Atrial Width Research Articles

EARLY FETAL HYDROPIC CHANGES ARE ASSOCIATED WITH MODERATE DILATATION OF THE BRAIN VENTRICULAR SYSTEM: A CLUE TO A POSSIBLE LINK BETWEEN CERVICAL LYMPHATIC ENGORGEMENT AND VENTRICULAR DILATATION?

The aim of this study is to assess whether early cervical lymphatic obstruction is associated with a sonographically detectable dilatation of the ventricular system in the 1st trimester of pregnancy. In particular, the objective is to assess whether fetuses with non-immune hydrops fetalis (NIHF), cystic hygroma, or enlarged nuchal translucency (NT) have a greater atrial width/biparietal diameter (AW/BPD) ratio than normal at time of the combined first trimester screening scan. This retrospective study included 96 first trimester fetuses (33 normal and 63 with various degree of cervical lymphatic engorgement). Inclusion criteria were CRL in the 45-84 mm range and availability of one or more three-dimensional volume datasets of the fetal head, acquired from the BPD plane. Each three-dimensional volume dataset was opened and multiplanar correlation employed to align the three orthogonal planes. The ratio between the atrial width and the BPD (AW/BPD ratio) was used to evaluate the possible presence of increased amount of cerebrospinal fluid. Abnormal cases were placed into 4 categories: 1) enlarged non-septated NT 2.5-3.9 mm, no hydrops; 2) grossly enlarged non-septated NT / edema >3.9 mm; 3) cystic hygroma and/ or NIHF; 4) major anomalies with NT <2.5 mm. Presence of dilatation of the laterocervical jugular lymphatic sacs, karyotype and presence of congenital anomalies were also recorded. The One-way ANOVA test was used to compare means. Intra- and inter-observer variability were also assessed. The AW/BPD ratio was found to be significantly higher in fetuses with grossly enlarged NT/nuchal edema and NIHF/septated cystic hygroma than in normal (p <0.05 and p <0.01, respectively). Also, the AW/BPD ratio was significantly higher in NIHF/septated cystic hygroma than in enlarged NT 2.5-3.9 mm (p <0.05). In case of enlarged NT (2.5-3.9 mm), the AW/BPD ratio is significantly higher in presence of JLS (p <0.01). At the end of the first trimester, presence of cervical lymphatic engorgement, in terms of grossly enlarged NT, nuchal edema, septated cystic hygroma, and NIHF, is statistically associated with a moderate dilatation of the ventricular system. Of note, among fetuses with moderately enlarged NT, those with evidence of dilatation of the JLS show a statistically significant increase in the AW/BPD ratio.

Long-term outcomes of prenatally diagnosed ventriculomegaly - 10 years of Polish tertiary centre experience.

To estimate the prevalence, associated anomalies, and postnatal outcomes in infants prenatally diagnosed with ventriculomegaly. All cases of ventriculomegaly that were examined and treated by the 1st Department of Obstet- rics and Gynecology, at the Medical University of Warsaw, from August 2007 until November 2017 were included in this study. Ultrasound data, and information on perinatal outcomes and long-term postnatal follow up were retrospectively collected by a standardised telephone survey. Ventriculomegaly was diagnosed when the atrial width of the lateral ventri- cles was ≥ 10 mm. The cases analyzed were divided into two subgroups: isolated ventriculomegaly (IVM) and non-isolated ventriculomegaly (NIVM). Neurodevelopmental complications were differentiated as either moderate or severe and were compared within each group and between groups. There were 118 cases of prenatally diagnosed ventriculomegaly. Complete follow up records were collected for 54 cases (45.8%). IVM was diagnosed in 29/54 (53.7%) cases, while NIVM was diagnosed in the remaining 25 (46.3%). The mean ventricular width for IVM was 16.93 mm (range 10.0 mm-73.0 mm) and 14.08 mm (range 9.0 mm-27.1 mm) for NIVM (p = 0.28). The mean gestational age at delivery for the IVM cases was 36 + 4 weeks and in the NIVM group 33 + 4 weeks (p = 0.022). Mild VM (10-12 mm) was diagnosed in 22/54 cases (40.7%), moderate VM (13-15 mm) in 12/54 (22.3%) and severe (≥ 15 mm) in 20/54 (37%). Among the infants with IVM the rate of severe medical complications was 29.6% (8/28) and for NIVM 667% (8/12) (p = 0.041). Less severe medical conditions affected 6/28 of the infants with IVM (21.4%) vs 9/12 NIVM cases (75%) (p = 0.012). In terms of prenatal diagnosis, treatment of ventriculomegaly remains challenging due to a lack of specific prognostic factors and the significant risk of neurodevelopmental disorders. Nevertheless, isolated ventriculomegaly has significantly better long-term outcomes compared with non-isolated ventriculomegaly. In our material, the rate of severe neurodevelopmental disorders in the non-isolated ventriculomegaly cases was associated with a 52% rate of adverse perinatal outcomes. On the other hand, less severe medical conditions occurred in 21.4% of the infants with IVM and in 75% of the NIVM cases. Furthermore, obstetrical data suggest that the risks of premature delivery and caesarean section are significantly higher in cases of non-isolated ventriculomegaly.

The value of left atrial structural and functional parameters combined with cardiac biomarkers in predicting left atrial spontaneous echo contrast in patients with non-valvular atrial fibrillation

Objective To investigate the relationships between the structure, function of left atrial as well as cardiac biomarkers and left atrial spontaneous echo contrast (SEC) in patients with non-valvular atrial fibrillation (NVAF), and evaluate its predictive value for left atrial SEC. Methods Thirty-four control subjects and 80 patients with NVAF were included, patients with NVAF were divided into positive group (30 cases) and negative group (50 cases) according to whether SEC was presented on transesophageal echocardiography (TEE). Clinical and laboratory data were collected, including medical history, cardiac troponin I (cTnI), and pro-brain natriuretic peptide (pro-BNP), etc. Then CHA2DS2-VASc scores were calculated.The left atrial appendage width (WLAA), left atrial appendage depth (DLAA), left atrial appendage blood flow velocity (VLAA), left atrial volume index (LAVI) and other parameters were measured by TEE and transthoracic echocardiography (TTE), and left atrial ejection fraction (LAEF) was calculated. The clinical and TEE parameters were compared between the positive and negative group, TTE parameters and cardiac biomarkers levels were compared among the three groups, and ROC curve was used to evaluate the diagnostic efficiency. Results ①Compared with those in control group, the value of LAVI and pro-BNP were significantly increased and LAEF was significantly decreased in negative group (all P 0.05), but presented a significant increase in positive group compared with those in control group and negative group (all P<0.01). The AUC, sensitivity and specificity of CHA2DS2-VASc scores for SEC were 0.71 (95% CI: 0.60~0.82), 73.3% and 62.0%, respectively. When left atrial structural and functional parameters (LAVI and LAEF) combined with cardiac biomarkers (cTnI and pro-BNP), the AUC, sensitivity and specificity for SEC were 0.90 (95%CI: 0.84~0.97), 74.0% and 100%, respectively, both enhanced when compared with CHA2DS2-VASc scores alone(P<0.01). Conclusions Left atrial enlargement, decreased function and elevated levels of cardiac biomarkers are associated with left atrial SEC in patients with NVAF.CHA2DS2-VASc scores can be used for perdicting left atrial SEC, left atrial structural and functional parameters (LAVI and LAEF) combined with cardiac biomarkers (cTnI and pro-BNP) provide significant increments in prediction of left atrial SEC. Key words: Echocardiography, transesophageal; Atrial fibrillation; Atrial function, left; Spontaneous echo contrast; Cardiac biomarker

The third ventricle of the human fetal brain: Normative data and pathologic correlation. A 3D transvaginal neurosonography study.

The objective of the study are to describe (a) the technical aspects and (b) the anatomical boundaries of the fetal third ventricle (3V) on the midsagittal sonographic view and to assess (c) different biometric parameters in normal and abnormal fetuses and (d) and their reproducibility. This study included 67 normal and 50 CNS anomalies fetuses which include (1) obstructive severe ventriculomegaly (SVM; atrial width≥15mm), (2) moderate ventriculomegaly (10-14.9mm), and (3) corpus callosum agenesis (ACC). All underwent transvaginal 3D neurosonography of the midsagittal view of the 3V. The following parameters were measured: area, perimeter, craniocaudal and anteroposterior (AP) diameters, interthalamic adhesion diameter (ITAD), wedge angle, and the ratio between the last 2 variables (ITAD/WA). Repeatability was also assessed. The ITAD and the ITAD/WA are significantly different between normal fetuses and the SVM (P≤.001). Interthalamic adhesion diameter of ≤7.1mm is able to identify SVM with 98.6% accuracy (CI: 0.92-0.99). In ACC cases, the AP diameter is significantly shorter than both normal fetuses and ventriculomegaly. Intraobserver/interobserver reliability was good for most variables. Transvaginal neurosonography enables visualization of the normal and abnormal fetal third ventricle. An ITAD <7.1 identifies aqueductal stenosis as the likely etiology of severe ventriculomegaly with an accuracy of 98.6%.

Altered cortical development in fetuses with isolated nonsevere ventriculomegaly assessed by neurosonography.

To perform a comprehensive assessment of cortical development in fetuses with isolated nonsevere ventriculomegaly (INSVM) by neurosonography. We prospectively included 40 fetuses with INSVM and 40 controls. INSVM was defined as atrial width between 10.0 and 14.9mm without associated malformation, infection, or chromosomal abnormality. Cortical development was assessed by neurosonography at 26 and 30weeks of gestation measuring depth of selected sulci and applying a maturation scale from 0 (no appearance) to 5 (maximally developed) of main sulci and areas. INSVM showed underdeveloped calcarine and parieto-occipital sulci. In addition, significant delayed maturation pattern was also observed in regions distant to ventricular system including Insula depth (controls 30.8mm [SD 1.7] vs INSVM 31.7mm [1.8]; P=.04), Sylvian fissure grading (>2 at 26weeks: controls 87.5% vs INSVM 50%, P=.01), mesial area grading (>2 at 30weeks: controls 95% vs INSVM 62.5%; P=.03), and cingulate sulcus grading (>2 at 30weeks: controls 100% vs INSVM 80.5%; P=.01). Fetuses with INSVM showed underdeveloped cortical maturation including also regions, where effect of ventricular dilatation is unlikely. These results suggest that in a proportion of fetuses with INSVM, ventricular dilation might be related with altered cortical architecture.

Pregnancy outcomes and neurodevelopment in 173 cases of mild or moderate fetal ventriculomegaly

Objective To investigate pregnancy outcomes and neurodevelopment in fetuses with ventriculomegaly. Methods This was a cohort study of 173 gravidas with singleton pregnancy who were diagnosed with fetal ventriculomegaly by ultrasound in Prenatal Diagnostic Center of Nanfang Hospital Affiliated to Southern Medical University from March 2010 to July 2016. Thirty normal gravidas who received antenatal care in the same hospital and at the same period were selected as control. Clinical data were collected. Gravidas who had chosen to continue their pregnancy were followed up to monitor the variations of fetal ventricular. Fetal mild and moderate ventriculomegaly were respectively defined as a ventricular atrial width of 10-12 mm and >12 mm but <15 mm. Isolated ventriculomegaly (IVM) indicated those without any other ultrasound abnormalities, otherwise the case would be defined as non-isolated ventriculomegaly (NIVM). Among the 173 gravidas, 54 cases were mild IVM, 53 mild NIVM, 26 moderate IVM and 40 moderate NIVM. Fetuses with chromosome abnormalities were excluded from the study. Neonatal behavioral neurological assessment (NBNA) was used to analyze the neonatal neurodevelopment at the age of 7 days, and Bayley scales of infant development was used to evaluate the development of nervous system at the age of 6 months through analyzing their mental development index (MDI) and psychomotor development index (PDI). Statistical methods included t test, χ2 test (or Fisher's exact test), nonparametric test, Mann-Whitney test and multiple Kruskal-Wallis H test. Results (1) Among the 107 fetuses with mild ventriculomegaly, 72.9% (78), 23.4% (25) and 3.7% (4) of them regressed, stabilized and progressed,respectively; however, among the 66 moderate cases, the figures were 45.4% (30), 37.9% (25) and 16.7% (11) respectively (χ2=15.769, P 0.05). Conclusions Prognosis of fetal ventriculomegaly is affected by co-existed abnormalities and intrauterine progression. Fetus with mild ventriculomegaly can also have risk of abnormal neural development, suggesting that we should pay much attention to such cases and a regular follow-up is required. Key words: Ventriculomegaly; Pregnancy outcome; Central nervous system; Ultrasonography, prenatal; Follow-up studies

EP02.02: Ventricular wall morphology in cases with mild/moderate ventriculomegaly at 18–21 weeks

It is a hard task to predict subsequent course in cases of mild-moderate ventriculomegaly(VM) with atrial width (AW) of 10-15 mm between 18 and 21weeks. It might resolve spontaneously in several weeks with favourable prognosis, and it might be associated with cerebral maldevelopment such as migration disorder. For proper management and counselling, it is required to differentiate those with or without favourable prognosis. Close observation by transvaginal 3D approach of ventricular wall morphology may be useful. Five cases of mild/moderate VM at 18-21 weeks gestation in our institute between 2010 and 2016 were retrospectively investigated. We studied ventricular morphology findings by transvaginal high-frequency 3D ultrasonography and subsequent outcome/prognosis or autopsy findings. Amniotic cell microarray was normal in all cases. In 2 cases with good prognosis, the ventricular wall was extremely smooth, and MVM was normalised promptly in the time course. One out of three cases with ventricular wall irregularity selected abortion and autopsy revealed multifocal nodular heterotopia which is considered to lead a very poor prognosis. Two cases continued pregnancy, but in one case, a migration disorder which is obvious in subsequent diagnostic imaging has been found out. We investigate exosome analysis in migration abnormal cases. It is extremely difficult to predict postnatal prognosis in cases of mild/moderate VM. It is suggested that it might be possible to predict unfavourable prognosis accompanying with migration disorder by close observation of ventricular wall morphology.

Perinatal and long-term outcomes in fetuses diagnosed with isolated unilateral ventriculomegaly: systematic review and meta-analysis.

The majority of studies on fetal ventriculomegaly have focused on the perinatal and long-term outcomes in fetuses with an antenatal diagnosis of bilateral ventriculomegaly. The aim of this study was to undertake a systematic review and meta-analysis to quantify the perinatal and long-term outcomes in fetuses diagnosed in the second or third trimester of pregnancy with isolated unilateral ventriculomegaly. MEDLINE, EMBASE and The Cochrane Library were searched electronically. Outcomes investigated included incidence of aneuploidy, congenital infection, progression of ventriculomegaly, associated brain and extracerebral abnormalities in the apparently isolated cases and neurodevelopmental delay in both apparently and truly isolated cases. Sensitivity analysis was performed according to whether the ventriculomegaly was mild/moderate (atrial width < 15 mm) or severe (atrial width ≥ 15 mm). Reference lists within relevant articles and reviews were hand-searched for additional reports. Cohort and case-control studies were included. Meta-analysis of proportions was used, and between-study heterogeneity was assessed using the I2 test. The search yielded 2053 citations. The full text was retrieved for 202, and 11 studies were included in the systematic review. In fetuses with apparently isolated unilateral ventriculomegaly, no chromosomal abnormalities were identified and the pooled prevalence of congenital infection was 8.2% (95% CI, 3.6-14.5%). The pooled prevalence of additional brain abnormalities detected prenatally and postnatally by magnetic resonance imaging was 5.1% (95% CI, 0.2-16.1%) and 6.4% (95% CI, 0.3-19.4%), respectively. The pooled prevalence of abnormal neurodevelopment was 5.9% (95% CI, 2.2-11.2%) in apparently isolated cases with an atrial width of < 15 mm, and it was 7.0% (95% CI, 3.2-12.2%) in fetuses with truly isolated unilateral ventriculomegaly. Most cases with apparently isolated ventriculomegaly were classified as mild/moderate (93.5%) and therefore the outcomes in this group were similar to those in the whole cohort of apparently isolated ventriculomegaly. The prevalence of aneuploidy, congenital infection and neurodevelopmental delay in fetuses with a prenatal diagnosis of isolated unilateral ventriculomegaly is likely to be low. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Feasibility, Within-Day and Between-Day Variability of Transthoracic Echocardiography in Sloths (Bradypus Variegatus and Choloepus Hoffmanni)

Bradypus variegatus (Xenarthra, Bradypodidae) and Choloepus hoffmanni (Xenarthra, Megalonychidae) are sloths from the tropical rain forest of the Caribbean and Pacific regions of Costa Rica. Because of their unique physiology and behavior, sloths have intrigued scientists, and several studies have already been conducted regarding blood pressure and heart rate variations. However, the use of transthoracic echocardiography (TTE) in these species has never been reported. The aim of the present study was therefore to determine the feasibility, and then the within-day (repeatability) and between-day (reproducibility) variability of TTE in sloths. A total of 36 TTE examinations (including a total of 1080 measurements) with continuous ECG monitoring were performed on 4 different days by a trained observer on 6 healthy, adult, sedated Choloepus hoffmanni (sexually intact females, age, mean ± SD [minmax] 5.1 ± 1.3 years [4.0-7.5]) from the Costa Rica Animal Rescue Centre. Standard transthoracic M-mode and two-dimensional mode measurements included left ventricular (LV) end-diastolic and endsystolic diameters and thicknesses, the LV fractional shortening, the E point-to-septal separation, the left atrium-to-aorta ratio, and the right atrial width-to-the left atrial width ratio. Pulsed-wave Doppler parameters included peak systolic aortic and pulmonary flow velocities as well as early and late diastolic mitral flow velocities. A general linear model was used to determine the within-day and between-day coefficients of variation (CV). The main results were the following: all measurements could be performed at each TTE examination. Most within- and between-day CV values (90%) were <15%, the lowest being observed for the right atrial width-to-left atrial width ratio (2.2%). These results suggest that TTE is feasible and reliable in sloths, and therefore can be part of the cardiovascular exploration in these species. Further studies are now required to determine the corresponding reference intervals.

Reference Ranges of Fetal Cerebral Lateral Ventricle Parameters by Ultrasonography.

Objectives This study was done to evaluate the normal fetal cerebral lateral ventricle dimensions with transabdominal ultrasonography. The atrial width (AW), ventricle-to-choroid measurement (V-C), ventricle-to-hemisphere ratio (VHR), and combined anterior horn measurement (CAHM) were taken. Methods This was a cross-sectional study involving 400 normal singleton pregnant subjects whose gestational ages were between 14 and 40 weeks. Transabdominal sonography was performed to obtain the values of the fetal cerebral lateral ventricle (FCLV) parameters. Data were reported as mean ± standard deviation (SD) for continuous variables. The degrees of correlation between FCLV parameters and the estimated gestational age (EGA) were obtained using Pearson's correlation. Regression equations were used to generate the reference limits for the FCLV measurements. Results The values of AW, V-C measurements and CAHM increased with advancing gestation. The mean values of the AW, V-C and CAHM from 14 to 40 weeks increased from 6.60 ± 0.94 mm to 9.75 ± 0.07 mm (R2 = 0.114), 0.80 ± 0.00 mm to 1.90 ± 0.14 mm (R2 = 0.266), and 6.95 ± 0.06 mm to 23.07 ± 4.02 mm (R2 = 0.692) respectively, while the mean VHR decreased from 61.20 ± 1.60% to 42.84 ± 2.91% (R2 = 0.706) over the same period. Conclusion The AW, V-C, and CAHM increase, while VHR decreases with advancing gestation.

Region-specific growth restriction of brain following preterm birth.

Regional brain sizes of very-preterm infants at term-equivalent age differ from those of term-born peers, which have been linked with later cognitive impairments. However, dependence of regional brain volume loss on gestational age has not been studied in detail. To investigate the spatial pattern of brain growth in neonates without destructive brain lesions, head MRI of 189 neonates with a wide range of gestational age (24–42 weeks gestation) was assessed using simple metrics measurements. Dependence of MRI findings on gestational age at birth (Agebirth) and the corrected age at MRI scan (AgeMRI) were assessed. The head circumference was positively correlated with AgeMRI, but not Agebirth. The bi-parietal width, deep grey matter area and the trans-cerebellar diameter were positively correlated with both Agebirth and AgeMRI. The callosal thickness (positive), atrial width of lateral ventricle (negative) and the inter-hemispheric distance (negative) were exclusively correlated with Agebirth. The callosal thickness and cerebral/cerebellar transverse diameters showed predominant dependence on Agebirth over AgeMRI, suggesting that brain growth after preterm-birth was considerably restricted or even became negligible compared with that in utero. Such growth restriction after preterm birth may extensively affect relatively more matured infants, considering the linear relationships observed between brain sizes and Agebirth.

Neurological Outcome in Fetuses with Mild and Moderate Ventriculomegaly.

Introduction Ventriculomegaly (VM) is one the most frequent anomalies detected on prenatal ultrasound. Magnetic resonance imaging (MRI) may enhance diagnostic accuracy and prediction of developmental outcome in newborns. Purpose The aim of this study was to assess the correlation between ultrasound and MRI in fetuses with isolated mild and moderate VM. The secondary aim was to report the neurodevelopmental outcome at 4 years of age. Methods Fetuses with a prenatal ultrasound (brain scan) diagnosis of VM were identified over a 4-year period. Ventriculomegaly was defined as an atrial width of 10-15 mm that was further divided as mild (10.1-12.0 mm) and moderate (12.1-15.0 mm). Fetuses with VM underwent antenatal as well as postnatal follow-ups by brain scan and MRI. Neurodevelopmental outcome was performed using the Griffiths Mental Development Scales and conducted, where indicated, until 4 years into the postnatal period. Results Sixty-two fetuses were identified. Ventriculomegaly was bilateral in 58% of cases. A stable dilatation was seen in 45% of cases, progression was seen in 13%, and regression of VM was seen in 4.5% respectively. Fetal MRI was performed in 54 fetuses and was concordant with brain scan findings in 85% of cases. Abnormal neurodevelopmental outcomes were seen in 9.6% of cases. Conclusion Fetuses in whom a progression of VM is seen are at a higher risk of developing an abnormal neurodevelopmental outcome. Although brain scan and MRI are substantially in agreement in defining the grade of ventricular dilatation, a low correlation was seen in the evaluation of VM associated with central nervous system (CNS) or non-CNS abnormalities.

Ventriculomegaly

ABSTRACT Fetal cerebral ventriculomegaly (VM) is defined as an enlargement of the lateral ventricles of the developing fetal brain. It is diagnosed when the width of one or both lateral ventricles, measured at the level of the atrium, is ≥10 mm. Ventriculomegaly is defined as mild when the atrial width is 10 to 12 mm, moderate 12.1 to 15 mm, and severe &gt;15 mm. It can be isolated, but often is a sign of different pathological conditions. Since the prognosis in cases of VM depends mainly on the associated anomalies, a careful examination of the fetus, particularly of the brain, is mandatory. Magnetic resonance imaging (MRI) can be a useful diagnostic tool complementary to ultrasound in order to recognize subtle brain anomalies, such as neuronal migration and proliferation disorders. In this review article, the diagnostic workup, the counseling, and the outcome of fetal VM are discussed. How to cite this article D’Addario V, Di Cagno L, Capuano P, Cialdella M. Ventriculomegaly. Donald School J Ultrasound Obstet Gynecol 2017;11(4):276-281.

Clinical significance of slightly lateral ventricular enlargement in healthy infants

Objective: The aim of this study was to determine the clinical significance of slightly lateral ventricular enlargement.Methods: We examined 1151 infants with a gestational age of 36 weeks or greater. We assessed for the presence of ventricular enlargement when apparent space was observed in the frontal horn or body of lateral ventricle by a transfontanel ultrasound scan.Results: Two hundred and forty-eight infants had ventricular enlargement. The atrial widths in most infants were less than 10 mm. Ventricular enlargement correlated with Cesarean delivery, gestational age, birth weight, respiratory disturbance at delivery and respiratory inhibition after crying (RIAC). Ventricular enlargement could be divided into three types by ultrasound findings. Forty-five infants showed only enlargement of the anterior horn (Type A), 97 infants showed enlargement from the body to the posterior horn (Type B), and 108 infants showed whole enlargement from the anterior to the posterior horn (Type C). The infants with Type A correlated with intrauterine growth restriction, placenta previa, male gender and birth weight. The infants with Type B correlated with cesarean delivery. The infants with Type C correlated with diabetes mellitus, respiratory disturbance at delivery, RIAC and feeding hypoxemia.Conclusions: Slightly lateral ventricular enlargement should be considered clinically significant.

Fetal cerebral ventricular atria width of 8–10 mm: A possible prenatal risk factor for adolescent treated Attention Deficit Hyperactivity Disorder (ADHD)

The purpose of our research was to study the in-utero and long term post-natal outcome of fetal isolated cerebral ventricular atria width between 8 and 10mm.We conducted a retrospective, observational, case–control study, of low risk pregnant women, between 1993 and 2001. One hundred and forty one fetuses with isolated cerebral ventricular atria width between 8 and 10mm, corresponding to 2–4 standard deviations above the mean, and 309 controls, with atrial width below this level, were included for the analysis.Clinical data concerning pre and post-natal outcome was retrieved from computerized medical records. Matching of cases with controls was based on age, with a ratio of 2–3 controls per case.Statistical analysis included: T-test, Chi-Square, and Multiple Logistic Regression analysis.The study group was characterized by a predominance of male gender, left side involvement, and higher birth weight, compared to the control group.Long term post-natal follow-up at a mean age of 12.7 years (±1.9) demonstrated an adjusted odds ratio of 2.589 (95% CI 1.415–4.737, p=0.001), being diagnosed as Attention Deficit Hyperactivity Disorder (ADHD), and treated by Methylphenidate (Ritalin®), during childhood, compared to the control group (23.6% and 10.0% respectively) (p=0.001). Cerebral atria width was an independent factor, controlled for the only two significant variants between groups, gender and weight over 90th centile.In conclusions, our preliminary results show that fetuses with prenatal finding of isolated cerebral ventricular atria width between 8 and 10mm are more likely of being diagnosed and treated as ADHD during childhood.

Complex Fetal Care: Implications of Fetal Ventriculomegaly: A Neurosurgical Perspective

Fetal cerebral ventriculomegaly is diagnosed in utero when the atrial width of at least one lateral ventricle is greater than 10 mm. It is often associated with hydrocephalus, a condition of excessive intracranial cerebrospinal fluid, but can also be related to a decrease in the amount of normal brain tissue. Neurodevelopmental outcomes may correlate with severity of ventricle enlargement, with wide variation based on cause and the presence of other associated malformations. Ultrasonography and magnetic resonance imaging are sufficient to achieve an accurate diagnosis. This article considers the prognosis and management of fetal ventriculomegaly. Special emphasis is placed on discussing the utility of neuroimaging in the diagnosis, prenatal counseling, and treatment planning for this condition.

Agenesis of the fetal corpus callosum: sonographic signs change with advancing gestational age

To assess the presence and degree of indirect signs of agenesis of the corpus callosum (ACC) according to gestational age and determine the percentage of cases in which each sign is present by 24 gestational weeks. We analyzed retrospectively 54 cases of ACC which underwent three-dimensional neurosonography at our unit between January 2005 and December 2012. A single examination was available in 48 cases and six cases were followed up longitudinally, giving a total of 69 examinations. The following variables were assessed: indication for referral, karyotype, width of the atrium and presence/absence of colpocephaly, the cavum septi pellucidi, dorsal cyst and additional central nervous system (CNS) and non-CNS anomalies. Overall, there were 31 cases of complete ACC (cACC, 42 examinations) and 23 cases of partial ACC (pACC, 27 examinations). The mean gestational age was lower in the cases referred because of anomalies other than ACC than it was in those referred because of ventriculomegaly and/or suspicion of ACC (P < 0.05). Atrial width showed a positive linear correlation with advancing gestational age (P < 0.0001); it was < 10.0 mm in 25/34 (73.5%) examinations < 24 gestational weeks and in 9/35 (25.7%) ≥ 24 weeks (P < 0.001). Colpocephaly was present in 20.6% (7/34) of examinations < 24 weeks and in 68.6% (24/35) of those after 23 weeks (P < 0.05). The cavum septi pellucidi was present and visible at least in part in 17 (63%) of the 27 pACC examinations. In nine of the 27 (33.3%) pACC examinations, there was neither ventriculomegaly nor absence of the cavum septi pellucidi. Associated anomalies were present in 25/54 (46.3%) cases, and in 11 these included or consisted of CNS abnormalities. Karyotype was abnormal in seven of the 40 (17.5%) cases in which it was available. In a significant proportion of cases, most of the indirect signs of ACC are either absent or barely visible at the time of the midtrimester screening ultrasound examination. Therefore, ACC may escape diagnosis at midtrimester screening ultrasound. In particular, a third of examinations in fetuses with pACC may not show any abnormality in the transventricular screening view < 24 weeks. The medicolegal implications of such findings are important and should be considered.

Oral Abstract Session: Novel non-invasive risk marker

Oral Abstract Session: Novel non-invasive risk marker

Pacemaker “Dysfunction” Treated by Radiofrequency Ablation

A 68-year-old female with a history of paroxysmal atrial fibrillation and complete atrioventricular (AV) block was referred for palpitations and suspicion of pacemaker dysfunction (model Philos II DR-T, Biotronik, Berlin, Germany). Baseline electrocardiogram (ECG) showed a dual-chamber pacemaker with an inappropriate behavior (Fig. 1, Panel A). Pacemaker programmed parameters were as follows: pacing mode DDD-R; basic rate 60 beats per minute (bpm); upper rate 130 bpm; dynamic paced AV delay 180/140 ms; dynamic sensed AV delay 135/95 ms; AV safety window 100 ms; atrial sensitivity 0.5 mV (bipolar); ventricular sensitivity 2.5 mV (bipolar); atrial and ventricular pulse amplitude and width 3.6 V and 0.40 ms, respectively (both unipolar). Pacemaker testing showed the following results: battery impedance 0.3 k ; sensed P wave 3 mV, sensed R wave 25 mV; atrial and ventricular pacing thresholds 0.6 and 0.4 V, respectively; atrial and ventricular lead impedances 442 and 560 , respectively (stable). Testing of the atrial pacing threshold in AAI mode at 70 bpm allowed the diagnosis to be made (Fig. 1, Panel B). What is the mechanism of the pacemaker “dysfunction”? How can it be solved?

Mild Fetal Ventriculomegaly: Diagnostic Work-up and Management

ABSTRACT Mild ventriculomegaly (VM), also defined as “borderline”, is a condition characterized by an atrial width between 10 and 15 mm independently from gestational age. Fetuses with mild ventriculomegaly require an accurate morphological examination to rule out for associated neural and extraneural anomalies. The percentage of this association is 41%. However, in almost 13% of cases, the associated anomaly is not recognized at the time of the initial presentation. It is important to monitor the atrial width during the third trimester because in 15% of the cases it increases. Most of the cases missed at the first examination have a late onset diseases (migrational disorders, parenchimal damage, hemorrhage, etc). For these conditions MRI may play a useful role. Maternal serum tests for congenital infections should be performed, since infections may be the cause of mild VM in 1.5% of the cases. Fetal karyotype should also be evaluated, since chromosomal abnormalities may be associated in 2.8% of the cases of isolated VM. The counseling in cases of apparently isolated mild VMs focuses on the possibility of neurodevelopmental delay in the surviving infants. The average percentage of neurodevelopmental delay reported in the literature is 10.9%. The possibility of late onset brain anomalies must be considered. In conclusion, the most important prognostic factors are the association with other abnormalities not detected at the first examination and the progression of the ventricular dilatation.