Fetal Echo Research Articles

OC18.07: Fetal echo and cardiovascular profile score (CVS) as a prognostic risk factor in fetal sacrococcygeal teratoma (SCT)

OC18.07: Fetal echo and cardiovascular profile score (CVS) as a prognostic risk factor in fetal sacrococcygeal teratoma (SCT)

OC5.07: Comparison of 3D power Doppler ultrasound (3D‐PDU) versus 3D with Inversion mode rendering in 3D fetal echocardiography

3D-PDU is an established technique in the assessment of the fetal cardiovascular system. The new “inversion mode (IM) rendering” enables without the use of Doppler to “invert” the hypoechoic informations in the volume box to a solid-like structure. We aimed to compared the accuracy of both techniques in 3D fetal echocardiography. 25 normal fetuses and 15 fetuses with various cardiac anomalies were examined between 20–30 weeks with both techniques. Presets were adapted individually according to the visualization conditions. Volumes were acquired in 3D static or in STIC (off-line 4D) technique. (GE-Voluson 730 Expert System). The evaluation was performed on an using the 4D-View software. Basic image quality was better with gray scale with a high image frame rate (80–110 Hz), vs PDU with slow rate (12–32 Hz). Time for presets optimisation was shorter for gray-scale in comparison to PDU image. Although on normal and abnormal hearts both techniques were similar in visualizing the heart and great vessels, this was easier and more accurately achieved using IM. IM was furthermore superior in visualizing tiny cardiac vessels in malformations, especially in unfavourable position. Power Doppler was superior in the demonstration of very small vessels and flow not seen on 2D as e.g. pulmonary veins, aberrant aortic arch vessels, muscular VSD or tricuspid regurgitation. Limitation of PDU was the overlapping of flow information, whereas the limitation of IM were the artefacts caused from shadowing (ribs, spine). The relationship to other thoracic structures was only possible in 3D-PDU glass body mode. 3D-IM technique is an easy accessible tool in 3D fetal echo. In regions with tiny vessels or in cases with hemodynamic events, power Doppler can be a complementary technique. The difficult preset optimisation and the low frame rates are still the main limitations of 3D-PDU.

Cardiac Function Assessment in Patients with Family History of Nonhypertrophic Cardiomyopathy: A Prenatal and Postnatal Study

Nonobstructive cardiomyopathies (CMs) may be familial in 20â<euro>"55% of cases. Little is known about the role of fetal echocardiography in such cases. We evaluated the cardiac function serially pre- and postnatally in cases with a family history of nonobstructive CM. The fetal and postnatal studies were performed in the echocardiogarphy laboratory at a tertiary institution. Twenty-six cases from 16 families with a family history of CM were studied. Three fetal echocardiograms were performed at or near 18, 25, and 32 weeks of gestation for complete cardiac functional assessment. Postnatally clinical evaluation, electrocardiogram, and an echocardiogram were performed within the first 3 months, with serial reevaluation for those identified with CM. The mean follow-up was 46 +/- 9 months. Abnormal cardiac function was observed in 8 cases (30%). Six had a previously affected sibling, 1 had other family members affected, and 1 had both antecedents. Four had dilated CM diagnosed prenatally of which 1 recovered, 2 died in utero, and 1 died soon after birth. The remaining 4 had normal fetal echoes and were diagnosed with CM in the first 3 months of life. Three had dilated CM with recovery, and 1 had restrictive CM requiring cardiac transplantation. This study demonstrates a high familial recurrence rate of CM. Fetal echo is useful for early diagnosis, although a normal study does not preclude ventricular dysfunction at a later stage, justifying serial prenatal and postnatal evaluation. Early identification may expedite listing for transplantation.

Second trimester ductus venosus measurements as a predictor of adverse perinatal outcome in congenital heart disease

PERINATAL OUTCOME IN CONGENITAL HEART DISEASE KATHERINE BIANCO, MARIA SMALL, NICOLE BROWNE, SVENA JULIEN, TRACE KERSHAW, MICA MICHON, JOSHUA COPEL, University of California, San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California, Yale University, OB/ GYN, New Haven, Connecticut, Yale University, Department of Obstetrics and Gynecology, New Haven, Connecticut, Yale University, Obstetrics and Gynecology, NewHaven, Connecticut, YaleUniversity, School of PublicHealth, New Haven, Connecticut, Yale University, Obstetrics & Gynecology, New Haven, Connecticut OBJECTIVE: To determine whether doppler velocimetry of the ductus venosus (DV) predicts adverse perinatal outcome in congenital heart disease (CHD). STUDY DESIGN: We conducted a retrospective cohort study of all women undergoing fetal echo for CHD, in a single perinatal center during a 2-year period. We compared outcomes for fetuses diagnosed with CHD in the midtrimester and abnormal DV Doppler velocimetry to those with CHD and normal DV Doppler. Karyotype, gestational age at delivery and rate of termination were assessed. The referral value for abnormal DV pulsatility index (PI) was >95th percentile for gestational age. Statistical analysis included t-test, Fischer’s exact test or Chi square tests. RESULTS: The incidence of CHD in our population was 8%. 98 patients had CHD, of those 31 had DV measurement. A total of 9 patients had abnormal DV. 33% (3/9) of this group had IUFD/perinatal death. In patients with CHD and normal DV measurements, 83% had living children vs. 33% in the group with abnormal DV; P ! .05. Aneuploidy was not more common in the abnormal DV group (15% aneuploidy in normal DV vs. 20% in abnormal DV; P ! .05). gestational age at delivery was similar, normal ductus mean gestational age 34.5 vs. abnormal ductus mean gestational age 31.66 P = .405. The rate of pregnancy termination was not different. Table. CONCLUSION: Abnormal second trimester ductus venosus measurements are predictive of adverse perinatal outcome in patients with CHD, independent of karyotype or gestational age at delivery. This information may have a role in the counseling of parents whith CHD.

Sensitivity and specificity of prenatal features of physiological shunts to predict neonatal clinical status in transposition of the great arteries.

Although prenatal diagnosis of transposition of the great arteries (TGA) reduces neonatal mortality, the preoperative course can be complicated in infants with a restrictive foramen ovale (FO) or a ductus arteriosus (DA) constriction. We sought to determine the specificity and sensitivity of prenatal features of physiological shunts in predicting postnatal clinical status in prenatally diagnosed TGA in babies delivered in a tertiary care center providing all facilities for neonatal urgent care. The outcomes of 130 fetuses with TGA were reviewed over a period of 5.5 years. Restriction of the FO and/or constriction of the DA could be analyzed in 119/130 fetuses at 36+/-2.7 weeks of gestation. Twenty-four out of 119 had at least 1 abnormal shunt (23 FO, 5 DA, and 4 both). Thirteen of 130 neonates had profound hypoxemia (PaO2<25 mm Hg) and metabolic acidosis (pH <7.15) in the first 30 minutes and required immediate balloon atrioseptostomy. Two who had abnormal FO and DA died despite aggressive resuscitation. The specificity and sensitivity of the fetal echo in predicting neonatal emergency were 84% and 54%, respectively. The specificity and sensitivity of a combination of restrictive FO and DA constriction were 100% and 31%, respectively. Restriction of the FO and/or of the DA has a high specificity to predict the need for emergency neonatal care in fetuses with TGA, but the sensitivity is too low to detect all high-risk fetuses. Exceptional procedures should be considered for fetuses that have a combination of restrictive FO and DA constriction.

OC043: Basal cardiac view on 3D/4D fetal echocardiography for the assessment of AV‐valves and great vessels arrangement

Objective: With 3D/4D fetal echocardiography new views can be demonstrated, which cannot be seen on 2D scan. The ‘‘basal cardiac (BC) view’’ is a en-face view to the atrioventricular valves (AV) showing at the same time a cross section of the embedded aorta and the anterior coursing pulmonary artery. In this study we evaluated the utility of this new plane in describing cardiac defects involving the AV-valves and/or the great arteries. Patients and methods: A Voluson 730 Expert system 3D/4D was used to acquire volume data set of fetal hearts in the second half of pregnancy. The examination was performed with following modes: 3D-static, gray scale and color Doppler STIC and live 4D. We included in this evaluation study volume data set from 20 normal and 25 fetuses with cardiac anomalies. Volumes were evaluated off-line on a work station (4D-view). Results: Volumes acquired from an apical four-chamber view offered the best possibility of ‘‘BC view’’ rendering. This view is easier demonstrated when Color or Power Doppler are combined with 3D/4D rendering. The BC-view was useful in cases with abnormal AV-valves (N = 11) and in cases with malpositions of the great vessels (N = 9). BC view was not reliably rendered in 5 abnormal hearts with a volume acquisition from a lateral view. Comments: The BC-view is a new view on 3D fetal echo simultaneously demonstrating both the AV and semilunar valves. It can be useful in cardiac defects affecting the valves and the arrangement of the great vessels. During volume acquisition the examiner should be aware about the post processing rendering in order to obtain optimal views.

The impact of abnormal fetal echocardiography on expectant parents’ experience of pregnancy: a pilot study

To examine the impact of an abnormal fetal echocardiogram (echo) on parental attitudes, emotions and coping strategies.Group interviews were performed for women and their male partners who had a fetal echo and were found to have a fetal congenital heart defect. The women and men were separated into four different focus groups. The interviews were tape recorded, transcribed and analyzed.The women expressed strong emotions of guilt, fear and sadness or hopelessness. They coped by attaching and bonding to the fetus, and were realistic about the future. The women began grieving at the time of the fetal echo. The men experienced emotions of anger and anxiety. They coped by remaining optimistic, and focused on supporting their wives. Men grieved after the birth of the baby. The fetal echo was felt to be beneficial and not harmful by the parents.The fetal echo led to significant changes in the couples’ perceptions of themselves and their relationships. Clinicians performing fetal imaging must be aware of parental affective responses and coping mechanisms in order to provide the required psychological support.

Fetal Echocardiographic Screening of Pregnancies of Mothers with Anti-Ro and/or Anti-La Antibodies

The objectives of this study are to assess the incidence of congenital complete heart block (CCHB) in pregnant women who are anti-Ro and/or La positive. Between January, 1988 and July 1997, 118 pregnancies in 105 women were assessed by fetal echo at 18, 24, and 32 weeks' gestation. Of these 105, 96 had no history of a previous fetus with CCHB; 11(12 pregnancies) a history of a pregnancy with CCHB; and 4 a previous child with cutaneous neonatal lupus erythematosus (CNLE). The 102 pregnancies in 96 women with anti-Ro and/or anti-La antibodies and no history of a previous child with NLB, resulted in 100 live-births with no CCHB. There was 1 dilated cardiomyopathy at 6 months, 1 child with CCHB, and 1 with sclerosis of the endocardium. No case of CCHB was observed in 102 pregnancies without a previous history of CCHB. These results suggest that the risks of CCHB, without a prior history are low.

Acquired right ventricular outflow tract obstruction in the recipient twin in twin-twin transfusion syndrome

OBJECTIVESThe goal of this study was to determine the prevalence and evolution of acquired right ventricular outflow tract obstruction (RVOTO) in the recipient twin in twin-twin transfusion syndrome (TTTS).BACKGROUNDTwin-twin transfusion syndrome complicates 4% to 26% of diamniotic monochorionic twin gestations and is associated with high fetal morbidity and mortality. Cardiac dysfunction and biventricular hypertrophy may develop in the recipient twin with the potential for RVOTO.METHODSThis was a retrospective review of a two-center experience of TTTS to describe the prevalence and evolution of acquired RVOTO in the recipient twin. Right ventricular outflow tract obstruction was diagnosed or excluded by fetal or postnatal echocardiography or clinical assessment.RESULTSOf 73 twin pregnancies with TTTS identified between 1994 to 1998, a total of seven (9.6%) were complicated by RVOTO in the recipient twin: two subvalvar/muscular, four valvar and one combined. Of 44 pregnancies with fetal echo, six had in utero RVOTO with antegrade flow diagnosed at gestational ages ranging from 19 to 27 weeks. In utero progression occurred in four cases over a period of four to eight weeks, with the development of RVOT atresia by delivery. Postnatal progression of RVOTO occurred in two cases, one of which required pulmonary balloon valvuloplasty at age two years. Postnatal regression of subvalvar RVOTO occurred in two cases in early infancy. Death related directly or indirectly to the RVOTO occurred in all four patients who developed complete RVOT obliteration.CONCLUSIONSRight ventricular outflow tract obstruction may occur in the recipient twin of at least 9% of pregnancies complicated by TTTS. Right ventricular outflow tract obstruction progression is common in utero and may worsen neonatal outcome.

Three‐dimensional quantitative echocardiographic assessment of ventricular volume in healthy human fetuses with and in fetuses with congenital heart disease

We examined the feasibility and appearance of 3D fetal echo assessment of ventricular volumes in 29 normal fetuses and 22 fetuses with congenital heart disease (gestation 18–35 weeks). Gated 3D volume sets could be obtained in 51 of 57 cases. Normal right and left ventricular volume, stroke volume data, and RV/LV ratios were obtained, together with normal changes with gestation. In patients with congenital heart disease, those with a biventricular heart (index lesion teratology of Fallot) demonstrated normal combined ventricular volumes and right/left volume ratios for gestation age. Fetuses with single ventricular heart with intact septum (hypoplastic left or right heart) demonstrated a small but significant reduction in combined ventricular size and stroke volume for gestation age.

Fetal echo cardiography: the state of the art of the state of the heart

Ultrasound in Obstetrics & GynecologyVolume 17, Issue 4 p. 277-284 EditorialFree Access Fetal echo cardiography: the state of the art of the state of the heart R. Chaoui, R. Chaoui Department of Obstetrics and Gynecology, Charité University Hospital, Schumannstr. 20/21, 10098-Berlin, GermanySearch for more papers by this author R. Chaoui, R. Chaoui Department of Obstetrics and Gynecology, Charité University Hospital, Schumannstr. 20/21, 10098-Berlin, GermanySearch for more papers by this author First published: 12 December 2002 https://doi.org/10.1046/j.1469-0705.2001.00413.xCitations: 14AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume17, Issue4April 2001Pages 277-284 RelatedInformation

Early prenatal diagnosis of major congenital heart defects

Specialized fetal echocardiography at 18 to 22 weeks for high-risk groups is well established as being sensitive and specific for most cardiac abnormalities. Early fetal echocardiography (< 16(+0) weeks, i.e. 16 weeks and 0 days) is a feasible alternative to mid second trimester scanning for families at risk of congenital heart disease. Two main areas have contributed to the increasing interest in first and early second trimester fetal echo. The recognition of the association between increased nuchal translucency and structural heart abnormalities has led to the identification of an important high-risk group at 11 to 14 weeks. Furthermore, the use of modern ultrasound technology has allowed greater utilization of transabdominal scanning in addition to the transvaginal route. Most major structural heart defects can accurately be diagnosed from the late first trimester of pregnancy and many families at-risk can be reassured of 'normality' of cardiac connections at an early stage. Some lesions may evolve throughout pregnancy and therefore early scans should not replace mid trimester fetal echocardiography.

Fetal gastrointestinal malformations

In an audit to evaluate fetal gastrointestinal (GIT) malformations, case sheets of all mothers who gave birth to newborns with GIT malformations were analysed regarding the maternal history, prenatal ultrasound and the postnatal structural malformations and perinatal management. In 1999, eleven babies were born with gastrointestinal malformations, one was a still birth. Nine had associated malformations of other systems, two had trisomy 21. Eight babies were operated in the immediate newborn period, 5 survived. Ultrasound was not very accurate in the diagnosis of GIT anomaly in this series. In view of associated chromosomal and structural anomaly a fetal ECHO and genetic amniocentesis is warranted. Most of these babies require immediate surgery after birth, so they need to be delivered in a centre which is equipped with good neonatal and pediatric surgery care.

Effect of injected spermatozoa morphology on the outcome of intracytoplasmic sperm injection in humans

Effect of injected spermatozoa morphology on the outcome of intracytoplasmic sperm injection in humans

Fetal echocardiography.

Since the first report of fetal echocardiography in 1972 by Winsberg, several advances in ultrasound technology have occurred allowing detailed evaluation of cardiac anatomy in the second trimester fetus. Fetal echo is indicated in high risk pregnancies where the chances of fetus having a congenital heart disease (CHD) are likely to be high e.g., in fetus with extracardiac anomalies picked up on obstetric ultrasound, those with a history of CHD in family, maternal diabetes (especially insulin dependent), maternal connective tissue disorder etc. The reported sensitivity of fetal echo has ranged from 4-96% in various series depending upon the equipment, level of training, study design and examination technique. Although many CHD can be detected in four chamber view, an important group malformations that would need early intervention are likely to be missed. Hence a detailed echocardiographic examination including the outflow views must be done. Defects like atrial septal defect and patent ductus arteriosus cannot be diagnosed in fetal echo, as these are part of normal fetal physiology. Other CHD like coarctation of aorta, small ventricular septal defects, mild valvular stenosis, partial anomalous pulmonary venous drainage are also difficult to diagnose. Ultrasound assessment of fetus, however, has a clear role in the diagnosis, monitoring and management of fetuses with sustained arrhythmias. Prenatal diagnosis of CHD helps in planning the optimal management of the baby e.g. a fetus with a ductus dependent lesion can be planned to be delivered in a tertially care centre for stabilisation and early initiation of prostaglandin therapy to avoid acidosis and organ damage. Future of fetal medicine lies in fetal cardiac surgery for which echocardiography will play a very important role.

Findings of Abdomninal Heterotaxia and Associated Congenital Heart Disease

The prenatal finding of abdominal heterotaxia in conjunction with complex congenital heart defects should indicate the possible diagnosis of cardiosplenic syndrome—specifically, asplenia or polysplenia. Unfortunately, the prognosis for patients with either of these syndromes is usually poor. In this case, antenatal findings were indicative of asplenia, but neonatal testing revealed a normal-functioning spleen. This finding, along with detailed documentation of the congenital heart defects by fetal echo examination, dramatically improved the patient's prognosis and ultimate outcome.

Multimedia system for fetal echo analysis

Multimedia system for fetal echo analysis

1052-1 Multimedia Instructional System for Fetal Echo

Congenital heart disease (CHD) is the most common congenital malformation with an incidence rate of 0.7%. Many pregnant woman (in some countries all) are offered an ultrasound scan at around 18 weeks of pregnancy. The scan incorporates a detailed anatomical survey of the fetus and if includes at least a four chamber view, it is an excellent opportunity to detect congenital heart defects. Therefore a Windows based multimedia computer program for the instruction of Fetal Echo for ultrasound technologists, students. residents, fellows and primary care physicians has been developed. The application includes a step by step tutorial to instruct the user in reading Fetal Echo data, a browsing library of definitions of CHD's, graphics images and digitized echocardiograms, and the Expert System for automatic diagnosis. The pictures, images and descriptions are linked to a database and can be viewed by searching for the defect name or symptoms. This provides a powerful instructional tool in this very difficult area of medical education. The minimum hardware requirements to run this program are: IBM/PC or compatible computer running MS Windows version 3.1 with 80386SX processor, 4 MB RAM, 30 MB free disk space, multimedia with dual speed CD ROM, and a VGA card capable to display at least 256 colors.

Diagnosis of Early Pregnancy by Ultrasound in Macaca fascicularis

Real-time ultrasonography was used to detect early pregnancy in 32 longtailed macaques (Macaca fascicularis). In 92% of the successful conceptions, a correct diagnosis was made. The earliest sign of pregnancy was an intrauterine ringlike structure (11 days). A "line swelling" (14 days) preceded definite fetal echoes (21 days), and fetal heart motion (30 days) proved fetal viability. Ultrasound is a rapid, noninvasive, and relatively cost-effective method of diagnosing and monitoring early pregnancy in M. fascicularis.

Prenatal detection of cardiovascular malformations by echocardiography: An indication for cytogenetic evaluation

Prenatal diagnosis of congenital cardiovascular malformations by echocardiography may signal associated chromosome abnormalities. The exact proportion of these associations is not known but is expected to be higher than that with live-birth. To estimate the risk that a fetus with an echocardiographically detected heart defect has an autosomal trisomy or Turner syndrome, we adjusted the known frequency of aneuploidy in live-born infants with congenital cardiovascular malformations by the reported rate of spontaneous abortion, with data from a population-based case-control study of congenital cardiovascular malformations in which 268 cases (12.7%) had both congenital cardiovascular malformations and a chromosome abnormality. Included in the present analysis were 188 aneuploid infants with congenital cardiovascular malformations that would have been detectable by fetal echo. When data are adjusted for the high spontaneous abortion rate of aneuploid fetuses, we estimate that there would have been more than a threefold increase in aneuploidy over the 13% seen at live-birth. Thus cytogenetic analysis is appropriate in a fetus with echo-diagnosed congenital cardiovascular malformations.