Fetal Cardiac Structure Research Articles

545 Completion of fetal echocardiogram (FE) in the obese parturient

Maternal obesity is a risk factor for fetal complications including fetal cardiac anomalies, but also decreases detection of anomalies. Thus, our objective was to evaluate completion rates of fetal echocardiography (FE) in patients with obesity. Retrospective review of all FE ultrasound (US) studies at an AIUM fetal echo accredited single academic center from2016 to 2019. Patients were stratified by pre-pregnancy body mass index (BMI) into normal weight (NW) and Class I, II and III obesity. Ten key cardiac structures were defined as critical for complete FE. The percentage of views completed on Level II anatomic US and first FE were compared between groups. Primary outcome was percentage of views obtained by the conclusion of initial FE, compared between groups, with secondary outcome of number of follow up examinations needed. Data compared by ANOVA with P<0.05 considered significant. A total of 749 patients underwent 899 FEs. Completion percentage differed significantly between groups (NW- 84%, Class I 80%, Class II 80%, Class III 77%, P=.001). There were also significantly more follow up FE scans (NW 1.83 ±0.87, Class I 2.26 ±1.31, Class II 2.21±1.01, Class III 3.57±2.06; P<.0001). Increasing BMI is associated with decreased visualization of fetal cardiac structures by the conclusion of initial FE and an increase in total ultrasounds needed even at a high-quality academic FE ultrasound unit. Given the increasing rate of maternal obesity, continued efforts to improve technique, technology and potentially to adjust timing of initial ultrasound evaluation should be explored.

VP15.18: Influence of intra‐amniotic infection and inflammation on the fetal cardiac structure

VP15.18: Influence of intra‐amniotic infection and inflammation on the fetal cardiac structure

VP15.20: Evaluation of ventricular systolic function in fetuses of overweight or obese mothers by two‐dimensional speckle‐tracking technique

Using left and right ventricle global longitudinal strain (GLS) and right ventricle free wall strain (FWSt) evaluate cardiac systolic function in fetuses of mothers with overweight and obese. 80 patients underwent fetal echocardiography in Tangdu Hospital from June 2019 to February 2020 were included (30 normal pregnant women, 27 overweight pregnant women and 23 obese pregnant women). Regular and two-dimensional speckle-tracking echocardiography (2D-STE) were performed for evaluation of fetal cardiac structure and function. All the echocardiographic parameters were compared among groups. Compared with the fetus whose mother have normal BMI before pregnancy, the myocardial strain of the fetus in overweight pregnancy is decreased, and declining further in the obese group. 2D-STE can sensitively reflect fetal myocardial deformability and can be used as a new method to evaluate the changes of early fetal myocardial systolic function.

AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days.

AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days.

Cardiac function in gestational diabetes mellitus: A longitudinal study from fetal life to infancy.

To determine whether cardiac functional and structural changes in fetuses of mothers with gestational diabetes mellitus (GDM) persist in the offspring beyond the neonatal period. Longitudinal study. Fetal Medicine Unit in a UK teaching hospital. 73 women with GDM and 73 women with uncomplicated pregnancy were recruited and fetal cardiac scans were performed at 35-36weeks' gestation. Repeat echocardiogram was performed in their offspring during infancy. Fetal and infant cardiac functional and structural changes. Fetuses of mothers with GDM, compared with controls, had more globular right ventricles (sphericity index 0.7, interquartile range [IQR] 0.6/0.7 versus 0.6, IQR 0.5/0.6, P<0.001) and reduced right global longitudinal systolic strain (-16.4, IQR -18.9/-15.3 versus -18.5, IQR -20.6/-16.8, P=0.001) and left global longitudinal systolic strain (-20.1, IQR -22.5/-16.9 versus -21.3, IQR -23.5/-19.5), P=0.021). In the GDM group, compared with controls, in infancy there was higher left ventricular E/e' (8.7, IQR 7.3/9.7 versus 7.9 IQR, 6.8/8.9 P=0.011) and lower left ventricular global longitudinal systolic strain (-21.0, IQR -22.5/-19.4 versus -22.3, IQR -23.5/-20.7, P=0.001) and tricuspid annular plane systolic excursion (13.8, IQR 12.7/16.1 versus 15.2, IQR 13.8/16.8, P=0.003). These differences remained following multivariable analysis. Gestational diabetes mellitus is associated with alterations in fetal cardiac function and structure compared with controls and persistent cardiac changes in infancy. Gestational diabetes mellitus, even when well controlled, is associated with fetal cardiac changes and these persist in infancy.

First trimester fetal echocardiography limitations and its expected clinical values

BackgroundFetal cardiac activity could be observed between 6th and 7th gestational weeks, early performance of fetal echocardiography could be implemented to screen for fetal heart disease. The effectiveness of early first trimester fetal echocardiography has not been adequately investigated, especially with modern sonographic technological advances. The purpose of the study is to evaluate the capability to visualize fetal cardiac structures within the first trimester as early as 10th gestational weeks and to elucidate the value of using color Doppler in visualization of cardiac structures within early gestation. A prospective clinical trial conducted on 150 study subjects, 44 of them were twin gestations. Cases were fully assessed by fetal echocardiographic examination from 10th gestational week to 13 gestational weeks in a sequential manner weekly. The research study was conducted at cardiology department fetal unit in one of the tertiary hospitals.ResultsFour chamber view was mostly visualized from 12 gestational weeks, whereas cardiac axis was fully visualized in all cases from 12 gestational weeks; on the other hand, IVC assessment by 2D was satisfactorily visualized in 78.26% of cases and by color Doppler in 82.61% of cases at 13 gestational weeks, pulmonary veins were visualized in 21.74% of cases by 2D and 43.5% of cases by color Doppler at 13 gestational weeks, and interestingly, ventricular inflows were satisfactorily visualized in almost all cases from 10th gestational weeks.ConclusionsFirst trimester fetal echo is an outstanding enhancement in management pathways of cases susceptible to have fetal cardiac abnormalities permitting early detection of structural cardiac anomalies triggering a cascade of scanning for extra cardiac anomalies to aid in evaluation and assessment of the best management course for those affected cases.

Comparison of Fetal Echocardiography for Fetal Cardiac Structure in Women with Gestational Diabetes Mellitus and Normal Pregnancies

BackgroundIncreased metabolic rate of hyperglycemia in gestational diabetes causes macrosomia, which can also affect the fetal heart. The thickness of the walls of the heart and its function in women with gestational diabetes mellitus (GDM) can change over time before treatment. We aimed to evaluate fetal cardiac structure in terms of ventricular wall thickness and its function in women with GDM and normal pregnancy for indirect evaluation of the effects of hyperglycemia on the heart.Materials and MethodsIn this case-control study, pregnant women who referred to Imam Khomeini hospital, Ahvaz, Iran that had normal ultrasound anomaly scan between the ages of 18 to 22 weeks; in 26-28 weeks of pregnancy using 3-hour glucose tolerance test, based on the results were divided into two groups of gestational diabetes (cases, n=45), and normal (control, n=48 group). Fetal echocardiography was performed between the ages of 28 to 32 weeks and the thickness of the ventricular and inter-ventricular septum and the shortening fraction were compared. ResultsNinety-three pregnant women were participants. The mean age of the subjects was 26.33+ 4.88 years. There was a significant and direct relationship between right ventricular wall thickness, left ventricular thickness and intra ventricular septum, besides, right ventricular fractional shortening increased significantly in the diabetes group compared to the normal pregnancy group (P< 0.05); however, there was no significant difference in left ventricular function between the two groups.ConclusionBased on the results, significant increases in the right ventricular wall thickness, left ventricular thickness and intra ventricular septum, as well as right ventricular fractional shortening; which points to the importance of fetal echocardiography in GDM.

EP09.07: New ultrasound technique in detection of fetal cardiac structure and function in normal pregnancy

To examine the potential of spatiotemporal image correlation (STIC) and tissue Doppler imaging (TDI) in the detection of fetal cardiac structure and function in normal pregnancy. 80 normal pregnancies were enrolled. Fetal echocardiogram was performed. STIC with M-mode display (STIC-M) was used to measure the thicknesses of the fetal ventricular wall and interventricular septum, and ventricular internal diameters at end-systole and end-diastole, and to calculate ventricular shortening fractions (SF). TDI ultrasound was used to measure fetal atrioventricular annular velocity in early diastole (Ea), annular velocity in late diastole(Aa) and annular velocity in systole (Sa), and to calculate the Ea/Aa ratios. Explore the trend of fetal cardiac structure and function in normal second and third trimester. The thickness of the fetal ventricular wall and interventricular septum at end-systole and end-diastole are in positive correlation with gestational age (P < 0.001). Ventricular internal diameter at end-systole and end-diastole are also in positive correlation with gestational age (P < 0.001). But left and right ventricular shortening fraction are in negative correlation with gestational age (P < 0.001). Ea, Aa, Ea/Aa and Sa of atrioventricular annulus are in positive correlation with gestational age. (P < 0.001). In normal second and third trimester, the thicknesses of the fetal ventricular wall and interventricular septum, and ventricular internal diameters at end-systole and end-diastole were increased with advancing gestation; the ventricular shortening fractions were decreased with advancing gestation; the Ea, Aa, Ea/Aa and Sa of atrioventricular annuluses were increased with advancing gestation. Fetal cardiac structure and function gradually become mature with the progress of pregnancy. STIC and TDI have certain value to detect fetal cardiac structure and function. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Evaluation of right ventricular volume and systolic function in normal fetuses using intelligent spatiotemporal image correlation.

BACKGROUNDHeart defects are the most common congenital malformations in fetuses. Fetal cardiac structure and function abnormalities lead to changes in ventricular volume. As ventricular volume is an important index for evaluating fetal cardiovascular development, an effective and reliable method for measuring fetal ventricular volume and cardiac function is necessary for accurate ultrasonic diagnosis and effective clinical treatment. The new intelligent spatiotemporal image correlation (iSTIC) technology acquires high-resolution volumetric images. In this study, the iSTIC technique was used to measure right ventricular volume and to evaluate right ventricular systolic function to provide a more accurate and convenient evaluation of fetal heart function.AIMTo investigate the value of iSTIC in evaluating right ventricular volume and systolic function in normal fetuses.METHODSBetween October 2014 and September 2015, a total of 123 pregnant women received prenatal ultrasound examinations in our hospital. iSTIC technology was used to acquire the entire fetal cardiac volume with off-line analysis using QLAB software. Cardiac systolic and diastolic phases were defined by opening of the atrioventricular valve and the subsequent closure of the atrioventricular valve. The volumetric data of the two phases were measured by manual tracking and summation of multiple slices and recording of the right ventricular end-systolic volume and the right ventricular end-diastolic volume. The data were used to calculate the right stroke volume, the right cardiac output, and the right ejection fraction. The correlations of changes between the above-mentioned indices and gestational age were analyzed. The right ventricular volumes of 30 randomly selected cases were measured twice by the same sonographer, and the intra-observer agreement measurements were calculated.RESULTSAmong the 123 normal fetuses, the mean right ventricular end-diastolic volume increased from 0.99 ± 0.34 mL at 22 wk gestation to 3.69 ± 0.36 mL at 35+6 wk gestation. The mean right ventricular end-systolic volume increased from 0.43 ± 0.18 mL at 22 wk gestation to 1.36 ± 0.22 mL at 35+6 wk gestation. The mean right stroke volume increased from 0.62 ± 0.29 mL at 22 wk gestation to 2.33 ± 0.18 mL at 35+6 wk gestation. The mean right cardiac output increased from 92.23 ± 40.67 mL/min at 22 wk gestation to 335.83 ± 32.75 mL/min at 35+6 wk gestation. Right ventricular end-diastolic volume, right ventricular end-systolic volume, right stroke volume, and right cardiac output all increased with gestational age and the correlations were linear (P < 0.01). Right ejection fraction had no apparent correlation with gestational age (P > 0.05).CONCLUSIONFetal right ventricular volume can be quantitatively measured using iSTIC technology with relative ease and high repeatability. iSTIC technology is expected to provide a new method for clinical evaluation of fetal cardiac function.

Fetal cardiac remodeling and dysfunction is associated with both preeclampsia and fetal growth restriction

Preeclampsia and fetal growth restriction share some pathophysiologic features and are both associated with placental insufficiency. Fetal cardiac remodeling has been described extensively in fetal growth restriction, whereas little is known about preeclampsia with a normally grown fetus. To describe fetal cardiac structure and function in pregnancies complicated by preeclampsia and/or fetal growth restriction as compared with uncomplicated pregnancies. This was a prospective, observational study including pregnancies complicated by normotensive fetal growth restriction (n=36), preeclampsia with a normally grown fetus (n=35), preeclampsia with fetal growth restriction (preeclampsia with a normally grown fetus-fetal growth restriction, n=42), and 111 uncomplicated pregnancies matched by gestational age at ultrasound. Fetal echocardiography was performed at diagnosis for cases and recruitment for uncomplicated pregnancies. Cord blood concentrations of B-type natriuretic peptide and troponin I were measured at delivery. Univariate and multiple regression analysis were conducted. Pregnancies complicated by preeclampsia and/or fetal growth restriction showed similar patterns of fetal cardiac remodeling with larger hearts (cardiothoracic ratio, median [interquartile range]: uncomplicated pregnancies 0.27 [0.23-0.29], fetal growth restriction 0.31 [0.26-0.34], preeclampsia with a normally grown fetus 0.31 [0.29-0.33), and preeclampsia with fetal growth restriction 0.28 [0.26-0.33]; P<.001) and more spherical right ventricles (right ventricular sphericity index: uncomplicated pregnancies 1.42 [1.25-1.72], fetal growth restriction 1.29 [1.22-1.72], preeclampsia with a normally grown fetus 1.30 [1.33-1.51], and preeclampsia with fetal growth restriction 1.35 [1.27-1.46]; P=.04) and hypertrophic ventricles (relative wall thickness: uncomplicated pregnancies 0.55 [0.48-0.61], fetal growth restriction 0.67 [0.58-0.8], preeclampsia with a normally grown fetus 0.68 [0.61-0.76], and preeclampsia with fetal growth restriction 0.66 [0.58-0.77]; P<.001). Signs of myocardial dysfunction also were observed, with increased myocardial performance index (uncomplicated pregnancies 0.78 z scores [0.32-1.41], fetal growth restriction 1.48 [0.97-2.08], preeclampsia with a normally grown fetus 1.15 [0.75-2.17], and preeclampsia with fetal growth restriction 0.45 [0.54-1.94]; P<.001) and greater cord blood B-type natriuretic peptide (uncomplicated pregnancies 14.2 [8.4-30.9] pg/mL, fetal growth restriction 20.8 [13.1-33.5] pg/mL, preeclampsia with a normally grown fetus 31.8 [16.4-45.8] pg/mL and preeclampsia with fetal growth restriction 37.9 [15.7-105.4] pg/mL; P<.001) and troponin I as compared with uncomplicated pregnancies. Fetuses of preeclamptic mothers, independently of their growth patterns, presented cardiovascular remodeling and dysfunction in a similar fashion to what has been previously described for fetal growth restriction. Future research is warranted to better elucidatethe mechanism(s) underlying fetal cardiac adaptation in these conditions.

Intracardiac echogenic focus and its location: association with congenital heart defects

Purpose: Significance of intracardiac echogenic focus (ICEF) in the fetal heart remains controversial. We aimed to investigate whether the location of ICEF is associated with fetal cardiac structure defects (CSDs) in low-risk pregnant women.Materials and Methods: A retrospective cohort study was conducted. Singleton pregnancies with normal values of triple fetal serum markers were included. 758 of 9782 fetuses with ICEF were reviewed for involvement of three ICEF locations (left, right, and bilateral ventricles (BVs)) in CSDs. χ2 or Fisher’s exact test was performed for statistical analysis.Results: ICEF prevalence was 7.7% and its location was most frequently in the left ventricle (LV) (84.8%), followed by the BV (11.6%) and the right ventricle (RV) (3.6%). No statistically significant difference was found between the ICEF location and maternal age (χ2 = 3.92, p-value = .1409). There were cardiac defects with an isolated echogenic focus in 24 of 758 fetuses (3.2%). Significant difference for CSDs was observed among groups of RV, LV, and BV (p-fisher = .0146).Conclusions: Significantly more CSDs cases were identified in fetuses with ICEF in RV. Further investigation is warranted to examine the histological characteristics of fetal echogenic focus in the RV.

Advances in fetal echocardiography: myocardial deformation analysis, cardiac MRI and three-dimensional printing.

Advances in ultrasound technology have led to new ways of evaluating cardiac function and structure, including myocardial deformation imaging (strain and strain rate), cardiac MRI and three-dimensional (3D) printing. As ultrasound technology has improved, it has become possible to use these modalities to evaluate the fetal heart. This article will review some of the more recent developments in applying these techniques to the evaluation of fetal cardiac structure and function. Myocardial deformation analyses have led to the establishment of normative values for strain and strain rate in the fetal heart and have also been used to evaluate fetal heart function in both fetal disease states and maternal disease states. Technological advances in MRI technology, 3D imaging and 3D printing have opened up new methods of evaluating fetal structural heart disease. A deeper understanding of the subtleties of myocardial dysfunction in various fetal and maternal disease states may elucidate the pathophysiology involved and lead to new treatment and/or counseling paradigms that may ultimately affect outcome. Similarly, the ability to image the fetal heart in new ways, including fetal MRI and 3D printing, could potentially change fetal counseling techniques and prenatal planning.

Z-scores for fetal atrial volume using real-time three-dimensional echocardiographic Xplane imaging in normal fetuses

Objective To establish Z-scores reference ranges for fetal atrial volume in normal fetuses for accurate assessment of fetal cardiac structure and function. Methods Two hundred ninty-three normal fetuses with gestational ages between 18 to 38 weeks were investigated.Biparietal diameter (BPD), femur length (FL) and gestational age (GA) were measured.Left atrial volume (LAV) and right atrial volume (RAV) were obtained using echocardiographic Xplane imaging. Subsequently, the optimal regression equation was established with BPD, FL and GA as the independent variable and LAV and RAV as the dependent variable, and then Z-scores of LAV and RAV were calculated. Results The linear regression equation of LAV and FL was Y=0.056×FL-1.791 (r=0.952); the linear regression equation of RAV and FL was Y=0.057×FL-1.833 (r=0.942); the linear regression equation of LAV and BPD was Y=0.046×BPD-2.289 (r=0.910); the linear regression equation of RAV and BPD was Y=0.047×BPD-2.348 (r=0.903); the linear regression equation of LAV and GA was Y=0.122×GA-2.403 (r=0.952); the linear regression equation of RAV and GA was Y=0.125×GA-2.456 (r=0.942). There was significant heteroscedasticity of standard deviation (SD) with increasing independent variables, then weighted regression of absolute residuals was used in order to minimize the effect of heteroscedasticity, and the linear regression equation was established. The linear regression equation of LAV-SD and FL was Y=0.005×FL-0.119 (r=0.272); the linear regression equation of RAV-SD and FL was Y=0.005×FL-0.104 (r=0.240); the linear regression equation of LAV-SD and BPD was Y=0.00375×BPD-0.125 (r=0.210); the linear regression equation of RAV-SD and BPD was Y=0.00375×BPD-0.10875 (r=0.192); the linear regression equation of LAV-SD and GA is Y=0.0125×GA-0.21125 (r=0.346); the linear regression equation of RAV-SD and GA was Y=0.0125×GA-0.20875 (r=0.308). According to these equations, the Z-score calculation formula for LAV was (measured LAV-predicted LAV from BPD, FL and GA)/SD of predicted LAV; Z-score calculation formula for RAV was (measured RAV-predicted RAV from BPD, FL and GA)/SD of predicted RAV. Conclusions Fetal Z-scores references for the LAV and RAV can be established using common fetal biometrical parameters (including FL, BPD and GA utilizing statistical methods based on a large sample size). This enhances accurate assessment of growth and development of fetal cardiac structures, and provides novel insights for the determination of fetal atrial volume in fetuses with congenital heart disease. Key words: Echocardiography; Left atrial volume; Right atrial volume; Z-score; Xplane

Preserving the border and curvature of fetal heart chambers through TDyWT perspective geometry wrap segmentation

Congenital heart defect leads to the structural abnormality in neonatal. Congenital heart defect (CHD) is the major cause for 20% perinatal mortality and 50% infant mortality. However, the fetal cardiac screening plays a vital role to diagnose the CHD during second –trimester. Evaluation of fetal cardiac chamber structure is difficult due to small in size and movement. Four-chamber view has become the first and foremost view of echocardiography to detect structural malformations in the fetal heart. Furthermore, trained obstetricians, Pediatric cardiologists, maternal-fetal medicine specialists, and radiologists need proper knowledge and skills to identify the chamber structure from echocardiography. In addition, the effective diagnosis of fetal heart four-chamber view consumes more time and needs extremely skilled radiologists owing to their low quality, small signal to noise ratio and rapid movement of fetal heart ultrasound images. Thus, the diagnosis of CHD is the most challenging task. In this paper, we propose the Transverse Dyadic Wavelet Transform (TDyWT) algorithm to preserve the border and curvature of four chambers from 18 to 22 weeks ultrasound fetal heart image. We validate the proposed TDyWT algorithm with normal and abnormal images from Mediscan radiological centre. The performance of the TDyWT algorithm analyses qualitatively and quantitatively to prove border and curvature of the chambers is superior to other conventional methods.

P22.06: HDliveFlow with spatiotemporal image correlation for diagnosing congenital heart diseases

To present our experiences of using HDliveFlow and/or HDliveFlow silhouette mode with spatiotemporal image correlation (STIC) to reconstruct normal and abnormal fetal cardiac structures, and to assess detection rates of these techniques for the three-vessel, and panoramic views in normal fetuses. 61 normal fetuses and three fetuses with congenital heart anomalies [transposition of great arteries (TGA), hypoplastic left heart syndrome (HLHS), and pulmonary valve stenosis (PS)] at 18-34 weeks were included. Detection rates of spatial three-vessel and panoramic views in normal fetuses were evaluated. In spatial three-vessel view, relationships and course of the outflow tracts and superior vena cava were clearly identified. The panoramic view facilitated visualisation of the course and relationships of out- and inflow tracts. Spatial relationships between cardiac chamber and vessels were clearly understood. Detection rate of spatial three-vessel view was 90.2%, for panoramic view was 75.4%. In TGA fetus, spatial parallel arrangement of aorta originating from the right ventricle and pulmonary artery left from left ventricle was clearly identified. In HLHS, extremely small aorta and tear-drop-like heart were depicted. In PS, a markedly large main pulmonary artery due to poststenotic dilatation was evident. HDliveFLow and HDliveFlow silhouette mode with STIC provide novel visual experience for operators due to clear visualisation of fetal cardiac structure. They may provide easier way of demonstration of spatial relationship among fetal cardiac chambers, great arteries, veins and the difference in the size of great vessels. These techniques might become important diagnostic modalities for assessment of fetal congenital heart disease.

OP26.10: Assessment of fetal cardiac function and structure in monochorionic diamniotic twins with Twin–twin transfusion syndrome before and after fetal therapy

OP26.10: Assessment of fetal cardiac function and structure in monochorionic diamniotic twins with Twin–twin transfusion syndrome before and after fetal therapy

P19.12: Ultrasonic screening of fetal cardiac structure in the first trimester

To explore the feasibility and clinical significance of ultrasonic screening of fetal cardiac structure at 11-13+6 weeks gestation. Transabdominal ultrasonography was used for two-dimensional (2D) imaging combined with colour Doppler. Fetal heart screening was performed in 156 pregnant women (156 fetuses) between 11 and 13+6 weeks gestation in our hospital from February to December in 2016 when they underwent nuchal translucency (NT) screening. We analysed the frequencies that adequate views of specific cardiac structures were obtained (display rates). All of the patients had follow up fetal echocardiograms in the second trimester. The display rates of cardiac structures in 156 fetuses were as follows: four-chamber view (4C) 95.5% (149/156), left ventricular outflow tract (LVOT) 78.2% (122/156), right ventricular outflow tract (RVOT) 79.4% (124/156), three vessel view (3V) 58.9% (92/156), aortic arch (AA) 72.4% (113/156), ductus arteriosus (DA) 60.2% (94/156), superior vena cava/inferior vena cava (SVC/IVC) 82% (128/156). The display rates for fetuses at 11-11+6 weeks (16 cases) were 4C 81.2% (13/16), SVC/IVC 50% (8/16), while those of LVOT, RVOT, 3V, AA and DA were all below 50%. The rates of the fetuses at 12-12+6 weeks(100 cases) were 4C 96% (96/100), RVOT 84% (84/100), LVOT 83% (83/100), AA 74% (74/100), DA 61% (61/100), SVC/IVC 86% (86/100), 3V 54% (54/100). In fetuses at 13-13+6 weeks (40 cases), the rates were 4C 100% (40/40), LVOT 82.5% (33/40), RVOT 82.5% (33/40), AA 85% (34/40), DA 70% (28/40), 3V 77.5% (31/40), SVC/IVC 85% (34/40). Three fetuses with cardiac defects were identified in the first trimester. They were Tetralogy of Fallot, pulmonary stenosis, and ventricular septal defect. All of them were confirmed in the second trimester. The display rates of fetal cardiac structures at 12-13+6 weeks are significantly higher than fetuses at 11-11+6 weeks, especially the LVOT and the RVOT. It is feasible to screen for severe cardiac malformations with ultrasound in the first trimester.

Sexual dimorphism in the fetal cardiac response to maternal nutrient restriction

Poor maternal nutrition causes intrauterine growth restriction (IUGR); however, its effects on fetal cardiac development are unclear. We have developed a baboon model of moderate maternal undernutrition, leading to IUGR. We hypothesized that the IUGR affects fetal cardiac structure and metabolism. Six control pregnant baboons ate ad-libitum (CTRL)) or 70% CTRL from 0.16 of gestation (G). Fetuses were euthanized at C-section at 0.9G under general anesthesia. Male but not female IUGR fetuses showed left ventricular fibrosis inversely correlated with birth weight. Expression of extracellular matrix protein TSP-1 was increased (p<0.05) in male IUGR. Expression of cardiac fibrotic markers TGFβ, SMAD3 and ALK-1 were downregulated in male IUGRs with no difference in females. Autophagy was present in male IUGR evidenced by upregulation of ATG7 expression and lipidation LC3B. Global miRNA expression profiling revealed 56 annotated and novel cardiac miRNAs exclusively dysregulated in female IUGR, and 38 cardiac miRNAs were exclusively dysregulated in males (p<0.05). Fifteen (CTRL) and 23 (IUGR) miRNAs, were differentially expressed between males and females (p<0.05) suggesting sexual dimorphism, which can be at least partially explained by differential expression of upstream transcription factors (e.g. HNF4α, and NFκB p50). Lipidomics analysis of fetal cardiac tissue exhibited a net increase in diacylglycerol and plasmalogens and a decrease in triglycerides and phosphatidylcholines. In summary, IUGR resulting from decreased maternal nutrition is associated with sex-dependent dysregulations in cardiac structure, miRNA expression, and lipid metabolism. If these changes persist postnatally, they may program offspring for higher later life cardiac risk.

Predictive Models for Normal Fetal Cardiac Structures

Clinicians rely on age- and size-specific measures of cardiac structures to diagnose cardiac disease. No universally accepted normative data exist for fetal cardiac structures, and most fetal cardiac centers do not use the same standards. The aim of this study was to derive predictive models for Z scores for 13 commonly evaluated fetal cardiac structures using a large heterogeneous population of fetuses without structural cardiac defects. The study used archived normal fetal echocardiograms in representative fetuses aged 12 to 39weeks. Thirteen cardiac dimensions were remeasured by a blinded echocardiographer from digitally stored clips. Studies with inadequate imaging views were excluded. Regression models were developed to relate each dimension to estimated gestational age (EGA) by dates, biparietal diameter, femur length, and estimated fetal weight by the Hadlock formula. Dimension outcomes were transformed (e.g., using the logarithm or square root) as necessary to meet the normality assumption. Higher order terms, quadratic or cubic, were added as needed to improve model fit. Information criteria and adjusted R2 values were used to guide final model selection. Each Z-score equation is based on measurements derived from 296 to 414 unique fetuses. EGA yielded the best predictive model for the majority of dimensions; adjusted R2 values ranged from 0.72 to 0.893. However, each of the other highly correlated (r>0.94) biometric parameters was an acceptable surrogate for EGA. In most cases, the best fitting model included squared and cubic terms to introduce curvilinearity. For each dimension, models based on EGA provided the best fit for determining normal measurements of fetal cardiac structures. Nevertheless, other biometric parameters, including femur length, biparietal diameter, and estimated fetal weight provided results that were nearly as good. Comprehensive Z-score results are available on the basis of highly predictive models derived from gestational age or other biometrics as preferable for clinical reasons. These results supplant current equations and will provide a foundation for future multicenter collaborations.

Fetal echocardiography: reference values for the Chinese population

Global racial variability in human development can lead to differences in size of fetal cardiac structures during gestation. Our objective is to establish normal reference ranges of fetal cardiac dimensions between 20 and 34 weeks from fetal echocardiograms recorded at a single center in China. A prospective cross-sectional study was undertaken on single pregnancies with normal fetuses of varying gestational ages (GAs). A total of 4396 normal fetuses were divided into 15 groups from 20 to 34 weeks according to the GA. Measurements included the inner diameter of the fetal cardiac chambers and arteries, the aortic arch isthmus (AI), the descending aorta (DAO), the ductus arteriosus (DA), and the foramen ovale (FO). Measurements were statistically analyzed and regression analysis was applied to assess for correlation with GA. Normal reference values of fetal cardiovascular dimensions between 20 and 34 weeks were obtained from 4396 subjects at a single center in China. Measurements of fetal cardiac structures increase with advancing GA. It seems there is no difference in r values among linear, cubic, and quadratic model analyses (P > 0.05). However, the r values for the exponential models appear to be smaller than those of the other three models (P < 0.05). Ratios of the diameters of fetal cardiac structures were calculated in order to identify for differential changes in the growth of structures. The presented data derived from 4396 normal fetuses provide the reference values of fetal echocardiography in China, which provide guidance to fetal echocardiography examinations.