Fetal Echocardiogram Research Articles

Diagnosis of fetal arrhythmia in echocardiography imaging using deep learning with cyclic loss.

Fetal arrhythmias frequently co-occur with congenital heart disease in fetuses. The peaks observed in M-mode fetal echocardiograms serve as pivotal diagnostic markers for fetal arrhythmias. However, speckles, artifacts, and noise pose notable challenges for accurate image analysis. While current deep learning networks mainly overlook cardiac cyclic information, this study concentrated on the integration of such features, leveraging contextual constraints derived from cardiac cyclical features to improve diagnostic accuracy. This study proposed a novel deep learning architecture for diagnosing fetal arrhythmias. The architecture presented a loss function tailored to the cardiac cyclical information and formulated a diagnostic algorithm for classifying fetal arrhythmias. The training and validation processes utilized a dataset comprising 4440 patches gathered from 890 participants. Incorporating cyclic loss significantly enhanced the performance of deep learning networks in predicting peak points for diagnosing fetal arrhythmia, resulting in improvements ranging from 7.11% to 14.81% in F1-score across different network combinations. Particularly noteworthy was the 18.2% improvement in the F1-score for the low-quality group. Additionally, the precision of diagnosing fetal arrhythmia across four categories exhibited improvement, with an average improvement rate of 20.6%. This study introduced a cyclic loss mechanism based on the cardiac cycle information. Comparative evaluations were conducted using baseline methods and state-of-the-art deep learning architectures with the fetal echocardiogram dataset. These evaluations demonstrated the proposed framework's superior accuracy in diagnosing fetal arrhythmias. It is also crucial to note that further external testing is essential to assess the model's generalizability and clinical value.

Abstract 15357: Assessing the Utility of Serial Fetal Echocardiography in Detecting In-Utero Changes for Single Ventricle Lesions

Introduction: Current guidelines recommend serial fetal echocardiograms (FE) for fetuses with single ventricle lesions (SV) to identify in-utero changes that can impact delivery management, but there is sparse data on the utility of serial FE. We aim to evaluate the incidence of serial FE changes in fetuses with SV. Hypothesis: There is a low incidence of in-utero changes in serial FE for fetuses with SV. Methods: Fetuses with SV and > 1 serial visit between 1/1/2012 to 1/1/2023 were retrospectively reviewed. FE were reviewed for significant, defined serial changes in the following: atrioventricular valve, ventricular function, atrial communication, ductus arteriosus, umbilical artery, umbilical vein, systemic venous Dopplers, hydrops, arrhythmias. Fisher’s exact test was used to compare proportions with change between both segmental findings and SV sub-type. Results: A total of 721 FE for 248 patients were reviewed, the majority with hypoplastic left heart syndrome (HLHS) (64%) and tricuspid atresia (15%). There was a mean of 2.9 visits per patient and 21 days between FE. Out of 3,699 possible changes, there was a total of 56 (1.5%) changes in 41 patients seen on all follow-up FE (Table 1). The most common changes were worsening atrial level restriction (10, 2.4%) and arrhythmias (10, 2.4%), all of which were premature atrial contractions (p<0.01). Out of 56 changes, only 20 (36%) were critical with clinical impact on perinatal management and 2 (4%) showed progressive, serial worsening. Most changes (85%) were noted in the third trimester. There were no differences in incidence of change on serial FE between SV sub-types (p=0.10). Conclusions: SV fetuses have a low incidence of significant physiologic change on serial FE, and progressive worsening of physiologic findings is even rarer. Special consideration should be given to those with HLHS who may develop atrial level restriction. This data should be considered in planning clinical follow-up intervals for fetal SV.

Abstract 13945: Evaluation of a Deep Neural Network for Detection of D-Transposition of the Great Arteries on Fetal Echocardiograms

Introduction: While prenatal detection of congenital heart disease (CHD) has improved over the years, a significant proportion of CHD remains unrecognized on fetal ultrasound. Prenatal identification of d-transposition of the great arteries (d-TGA) in particular would significantly alter delivery planning and postnatal course. Research Questions: We investigated whether a deep neural network (DNN) can accurately detect d-TGA on fetal echocardiograms. Aim: To evaluate a DNN for detection of d-TGA on second (2T) or third (3T) trimester fetal echocardiograms. Methods: Patients with a singleton pregnancy with a 2T or 3T fetal echocardiogram performed between Jan 1, 2022 and May 1, 2023 at one center were retrospectively evaluated. Cases of d-TGA and negative cases referred for family history of CHD or increased nuchal translucency were included. Cases were reviewed by 3 pediatric cardiologists to confirm that the recorded ultrasound clips were sufficient to diagnose the presence or absence of d-TGA, and were excluded otherwise. The DNN was trained on patients not included in the evaluation to detect the absence of the great artery cross-over pattern, a distinct finding in d-TGA. The DNN outputs the presence or absence of this finding using all recorded video clips of an examination. Results: We included 18 positive and 99 negative cases. The DNN detected suspicion for d-TGA with an AUC of 91.4%, sensitivity of 83.3% (60.8-94.2, 95%CI) and specificity of 92.9% (86.1-96.5, 95%CI). Conclusions: D-TGA can be accurately detected on fetal echocardiograms using a DNN. These promising results lay the foundation for reliable, computer-aided detection of CHD on screening fetal ultrasounds.

Abstract 18571: Fetal Sirolimus Therapy for Giant Cardiac Rhabdomyoma

Background: Cardiac rhabdomyomas in tuberous sclerosis regress spontaneously, large masses can cause hemodynamic compromise. Fetal sirolimus therapy cause regression. We report a case of successful fetal therapy in mother with fetally diagnosed tuberous sclerosis (TS). Case: A 22 year old female with uncomplicated pregnancy and negative cardiac history presented for fetal echocardiogram at 21 weeks due to cardiac masses. Fetal echocardiogram: levocardia, normal segmental cardiac anatomy, d-looped ventricles, normally related great arteries. Multiple masses seen in both ventricles, largest in LV free wall from base to apex and another involving mitral papillary muscle, no initial obstruction, patent ductal and aortic arches. Amniocentesis confirmed diagnosis of TS. Fetus was followed with serial monitoring of cardiac outputs and size of masses. At 30 weeks, LV mass had doubled from 1.7 to 4 cm with LV diastolic dysfunction and reduced cavity size, large pericardial effusion, left ventricular outflow tract obstruction (LVOTO). IVC was mildly dilated with liver enlargement. Fetal MRI confirmed diagnosis of rhabdomyoma with small subependymal nodules. Given LVOTO and large effusion, mother was started on sirolimus therapy with loading dose of 5 mg and subsequent dose adjustments for target trough sirolimus of 10 to 15 ng/ml. Serial mother monitored with labs, weekly ultrasounds and echocardiograms. Mass decreased in size with resolution of effusion and LVOTO. At 37 weeks, due to oligohydramnios, baby was delivered without hemodynamic compromise. Postnatally no LVOTO and normal systolic function with mass measuring ~ 2.0 cm. Baby has been followed off sirolimus therapy. Role of Imaging: Serial echocardiograms enabled optimal decision making to treat mother with sirolimus therapy. Conclusions: Maternal sirolimus therapy can help regress cardiac rhabdomyomas with hemodynamic implications with serial close outpatient monitoring.

Abstract 13368: Availability of PGE1 in Northern California Hospitals: Before and After Routine CCHD Screening

Introduction: Fetal echocardiogram and critical congenital heart disease (CCHD) screening has improved early detection of CCHD. CCHD screening has been recommended for all infants since 2011 and mandated in California since July 2013. In patients with suspected ductal dependent congenital heart disease, early intervention with prostaglandin E1 (PGE1) is the standard of care to reduce morbidity and mortality. Hypothesis: In 2004, we assessed the availability of PGE1 in Northern California hospitals that care for newborn infants and found that 32% of hospitals with obstetric services did not have the ability to institute PGE1 infusion. As California has adopted CCHD screening for all newborn infants prior to hospital discharge, our aim was to assess the percentage of hospitals that perform CCHD screening as well as reassess PGE1 availability. Our hypothesis was that CCHD screening would increase the availability of PGE1 at hospitals providing obstetric services. Methods: The initial study contacted 117 Northern California hospitals to determine PGE1 availability. We contacted the same hospitals, ending up with 106 hospitals due to closures and mergers. The newborn nursery and/or NICU for each of these hospitals was contacted to determine CCHD screening practices and availability of PGE1. Mileage to the nearest level IV NICU was used as a gross estimate of distance to a tertiary care center. Results: In 2004, 92 of 117 hospitals had obstetric service, and 30 (32.6%) of those did not have PGE1. In this study, 74 of the 106 provided obstetric services. All performed CCHD screening, but 15 (20.3%) did not have ability to provide PGE1 infusion. 8 of the 15 hospitals were more than 30 miles (range 1.5 - 192 miles) from the closest level IV NICU. Conclusions: All hospitals in Northern California providing obstetric service are performing CCHD screening. However, 20.3% of these hospitals still do not have the ability to administer PGE1 infusion. Of these, 53% were in suburban and rural areas of Northern California, with significant transportation distance to a tertiary care center. Delay in initiating PGE1 infusion in patients with ductal dependent CCHD may lead to morbidity or mortality, and increasing PGE1 availability is an opportunity to improve access to care.

Abstract 14569: Chemotherapy in Pregnancy: Assessing the Safety of Adriamycin Administration in Pregnancy Complicated by Breast Cancer

Introduction: Treatment of Pregnancy Associated Breast Cancer (PABC) with radiation and endocrine therapy is challenging due to potential risks to the fetus. Surgical treatment is safe throughout pregnancy, and chemotherapy agents such as anthracyclines are safe during 2 nd and 3 rd trimesters. Case Presentation: A 39-year-old G4P3 female presented at 8 weeks gestation with a twin pregnancy and a right breast mass with bloody nipple discharge. Past medical history was significant for obesity and chronic hypertension. Biopsy of the mass confirmed weakly ER+/PR-/HER2-, node+, stage IIb PABC. After radical mastectomy and axillary lymph node dissection, 4 Adriamycin and Cyclophosphamide (AC) based adjuvant chemotherapy cycles q3 weeks were started at 12 weeks of gestation with a maternal and fetal echocardiogram, brain natriuretic peptide and troponin measurements after each cycle. A baseline echocardiogram revealed cardiomyopathy with an LVEF of 45% and a severely dilated left ventricle. She was New York Heart Association class II at baseline. Carvedilol 6.25 mg BID was started prior to beginning AC and titrated to 12.5 mg BID due to palpitations after 1 st AC cycle. She tolerated 4 AC cycles with no change in EF from baseline, no symptoms of heart failure, and a normal fetal echocardiogram. Weekly Paclitaxel was resumed to complete 12 cycles prior to radiation treatment. She delivered healthy male and female infants at 32 weeks with no complications (M: APGAR 5 and 7; F: APGAR 8 and 7). Postpartum EF decreased to 40%, necessitating titration of carvedilol to 25mg BID and the addition of Sacubitril/Valsartan 24/26 mg BID. Chest pain complaint after delivery prompted evaluation with computed tomography-based angiogram and cardiac magnetic resonance imaging (CMR), ruling out coronary artery disease. Despite this, no evidence of microvascular disease on CMR symptomatic relief was reported on long-acting nitrates. Discussion: This case demonstrates the importance of multidisciplinary patient management, particularly for those with low LVEF who are at higher risk of decompensation. Despite not knowing the etiology of PABC, she could be suffering from thrombotic microangiopathy of small coronary vessels, which explains relief from nitrates.

Abstract 11801: Timing of Critical Congenital Heart Defect (CCHD) Detection at 7 U.S. Sites, the Birth Defects Study to Evaluate Pregnancy Exposures (BD-STEPS), 2014-2018

Background: CCHD detection prenatally or at birth hospitalization may reduce infant mortality and morbidity, yet little is known about prevalence and characteristics associated with timing of detection. Objective: To examine prevalence and characteristics associated with prenatal and late (>3 days after birth) detection of CCHD among infants in BD-STEPS, a multi-site population-based case-control study of risk factors for birth defects. Methods: Liveborn infants with non-syndromic CCHD without genetic causes born 2014-2018 with interviewed mothers were included. Timing of detection was based on date of earliest fetal or postnatal echocardiogram. Multivariable log-binomial models calculated adjusted prevalence ratios (aPR) for prenatal (vs postnatal) and late (vs not late) CCHD detection, by clinical and demographic characteristics. Log-linear models evaluated trends over time. Results: Among the 588/672 infants with CCHD and complete data, most infants’ mothers were Non-Hispanic White (53.4%), had some prenatal insurance (94.4%), and were multiparous (74.5%). Prenatal detection increased from 2014 to 2018 (24.7% to 40.1%) while late detection decreased (22.4% to 8.7%, Fig 1). Hypoplastic left heart syndrome had the highest prenatal detection (58.6%); late detection was highest for coarctation of the aorta (41.7%). Prenatal detection was more likely in infants of mothers 30-34 vs. 25-29 years at delivery (aPR=1.4, 95% confidence interval 1.0-1.9), and with additional non-cardiac defects (1.2, 1.1-1.4), and less likely among infants of mothers with <11 years of education vs. > bachelor’s degree (0.6, 0.3-1.0). Late detection was more likely among infants of mothers without prenatal insurance (1.8, 1.1-3.1), and less likely among those with non-cardiac defects (0.4, 0.2-0.8). Conclusion: From 2014 to 2018, prenatal detection increased and late detection decreased. Yet, disparities in detection by maternal insurance and education were observed.

Abstract 14220: Establishing Dosing Parameters for the Use of Maternal Hyperoxygenation to Affect Fetal Cardiovascular Physiology

Introduction: Maternal hyperoxygenation (MH) has been used to aid in the prognosis of fetal abnormalities. No data exist on the dose-response relationship or washout time of short-term MH administration related to fetal cardiovascular effects. Hypothesis: There may be a dose-response to MH with effect on pulmonary vascular resistance as measured by pulmonary artery pulsatility index (PAPI) and combined cardiac output (CCO). Aims: The aims of this study were: to determine the appropriate MH dose to obtain a physiologic response (i.e. decrease in PAPI), to evaluate the change in CCO, and to identify the washout period. Methods: Expectant mothers with normal fetal echocardiograms were prospectively recruited from 3/2019 to 6/2023. A research echocardiogram with MH was performed after 31 weeks gestation. Fetal cardiac abnormalities and other comorbidities were excluded. Patients were randomly assigned to either; 2 liters (L) nasal cannula (NC), 4L NC or 8L facemask, all at 100% Fi0 2 . Measurements of PAPI and CCO were performed at baseline, at 1 minute (min) and at 5 min intervals to 20 mins. The same time points were repeated off oxygen. Differences in PAPI were compared between doses and between time points using a mixed effects model. Results: We recruited 29 patients at a mean gestational age of 32.9 (± 0.9 weeks). On oxygen, there was a statistically significant decrease in the PAPI at 8L (-0.18 per min, 95% CI -0.32, -0.05), with the largest decrease occurring between baseline and 5 mins, and PAPI stabilizing after 10 mins (figure). During the washout period, starting at 1 min off oxygen, PAPI values normalized, with no statistically significant changes with 2L, 4L or 8L compared to baseline. No effect on CCO was seen from MH administration. Conclusions: An oxygen dose of 8L is needed for an appropriate PAPI response, with the largest effect occurring before 10 mins. After oxygen is removed, PAPI values normalize by one min. Changes in CCO were not seen with MH in this normal population.

Patterns of Aortic Dilation in Tetralogy of Fallot: An Analysis of 100 Fetal Echocardiograms Compared With Matched Controls.

Background Although aortic dilation is common in tetralogy of Fallot (TOF), its progression and risk of dissection are not well understood. The mechanism of dilation is primarily attributed to increased flow in utero; an alternative is unequal septation of the truncus arteriosus resulting in a larger aorta and inherently hypoplastic pulmonary artery (PA). If the latter is true, we hypothesize the aorta to PA ratio in TOF is stable throughout gestation, and sums of great artery dimensions are similar to controls. Methods and Results We performed a single-center retrospective study of fetuses with TOF (2014-2020) and matched controls. We compared sums of diameters, circumferences, and cross-sectional areas of the aorta and PA and evaluated the aorta to PA ratio across gestation in 2 TOF subtypes: pulmonary stenosis and atresia (TOF-PA). There were 100 echocardiograms with TOF (36% TOF-PA) with median gestational age of 31 weeks (interquartile range 26.5-34.4) and median maternal age of 34 years (interquartile range 30-37). There were no differences in sums of great artery dimensions between TOF-pulmonary stenosis and controls. In TOF-PA, sums were significantly lower than controls (P values <0.01). The aorta to PA ratio was stable throughout gestation (Pearson's r=0.08 [95% CI, -0.12 to 0.27], -0.06 [95% CI, -0.25 to 0.14]). Conclusions The aorta in fetal TOF is large but grows proportionally throughout gestation, with sums of great artery dimensions similar to controls. TOF-PA appears distinct from TOF-pulmonary stenosis (with smaller sums), warranting further investigation. In conclusion, our findings suggest an intrinsic developmental mechanism contributes to aortic dilation in TOF.

Reference Values for Fetal Cardiac Dimensions, Volumes, Ventricular Function and Left Ventricular Longitudinal Strain Using Doppler Ultrasound Gated Cardiac Magnetic Resonance Imaging in Healthy Third Trimester Fetuses.

Recent advances in hardware and software permit the use of cardiac MRI of late gestation fetuses, however there is a paucity of MRI-based reference values. To provide initial data on fetal cardiac MRI-derived cardiac dimensions, volumes, ventricular function, and left ventricular longitudinal strain in healthy developing fetuses >30 weeks gestational age. Prospective. Twenty-five third trimester (34 ± 1 weeks, range of 32-37 weeks gestation) women with healthy developing fetuses. Studies were performed at 1.5 T and 3 T. Cardiac synchronization was achieved with a Doppler ultrasound device. The protocol included T2 single shot turbo spin echo stacks for fetal weight and ultrasound probe positioning, and multiplanar multi-slice cine balanced steady state free precession gradient echo sequences. Primary analyses were performed by a single observer. Weight indexed right ventricular (RV) and left ventricular (LV) volumes and function were calculated from short axis (SAX) stacks. Cardiac dimensions were calculated from the four-chamber and SAX stacks. Single plane LV longitudinal strain was calculated from the four-chamber stack. Interobserver variability was assessed in 10 participants. Cardiac MRI values were compared against available published normative fetal echocardiogram data using z-scores. Mean and SDs were calculated for baseline maternal/fetal demographics, cardiac dimensions, volumes, ventricular function, and left ventricular longitudinal strain. Bland-Altman and intraclass correlation coefficient analysis was performed to test interobserver variability. The mean gestational age was 34 ± 1.4 weeks. The mean RV and LV end diastolic volumes were 3.1 ± 0.6 mL/kg and 2.4 ± 0.5 mL/kg respectively. The mean RV cardiac output was 198 ± 49 mL/min/kg while the mean LV cardiac output was 173 ± 43 mL/min/kg. This paper reports initial reference values obtained by cardiac MRI in healthy developing third trimester fetuses. MRI generally resulted in slightly larger indexed values (by z-score) compared to reports in literature using fetal echocardiography. 1 TECHNICAL EFFICACY: Stage 2.

Diagnostic Challenges of Vascular Rings: Insights from a Case Report

The vascular ring (VR) is a rare congenital anomaly that can cause compression of the trachea or esophagus, resulting in respiratory and/or gastrointestinal symptoms. The severity of symptoms depends on the type of VR, with patients who have anatomically complete VRs typically presenting earlier in life. The diagnosis of VR has advanced with the availability of improved imaging modalities. Prenatal diagnosis is possible with fetal echocardiogram, while non-invasive multidetector CT and MRA can be utilized for later diagnosis. These imaging modalities allow for the delimitation of the defect and the identification of the anatomy for treatment planning. This case report presents the evaluation and management of a male neonate who was diagnosed with VR after initially presenting with respiratory and gastrointestinal symptoms that were suspected to be related to gastroesophageal reflux. This case highlights the importance of considering VR in the differential diagnosis of patients presenting with these symptomatologies.

The Burden of Neonatal Referrals on a Pediatric Cardiology Service: A Local Center Experience.

Congenital heart disease (CHD) is a common occurrence in live births, with some exhibiting critical congenital heart disease; therefore, cardiology services should be available around the clock to ensure timely diagnosis and management. This study aims to describe the workload and the need for pediatric cardiac services in a maternity hospital for newborn referrals. Moreover, the study describes the indications for neonatal cardiology consultations. The prospective cohort study was conducted over four months, from January to April 2022, in the Prince Sultan Cardiac Center Al Qassim region of Saudi Arabia. Prince Sultan Cardiac Center's pediatric cardiology department provides cardiac services to the Maternity and Children Hospital Buraidah Al Qassim. Out of the total 2,606 live births during the study period, the cardiology team evaluated 352 neonates. Neonates less than 30 days of age who were born in the maternity hospital were enrolled in the study. The outborn babies referred from other centers as suspected congenital heart disease for whom a cardiac evaluation was done were excluded. In addition, babies assessed in the emergency room and born elsewhere were excluded. Only new consultations have been considered, excluding follow-up consultations. Data about patients' demographic, clinical and echocardiographic findings were recorded on Google Forms and converted to a Google spreadsheet. The Google spreadsheet's inbuilt statistical software was used for analysis. Categorical data were presented as percentages, and numerical data as median and range. The cardiology team evaluated 352 neonates from 2,606 live births over four months, accounting for 13.5 per 100 live births. The median weight was 2.8 kilograms, with a 0.5-4.3 kilogram range. Males comprised 187 (53%), and females comprised 165 (47%). Moreover, full-term, preterm, and post-term accounted for 236 (67%), 113 (32%), and 3 (0.8%) of patients, respectively. The common indications for neonatal cardiac referral were respiratory distress 60 (17%), infants born to diabetic mothers 50 (14%), abnormal fetal echocardiogram 49 (13.9%), family history of abortion or neonatal death 31 (8.8%), and congenital anomalies 30 (8.5%). Systolic murmur was the commonest clinical finding that prompted cardiology referrals 82 (23.2%), followed by desaturation 38 (10.7%) and dysmorphic features 31 (8.8%). Among the congenital cardiac defects, an isolated atrial septal defect (ASD) was seen in 66 (18.5%), isolated patent ductus arteriosus in 50 (14.2%), and ventricular septal defect in 21 (5.9%). Moreover, 13 (4.4%) lesions were critical CHDs. Finally, 27 (7.6%) had adiagnosis of pulmonary hypertension. Knowing the burden of neonatal cardiac assessment on pediatric cardiology services in any maternity center may help the healthcare authorities to allocate resources and optimize the delivery of cardiac services among the neonatal population. Properly allocating pediatric cardiologists to the needed centers may optimize neonatal cardiac services. Moreover, it may decide on the number of pediatric cardiologists that need to be trained each year to meet the requirements of neonatal cardiac services.

EP24.07: Sensitivity and specificity of second trimester anatomy ultrasound in the detection of cardiac anomalies in fetal echocardiogram in twin pregnancies

EP24.07: Sensitivity and specificity of second trimester anatomy ultrasound in the detection of cardiac anomalies in fetal echocardiogram in twin pregnancies

EP24.12: Sensitivity and specificity of second trimester anatomy ultrasound in the detection of abnormal fetal echocardiogram when performed by perinatologists

EP24.12: Sensitivity and specificity of second trimester anatomy ultrasound in the detection of abnormal fetal echocardiogram when performed by perinatologists

Utility of the Angle between the Right Aortic Arch and First Branch for Detecting Double Aortic Arch via Fetal Echocardiography

Introduction: The presence of a double aortic arch (DAA) is manifested by compressive symptoms, requiring surgery. DAA cases are classified as either complete or incomplete type. DAA and a right aortic arch with mirror image branching (mRAA) have a similar configuration to the first branch artery. The first branch of the mRAA is the left brachiocephalic artery, which appears to be the same as that of an incomplete DAA due to blood flow interruption. The present retrospective study aimed to evaluate the differences between DAA and mRAA by fetal echocardiography. Methods: This single retrospective cohort study included all patients diagnosed with complete DAA, incomplete DAA, or mRAA at our facility between 2010 and 2022. The patients were diagnosed with complete DAA, incomplete DAA, or mRAA after birth and remaining fetal echocardiograms. The patients were divided into the DAA (complete DAA: n = 4, incomplete DAA: n = 3) and mRAA (n = 4) groups. The following three outcomes were compared: (1) angle between the right aortic arch and first branch (RF angle), (2) ratio of height to width of the region bounded by the aortic arch, first branch of the aortic arch, and descending aorta, and (3) maximum tracheal diameter on a three-vessel trachea view. Results: The incomplete DAA cases were difficult to diagnose via fetal echocardiography. On fetal echocardiography, the RF angle was significantly steeper in the DAA group than in the mRAA group (median 57° [36°–69°] vs. 75° [62°–94°]; p < 0.05). The DAA and RAA groups showed no significant differences in the ratio of height to width of the region bounded by the aortic arch, first branch of the aortic arch, and descending aorta (median 0.57 [0.17–0.68] vs. 0.73 [0.56–1.0]) and maximum tracheal diameter (median 2.5 [1.4–3.3] vs. 3.2 [2.8–3.5] mm). The cut-off value for the presence of DAA was an RF angle <71°. Conclusion: The DAA group (complete and incomplete DAA) had a significantly steeper RF angle than the mRAA group. Therefore, RF angle measurement could improve the fetal diagnosis and postnatal prognosis of DAA.

Interaction between ozone and paternal smoking on fetal congenital heart defects among pregnant women at high risk: a multicenter maternal-fetal medicine study.

Evidence remains limited on the association between maternal ozone (O3) exposure and congenital heart defects (CHDs) in offspring, and few studies have investigated the interaction and modification of paternal smoking on this association. Using a sample including pregnant women at high risk of fetal CHD (with metabolic disease, first-trimester viral infection, family history of CHD, etc.) from a maternal-fetal medicine study covering 1313 referral hospitals in China during 2013-2021, we examined the associations between maternal O3 exposure during 3-8 weeks of gestational age and fetal CHD in offspring and investigated the interaction and modification of paternal smoking on this association. CHD was diagnosed by fetal echocardiograms, maximum daily 8-hour average O3 exposure data at a 10 km × 10 km spatial resolution came from the Tracking Air Pollution in China dataset, and paternal smoking was collected using questionnaires. Logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Among 27,834 pregnant women at high risk of fetal CHD, 17.4% of fetuses were diagnosed with CHD. Each 10 μg/m3 increase in maternal O3 exposure was associated with a 17% increased risk of CHD in offspring (OR= 1.17, 95% CI =1.14-1.20). Compared with paternal nonsmoking and maternal low O3 exposure, the ORs (95% CI) of CHD for smoking and low O3 exposure, nonsmoking and high O3 exposure, and smoking and high O3 exposure were 1.25 (1.08-1.45), 1.81 (1.56-2.08), and 2.23 (1.84-2.71), respectively. Paternal smoking cessation seemingly mitigated the increased risk of CHD. Maternal O3 exposure and paternal smoking were interactively associated with an increased risk of fetal CHD in offspring, which calls for effective measures to decrease maternal exposure to O3 pollution and secondhand smoke for CHD prevention.

Body stalk anomaly

A 29-year-old pregnant woman was referred to our hospital at the gestational age of 15 weeks. The umbilical cord hernia was pointed out during a fetal echocardiogram at the previous obstetrician’s office, and the patient was referred to our obstetrician

Fetal congenital heart diseases: Diagnosis by anatomical scans, echocardiography and genetic tests.

To determine the distribution of major fetal congenital heart diseases (CHDs) diagnosed antenatally during routine second-trimester obstetric anatomical scans in an unselected population at a single tertiary centre and to characterise and stratify risk factors, genetic diagnosis and long-term health at 4 years old. A single-centre cohort study of all major fetal CHDs detected on routine obstetric fetal anatomical ultrasound scans between January 2014 and December 2017 was performed in an unselected population. Demographic details, fetal echocardiogram reports, genetic test results, delivery outcomes and postnatal progress were stratified by CHD subtype. Of 20,031 screened pregnancies, 109 pregnancies (0.53%) had major fetal CHDs. The most common subtypes were coarctation of aorta (17.4%), transposition of great arteries (16.5%), and tetralogy of Fallot and univentricular hearts (13.8% each). Of the 60.5% that underwent confirmatory genetic testing-mostly conventional karyotyping and testing for 22q11 microdeletion-about a quarter had abnormalities, of which 22q microdeletion was the most common. We had complete obstetric data in 85 pregnancies (78%), of which 76.5% progressed to live birth. Among these, 92.1% of postnatal echocardiograms concurred with antenatal ones. At 4 years old, 43.2% of offspring had no medical or developmental issues, 20.0% had mild medical or developmental issues, 21.5% had major medical or developmental issues, and 12.3% had deceased. Fetal echocardiograms accurately diagnose CHDs. Future studies should evaluate the roles of chromosomal microarray and next-generation sequencing in diagnosing CHD.

The Influence of Maternal Condition on Fetal Cardiac Function during the Second Trimester.

Maternal health has a direct, profound and lasting effect on the formation and development of the fetal cardiovascular system. The aim of this research was to find whether maternal age, BMI hypertension (GH) or gestational diabetic mellitus (GDM) would affect fetal cardiac function in the second trimester. 329 mothers who had a fetal echocardiogram examination at the International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China, from 1 January 2020 to 30 April 2020 were enrolled at the gestational age of 21 to 26 weeks (mean 22.78 ± 1.13 weeks). Single-factor analysis and multi-factor line regression analysis were used to find the contribution values of each factor to fetal cardiac function. at the second trimester, maternal age had a minor influence on the fetal left ventricle diastolic function. Higher maternal BMI could cause a decrease in the fetal diastolic function of both the left and right ventricle and the systolic function of the left ventricle. Maternal hypertension and gestational diabetic mellitus had a profound influence on both the left and right fetal heart ventricles of both systolic and diastolic function. maternal condition will have a profound influence on fetal cardiac function as early as the second trimester.

Prenatal detection of congenital heart disease: Recent experience across the state of Arizona.

To determine the prenatal detection rate (PDR) of congenital heart disease (CHD) in Arizona as well as describe various factors that may influence detection rates. This was a retrospective chart review using the Society of Thoracic Surgeons and Phoenix Children's Fetal Cardiology databases. We included all cases of CHD requiring surgery <1year of age between 2013 and 2018. A total of 1137 patients met the criteria, and various demographic, socioeconomic, and patient outcome data were collected. The overall PDR was 58% with an improving detection rate over the course of our study, with the final year having a PDR of 67%. Over time, PDR improved in urban communities, but this was not seen in rural communities. Rural address, public insurance, and Native American ethnicity were associated with lower PDR. Postnatal outcomes, including Apgars, initial pH, and lactate, did not differ with the presence of a prenatal diagnosis. Diagnoses typically identified with the outflow tract and 3-vessel views on the fetal echocardiogram were less likely to be detected prenatally. The PDR of CHD continues to improve with evolving technologies and guidelines. We highlight a discrepancy between urban, rural, and Native American populations. Additionally, by supplying descriptors of missed diagnosis and associated echocardiography views, we hope to provide data for future interventions.