Pre-Natal Diagnosis of Complex Congenital Cardiac Disease: Is There any Neuro-Developmental Benefit at 2 Years of Age?

Abstract

s S95 assess cardiac anatomy. Due to the diminutive size of the cardiac structures at this early gestation, 2 Dimensional (2D) imaging alone is often insufficient to identify cardiac anatomy and great vessel relationships. We sought to evaluate the additive benefit of Color Doppler (CD) in addition to routine 2D imaging in early FE before 14 weeks GA. METHODS: From February 2009 we prospectively recruited pregnant women for first trimester FE for a variety of indications including increased nuchal translucency as well as healthy controls. All had 2D cardiac imaging combined with CD assessment. Trans abdominal scanning was used in all cases with trans vaginal scanning used additionally in most cases prior to the 11th week GA (n1⁄492/107, 86%). RESULTS: 254 pregnancies undergoing first trimester FE were included for review. Mean GA at FE was 10+6 weeks (range 6+1 to 13+6 weeks). Significant improvement in image resolution of the fetal heart was gained with every advancing week of gestation. CD significantly improved identification of cardiac arterial outflows and systemic venous inflows from the beginning of the 8th week GA through to the end of the 12th week GA (table 1). Pulmonary venous drainage was not identified in any patient until the 11th week GA. CONCLUSION: When performing early FE, prior to 14 weeks GA, identification of cardiac arterial outflows and systemic venous inflows is greatly improved by the use of color Doppler. When very early FE is performed the use of color Doppler should be routine. WCHRI 021 OPTICAL COHERENCE TOMOGRAPHY TO ASSESS FOR CORONARY ALLOGRAFT VASCULOPATHY IN PEDIATRIC TRANSPLANT RECIPIENTS A Manouzi, MC Hosking, A Fung, A De Souza, JE Potts, KC Harris Vancouver, British Columbia BACKGROUND: Optical Coherence Tomography (OCT) is a highresolution intravascular imaging technique (resolution w 10 microns) that has been used in adults to assess for coronary allograft vasculopathy. The purpose of this study is to describe technical modifications that permit its use in children and compare the coronaryfindings in pediatric transplant recipients to those seen in adults. METHODS: Pediatric cardiac transplant patients were assessed during their routine annual catheterization between December 2012 and April 2013.Modifications weremade to the traditional OCT protocol used in adults in order to adapt this technique to the pediatric population. OCT recordings (Ilumien System, LightLabs,Massachussets)were performed selectively in the right or left coronary artery. Serial measurements of the cross sectional area (CSA) of the lumen, intima and media were made along the length of the vessel. Entire imaging data was analyzed for the presence of mural thrombus, plaque and calcification. We defined the intima-to-media (I/M) area ratio as normal ( 1) or abnormal (>1) as has been done in adult transplant recipients. RESULTS: Seven patients with a history of cardiac transplant were evaluated. The mean age of children was 10.5 years (range 5.5-17) and coronary evaluation was performed a mean of 5.1 years (range 7 months to 15.7 years) following cardiac transplantation. OCT imaging demonstrated intimal thickening in 6/7 (86%) of patients, while conventional angiography was normal in all patients. The median I/M CSA ratio for all patients was 1.25 (0.94-1.79). The intima to lumen CSA ratio was 0.2 in all 7 patients. Intimal thickening was more pronounced in the proximal aspect of the coronaries (figure 1). In contrast to the findings in adults, no other vessel wall abnormalities were identified in this series of children. CONCLUSION: In pediatric cardiac transplant recipients, there are early coronary artery changes seen in the vessel wall with OCT, despite normal selective coronary angiograms. Intimal thickening is present in a significant proportion of children and is most apparent in the proximal coronaries. This is the first description of high-resolution, invivo imaging, of coronary changes in children following cardiac transplantation. 022 CORONARY ARTERY ABNORMALITIES IDENTIFIED WITH OPTICAL COHERENCE TOMOGRAPHY IN CHILDREN WITH KAWASAKI DISEASE A Manouzi, MC Hosking, A Fung, A De Souza, JE Potts, KC Harris Vancouver, British Columbia BACKGROUND: Optical Coherence Tomography (OCT) is an intravascular imaging technique allowing high-resolution