Fetal Cardiovascular Anomalies Research Articles

Fetal pulmonary hemodynamics: Doppler reference values in low risk pregnancies

Objective To investigate fetal pulmonary hemodynamics in normal pregnancy using pulsed and color Doppler ultrasonography and to define Doppler reference ranges values in the whole fetal pulmonary circulation during different gestational ages. Materials and methods A prospective observational study was conducted to evaluate 190 healthy singleton pregnancies between 20 and 38 weeks of gestation, including 10 cases for each gestational age. The main pulmonary artery, right pulmonary artery, left pulmonary artery, ductus arteriosus and pulmonary veins waveforms were evaluated. The waveform profile was studied for each pulmonary vessel investigated. We calculated the normal distribution of data of 12 Doppler parameters, their values were expressed as 5th, 25th, 50th, 75th and 95th centile. Results We report several pulmonary hemodynamic changes with the progression of pregnancy. We focused on the hemodynamic values of the parameters most useful in clinical practice and that would better describe the hemodynamic events of this vascular district. Conclusion This study reports a complete description of the fetal pulmonary hemodynamics at different gestational ages. Many hemodynamic parameters show a typical change during gestation. The reference ranges described in this study may help in situations where is indicated to evaluate the pulmonary hemodynamics and to identify healthy fetuses from those affected by pathological conditions related mainly to fetal cardiovascular anomalies and/or feto-maternal pathologic conditions.

Effectiveness of fetal ultrasound diagnostics in cardiac malformations and association with polyhydramnios and oligohydramnios.

Examine the effectiveness of prenatal ultrasound diagnostics in the detection of cardiovascular malformations, and their association with polyhydramnios and oligohydramnios. We examined the fetal ultrasonography and postnatal clinical/fetopathological data of 372 newborns/fetuses over a 7-year period in a tertiary centre. Fetal echocardiography was performed in cases of suspected US findings between 18-32 weeks. During the ultrasound the amniotic fluid amount was measured and the amniotic fluid index (AFI) or largest amniotic fluid pocket was determined. Prenatal ultrasonographic results and postnatal/fetopathological diagnosis were fully congruent in 236/372 cases (63.4%), and in 66/372 cases of cardiovascular anomalies (17.7%) the discovery was partial, while in 70/372 cases no fetal cardiovascular anomalies were diagnosed during pregnancy (18.8%) (false negative). Cardiovascular malformations were isolated in 255 cases, in 172 of which (67.5%) the results of prenatal ultrasonography and postnatal diagnostics were fully congruent. In 43 cases (16.9%) the prenatal discovery was partial, and in 40 cases (15.7%) there was no prenatal recognition of the malformation. Cardiovascular abnormalities were found as a part of multiple malformations in 76 cases. In 41 fetuses the cardiovascular malformation was associated with chromosomal abnormalities. Cardiovascular malformations were significantly associated with polyhydramnios. Although in some of the cardiovascular malformations the association rate with polyhydramnios was high (AVSD, double outlet right ventricle, tetralogy of Fallot), we found a moderate association rate (19.7%). The association with oligohydramnios was 8.57%. Echocardiography plays an important role in the prenatal diagnostics. In cases of polyhydramnios and oligohydramnios, fetal echocardiography should be performed.

VP17.11: The value of four‐chamber view with three‐vessel trachea view in ultrasonic screening for fetal cardiovascular anomalies in first trimester pregnancy

VP17.11: The value of four‐chamber view with three‐vessel trachea view in ultrasonic screening for fetal cardiovascular anomalies in first trimester pregnancy

EP04.02: Clinical application of CASSEAL (fetal cardiovascular system sonographic evaluation algorithm) for the diagnosis of fetal cardiovascular anomalies

To evaluate the diagnostic capability of CASSEAL in the ultrasound detection of congenital cardiovascular anomalies in the second trimester of pregnancy. CASSEAL is an algorithm for exploring the fetal super extended cardiovascular system and it is based on the acquisition of 9 different axial views, from the umbilical vein to the subclavian arteries. CASSEAL was applied in a cross-sectional study on singleton/multiple gestations from 19–22 weeks attending our unit for routine US examination along a 6 months period. When a fetal cardiovascular anomaly was detected, the affected views were registered. Pathological cases were followed-up until birth to confirm the findings. Sensitivity and specificity of CASSEAL were estimated. A total of 174 women and 198 fetuses were assessed using CASSEAL. Mean gestational age was 20 (±0.6) weeks. In 9 (4.5%) cases a cardiovascular anomaly was found, with 2 cases (1%) showing mayor defects (table 1). All cases were confirmed after birth and there was 1 false negative case detected at 35 weeks of gestation. Sensitivity and specificity were 90% and 100%, respectively. CASSEAL may be a useful algorithm for the prenatal diagnosis of fetal cardiovascular anomalies. It allows detection of mayor anomalies as well as minor anomalies or anatomical variants which could be associated to cardiac defects and syndromes.

Fetal Magnetic Resonance Imaging for the Prenatal Assessment of the Extended Cardiovascular System by CASSEAL (Cardiovascular System Sonographic Evaluation Algorithm)

Purpose: To compare axial view images obtained with fetal ultrasound (US) and magnetic resonance imaging (MRI) when applying the Cardiovascular System Sonographic Evaluation Algorithm (CASSEAL). Materials and method: CASSEAL is an US algorithm consisting on the acquisition of 9 different axial views of the fetal abdomen and chest, from the umbilical vein to the subclavian arteries. It was designed for a thorough US assessment of the extended fetal cardiovascular system. Feasibility and reproducibility of CASSEAL have already been proven; however, its application in fetal MRI has yet to be established. A fetal MRI was performed to a 25 week-old fetus with ventriculomegaly (11 mm) in order to obtain the 9 axial views required by CASSEAL. Subsequently, a comparison between both imaging techniques was performed for each view. Results: The comparison of the images obtained with these two imaging techniques showed a good correlation in the identification of cardiovascular anatomical structures. Conclusion: CASSEAL US axial views can be obtained in fetal MRI and correlation between the 2 techniques is good. This finding suggests that MRI may be a useful complement to US in the assessment of fetal cardiovascular anomalies using the same views by which sonographers assess fetal cardiovascular structures.

Fetal congenital deformity resulting from ambient inhalable particulate matters: a case-control study

Objective To investigate the relationship between maternal exposure to airborne inhalable particulate matters (PM10) in the first trimester of pregnancy and the risk of fetal congenital deformity.Methods Relationship between exposure to airborne PM10 during the 1st,2nd,3rd and 1-3 months of gestation and the risk of fetal anomalies in 203 pregnant women with deformed fetuses,which paralleled to normal pregnant women with discrepancy of conception date ＜30 days (control),were retrospectively analyzed by a case-control study from May 14,2007 to April 30,2012 in Fujian Medical University and Fuzhou General Hospital.Multivariate Logistic regression adjusted for potential confounders including maternal age,gravidity and parity was performed for data analysis.Results According to the inclusion and exclusion criteria,178 pregnant women with deformed fetuses and 356 controlled cases were enrolled.The average levels of PM10 exposed in pregnant women Withfetal cardiovascular anomalies during 1-3 months of gestation were significantly higher than in the controls [(73.80±11.55) μg/m3 vs (70.49±10.83) μg/m3] (t=2.066,P=0.040),but PM10 exposure in the 1st,2nd and the 3rd month of pregnancy were comparable between the observed and control groups [(74.00±17.34) μg/m3 vs (71.70±15.39) μg/m3,t=0.992,P=0.322;(75.15±16.80) μg/m3 vs (71.38±15.66) μg/m3,t=1.625,P=0.106; (70.28±15.84) μg/m3 vs (69.41± 15.84) μg/m3,t=0.383,P=0.702].There were no significant differences of PM10 exposure levels when compared between facial-cervical anomalies,neurologic anomalies and total anomalies and their corresponding controls (P＞0.05).Each increased quartile of the PM10 exposure levels was associated with an elevated risk of fetal cardiovascular anomalies by 1.218 folds (OR =2.218,95 ％ CI:1.232-3.994,P=0.008).Paired multivariate Logistic regression analysis revealed,a positive correlation between PM10 levels at 1-3 months of gestation and fetal cardiovascular anomalies (OR =1.106,95％CI:1.035-1.183,P =0.003).Conclusions Maternal exposure to PM10 in the first trimester of pregnancy possibly exerts negative effects on fetal cardiovascular anomalies. Key words: Pregnancy; Particulate matter; Air pollutants; Fetus; Congenital abnormalities; Case-control studies

Preliminary experience with cardiovascular magnetic resonance in evaluation of fetal cardiovascular anomalies.

BackgroundThe cardiovascular system is the part of the fetal anatomy that most frequently suffers from congenital pathology. This study shows our preliminary experience with fetal cardiovascular magnetic resonance (CMR) to evaluate congenital cardiovascular abnormalities.MethodsBetween January 2006 and June 2011, Prenatal routine obstetric ultrasound (US), echocardiography and CMR data from 68 pregnant women carrying fetuses with congenital cardiovascular anomalies were compared with postnatal diagnoses (postnatal imagings, surgery and autopsy). All prenatal CMR was performed at 1.5 T. Imaging sequences included steady-state free-precession (SSFP) sequences, real-time SSFP and single-shot turbo spin echo (SSTSE) sequences. The images were analyzed with an anatomic segmental approach by two radiologists.ResultsFetal CMR yielded the same diagnosis as postnatal findings in 79% (54/68) of patients. The diagnostic sensitivity of routine obstetric US for cardiac anomalies was 46% (31/68). The diagnostic sensitivity of fetal echocardiographic examination by a fetal cardiac specialist was 82% (56/68). In 2 (3%) of 68 cases, diagnoses with both echocardiography and CMR were incorrect when compared with postnatal diagnosis. In ten (15%) cases, diagnosis at echocardiography was incorrect and that at CMR was correct. In twelve (18%) cases, diagnosis at echocardiography was correct and that at CMR was incorrect. Ten cases missed or misdiagnosed by echocardiography but correctly diagnosed by fetal CMR included asplenia syndrome (n = 2), interrupted inferior vena cava of polysplenia syndrome (n = 1), tricuspid incompetence (n = 1), double outlet right ventricle (n = 2), double aortic arch (n = 1), right pulmonary artery hypoplasia (n = 1), right-sided aortic arch of tetralogy of Fallot (n = 1) and hypoplastic left heart syndrome of a twin fetus (n = 1).ConclusionFetal CMR is a promising diagnostic tool for assessment of congenital cardiovascular abnormalities, especially in situations that limit echocardiography.

3D ultrasound and Doppler angiography for evaluation of fetal cardiovascular anomalies

ObjectiveTo highlight the value of 3D ultrasound in the prenatal assessment of fetal cardiovascular anomalies through offline diagnosis and/or second opinion (e.g. via internet link). MethodsA retrospective offline analysis of volume datasets of fetuses diagnosed with cardiovascular anomalies by 2D ultrasound was conducted. ResultsThirty-three fetuses with 38 cardiac malformations were evaluated. Mean gestational age at diagnosis was 26weeks (range, 20–34weeks). Isolated cardiovascular malformations were detected in 23 fetuses. Extracardiac abnormalities were identified in 8 fetuses, of which 2 had trisomy 21 and 1 had trisomy 18. One fetus exhibited 22q11 microdeletion. Ten pregnancy terminations were performed. ConclusionOffline analysis of cardiovascular anomalies conferred significant diagnostic advantages over 2D ultrasound. 3D ultrasound is invaluable for the prenatal diagnosis and management of congenital heart diseases. It may be used to facilitate scientific cooperation between high- and low-income countries.

Developmental effects of trichloroacetonitrile administered in corn oil to pregnant Long-Evans rats.

Trichloroacetonitrile (TCAN) is a by-product of the chlorine disinfection of water containing natural organic material. When administered by gavage to pregnant Long-Evans rats in a medium-chain triglyceride vehicle, tricaprylin oil (Tricap), at a volume of 10 ml/kg, TCAN induced fetal cardiovascular anomalies at doses as low as 1 mg/kg/d (Smith et al., 1988). A slight but possibly biologically significant increase over the water control group in adverse pregnancy outcomes (resorptions, reduced fetal weight, and anomalies) was observed in the Tricap control group. This led us to reexamine the development effects of TCAN in a second vehicle, corn oil (CO). Five groups of approximately 20 pregnant female rats received TCAN in CO at 15, 35, 55, and 75 mg/kg/d, and in Tricap at 15 mg/kg/d (10 ml/kg dosing volume). Corn oil, Tricap, and water served as vehicle controls. Animals were treated by oral intubation on gestation d 6-18 (vaginal plug = d 0). Five out of 20 dams (75 mg/kg) died during treatment. Adjusted maternal weight gain was lower in females receiving 35 mg/kg TCAN or greater. The mean percent of nonlive implants per litter was elevated at 55 and 75 mg/kg TCAN (CO). The TCAN dose-response curve for fetal (but not maternal) effects was shifted to the right when CO was compared to Tricap. Fetal weight was reduced at 15 mg/kg TCAN (Tricap) and at > or = 55 mg/kg TCAN (CO). When TCAN was administered in CO, the mean frequency of soft-tissue malformations decreased with significantly fewer septal and great vessel cardiovascular defects observed. We hypothesize that the volatile haloacetonitrile, TCAN, may interact with the Tricap vehicle in such a way that effects on the developing cardiovascular system are potentiated. The lowest observed adverse effect level for TCAN (CO) was determined to be 35 kg/kg.

Diagnoses and prognoses of fetal cardiovascular anomalies in utero, assessed echocardiographically.

AbstractThis echocardiographic study was designed to determine the accuracy of prenatal diagnoses of fetuses with cardiac anomalies and also to evaluate the manner in which various types of disorders affect the prognoses in utero. In 13 fetuses studied, the following cardiac anomalies were present: ventricular septal defect (VSD), atrial septal defect (ASD), atrio‐ventricular septal defect (AVSD), double outlet of the right ventricle, hypoplastic right (HPRV) and left (HPLV) ventricles, Ebstein's anomaly, endocardial fibroelastosis (EFE), transposition of the great arteries, coarctation of the aorta and cardiac tumor.These were categorized by the minimum unit of cardiovascular anomalies. According to this criteria, the correct, false positive, false negative, and misinterpretations were estimated to be 71.4, 4.8, 14.3 and 9.5%, respectively. After division of correctly diagnosed cases into 2 groups, 86.7% of heart anomalies and 50.0% of those of great vessels were found to be accurately diagnosed.Fetal prognoses with cardiovascular anomalies were classified into 3 groups: cardiac failure, intrauterine growth retardation and no sequelae.The first group was representative of EFE and HPRV, the second group, representative of hypoplastic ventricle and deffective heart diseases complicated by chromosome anomalies or other major malformations. The third group included all anomalies but with no sequelae in utero.