortality was 96% with 79% dying within 12 hours, compared with 59% and 36%, respectively, for non-VLBW. One-third of VLBW infants received life support compared with 65% of non-VLBW. Surgery was reported for 34% of VLBW and 68% of non-VLBW infants. Congenital heart disease was reported in 8% of VLBW and 36% of non-VLBW, with conotruncal abnormalities most common. Survival exceeded 50% for infants >2500 g and >37 weeks of gestation. CONCLUSIONS Survival of VLBW infants with ectopia cordis was poor and substantially worse compared with non-VLBW, with notable discrepancies in resuscitative efforts and surgical interventions. Although gestational age and weight strongly influence current survival, more detailed information regarding the severity of cardiac and noncardiac abnormalities is required to fully determine prognosis and inform counseling.
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Affiliation(s)
| | - Jonathan N Flyer
- Department of Pediatrics, University of Vermont, Burlington, VT; Division of Pediatric Cardiology, University of Vermont, Burlington, VT
| | - Erika M Edwards
- Department of Pediatrics, University of Vermont, Burlington, VT; Department of Mathematics and Statistics, University of Vermont, Burlington, VT; Vermont Oxford Network, Burlington, VT
| | - Roger F Soll
- Department of Pediatrics, University of Vermont, Burlington, VT; Vermont Oxford Network, Burlington, VT; Division of Neonatology, University of Vermont, Burlington, VT
| | - Jeffrey D Horbar
- Department of Pediatrics, University of Vermont, Burlington, VT; Vermont Oxford Network, Burlington, VT; Division of Neonatology, University of Vermont, Burlington, VT
| | - Scott B Yeager
- Department of Pediatrics, University of Vermont, Burlington, VT; Division of Pediatric Cardiology, University of Vermont, Burlington, VT.
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7
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García Delgado R, García Rodríguez R, Segura González J, de Luis Alvarado M, Medina Castellano M, García Hernández JÁ. Echocardiographic features of fetal mesocardiac: a different heart. ACTA ACUST UNITED AC 2019; 73:260-262. [PMID: 31744756 DOI: 10.1016/j.rec.2019.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/12/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Raquel García Delgado
- Servicio de Obstetricia y Ginecología, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain.
| | - Raquel García Rodríguez
- Servicio de Obstetricia y Ginecología, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Javier Segura González
- Servicio de Obstetricia y Ginecología, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - María de Luis Alvarado
- Servicio de Obstetricia y Ginecología, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Margarita Medina Castellano
- Servicio de Obstetricia y Ginecología, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - José Ángel García Hernández
- Servicio de Obstetricia y Ginecología, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
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8
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Chen PC, Swanson JC, Masand P, Rodriguez JR, Mery CM. Diaphragmatic Hernia Associated With Absent Ductus Venosus and Anomalous Connection of an Obliterated Umbilical Vein to the Coronary Sinus. World J Pediatr Congenit Heart Surg 2017; 11:NP80-NP82. [PMID: 28933239 DOI: 10.1177/2150135117710927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Umbilical vein anomalies are a rare congenital defect, which have been associated with absent ductus venosus, with few cases also involving a congenital diaphragmatic hernia. We describe a case of postnatal development of an anterior diaphragmatic hernia of Morgagni in a four-year-old patient diagnosed prenatally with mesocardia, absent ductus venosus with a large umbilical vein, a large secundum atrial septal defect, and patent ductus arteriosus.
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Affiliation(s)
- Peter C Chen
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Julia C Swanson
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Prakash Masand
- Divison of Cardiovascular Imaging, Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jose R Rodriguez
- Department of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Carlos M Mery
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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9
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Yeo L, Luewan S, Markush D, Gill N, Romero R. Prenatal Diagnosis of Dextrocardia with Complex Congenital Heart Disease Using Fetal Intelligent Navigation Echocardiography (FINE) and a Literature Review. Fetal Diagn Ther 2017. [PMID: 28641300 DOI: 10.1159/000468929] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fetal dextrocardia is a type of cardiac malposition where the major axis from base to apex points to the right side. This condition is usually associated with a wide spectrum of complex cardiac defects. As a result, dextrocardia is conceptually difficult to understand and diagnose on prenatal ultrasound. The advantage of four-dimensional sonography with spatiotemporal image correlation (STIC) is that this modality can facilitate fetal cardiac examination. A novel method known as fetal intelligent navigation echocardiography (FINE) allows automatic generation of nine standard fetal echocardiography views in normal hearts by applying intelligent navigation technology to STIC volume datasets. In fetuses with congenital heart disease, FINE is also able to demonstrate abnormal cardiac anatomy and relationships when there is normal cardiac axis and position. However, this technology has never been applied to cases of cardiac malposition. We report herein for the first time, a case of fetal dextrocardia and situs solitus with complex congenital heart disease in which the FINE method was invaluable in diagnosing multiple abnormalities and defining complex anatomic relationships. We also review the literature on prenatal sonographic diagnosis of dextrocardia (with an emphasis on situs solitus), as well as tricuspid atresia with its associated cardiac features.
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Affiliation(s)
- Lami Yeo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, and Detroit, MI, USA
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10
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Escobar-Diaz MC, Sunderji S, Tworetzky W, Moon-Grady AJ. The Fetus with Ectopia Cordis: Experience and Expectations from Two Centers. Pediatr Cardiol 2017; 38:531-538. [PMID: 27995289 DOI: 10.1007/s00246-016-1545-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 12/01/2016] [Indexed: 11/29/2022]
Abstract
Ectopia cordis (EC) is a rare congenital anomaly often associated with congenital heart disease (CHD). There is a lack of contemporary information on EC diagnosed prenatally. We sought to combine the experiences of two regional referral centers in order to evaluate current outcomes for EC. Clinical, echocardiographic features and perinatal outcomes of fetuses with EC managed at two large cardiac centers from 1995 to 2014 were retrospectively reviewed. Seventeen fetuses with EC were diagnosed at a median gestational age of 23 weeks (range 17-36). There were 6 thoracic EC and 11 thoracoabdominal. Fifteen had associated CHD: 10 conotruncal defects, 2 tricuspid atresia, 1 aortic stenosis, 1 atrial septal defect, and 1 atrioventricular septal defect. There were 2 terminations of pregnancy, 2 fetal deaths, 2 lost to follow-up, and 11 live born. Mean gestational age at birth was 36.4 weeks (range 26-39). Three patients died shortly after birth with comfort care, and 8 were actively managed. Six patients underwent postnatal cardiac intervention and are currently alive with a mean follow-up of 7.3 years (range 1.4-11.4), 2 of them with chronic dependency on ventilatory support. Two patients without CHD died after attempted chest closure. When diagnosed in utero, a high proportion of pregnancy termination or fetal demise is expected. In our cohort, conotruncal anomalies were the most common associated CHD. Though mortality in actively managed patients was not as high as previously reported, and cardiac surgical intervention may be achieved, EC is still associated with high mortality and significant long-term morbidity.
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Affiliation(s)
- Maria C Escobar-Diaz
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA. .,Department of Pediatric Cardiology, Universidad Pontificia Bolivariana, Medellín, Colombia.
| | - Sherzana Sunderji
- Department of Pediatrics, Division of Cardiology, University of California, San Francisco Benoiff Children's Hospital, San Francisco, CA, USA
| | - Wayne Tworetzky
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Anita J Moon-Grady
- Fetal Treatment Center, University of California, San Francisco Benoiff Children's Hospital, San Francisco, CA, USA
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11
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Dong SZ, Zhu M. MR imaging of fetal cardiac malposition and congenital cardiovascular anomalies on the four-chamber view. SPRINGERPLUS 2016; 5:1214. [PMID: 27516952 PMCID: PMC4967070 DOI: 10.1186/s40064-016-2833-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/14/2016] [Indexed: 11/10/2022]
Abstract
Fetal echocardiography is the method of choice to visualize the fetal congenital cardiovascular anomalies. However, there are some disadvantages. Fetal cardiac magnetic resonance imaging (MRI) has the potential to complement ultrasound in detecting congenital cardiovascular anomalies. This pictorial review draws on our experience about fetal cardiac MRI; it describes the four-chamber view on fetal cardiac MRI and important clues on an abnormal four-chamber view to the diagnosis of fetal congenital cardiovascular anomalies.
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Affiliation(s)
- Su-Zhen Dong
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Rd., Shanghai, 200127 China
| | - Ming Zhu
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Rd., Shanghai, 200127 China
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12
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Gaur L, Talemal L, Bulas D, Donofrio MT. Utility of fetal magnetic resonance imaging in assessing the fetus with cardiac malposition. Prenat Diagn 2016; 36:752-9. [PMID: 27292912 DOI: 10.1002/pd.4856] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/24/2016] [Accepted: 06/04/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Abnormal cardiac axis and/or malposition prompts evaluation of congenital heart disease; however, etiology may be difficult to clarify using obstetrical ultrasound or fetal echocardiography (echo) alone. We aimed to use fetal magnetic resonance imaging (MRI) as a complementary tool to identify causes of cardiac malposition. METHODS Review of fetuses diagnosed with cardiac malposition by fetal ultrasound and echo was performed. Etiology was classified as either because of heterotaxy syndrome or extracardiac masses. Reclassification was then performed with fetal MRI findings. Results were compared with postnatal diagnoses. RESULTS Forty-two fetuses were identified as having abnormal cardiac axis and/or malposition. Twenty three of 42 cases (55%) had extracardiac anomalies, while 19 (45%) were because of heterotaxy. Twelve of 42 (29%) cases were reassigned by fetal MRI (five in heterotaxy group and seven in the lung anomaly group). Four cases (33%) had both cardiac disease and extracardiac masses, not previously recognized. Fetal MRI clarified heterotaxy subtype or removed heterotaxy diagnosis in five (26%) patients. Fetal MRI findings were confirmed in 8 of these 12 cases postnatally. CONCLUSION Fetal MRI is a useful complementary tool to define etiology of cardiac malposition in complex cases for informative prenatal counseling and planning. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lasya Gaur
- Division of Cardiology/Taussig Heart Center, Bloomberg Children's Center, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - Lauren Talemal
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Dorothy Bulas
- Division of Radiology, Children's National Medical Center, Washington, DC, USA
| | - Mary T Donofrio
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
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13
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Loomba R, Shah PH, Anderson RH. Fetal Magnetic Resonance Imaging of Malformations Associated with Heterotaxy. Cureus 2015; 7:e269. [PMID: 26180693 PMCID: PMC4494530 DOI: 10.7759/cureus.269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2015] [Indexed: 02/07/2023] Open
Abstract
Magnetic resonance imaging (MRI) is increasingly used as an investigation during fetal life, particularly for assessment of intracranial masses, congenital diaphragmatic hernia, myelomeningocele, and abdominal masses. As the number of scans increases, so is the variety of congenital malformations being recognized. It is axiomatic that interpretation of the findings is enhanced when attention is paid to the likely findings in the setting of known syndromes, this information then dictating the need for additional acquisition of images. One such syndrome is so-called "visceral heterotaxy", in which there is typically an isomeric, rather than a lateralized, arrangement of the thoracic and abdominal organs. Typically associated with complex congenital cardiac malformations, heterotaxy can also involve the central nervous system, and produce pulmonary, gastrointestinal, immunologic, and genitourinary malformations. In this review, we discuss how these findings can be demonstrated using fetal MRI.
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Affiliation(s)
- Rohit Loomba
- Cardiology Dept., Children's Hospital of Wisconsin
| | - Parinda H Shah
- Department of Radiology, Advocate Illinois Masonic Medical Center
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14
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Oztunc F, Madazli R, Yuksel MA, Gökalp S, Oncul M. Diagnosis and outcome of pregnancies with prenatally diagnosed fetal dextrocardia. J Matern Fetal Neonatal Med 2014; 28:1104-7. [PMID: 25007986 DOI: 10.3109/14767058.2014.943659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the incidence, associated cardiac and extracardiac malformations and clinical outcome of fetuses with dextrocardia. METHOD A retrospective review of 3556 fetal echocardiograms between 2000 and 2011 revealed 39 cases of dextrocardia. Dextrocardia was defined as right-sided positioning of the fetal heart. Prenatal and postnatal records of the fetuses were reviewed. RESULTS The incidence was 1.1%. Of the 39 fetuses, 22 were primary dextrocardia and 17 were dextroposition. Diaphragmatic hernia was the most common cause of dextroposition with the incidence of 76%. Of the fetuses with dextroposition 35.5% had a cardiac anomaly. The survival rate of dextroposition was 31.2% and none of the survivors had an associated cardiac anomaly. Primary fetal dextrocardia was most common with situs solitus (45.4%), followed by situs ambiguous (36.3%) and then situs inversus totalis (18.1%). Structural cardiac malformations were found in 100%, 80% and 25% of fetuses with situs ambiguous, solitus and inversus, respectively. Of the dextroposition, 47.6% terminated pregnancy, 14.2% resulted in intrauterine death, 9.5% died after birth, and 28.5% survived. CONCLUSION A wide spectrum of complex cardiac malformations are associated with fetal dextrocardia. Fetal echocardiography enables detection of complex cardiac anomalies so that parents can be appropriately counselled.
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15
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Morisaki A, Hattori K, Motoki M, Takahashi Y, Nishimura S, Shibata T. Mitral valve repair in a patient with mesocardia. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:734-7. [PMID: 24088917 DOI: 10.5761/atcs.cr.13-00097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 75-year-old man was referred for treatment of mitral valve prolapse secondary to tendon rupture. He had been receiving oral and inhaled corticosteroids for bronchial asthma and bronchial ectasia. Chest X-ray showed cardiomegaly with protrusion of the right atrium shadow. Computed tomography revealed dislocation and counterclockwise rotation of the heart with the apex of the heart located in the mid-thorax, indicating mesocardia. We believed that it would have been difficult to expose the mitral valve through a right-sided left atrial approach. Thus, we planned to perform mitral valve repair via a trans-septal approach. The right thoracotomy approach was not suitable because of respiratory dysfunction. After a median sternotomy, the left anterior descending coronary artery was identified just beneath the midline of the sternum. Even after decompression of the heart under cardiopulmonary bypass, we could not obtain a good view of the right side of the left atrium. By a transseptal approach with a self-retaining retractor and atrial hooks, we obtained adequate exposure of the mitral valve and performed the mitral valve repair uneventfully.
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Affiliation(s)
- Akimasa Morisaki
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Osaka, Japan
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16
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Ludwig K, Salmaso R, Cosmi E, Iaria L, De Luca A, Margiotti K, Valentina C, Manara R, Rugge M. Pentalogy of cantrell with complete ectopia cordis in a fetus with asplenia. Pediatr Dev Pathol 2012; 15:495-8. [PMID: 22900993 DOI: 10.2350/12-03-1169-cr.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cantrell's pentalogy (CP) is a rare, mainly sporadic spectrum of congenital midline thoracoabdominal defects that includes sternal anomalies, ventral diaphragmatic hernia, partial absence of the pericardium, supraumbilical abdominal wall defects, and congenital heart malformations. The approximate incidence is 1 in 100 000, with a 2∶1 male predominance. A 25-year-old pregnant woman was referred to the Prenatal Diagnosis Unit of the University Hospital of Padua for multiple congenital malformations at 21 weeks of gestation. A level 2 ultrasound scan was performed and confirmed the presence of multiple anomalies compatible with the diagnosis of CP associated with complete ectopia cordis. Fetal autopsy furthermore revealed asplenia, which usually presents as part of the heterotaxia spectrum. To our knowledge, an association of CP and complete ectopia cordis with asplenia has never been reported so far.
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Affiliation(s)
- Kathrin Ludwig
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padova, Padova, Italy
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17
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Hannoun A, Usta IM, Sawaya F, Nassar AH. First trimester sonographic diagnosis of ectopia cordis: a case report and review of the literature. J Matern Fetal Neonatal Med 2011; 24:867-9. [DOI: 10.3109/14767058.2010.531306] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Sekar P, Hornberger LK. The role of fetal echocardiography in fetal intervention: a symbiotic relationship. Clin Perinatol 2009; 36:301-27, ix. [PMID: 19559322 DOI: 10.1016/j.clp.2009.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this review, the authors explore the role of noninvasive and invasive fetal interventions in fetal cardiovascular disease guided by observations at fetal echocardiography. They first review fetal cardiac lesions that may be ameliorated by fetal intervention and then review noncardiac fetal pathologic findings for which fetal echocardiography can provide important insight into the pathophysiology and aid in patient selection for and timing of intervention and postintervention surveillance.
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Affiliation(s)
- Priya Sekar
- Department of Pediatrics, Division of Cardiology, Fetal and Neonatal Cardiology Program, WCMC 4C2 Stollery Children's Hospital, Alberta, Canada
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19
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Ghi T, Kuleva M, Perolo A, Pilu G, Prandstraller D, Tani G, Lima M, Contro E, Youssef A, Pelusi G. Apparently isolated fetal mesocardia at midtrimester: report of a series. Prenat Diagn 2009; 29:889-91. [PMID: 19455586 DOI: 10.1002/pd.2298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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