Atrial Width Research Articles

Fetal cerebral ventricle volumetry: comparison between 3D ultrasound and magnetic resonance imaging in fetuses with ventriculomegaly

Objectives. The aim of this study was to evaluate feasibility of fetal lateral ventricle (LV) volumetry in fetuses with ventriculomegaly and to compare measurements performed by 3D sonographic method virtual organ computer-aided analysis (VOCAL) with those obtained by magnetic resonance imaging (MRI).Methods. This cross-sectional study evaluated 30 fetuses with atrial width (AW) between 10 and 30 mm, from 20 to 36 gestational weeks. Fifty-nine ventricles were measured by two observers. Sonographic volumetric measurements using VOCAL 30° were performed with an ACCUVIX XQ machine (Medison, Korea) and MRI assessments with a Sonata system using ARGUS software (Siemens, Germany). Agreement between both techniques was assessed by intraclass correlation coefficient (ICC) calculation, and proportionate Bland–Altman plots were constructed.Results. A high degree of reliability was observed between VOCAL and MRI measurements (ICC 0.928, 95%CI [0.876;0.958]). Bland–Altman plots confirmed the high correlation (mean of differences: 1.62 cm3 and standard deviation: ± 8.41 cm3).Conclusion. Three-dimensional volumetry of fetal LVs by VOCAL method has good agreement with fetal MRI in fetuses with ventriculomegaly and may be used as an additional tool in patient counseling and prognosis prediction.

Triplanar estimation of left atrial volume

Methods Consecutive atrial fibrillation (AF) patients referred for CMR to assess pulmonary veins and left atrial size prior to catheter based treatment were included. During the study period, patients without AF and minimal structural heart disease on CMR were also examined. For each patient group, a 1.5T magnet was used to acquire 2, 3 and 4 CH cines in addition to an axial stack through the heart. Left atrial dimensions, width (W) and length (L), and areas (A) were measured on each of the three long axis views and the LaV was estimated using the AL biplane formula. The axial stack was used to calculate the true LaV by a method of disks (MoD) summation. To find the optimum formula for estimating LaV, a full quadratic model equation was used. The regressor variables included dimensions and area of the left atrium obtained from each of the three long axis views. All calculated LaVs were compared to the true LaV to assess for accuracy. Results

OP20.05: Fetal volume measurement at gestational age of 11 + 0–13 + 6 weeks by three‐dimensional ultrasound

Objectives: Cases of ventricumegaly were evaluate fetal MRI to establish the contribution of the MRI regarding aetiological diagnosis, additional findings and management. Methods: We evaluate 91 cases of ventriculomegaly (VM) between 20–28 gestational weeks (range 23.4 weeks). All cases of VM were screened by ultrasound (US) using the atrial width classified as normal when atrial width 15.0 mm. All MRI studies were performed up to 7 days after the US diagnosis. All cases were followed by US every 4 weeks and a 2nd MRI was performed between 32–36 weeks. Results: There was 68 cases of mild VM (74.2%) and 25.1% cases of severe VM. Fetal MRI brings additional information regarding the size of the 4th ventricule, evaluating the walls and surface of the ventricules, the position of the fornix, analyses of the germinal zone, posterior fossa (cerebellar herniation), gyration process and evaluation of ventricular symetry or asymetry. The 2nd MRI allow us to understand the progression of different aetilogical processes of VM. Conclusions: Fetal MRI should be used in cases of VM as a complementary method to evaluate intracranial additional findings that could contribute to a more refined aetilogical diagnosis of ventriculomegaly.

OP05.05: Validity and reliability of fetal brain MRI in ventricular volume measurement

Objectives: Fetal magnetic resonance (MR) has greatly improved the ability to counsel patients with fetal diagnosis of ventriculomegaly, since it allows accurate study of the lateral ventricles as well as the whole brain structure in search for additional anomalies. Quantitative MR indices along with qualitative assessment may certainly improve the diagnostic utility of MR to predict postnatal outcomes. Our aim was to assess inter and intraobserver variability in determining fetal lateral ventricle volume using brain MR in fetuses referred for ventriculomegaly (VM). Methods: Lateral ventricle volumes were measured by using planimetry on single-shot rapid acquisition with relaxation enhancement MR images obtained in 30 fetuses with sonographically diagnosed VM (atrial width between 10 and 28 mm). All fetuses aged between 20 and 26 gestational weeks. Exams were performed in a Sonata Maestro Class 1,5-T system (Siemens, Erlangen, Germany) and measurements attained in a Leonardo workstation using ARGUS VA60C software. Ventricular volumes were independently assessed (60 ventricles) in the coronal section plane by two experienced observers, twice by the first observer with at least 1 month of interval between measurements. Reliability and agreement of the volumes were evaluated with intraclass correlation coefficients (ICCs), and proportionate Bland-Altman plots were constructed. Results: Inter and intraobserver analysis showed good agreement between measurements, as shown on the dispersion and BlandAltman plots (most of the measurements were within the mean ±2 SD). ICC was 0.999 for both intra and interobserver (95% CI: 0.999; 1.000; and mean of differences was 0.01 (95% LA: ±2.26; SD: ±1.15) and 0.26 (95% LA: ±1.28 and SD: ±0.65) respectively. Conclusions: Fetal lateral ventricle volume can be readily assessed during the second and third trimesters of gestation. The reliability and validity of MR volume measurements are high, with very good interobserver agreement.

Natural history and outcome of prenatally detected mild cerebral ventriculomegaly from an unselected obstetric population encompassing the northern region of England

BackgroundThe prenatal ultrasound finding of mild/moderate ventriculomegaly (VM) (atrial width of lateral ventricles 10–15 mm) presents a counselling dilemma. Large scale population outcome data are lacking. To date studies describing...

Re: Counseling in isolated mild fetal ventriculomegaly

We read with interest the paper by Melchiorre et al.1. The authors aimed at providing up-to-date and evidence-based answers to common questions regarding isolated mild fetal ventriculomegaly. One of the recent concerns regarding ventriculomegaly is whether the fetal lateral ventricular atrium measuring between 10 and 12 mm is simply a variation of the norm2. Using pooled data from previous studies, Melchiorre et al. concluded that there was no significant difference in the incidence of abnormal neurological outcome between the groups with atrial width 10.0–11.9 mm and 12.0–15.0 mm, the incidence being 12% and 16%, respectively. We are concerned that this conclusion might have been incorrect for the following reasons. First, there was an error in data extracted from the study by Ouahba et al.3, who explicitly reported that the rate of children having a neurological disease and with an atrial width between 12 and 15 mm was 24.2% (8/33), significantly higher than the rate of 5.9% (4/68) when the atrial width was between 10 and 12 mm. These incidences were incorrectly quoted as 28% and 33% by Melchiorre et al.1. Second, there are two recent articles which were not included in the review4, 5. When data from these two studies are included for analysis, together with the correct data from Ouahba's study3, there is actually a significant difference in abnormal neurological outcome in these two groups (Table 1): 16/90 (17.8%) fetuses with atrial width 12–15 mm vs. 20/330 (6.1%) fetuses with atrial width 10–12 mm (relative risk, 2.07; 95% CI, 1.38–3.12; P = 0.002). This abnormal neurological outcome for the group with ventriculomegaly between 10 and 12 mm is approximately half that reported by Melchiorre et al.1. We believe that this supplementary information is important in assisting clinicians to provide a more reassuring prognosis to the couple whose fetus is noted to have ventriculomegaly between 10 and 12 mm. L. W. Chan*, T. K. Lau*, * Fetal Medicine Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong

Fetal brain asymmetry: in utero sonographic study of normal fetuses

The objective of the study was to evaluate the magnitude of normal fetal brain asymmetry. This was a prospective study. Normal fetuses between 19-28 weeks of gestation were studied. The cerebral atria, occipital cortex, and hemispheres in both sides were measured. The difference between each side was evaluated and was correlated with sex, head biometry, and estimated weight. Four hundred six fetuses were studied. Mean atrial width was larger in the males and on the left side (5.2% and 6.5%, respectively). Mean cortical width was 2.6% larger in males but 5.5% thinner on the left side. Mean hemisphere width was larger in males and on the left side (2.3% and 1.5%, respectively). The atria and the cortex presented an inverse relationship regarding fetal growth parameters. Brain asymmetry represents normal fetal brain developmental phenomena. It is sex dependent and lateralized in most cases to the left. Lateralization was more accentuated in males.

Counseling in isolated mild fetal ventriculomegaly

In this Review we aim to provide up-to-date and evidence-based answers to the common questions regarding the diagnosis of isolated mild fetal ventriculomegaly (VM). A literature search was performed to identify all reports of antenatal VM in the English language literature. In addition, reference lists of articles identified using the search were scrutinized to further identify relevant articles. Fetal mild VM is commonly defined as a ventricular atrial width of 10.0-15.0 mm, and it is considered isolated if there are no associated ultrasound abnormalities. There is no good evidence to suggest that the width of the ventricular atria contributes to the risk of neurodevelopmental outcome in fetuses with mild VM. The most important prognostic factors are the association with other abnormalities that escape early detection and the progression of ventricular dilatation, which are reported to occur in about 13% and 16% of cases, respectively. Most infants with a prenatal diagnosis of isolated mild VM have normal neurological development at least in infancy. The rate of abnormal or delayed neurodevelopment in infancy is about 11%, and it is unclear whether this is higher than in the general population. Furthermore, the number of infants that develop a real handicap is unknown. There are limitations of existing studies of mild VM. Although they address many of the relevant questions regarding the prognosis and management of fetal isolated mild VM, there is a lack of good-quality postnatal follow-up studies. The resulting uncertainties make antenatal counseling for this abnormality difficult.

Neurological outcome following isolated 10–12 mm fetal ventriculomegaly

The outcome of non-progressive, isolated fetal ventriculomegaly is uncertain. The normal width of the atrium of the lateral ventricle is less than or equal to 9 mm.1 Severe ventriculomegaly (or...

Atrial reservoir function by strain rate imaging in asymptomatic mitral stenosis: prognostic value at 3 year follow-up

Assessment of left and right systolic atrial reservoir function in asymptomatic mitral stenosis (MS) by strain and strain rate imaging (SRI) and their prognostic power at 3 year follow-up was the purpose of this study. There is clear indication to treat (by surgery or percutaneous valvotomy) symptomatic patients with MS, whereas for the asymptomatic ones, the question is much debated. So, we need new echocardiographic parameters helpful for the management of asymtomatic patients. Atrial reservoir function by SRI could help in evaluation of these patients. Fifty-three asymptomatic patients with MS and 53 healthy controls were evaluated by the standard echo-Doppler study [mitral valve (MV) area, mean gradient, systolic pulmonary pressure, left atrial (LA) width, LA volumes, LA compliance index] and by Doppler myocardial imaging (velocity, strain, and SR of both atria). The endpoint at 3 year follow-up was symptoms, hospitalization for cardiac cause, atrial fibrillation, thrombo-embolic events, valvular surgery, or percutaneous commissurotomy. LA width, volumes, and systolic pulmonary pressure were significantly increased in MS patients (P < 0.001). Atrial myocardial velocities and deformation indices were significantly compromised in MS patients (P < 0.0001). Significant correlation was found between atrial myocardial velocity and MV area (by pressure half-time method: P = 0.019, R = 0.41; by planimetric method: P = 0.016, R = 0.43). Peak systolic LA myocardial strain and SR were significantly correlated with atrial volumes (strain: P = 0.03, R = -0.28; SR: P = 0.0008, R = -0.42), with atrial compliance index (strain: P = 0.04, R = 0.26; SR: P = 0.04, R = 0.16), with atrial ejection fraction (strain: P < 0.0001, R = 0.56; SR: P = 0.03, R = 0.43). At 3 year follow-up, 22 (41%) patients had events. Comparing the MS patients who had events during the 3 year follow-up with those who did not, the former had bigger LA volumes, although these parameters did not reached a significant value, whereas atrial myocardial systolic SR was significantly impaired in patients with events. In multivariate analysis, the best predictor of adverse events was LA peak systolic SR average (P = 0.04; coefficient: 0.113; SE: 0.055; cut-off value of 1.69 s(-1) for LA peak systolic SR average) with a sensitivity of 88%, specificity of 80.6%, area under the receiver operating characteristic curve of 0.852 (SE: 0.048; 95% CI: 0.74-0.93, P = 0.0001). Atrial myocardial deformation properties, assessed by SRI, are abnormal in asymptomatic patients with rheumatic MS. The degree of this impairment is predictor of events in a 3 year follow-up. SRI could be helpful in decision-making of asymtomatic patients with MS.

Fetal Cerebral Ventriculomegaly: Sonographic Diagnostic Workup

Abstract Dilatation of the fetal cerebral ventricles (ventriculomegaly) is a generic sonographic sign, which is common to several pathological entities carrying different prognosis. Ventriculomegaly is easily recognized by ultrasound by measuring the atrial width. This simple measure allows the recognition of even mild forms of ventricular dilatation and is used as a screening method for ventriculomegaly. However, although the diagnosis of ventriculomegaly is easy, the prenatal identification of the cause of ventricular dilatation is a more difficult task. The recognition of associated brain anomalies is a crucial point. The research of the cause of ventriculomegaly is clinically useful, since the prognosis mainly depends on the etiology and on the presence of associated abnormalities. In this article the role of prenatal sonography in recognizing the cause of the ventriculomegaly is reviewed.

Quality of ECG Monitoring with a Miniature ECG Recorder

Long-term monitoring of patients at risk of arrhythmias would benefit from a miniaturized device. This study evaluated the quality of electrocardiogram (ECG) signals recorded by a miniaturized ECG recorder. ECG data were concurrently recorded with an investigational device (Philips Medical Systems, Seattle, WA, USA) and a Holter recorder from patients with cardiac-related symptoms at the emergency department of a tertiary care university hospital. The device was attached in one of four locations (L1: below left clavicle, L2: midsternal, L3: below left breast, L4: left anterior axillary line in 5th intercostal space). Selected ECG strips were analyzed for atrial activity, QRS width, and basic rhythm by two physicians. Patients were divided into groups based on their number of strips (A 2-5, B 6-9, C 10-21) for descriptive presentation of the data. For statistical analyses, nonlinear mixed-effects models were used. In 90 patients, 574 pairs of strips were analyzed. In L1 (n = 37), agreement between the device and the Holter recorder on presence of P wave was 58-80% in groups A-C and in L2 (n = 28):94-98%, L3 (n = 12):30-72%, and L4 (n = 13):0-70%; on PR interval in L1:58-80%, L2:94-98%, L3:30-62%, and L4:0-70%; on rhythm in L1:56-79%, L2:94-98%, L3:30-62%, and L4:0-70%; on QRS width in L1:86-100%, L2:88-98%, L3:100%, and L4:96-100%. The agreement of L2 in the parameters P wave, PR interval, and rhythm diagnosis was better than in the other locations (P < 0.01). A miniature ECG monitor provided accurate assessment of atrial beats and rhythm diagnosis at a midsternal location and of QRS width at all locations.

Electrical Remodeling and Cardiac Dimensions in Patients Treated by Cardiac Resynchronization and Heart Failure Controls

Cardiac resynchronization therapy (CRT) reduces the left ventricular diameter (LVEDD) in heart failure (HF) patients with left bundle branch block (LBBB). The study compares structural and electrical remodeling in HF patients on CRT and matched HF controls without LBBB. In 42 patients (64 +/- 9 years left ventricular ejection fraction [LVEF] 25 +/- 8%, 16 coronary artery disease, 26 nonischemic cardiomyopathy, 21 with LBBB and CRT indication vs 21 controls [matched for gender, age, LVEF, and underlying disease]) an unpaced electrocardiogram (ECG) and echocardiogram were recorded at baseline (bl) and after 20.6 +/- 13.8 months (fup). LVEDD, left atrial (LA) width, mitral regurgitation (MR), P-wave, PR interval, QRS width, QRS vector, and QT interval were analyzed. LVEDD diminished with CRT (bl 68.7 +/- 10.3 vs fup 62.0 +/- 7.7 mm, P = 0.002). Controls showed no change (bl 64.1 +/- 9.4 vs fup 64.8 +/- 8.4 mm, P = n.s.). MR improved with CRT (bl 1.2 +/- 0.6 vs fup 0.8 +/- 0.7, P = 0.02), but not among controls. LA width tended to decrease on CRT (CRT bl 48.9 +/- 4.4 vs fup 46.9 +/- 7.2 mm, P = 0.17, controls bl 48.5 +/- 5.1 vs fup 47.5 +/- 6.5 mm, P = 0.49). PR interval lengthened in both groups (CRT bl 175 +/- 29 vs fup 188 +/- 30 ms, P = 0.03, controls bl 177+/-25 vs fup 187 +/- 19 ms, P = 0.27). QRS increased in both groups (CRT bl 165 +/- 22 vs fup 171 +/- 20 ms, P = 0.07, controls bl 111 +/- 17 vs fup 118 +/- 19 ms, P = 0.01). Analyses revealed no significant association of echocardiographic and ECG parameters. Despite LVEDD reduction with CRT, electrical activation does not recover. Electrical remodeling does not differ between LBBB patients under CRT and matched controls without CRT indication.

Fetal Ventriculomegaly

Abstract The causes of fetal ventriculomegaly vary. Ventriculomegaly can be caused by not only obstruction of cerebrospinal flow tract but also brain maldevelopment or other reasons. Recent advanced imaging technology and approaching technique of transvaginal sonography have contributed to an accurate prenatal diagnosis and clearly revealed fetal intracranial condition. However, management of the condition and counseling of parents are still difficult, because the initial cause, absolute risk, and degree of resulting neurological deficit cannot be determined with confidence. Ventriculomegaly is evaluated according to atrial width &gt; 10 mm and mild ventriculomegaly is defined as an atrial width of 10 to 15 mm. In ventriculomegaly cases, accurate detection of intracranial structure and additional abnormalities is required. Furthermore, ventriculomegaly may resolve spontaneously or progress during pregnancy. Therefore, detailed neuroscan by advanced imaging technology, detailed extra-CNS scan, longitudinal serial scan during pregnancy are mandatory for proper counseling and management. Longitudinal observation study of not only short-term but also long-term neurological prognosis will be required.

Clinical implication of isolated right dominant heart in the fetus

To evaluate the clinical implication of isolated right dominant heart (RDH) in fetal echocardiography. We reviewed the medical records of pregnant women diagnosed with fetal RDH at Asan Medical Center from December 1999 to December 2005. The criteria of RDH were the ratio of right-to-left atrial and ventricular width and the ratio of the diameter of pulmonary artery-to-aorta were greater than 1.5. Fetuses with congenital heart disease, including coarctation of the aorta (CoA), noncardiac anomalies or chromosomal abnormalities were excluded. RDH was identified in 44 fetuses. Twenty-nine (66%) were confirmed to have normal heart and 15 (34%) had cardiac anomalies by postnatal echocardiogrphy; 11 CoA, 1 interruption of aortic arch, 1 patent ductus arteriosus, and 2 ventricular septal defect. Mean gestational age at presentation with RDH was later in normal fetuses as compared to fetuses with CoA (p < 0.005). Only 26% (4/15) of fetuses presenting with RDH during the second-trimester were found to have normal heart postnatally, compared with 86% (25/29) of those diagnosed in the third-trimester. RDH in the fetus is a risk factor for postnatal CoA particularly when diagnosed in the second-trimester, and should be an indication for neonatal echocardiography.

Effects of maternal smoking in pregnancy on prenatal brain development. The Generation R Study

Nicotine, as has been shown in animal studies, is a neuroteratogen, even in concentrations that do not cause growth retardation. In humans, there is only indirect evidence for negative influences of nicotine on brain development from studies on the association between maternal smoking in pregnancy and behavioural and cognitive development in the offspring. We investigated the associations of maternal smoking in pregnancy with foetal head growth characteristics in 7042 pregnant women. This study was embedded in the Generation R Study, a population-based prospective cohort study from foetal life until adulthood. Maternal smoking was assessed by questionnaires in early, mid- and late pregnancy. Head circumference, biparietal diameter, transcerebellar diameter and atrial width of lateral ventricles were repeatedly measured by ultrasound. When mothers continued to smoke during pregnancy, foetal head circumference showed a growth reduction of 0.13 mm [95% confidence interval (CI): -0.18, -0.09] per week compared to foetuses of mothers who never smoked during pregnancy. Biparietal diameter of foetuses with smoking mothers grew 0.04 mm (95% CI: -0.05, -0.02) less per week than that of foetuses of nonsmoking mothers. Atrial width of lateral ventricle was 0.12 mm (95% CI: -0.22, -0.02) smaller and transcerebellar diameter was 0.08 mm (95% CI: -0.15, -0.00) smaller if mothers smoked, but growth per week of these characteristics was not affected by maternal smoking in pregnancy. In conclusion, continuing to smoke during pregnancy leads to reduced growth of the foetal head. Further research should focus on the causal pathway from prenatal cigarette exposure via brain development to behavioural and cognitive functions.

Sonographic examination of the fetal central nervous system: guidelines for performing the ‘basic examination’ and the ‘fetal neurosonogram’

Sonographic examination of the fetal central nervous system: guidelines for performing the ‘basic examination’ and the ‘fetal neurosonogram’

Prenatal Isolated Mild Ventriculomegaly: Outcome in 167 Cases

Ventriculomegaly, the commonest anomaly of the fetal brain, carries a mortality rate of 70% to 80%, and half of surviving children fail to develop normally. This poor outcome is related to the fact that two thirds of affected individuals have associated anomalies and 9% are aneuploid. The outlook is better for isolated mild ventriculography (IMV), defined by an atrial width of 10-15 mm. Currently available data suggests that only 15% of those with IMV die and a large majority of survivors develop normally. However, because IMV is a diagnosis of exclusion, many clinicians still do karyotype testing, targeted sonograms, and even fetal MRI to search for other abnormalities. To determine if this detailed evaluation is necessary and to confirm the prognosis of IMV, the authors carried out this retrospective study of 167 cases of IMV. Affected fetuses had unilateral or bilateral ventriculomegaly, with an atrial width of 10 to 15 mm, and no associated anomalies identified during the first sonogram. Two sonographers specializing in fetal brain disorders made the diagnosis. After excluding terminations, there were 146 live births, and psychomotor assessment was carried out in 101 children. The median maternal age at the time IMV was diagnosed was 30 years, and the mean gestational age at diagnosis was 26.5 weeks. The ratio of male to female fetuses was 1.31. Ventriculomegaly was unilateral in 48% of cases, bilateral and symmetrical in 42%, and bilateral and asymmetrical in 10%. Amniocentesis identified four aneuploidies (two cases of Trisomy 21, one 47XXY, and one 47XYY). MR imaging, done at a mean gestational age of 33 weeks, revealed associated major brain anomalies in 12% and normal ventricles in 7% of cases. IMV remained stable in 55% of cases, regressed in 34%, and became worse in 11%. In 17% of cases, follow up sonography identified major intracerebral and extracerebral anomalies not previously seen. Sixteen pregnancies were terminated, and all these fetuses had additional anomalies. At follow-up evaluation, done at a mean age of 4.5 years, twelve of 101 children had neurological disease or delayed psychomotor development. An atrial width of 12 mm or more at the time of the initial ultrasound examination and progressive ventricular enlargement (defined as an increase in ventriculomegaly of more than 3 mm) were correlated with a poor neurological outcome. Asymmetrical bilateral ventriculomegaly was also strongly associated with a poor outcome, with 50% having postnatal neurological disease, compared to only 7.5% of those with unilateral dilation and 10% with symmetrical ventriculomegaly. At the time of the initial ultrasound exam, 65 fetuses had nonprogressive unilateral or bilateral symmetrical ventriculography of less than 12 mm, and 61 of these (94%) had totally normal psychomotor development.

Prenatal isolated mild ventriculomegaly: outcome in 167 cases

To define the contribution of prenatal investigation and evaluate the prognosis of isolated mild ventriculomegaly (IMV). Retrospective study. University hospital between January 1992 and December 2002. One hundred and sixty-seven cases of prenatal unilateral or bilateral IMV without any associated anomaly at the time of initial diagnosis. Complementary investigations were performed: amniocentesis with karyotyping, screening for viruses and acetylcholinesterase electrophoresis, magnetic resonance imaging (MRI), and ultrasonography every 3-4 weeks. Results of prenatal investigations, pregnancy outcome, and postnatal psychomotor development. IMV was diagnosed around 26.5 weeks. Amniocentesis revealed four chromosomal anomalies and two cytomegalovirus infections. MRI diagnosed brain-associated anomalies in 15 cases and ultrasonographic monitoring highlighted malformations not initially diagnosed in 28 cases. Termination of pregnancy (TOP) was considered in 21 pregnancies (12.6%). Indications were aneuploidy, fetal infectious disease or associated malformations. In women for whom a TOP was considered, consanguinity, fetus of female sex and frontal horn enlargement were statistically more frequent, ventriculomegaly was more often bilateral and asymmetrical, atrial width, and the rate of progressive ventricular enlargement were significantly higher. One hundred and one children with prenatal IMV were assessed between 19 and 127 months (mean age 54.68 +/- 2.87 months). Twelve children had neurological disease or psychomotor delay and 89 children had a normal psychomotor development. Poor neurological outcome was more often associated with atrial width greater than or equal to 12 mm, asymmetrical bilateral enlargement, and progression of the ventriculomegaly. The detection of IMV raises the question of the child's psychomotor development and justifies meticulous prenatal investigation. In addition to associated anomalies, three criteria are often associated with an unfavourable outcome: atrial width greater than 12 mm, progression of the enlargement, and asymmetrical and bilateral ventriculomegaly.

Multi‐Center Clinical Experience with a Lumenless, Catheter‐Delivered, Bipolar, Permanent Pacemaker Lead: Implant Safety and Electrical Performance

Reduced lead diameter and reliability can be designed into transvenous permanent pacing leads through use of redundant insulation and removal of the stylet lumen. The model 3830 lead (Medtronic Inc., Minneapolis, MN, USA) is a bipolar, fixed-screw, steroid-eluting, lumenless, 4.1-Fr pacing lead. Implantation can be performed in a variety of right heart sites using a deflectable catheter (Model 10600, Medtronic). Lead performance and safety were studied. Two prospective trials of 338 implanted subjects from 56 global sites were conducted. Electrical and safety data were obtained at implant, pre-discharge, and up to 18 months post-implant. Leads were implanted at traditional and alternate right heart sites. The study enrolled 338 subjects (204 males, 70.6 +/- 11.6 years) followed-up for a mean of 10.2 months (range, 0-21.6). Mean P-wave amplitudes ranged from 3.2 mV at 3 months to 2.9 mV at 18 months, while mean atrial pulse width thresholds at 2.5 V ranged from 0.07 ms at 3 months to 0.09 ms at 18 months. Mean R-wave amplitudes ranged from 11.3 mV to 11.1 mV and mean ventricular pulse width thresholds at 2.5 V ranged from 0.10 ms to 0.14 ms. There were 22 ventricular and 12 atrial lead complications within 3 months post-implant. Survival from lead-related complications improved to a clinically acceptable rate in the cohort of patients when revised implant techniques were employed. With the use of recommended implant techniques, the study results support the electrical efficacy and safety of a catheter-delivered, lumenless lead in traditional or alternate right atrium or right ventricle sites through 18 months post-implant.