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Anuwutnavin S, Russameecharoen K, Ruangvutilert P, Viboonchard S, Yaiyiam C, Sklansky M, DeVore GR. Evaluation of cardiac findings using speckle-tracking echocardiography in fetuses with hemoglobin Bart's disease. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:755-767. [PMID: 38706423 PMCID: PMC11609887 DOI: 10.1002/uog.27676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Hemoglobin (Hb) Bart's disease is a severe manifestation of alpha-thalassemia, resulting in fetal tissue hypoxia and severe anemia. There is limited research available on assessing speckle-tracking analysis of the fetal heart as a response to fetal anemia caused by Hb Bart's disease. This study aimed to assess the diagnostic performance of fetal cardiac measurements derived from speckle-tracking analysis to identify fetuses with Bart's anemia between 17 and 24 weeks of gestation. METHODS This prospective cohort study included 115 women with singleton pregnancies at risk for fetal Hb Bart's disease who underwent either amniocentesis or cordocentesis at Siriraj Hospital, Bangkok, Thailand, in the period between January 2019 and January 2021. Speckle-tracking analysis of the fetal heart was performed in the four-chamber view (4CV), assessing ventricular size and shape, ventricular contractility and left ventricular function, prior to invasive prenatal testing. Logistic regression analysis was used to determine significant cardiac predictors and calculate the probability of a fetus having Hb Bart's anemia. RESULTS Among the cohort, 38 (33.0%) fetuses were diagnosed with Hb Bart's disease, and of these, nine (23.7%) cases exhibited fetal hydrops. In comparison to the control group, affected fetuses displayed enlargement of the 4CV, with a globular shape of the right ventricular chamber. Additionally, there were significant reductions in both global and longitudinal left ventricular contractility in non-hydropic affected fetuses compared with the controls. At mid-gestation, no significant differences were observed in transverse contractility or left ventricular function, except for the ejection fraction, between the two groups. Based on logistic regression analysis, combined cardiac measurements derived from speckle-tracking analysis, as a function of head circumference, could differentiate non-hydropic fetuses with Hb Bart's anemia from unaffected fetuses, achieving a sensitivity of 100%, specificity of 98.7% and overall accuracy of 99.1%. CONCLUSIONS Speckle-tracking analysis of the fetal heart has the potential to accurately identify early fetal cardiac changes during the second trimester in individuals with Bart's anemia. These findings not only offer a novel predictive marker for Hb Bart's anemia, but also help address the question of the underlying mechanisms of heart failure associated with fetal anemia. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S. Anuwutnavin
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj HospitalMahidol UniversityBangkokThailand
| | - K. Russameecharoen
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj HospitalMahidol UniversityBangkokThailand
| | - P. Ruangvutilert
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj HospitalMahidol UniversityBangkokThailand
| | - S. Viboonchard
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj HospitalMahidol UniversityBangkokThailand
| | - C. Yaiyiam
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj HospitalMahidol UniversityBangkokThailand
| | - M. Sklansky
- Division of Pediatric Cardiology, Department of PediatricsUCLA Mattel Children's Hospital, David Geffen School of Medicine, UCLALos AngelesCAUSA
| | - G. R. DeVore
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and GynecologyDavid Geffen School of Medicine, UCLALos AngelesCAUSA
- Fetal Diagnostic CentersPasadenaCAUSA
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Audira G, Lee JS, Vasquez RD, Roldan MJM, Lai YH, Hsiao CD. Assessments of carbon nanotubes toxicities in zebrafish larvae using multiple physiological and molecular endpoints. Chem Biol Interact 2024; 392:110925. [PMID: 38452846 DOI: 10.1016/j.cbi.2024.110925] [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: 07/31/2023] [Revised: 10/01/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
In recent years, carbon nanotubes (CNTs) have become one of the most promising materials for the technology industry. However, due to the extensive usage of these materials, they may be released into the environment, and cause toxicities to the organism. Here, their acute toxicities in zebrafish embryos and larvae were evaluated by using various assessments that may provide us with a novel perspective on their effects on aquatic animals. Before conducting the toxicity assessments, the CNTs were characterized as multiwall carbon nanotubes (MWCNTs) functionalized with hydroxyl and carboxyl groups, which improved their solubility and dispersibility. Based on the results, abnormalities in zebrafish behaviors were observed in the exposed groups, indicated by a reduction in tail coiling frequency and alterations in the locomotion as the response toward photo and vibration stimuli that might be due to the disruption in the neuromodulatory system and the formation of reactive oxygen species (ROS) by MWCNTs. Next, based on the respiratory rate assay, exposed larvae consumed more oxygen, which may be due to the injuries in the larval gill by the MWCNTs. Finally, even though no irregularity was observed in the exposed larval cardiac rhythm, abnormalities were shown in their cardiac physiology and blood flow with significant downregulation in several cardiac development-related gene expressions. To sum up, although the following studies are necessary to understand the exact mechanism of their toxicity, the current study demonstrated the environmental implications of MWCNTs in particularly low concentrations and short-term exposure, especially to aquatic organisms.
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Affiliation(s)
- Gilbert Audira
- Department of Bioscience Technology, Chung Yuan Christian University, Chung-Li, 320314, Taiwan; Department of Chemistry, Chung Yuan Christian University, Chung-Li, 320314, Taiwan
| | - Jiann-Shing Lee
- Department of Applied Physics, National Pingtung University, Pingtung, 900391, Taiwan
| | - Ross D Vasquez
- Department of Pharmacy, Faculty of Pharmacy, University of Santo Tomas, Manila, 1015, Philippines; Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila, 1015, Philippines; The Graduate School, University of Santo Tomas, Manila, 1015, Philippines
| | - Marri Jmelou M Roldan
- Faculty of Pharmacy, The Graduate School, University of Santo Tomas, Espana Blvd., Manila, 1015, Philippines
| | - Yu-Heng Lai
- Department of Chemistry, Chinese Culture University, Taipei, 11114, Taiwan
| | - Chung-Der Hsiao
- Department of Bioscience Technology, Chung Yuan Christian University, Chung-Li, 320314, Taiwan; Department of Chemistry, Chung Yuan Christian University, Chung-Li, 320314, Taiwan; Center of Nanotechnology, Chung Yuan Christian University, Chung-Li, 320314, Taiwan; Center for Aquatic Toxicology and Pharmacology, Chung Yuan Christian University, Chung-Li, 320314, Taiwan.
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Luewan S, Apaijai N, Chattipakorn N, Chattipakorn SC, Tongsong T. Fetal hemodynamic changes and mitochondrial dysfunction in myocardium and brain tissues in response to anemia: a lesson from hemoglobin Bart's disease. BMC Pregnancy Childbirth 2024; 24:141. [PMID: 38365664 PMCID: PMC10870590 DOI: 10.1186/s12884-023-06232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/27/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE Whether or not the effects of anemia in the early phase, while the fetuses attempts to increase cardiac output to meet oxygen requirement in peripheral organs, is detrimental to the fetal developing vital organs is little-known. The objective of this is to compare prenatal cardiovascular changes and post-abortal cellular damages in the myocardium as a pumping organ and the brain as a perfused organ between anemic fetuses (using fetal Hb Bart's disease as a study model) in pre-hydropic phase and non-anemic fetuses. METHODS Fetuses affected by Hb Bart's disease and non-anemic fetuses at 16-22 weeks were recruited to undergo comprehensive fetal echocardiography. Cord blood analysis was used to confirm the definite diagnosis of fetal Hb Bart's disease and normal fetuses. Fetal cardiac and brain tissues were collected shortly after pregnancy termination for the determination of oxidative stress and mitochondrial function, including mitochondrial ROS production and mitochondrial membrane changes. RESULTS A total of 18 fetuses affected by Hb Bart's disease and 13 non-anemic fetuses were recruited. The clinical characteristics of both groups were comparable. The affected fetuses showed a significant increase in cardiac dimensions, cardiac function, cardiac output and brain circulation without deteriorating cardiac contractility and preload. However, in the affected fetuses, mitochondrial dysfunction was clearly demonstrated in brain tissues and in the myocardium, as indicated by a significant increase in the membrane potential change (p-value < 0.001), and a significant increase in ROS production in brain tissues, with a trend to increase in myocardium. The findings indicated cellular damage in spite of good clinical compensation. CONCLUSION The new insight is that, in response to fetal anemia, fetal heart increases in size (dilatation) and function to increase cardiac output and blood flow velocity to provide adequate tissue perfusion, especially brain circulation. However, the myocardium and brain showed a significant increase in mitochondrial dysfunction, suggesting cellular damage secondary to anemic hypoxia. The compensatory increase in circulation could not completely prevent subtle brain and heart damage.
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Affiliation(s)
- Suchaya Luewan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nattayaporn Apaijai
- Cardiac Electrophysiology Research and Training Center (CERT), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center (CERT), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Cardiac Electrophysiology Research and Training Center (CERT), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Dionysopoulou A, Pirih E, Macchiella D, Fruth A, Jahn-Eimermacher A, Kampmann C, Mildenberger E, Whybra C. The Cardiovascular Profile Score in Patients with Non-immune Hydrops Fetalis and Cardiac Anomalies - a Pilot Study. Reprod Sci 2023; 30:2805-2812. [PMID: 36988903 PMCID: PMC10480243 DOI: 10.1007/s43032-023-01216-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
The purpose of this paper is to explore whether the cardiovascular profile score (CVPS) correlates with fetal outcome in patients with non-immune hydrops fetalis (NIHF) and cardiac anomalies. In this retrospective study, we included fetuses with NIHF and the suspicion of a cardiac anomaly in prenatal ultrasound. The CVPS was calculated using information obtained by fetal echocardiographic examination. Feto-neonatal mortality (FNM) was defined as intrauterine fetal demise or death in the first 6 months of life. We reviewed 98 patients, who were referred to the Department of Obstetrics and Gynecology of the Johannes Gutenberg University in Mainz with the diagnosis of NIHF between January 2007 and March 2021. By eighteen of them, the suspicion of a cardiac anomaly was raised. After exclusion of six pregnancies (one termination of pregnancy and five because of incomplete data), 12 cases were left for analysis. Mean gestational age at which the CVPS was calculated was 29 + 2 weeks. Two fetuses died in utero. Of the remaining ten hydropic fetuses, three newborns died in the neonatal period, and seven survived after a 6-month surveillance period. Median CVPS of all fetuses was 6 points. Surviving fetuses showed statistically significantly higher CVPS values (median 8 points) than fetuses with FNM (median 5 points, p value = 0.009). Our results point towards a positive association between CVPS and fetal outcome in fetuses with NIHF and cardiac anomalies. The CVPS appears to be a useful marker in the assessment of heart failure in utero.
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Affiliation(s)
- Anna Dionysopoulou
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Etienne Pirih
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Doris Macchiella
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Anja Fruth
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Antje Jahn-Eimermacher
- Department of Mathematics and Natural Sciences, University of Applied Sciences, Darmstadt, Germany
| | - Christoff Kampmann
- Department of Pediatric Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eva Mildenberger
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Catharina Whybra
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Luewan S, Tongprasert F, Srisupundit K, Traisrisilp K, Jatavan P, Tongsong T. Fetal Hemodynamic Response to Anemia in Early Gestation: Using Hemoglobin Bart's Disease as a Study Model. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:e83-e90. [PMID: 34749405 DOI: 10.1055/a-1499-7045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess fetal hemodynamic changes in response to anemia in early gestation, using fetal Hb Bart's disease as a study model. METHODS A prospective study was conducted on pregnancies at risk for fetal Hb Bart's disease at 12-14 weeks of gestation. Fetal hemodynamics were comprehensively assessed by 2D ultrasound, Doppler velocity, and cardio-STIC just prior to the invasive procedure for diagnosis. The various hemodynamic parameters of the affected and unaffected fetuses were compared. RESULTS Of 56 fetuses at risk, 17 had Hb Bart's disease and 39 were unaffected. The right and combined ventricular cardiac outputs (CO) were significantly higher in the affected fetuses (0.993 vs. 1.358; p < 0.001 and 1.010 vs. 1.236; p < 0.001, respectively), whereas the left CO tended to be higher but not significantly (1.027 vs. 1.113; p = 0.058). Cardiac dimensions, middle-cerebral artery peak systolic velocity, Tei index, and isovolemic contraction time were significantly increased, while the global sphericity index was significantly decreased. Interestingly, cardiac preload, ventricular wall thickness, shortening fraction, isovolemic relaxation time, and fetal heart rate were unchanged. Four fetuses had hydropic changes, but all cardiac functions were normal. CONCLUSION Fetal anemia induces hypervolemia and increases cardiac output to meet the tissue oxygen requirement, resulting in an increase in size without hypertrophy, volume load without pressure load, and a decrease in the globular sphericity index. The heart works very well but works harder, especially systolic ventricular load. Hydrops fetalis due to anemia appears not to be caused by heart failure as previously believed but rather by volume load with high vascular permeability at least in early pregnancy.
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Affiliation(s)
- Suchaya Luewan
- Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | - Phudit Jatavan
- Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
| | - Theera Tongsong
- Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
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Jatavan P, Sekararithi R, Jaiwongkam T, Kumfu S, Chattipakorn N, Tongsong T. Comparisons of serum non-transferrin-bound iron levels and fetal cardiac function between fetuses affected with hemoglobin Bart's disease and normal fetuses. Front Med (Lausanne) 2023; 9:1015306. [PMID: 36660002 PMCID: PMC9842659 DOI: 10.3389/fmed.2022.1015306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/24/2022] [Indexed: 01/04/2023] Open
Abstract
Objective To compare the levels of Non-transferrin bound iron (NTBI) in fetuses with anemia, using Hb Bart's disease as a study model, and those in unaffected fetuses and to determine the association between fetal cardiac function and the levels of NTBI. Patients and methods A prospective study was conducted on pregnancies at risk of fetal Hb Bart's disease. All fetuses underwent standard ultrasound examination at 18-22 weeks of gestation for fetal biometry, anomaly screening and fetal cardiac function. After that, 2 ml of fetal blood was taken by cordocentesis to measure NTBI by Labile Plasma Iron (LPI), serum iron, hemoglobin and hematocrit. The NTBI levels of both groups were compared and the correlation between NTBI and fetal cardiac function was determined. Results A total of 50 fetuses, including 20 fetuses with Hb Bart's disease and 30 unaffected fetuses were recruited. There was a significant increase in the level of serum iron in the affected group (median: 22.7 vs. 9.7; p-value: 0.013) and also a significant increase in NTBI when compared with those of the unaffected fetuses (median 0.11 vs. 0.07; p-value: 0.046). In comparisons of fetal cardiac function, myocardial performance (Tei) index of both sides was significantly increased in the affected group (left Tei: p = 0.001, Right Tei: p = 0.008). Also, isovolumetric contraction time (ICT) was also significantly prolonged (left ICT: p = 0.00, right ICT: p = 0.000). Fetal LPI levels were significantly correlated inversely with fetal hemoglobin levels (p = 0.030) but not significantly correlated with the fetal serum iron levels (p = 0.138). Fetal LPI levels were also significantly correlated positively with myocardial performance index (Tei) of both sides (right Tei: R = 0.000, left Tei: R = 0.000) and right ICT (R = 0.013), but not significantly correlated with left ICT (R = 0.554). Conclusion Anemia caused by fetal Hb Bart's disease in pre-hydropic stage is significantly associated with fetal cardiac dysfunction and increased fetal serum NTBI levels which are significantly correlated with worsening cardiac dysfunction. Nevertheless, based on the limitations of the present study, further studies including long-term data are required to support a role of fetal anemia as well as increased fetal serum NTBI levels in development of subsequent heart failure or cardiac compromise among the survivors, possibly predisposing to cardiovascular disease in adult life.
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Affiliation(s)
- Phudit Jatavan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Rattanaporn Sekararithi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thidarat Jaiwongkam
- Cardiac Electrophysiology Research and Training Center (CERT), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sirinart Kumfu
- Cardiac Electrophysiology Research and Training Center (CERT), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center (CERT), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,*Correspondence: Theera Tongsong,
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Young AYW, Audira G, Saputra F, Alos HC, Aventurado CA, Lai YH, Vasquez RD, Hsiao CD, Hung CH. Toxicity Assessment of an Anti-Cancer Drug of p-Toluene Sulfonamide in Zebrafish Larvae Based on Cardiovascular and Locomotion Activities. Biomolecules 2022; 12:1103. [PMID: 36008997 PMCID: PMC9405983 DOI: 10.3390/biom12081103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
p-Toluene sulfonamide (p-TSA), a small molecular drug with antineoplastic activity is widely gaining interest from researchers because of its pharmacological activities. In this study, we explored the potential cardio and neural toxicity of p-TSA in sublethal concentrations by using zebrafish as an in vivo animal model. Based on the acute toxicity assay, the 96hr LC50 was estimated as 204.3 ppm, suggesting the overall toxicity of p-TSA is relatively low in zebrafish larvae. For the cardiotoxicity test, we found that p-TSA caused only a minor alteration in treated larvae after no overall significant alterations were observed in cardiac rhythm and cardiac physiology parameters, as supported by the results from expression level measurements of several cardiac development marker genes. On the other hand, we found that acute p-TSA exposure significantly increased the larval locomotion activity during the photomotor test while prolonged exposure (4 days) reduced the locomotor startle reflex activities in zebrafish. In addition, a higher respiratory rate and blood flow velocity was also observed in the acutely treated fish groups compared to the untreated group. Finally, by molecular docking, we found that p-TSA has a moderate binding affinity to skeletal muscle myosin II subfragment 1 (S1), ATPase activity, actin- and Ca2+-stimulated myosin S1 ATPase, and v-type proton ATPase. These binding interactions between p-TSA and proteins offer insights into the potential molecular mechanism of action of p-TSA on observed altered responses toward photo and vibration stimuli and minor altered vascular performance in the zebrafish larvae.
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Affiliation(s)
- Andrew Yau Wah Young
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung 84001, Taiwan
| | - Gilbert Audira
- Department of Bioscience Technology, Chung Yuan Christian University, Chung-Li 320314, Taiwan
| | - Ferry Saputra
- Department of Bioscience Technology, Chung Yuan Christian University, Chung-Li 320314, Taiwan
- Department of Chemistry, Chung Yuan Christian University, Chung-Li 320314, Taiwan
| | - Honeymae C. Alos
- The Graduate School, University of Santo Tomas, Manila 1008, Philippines
| | | | - Yu-Heng Lai
- Department of Chemistry, Chinese Culture University, Taipei 11114, Taiwan
| | - Ross D. Vasquez
- Department of Pharmacy, Research Center for Natural and Applied Sciences, University of Santo Tomas, Manila 1008, Philippines
| | - Chung-Der Hsiao
- Department of Bioscience Technology, Chung Yuan Christian University, Chung-Li 320314, Taiwan
- Department of Chemistry, Chung Yuan Christian University, Chung-Li 320314, Taiwan
- Research Center for Aquatic Toxicology and Pharmacology, Chung Yuan Christian University, Chung-Li 320314, Taiwan
| | - Chih-Hsin Hung
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung 84001, Taiwan
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Thammavong K, Luewan S, Wanapirak C, Tongsong T. Ultrasound Features of Fetal Anemia Lessons From Hemoglobin Bart Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:659-674. [PMID: 32815580 DOI: 10.1002/jum.15436] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 05/14/2023]
Abstract
Insights gained from this review are as follows: (1) Ultrasound is highly effective in early detection of fetal hemoglobin (Hb) Bart disease. (2) The most sensitive parameters in predicting Hb Bart anemia appear to be the cardiac diameter-to-thoracic diameter ratio, middle cerebral artery peak systolic velocity, and placental thickness. (3) Several other ultrasound markers are helpful in increasing specificity, such as hepatosplenomegaly. (4) Hydrops fetalis is not a consequence of heart failure but rather of hypervolemia and high vascular permeability of fetuses, whereas heart failure is a very late consequence of a long-standing overworked heart. (5) Management guidelines for fetuses at risk of Hb Bart disease are proposed.
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Affiliation(s)
- Keooudone Thammavong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chang Mai, Thailand
| | - Suchaya Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chang Mai, Thailand
| | - Chanane Wanapirak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chang Mai, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chang Mai, Thailand
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Fetal cardiac function by mitral and tricuspid annular plane systolic excursion using spatio-temporal image correlation M-mode and left cardiac output in fetuses of pregestational diabetic mothers. Obstet Gynecol Sci 2021; 64:257-265. [PMID: 33499582 PMCID: PMC8138066 DOI: 10.5468/ogs.20274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/09/2020] [Indexed: 01/18/2023] Open
Abstract
Objective To assess the mitral and tricuspid annular plane systolic excursions (MAPSE and TAPSE, respectively) and cardiac output (CO) in fetuses of pregnant women with pregestational diabetes mellitus (DM) using spatio-temporal image correlation M-mode (STIC-M) and virtual organ computer-aided analysis (VOCAL). Methods This study was prospective and cross-sectional. It included 45 fetuses each from mothers with pregestational DM and healthy mothers, with gestation ages ranging from 20 to 36.6 weeks. The fetal cardiac volumes were obtained and analyzed by STIC and VOCAL methods. MAPSE and TAPSE were measured by STIC-M in the apical or basal four-chamber view. The values of the right (RV) and left ventricular (LV) CO were calculated by STIC and VOCAL. Results The median values of TAPSE were 6.1 and 6.2 mm in the diabetic and control groups (P<0.001), respectively. The median values of MAPSE were 4.6 mm in the fetuses of mothers with diabetes and 4.8 mm in fetuses of healthy mothers. The fetal LV CO (60.4 L/min vs. 71.1 L/min; P=0.033, respectively) and RV CO (65.2 vs. 70.1 L/min; P=0.026, respectively) were lower in the pregestational DM group than in the control group. A significant effect of pregestational DM was observed in all functional parameters after adjusting, with fetal heart rate as covariant. There was moderate significant positive correlation between MAPSE and LV CO (r=0.53; P=0.0001) and between TAPSE and RV CO (r=0.46; P=0.0001). Conclusion Significant difference in functional parameters (TAPSE, MAPSE and LV CO) obtained by STIC and VOCAL were observed in the fetuses of the pregestational DM group compared to those of the control group.
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Thammavong K, Luewan S, Jatavan P, Tongsong T. Foetal haemodynamic response to anaemia. ESC Heart Fail 2020; 7:3473-3482. [PMID: 32909688 PMCID: PMC7754976 DOI: 10.1002/ehf2.12969] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/08/2020] [Accepted: 08/06/2020] [Indexed: 12/02/2022] Open
Abstract
This study aims to update new knowledge regarding foetal cardiovascular response to anaemia, using foetal haemoglobin Bart's disease as a study model. Original research articles, review articles, and guidelines were narratively reviewed and comprehensively validated. The main foetal cardiovascular changes in response to anaemia are consequences of hypervolaemia and increased cardiac output to meet tissue oxygen requirement. New challenging insights are as follows: (i) the earliest morphological change is an increase in cardiac size and remodelling of the sphericity (an increase in diameter more pronounced than that in long axis) followed by several markers, such as placentomegaly and hepatosplenomegaly. (ii) The earliest functional change is increased peak systolic velocity of the red blood cells because of low viscosity, especially in the middle cerebral artery. (iii) The foetal heart has very high reserve potentials to cope with anaemia: increasing workload without increased central venous pressure and increased myocardial performance without compromising shortening fraction. This hard‐working period with good performance lasts long, including most part of the second and third trimester. (iv) At the time cardiomegaly myocardial cellular damage has already occurred, in spite of good cardiac function. (v) Anaemic hydrops foetalis is mainly due to hypervolaemia, hypoalbuminaemia, and high vascular permeability, not heart failure. (vi) Foetal heart failure occurs only when the adaptive mechanism becomes exhausted or long after the development of anaemic hydrops foetalis. Heart failure is a very late result of a longstanding overworked heart. (vii) Ultrasound is highly effective in the detection of foetal response to anaemia. An increase in cardiac size and middle cerebral artery is very helpful in predicting the affected foetuses in pre‐hydropic phase. (viii) Theoretically, intrauterine treatment of anaemic hydrops results in satisfactory outcomes as long as cardiac function is normal, but intrauterine intervention should be strongly considered in pre‐hydropic phase because myocardial cell damage could have already occurred in this phase or early hydropic phase. Anaemic hydrops foetalis is not primarily caused by heart failure as commonly advocated, but it is rather a consequence of hypervolaemia, hypoalbuminaemia, and high vascular permeability while heart failure is a very late consequence of a longstanding overworked heart. New insights gained from this review may be useful to base clinical practice on which sonographic markers imply significant pathological changes, how ultrasound can be helpful in early detection of anaemic response, when intrauterine transfusion for anaemia due to non‐lethal causes should be administered, etc.
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Affiliation(s)
- Keooudone Thammavong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Suchaya Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Phudit Jatavan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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Peixoto AB, Bravo-Valenzuela NJM, Martins WP, Mattar R, Moron AF, Pares DBDS, Tonni G, Araujo Júnior E. Reference ranges of filling time and systolic-to-diastolic time index of the left ventricle, right ventricle, and interventricular septum using both spectral and tissue Doppler of fetal heart between 20 and 36 + 6 weeks of gestation. Eur J Obstet Gynecol Reprod Biol 2020; 252:366-372. [PMID: 32682211 DOI: 10.1016/j.ejogrb.2020.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study is to determine the reference ranges for filling time (FT) and systolic-to-diastolic time index (SDI) of the left ventricle (LV) by using spectral Doppler, and FT' and SDI' of the LV, right ventricle, and interventricular septum (IVS) by using tissue Doppler of the fetal heart. STUDY DESIGN This prospective and cross-sectional study included 360 low-risk singleton pregnancies between 20 and 36 + 6 weeks of gestation. The SDI/SDI' is the sum of the ejection time, isovolumic contraction time, and isovolumic relaxation time (IRT) divided by the FT. We measured FT/FT' from the beginning of the opening click of the E wave of the mitral valve to the closing click of the A wave of the mitral valve. We used regression analysis to obtain the best-fit model polynomial equation for the parameters. Additionally, we assessed intra- and inter-observer reproducibility by using concordance correlation coefficient (CCC). RESULTS There was a weak correlation among FT LV (r = 0.31, p < 0.0001), SDI LV (r = -0.23, p < 0.0001), and gestational age (GA). Additionally, there was a very weak positive correlation among FT' RV (r = 0.09, p = 0.0001), FT' LV (r = 0.07, p < 0.0001), FT' IVS (r = 0,08, p < 0.0001), and GA. In contrast, there was a very weak negative correlation among SDI' LV (r=-0.09, p < 0.0001), SDI' IVS (r=-0.05, p < 0.0021), and GA. There was no significative correlation between SDI' RV (r=-0.06, p < 0.081) and GA. Poor/very poor intra- and inter-observer reliability was observed for all the parameters (CCC = 0.19-0.79), whereas moderate intra- and inter-observer agreement was observed for all parameters (CCC = 0.37-0.72). CONCLUSIONS The reference ranges for FT and SDI were determined by using spectral and tissue Doppler of the fetal heart and showed a poor reproducibility.
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Affiliation(s)
- Alberto Borges Peixoto
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil; Mario Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba-MG, Brazil; Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
| | - Nathalie Jeanne Magioli Bravo-Valenzuela
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil; Discipline of Pediatrics (Pediatric Cardiology), Department of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
| | | | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - David Baptista da Silva Pares
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Gabriele Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
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Bravo-Valenzuela NJ, Peixoto AB, Carrilho MC, Siqueira Pontes AL, Chagas CC, Simioni C, Araujo Júnior E. Fetal cardiac function by three-dimensional ultrasound using 4D-STIC and VOCAL - an update. J Ultrason 2019; 19:287-294. [PMID: 32021711 PMCID: PMC6988455 DOI: 10.15557/jou.2019.0043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/16/2019] [Indexed: 01/13/2023] Open
Abstract
Three- and four-dimensional (3D/4D) ultrasonography with spatio-temporal image correlation (4D-STIC) allows obtaining fetal cardiac volumes and their static and real-time analysis in multiplanar and rendering modes. Cardiac biometrics and Doppler-echocardiographic parameters for evaluation of fetal heart function, including cardiac output and stroke volume, can be analyzed using M-mode, two-dimensional (2D), and 3D/4D cardiac ultrasound. In recent years, functional echocardiography has been used to study fetuses without a structurally cardiac defect but who are at risk of heart failure due to the presence of extra-cardiac conditions, such as, fetal growth restriction, tumors/masses, twin-to-twin transfusion syndrome, fetal anemia (Rh alloimmunization), congenital infections, or maternal diabetes mellitus. The assessment of cardiac function provides important information on hemodynamic status and can help optimize the best time for delivery and reduce perinatal morbidity and mortality. Since 2003, with the advent of the 4D-STIC software, it is possible to evaluate the fetal heart in multiplanar, and rendering modes. This technology associated with virtual organ computer-aided analysis (VOCAL) enables determining the ventricular volume (end-diastole, end-systole), the stroke-volume, the ejection fraction, and the cardiac output of each ventricle. Since 2004, several studies demonstrated that the 4D-STIC and VOCAL had good reproducibility to measure cardiac volumes This study reviews published studies that evaluated the fetal cardiac function by 3D ultrasound using 4D-STIC and VOCAL software.
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Affiliation(s)
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
| | - Milene Carvalho Carrilho
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Ana Letícia Siqueira Pontes
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Caroline Cevante Chagas
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Christiane Simioni
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
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Rocha LA, Rolo LC, Araujo Júnior E. How to perform a functional assessment of the fetal heart: a pictorial review. Ultrasonography 2019; 38:365-373. [PMID: 31288508 PMCID: PMC6773963 DOI: 10.14366/usg.18065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/07/2019] [Indexed: 11/24/2022] Open
Abstract
The purpose of this pictorial review was to describe various echocardiographic techniques that can be used for the functional assessment of the fetal heart. The systolic and diastolic assessments of the fetal heart are presented separately, with an emphasis on 2-dimensional Doppler methods and an overview of new technologies. The aim of this summary was to review the tools that can be used by the echocardiographer, and on that basis, to systematize the process of performing a functional assessment.
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Affiliation(s)
- Luciane Alves Rocha
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPMUNIFESP), São Paulo, Brazil
| | - Liliam Cristine Rolo
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPMUNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPMUNIFESP), São Paulo, Brazil
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Jatavan P, Chattipakorn N, Tongsong T. Fetal hemoglobin Bart’s hydrops fetalis: pathophysiology, prenatal diagnosis and possibility of intrauterine treatment. J Matern Fetal Neonatal Med 2017; 31:946-957. [DOI: 10.1080/14767058.2017.1301423] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Phudit Jatavan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Theera Tongsong
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
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Tedesco GD, de Souza Bezerra M, Barros FSB, Martins WP, Nardozza LMM, Carrilho MC, Moron AF, Carvalho FHC, Rolo LC, Araujo Júnior E. Reference Ranges of Fetal Cardiac Biometric Parameters Using Three-Dimensional Ultrasound with Spatiotemporal Image Correlation M Mode and Their Applicability in Congenital Heart Diseases. Pediatr Cardiol 2017; 38:271-279. [PMID: 27878625 DOI: 10.1007/s00246-016-1509-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 11/08/2016] [Indexed: 02/07/2023]
Abstract
To determine reference values for fetal heart biometric parameters using the spatiotemporal image correlation (STIC) M mode and their applicability in congenital heart diseases (CHDs). A cross-sectional prospective study was conducted with 300 singleton pregnancies between 20 and 33 + 6 weeks of gestation. Right ventricular wall thickness (RVWT), interventricular septum thickness (IVST), and left ventricular wall thickness (LVWT) were measured off-line using the STIC-M mode with the cursor perpendicular to the interventricular septum. Polynomial regressions adjusted with the coefficient of determination (R 2) were performed. The curves were applied to 14 fetuses with structural CHD. For the reproducibility calculations, the concordance correlation coefficient (CCC) was used. The mean RVWT, IVST, and LVWT were 0.34 ± 0.09 cm, 0.28 ± 0.09 cm, and 0.30 ± 0.07 cm, respectively. There was correlation between RVWT, IVST, and LVWT and gestational age (GA): RVWT = -0.002 + 0.013 × GA (R 2 = 0.33), IVST = -0.011 + 0.011 × GA (R 2 = 0.25), and LVWT = 0.056 + 0.009 × GA (R 2 = 0.26). RVWT, IVST, and LVWT were altered (<5th or >95th percentile) in 5/14, 5/14, and 7/14 of the fetuses with CHD, respectively. For RVWT, IVST, and LVWT, intra-observer (CCC = 0.86, 0.85, and 0.87, respectively) and inter-observer (CCC = 0.86, 0.86, and 0.86, respectively) reproducibility were good/moderate. The reference ranges determined for fetal heart biometric parameters using STIC-M had good intra- and inter-observer reproducibility and were applicable to fetuses with CHD.
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Affiliation(s)
- Giselle Darahem Tedesco
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Marilim de Souza Bezerra
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Fernanda Silveira Bello Barros
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Luciano Marcondes Machado Nardozza
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Milene Carvalho Carrilho
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | | | - Liliam Cristine Rolo
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil.
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Yeo L, Romero R. How to Acquire Cardiac Volumes for Sonographic Examination of the Fetal Heart: Part 1. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1021-42. [PMID: 27091914 PMCID: PMC8475630 DOI: 10.7863/ultra.16.01081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/29/2016] [Indexed: 05/13/2023]
Abstract
Four-dimensional sonography with spatiotemporal image correlation (STIC) technology allows acquisition of a fetal cardiac volume data set and displays a cine loop of a complete single cardiac cycle in motion. Part 1 of this 2-part article reviews STIC technology and its features, the importance of operator training/experience, and acquisition of high-quality STIC volumes, as well as factors that affect STIC volume acquisition rates. We also propose a detailed and practical stepwise approach to performing 4-dimensional sonography with STIC and begin herein by providing general recommendations. Part 2 will discuss specifics of the approach, along with how to determine whether such volumes are appropriate for analysis.
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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
- Detroit Medical Center, Hutzel Women’s Hospital, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- 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
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Department of Molecular Obstetrics and Genetics, Wayne State University, Detroit, MI, USA
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Abstract
Foetal echocardiography has progressed to be able to diagnose many forms of CHD and to assess the prognosis of cardiac lesions based on their anatomy and presentation in utero. This article outlines a straightforward method for the rapid evaluation of foetus that may have congestive heart failure with or without hydrops and for the differentiation of the pre-hydropic state from normal. The presence of signs of foetal heart failure, such as cardiomegaly or valvular regurgitation, gives clues to the aetiology of hydrops. The assessment of the prognosis of hydrops foetalis can be difficult but can be aided by the use of the cardiovascular profile score. Once identified, the neurohumoral effects of foetal heart failure can be ameliorated using transplacental digoxin if the hydrops has not progressed.
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Luewan S, Tongprasert F, Srisupundit K, Tongsong T. Fetal cardiac Doppler indices in fetuses with hemoglobin Bart's disease at 12-14weeks of gestation. Int J Cardiol 2015; 184:614-616. [PMID: 25770840 DOI: 10.1016/j.ijcard.2015.02.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/21/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Suchaya Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Thailand
| | - Fuanglada Tongprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Thailand
| | - Kasemsri Srisupundit
- Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Thailand.
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Araujo Júnior E, Darahem Tedesco G, Carvalho Carrilho M, Borges Peixoto A, Costa Carvalho FH. 4D Fetal Echocardiography in Clinical Practice. ACTA ACUST UNITED AC 2015. [DOI: 10.5005/jp-journals-10009-1425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Spatiotemporal image correlation (STIC) is a technique that acquires the fetal cardiac volumes, and then analyzes it offline in both multiplanar and rendered modes, using both static and moving images from a four-dimensional (4D) cine sequence simulating a full cardiac cycle. Spatiotemporal image correlation makes it possible to evaluate cardiac structures and their vascular connections, is less operator dependent, and allows cardiac volumes to be sent to specialists in tertiary centers for examination. Spatiotemporal image correlation can be combined with other software techniques, such as virtual organ computer-aided analysis (VOCAL) and automatic volume calculation (SonoAVC), to calculate cardiac function parameters. It can also be used in association with Omniview® in order to obtain standard echocardiographic planes using simple targets arterial rendering (STAR) and four-chamber view and swing technique (FAST). Recently, fetal intelligent navigation echocardiography (FINE), acquired from 3D STIC volumes, has made it possible to automatically obtain nine standard echocardiographic planes. In this article, we review the chief applications of 4D echocardiography using STIC technique in clinical practice.
How to cite this article
Araujo Júnior E, Tedesco GD, Carrilho MC, Peixoto AB, Carvalho FHC. 4D Fetal Echocardiography in Clinical Practice. Donald School J Ultrasound Obstet Gynecol 2015;9(4): 382-396.
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Araujo Júnior E, Rolo LC, Rocha LA, Nardozza LMM, Moron AF. The value of 3D and 4D assessments of the fetal heart. Int J Womens Health 2014; 6:501-7. [PMID: 24868174 PMCID: PMC4032184 DOI: 10.2147/ijwh.s47074] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The objective of this review was to demonstrate the main tools of three- and four-dimensional ultrasonography, using the spatiotemporal image correlation software and its respective applications for assessing the fetal heart and its vascular connections, along with its potential contribution towards screening for congenital heart diseases. Today, conventional, two-dimensional, echocardiography continues to be the gold standard for diagnosing congenital heart diseases. However, recent studies have demonstrated that spatiotemporal image correlation offers some advantages that boost two-dimensional accuracy in detecting congenital heart diseases, given that the fetal heart assessment can be completed in the absence of the patient (offline) and be discussed by different examiners. Additionally, data volumes can be sent for analysis in reference centers via internet links. Spatiotemporal image correlation also enables direct measurement of heart structures in rendering mode, such as the interventricular septum and the annulus of the atrioventricular valves. Furthermore, it enables assessment of cardiac function when used in association with the virtual organ computer-aided analysis software, thus making it possible to calculate the total systolic function, ejection fraction, and cardiac output.
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Affiliation(s)
- Edward Araujo Júnior
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Liliam Cristine Rolo
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Luciane Alves Rocha
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Echocardiographic assessment of embryonic and fetal mouse heart development: a focus on haemodynamics and morphology. ScientificWorldJournal 2014; 2014:531324. [PMID: 24707208 PMCID: PMC3951091 DOI: 10.1155/2014/531324] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/31/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Heart development is a complex process, and abnormal development may result in congenital heart disease (CHD). Currently, studies on animal models mainly focus on cardiac morphology and the availability of hemodynamic data, especially of the right heart half, is limited. Here we aimed to assess the morphological and hemodynamic parameters of normal developing mouse embryos/fetuses by using a high-frequency ultrasound system. Methods. A timed breeding program was initiated with a WT mouse line (Swiss/129Sv background). All recordings were performed transabdominally, in isoflurane sedated pregnant mice, in hearts of sequential developmental stages: 12.5, 14.5, and 17.5 days after conception (n = 105). Results. Along development the heart rate increased significantly from 125 ± 9.5 to 219 ± 8.3 beats per minute. Reliable flow measurements could be performed across the developing mitral and tricuspid valves and outflow tract. M-mode measurements could be obtained of all cardiac compartments. An overall increase of cardiac systolic and diastolic function with embryonic/fetal development was observed. Conclusion. High-frequency echocardiography is a promising and useful imaging modality for structural and hemodynamic analysis of embryonic/fetal mouse hearts.
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Tongprasert F, Srisupundit K, Luewan S, Tongsong T. Comparison of maternal serum PlGF and sFlt-1 between pregnancies with and without fetal hemoglobin Bart's disease. Prenat Diagn 2013; 33:1272-5. [PMID: 24122800 DOI: 10.1002/pd.4246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 08/27/2013] [Accepted: 09/22/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to compare the levels of maternal serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) between pregnancies with fetal hemoglobin (Hb) Bart's disease and unaffected pregnancies. METHODS Ninety-one pregnancies at risk for fetal Hb Bart's disease scheduled for cordocentesis at 18-22 weeks were recruited into the study. Maternal serum PlGF and sFlt-1 concentrations were measured before cordocentesis. Fetal blood samples were collected for thalassemia diagnosis based on fetal Hb typing using high-performance liquid chromatography. PlGF, sFlt-1, and sFlt-1/PlGF ratio were compared between the fetal Hb Bart's group and the non-Hb Bart's group (normal Hb typing or α-thalassemia-1 carrier). RESULTS Maternal serum concentration of PlGF was significantly higher in women with fetal Hb Bart's disease (18 cases) than those with unaffected fetuses (71 cases) (P = 0.008), whereas the concentration of sFlt-1 was not significantly different (P = 0.139). However, the sFlt-1/PlGF ratio was significantly lower in women with fetal Hb Bart's disease than those with unaffected fetuses (P = 0.001). CONCLUSION Placental growth factor may help differentiate affected from unaffected fetuses among pregnancies at risk, though further studies are needed to confirm its usefulness. In addition, preeclampsia prediction using these markers may be unreliable in pregnancies with placental dysfunction secondary to severe fetal anemia.
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Affiliation(s)
- Fuanglada Tongprasert
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Godfrey M, Messing B, Valsky D, Cohen S, Yagel S. Fetal Cardiac Function: M-Mode and 4D Spatiotemporal Image Correlation. Fetal Diagn Ther 2012; 32:17-21. [DOI: 10.1159/000335357] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 11/26/2011] [Indexed: 11/19/2022]
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