Anatomy Of Heart Research Articles

Interventional Electrophysiology in Patients With Congenital Heart Disease

“The treatment of congenital heart disease is unsatisfactory. As a rule, nothing can be done to improve patients symptomatically; in some instances digitalis may be of help.” — —L. Emmett Holt, MD, 1933 On August 26, 1938, Dr Robert Gross performed the first successful surgery for a congenital heart defect by closing a patent ductus arteriosus in a 7-year-old girl. The event marked the beginning of an interventional approach to congenital heart disease (CHD) that forever banished the sort of pessimism expressed by Dr Holt in his classic pediatric textbook only 5 years earlier.1 Subsequent diagnostic and operative innovations ultimately led to surgical solutions for nearly all anatomic heart defects, allowing the vast majority of infants born with CHD in the modern era to survive into adulthood. However, improved hemodynamic longevity has exposed alternate sources of morbidity and mortality for this population, central among which are cardiac rhythm disorders. In some instances, arrhythmias are intrinsic to the CHD lesion itself, but in most cases, they arise as an unintended consequence of prior corrective surgery whenever patches and suture lines function in conjunction with hypertrophy and fibrosis to create the substrate for reentrant tachycardias. It is fortunate that improved understanding of rhythm abnormalities in CHD has coincided with the emergence of interventional electrophysiological techniques. Catheter ablation, arrhythmia surgery, pacemakers, and implantable defibrillators have now become indispensable treatment options for this group. It is the purpose of this article to review the application of these tools to CHD with an emphasis on unique technical challenges. Congenital heart defects occur in roughly 0.8% of live births, and in 30% to 50% of cases, the malformations are severe enough to warrant ≥1 surgical procedures during early childhood.2 Arrhythmia mechanisms vary according to the underlying anatomic defect and method of surgical repair. The …

Dysregulation of Cardiogenesis, Cardiac Conduction, and Cell Cycle in Mice Lacking miRNA-1-2

MicroRNAs (miRNAs) are genomically encoded small RNAs used by organisms to regulate the expression of proteins generated from messenger RNA transcripts. The in vivo requirement of specific miRNAs in mammals through targeted deletion remains unknown, and reliable prediction of mRNA targets is still problematic. Here, we show that miRNA biogenesis in the mouse heart is essential for cardiogenesis. Furthermore, targeted deletion of the muscle-specific miRNA, miR-1-2, revealed numerous functions in the heart, including regulation of cardiac morphogenesis, electrical conduction, and cell-cycle control. Analyses of miR-1 complementary sequences in mRNAs upregulated upon miR-1-2 deletion revealed an enrichment of miR-1 "seed matches" and a strong tendency for potential miR-1 binding sites to be located in physically accessible regions. These findings indicate that subtle alteration of miRNA dosage can have profound consequences in mammals and demonstrate the utility of mammalian loss-of-function models in revealing physiologic miRNA targets.

Fetal echocardiography at the time of the nuchal translucency scan

The fetal heart is not studied routinely in the first trimester because of technical and time limitations. Our aim was to assess the feasibility of performing a fetal cardiac study in pregnancies referred for nuchal translucency (NT) screening, using high-frequency linear transabdominal transducers with a specific ultrasound preset. A single trained operator assessed the fetal heart in pregnancies with a fetal crown-rump length (CRL) of 60-84 mm that had been referred for NT screening. A 15- or 6-MHz transabdominal linear transducer with a specific preset suitable mainly for color-flow mapping was used to confirm or refute normal cardiac anatomy rather than to establish a specific diagnosis. Fetuses having an increased risk for congenital heart disease were referred to a tertiary center for a further examination within 1 week. This group consisted of all fetuses with NT > 95(th) centile and those in which a family history or the initial heart scan increased the risk. A total of 608 fetuses with a median CRL of 65 mm was examined between 2003 and 2005. A cardiac scan was performed successfully in 456 (75%) using a 15-MHz linear transducer alone, and the additional use of a 6-MHz transducer allowed diagnostic images to be obtained in a further 152. Normal cardiac anatomy was assessed confidently within 10 min in 517/608 (85%) pregnancies; in 85 (14%) a longer time was needed and six patients were rescheduled within 2 weeks because of non-diagnostic images at the initial scan. In 571/608 (94%) the risk for congenital heart disease (CHD) was not increased and the heart was considered normal at initial echocardiography; this was confirmed by later scans and at postnatal follow-up. In 37/608 (6%) fetuses the risk for CHD was increased (35 for NT > 95(th) centile and two for family history). In this group normal heart anatomy was described in 34 fetuses and confirmed by subsequent specialist echocardiography. Cardiac defects were suspected in three fetuses (all with increased NT) and confirmed by a fetal cardiologist in each case. A trained operator can perform a fetal heart study during the NT screening test using transabdominal high-resolution transducers in an acceptable length of time.

The Simultaneous Assessment of Aortic Valve Area and Coronary Artery Stenosis Using 16-Slice Multidetector-Row Computed Tomography in Patients With Aortic StenosisComparison With Echocardiography

Recent advancements in 16-slice multidetector-row computed tomography (16-slice MDCT) provide for non-invasive assessment of not only coronary artery disease (CAD), but also myocardial properties and the anatomy of the whole heart. The purpose of the present study was to investigate whether the aortic valve area (AVA) in patients with aortic stenosis (AS) assessed by 16-slice MDCT corresponds to echocardiographic assessment and to evaluate simultaneously the clinical accuracy in detecting CAD with 16-slice MDCT. The AVA of 29 consecutive AS patients with transthoracic echocardiography (TTE) and 16-slice MDCT were analyzed. The AVA was estimated by means of the continuity equation method in 2-dimensional echocardiography (DE) and the quantitative planimetric method after multi-planar reformation in 16-slice MDCT. Concomitantly, the severity of the coronary artery stenosis was assessed by 16-slice MDCT. In the present study, the AVA assessed by TTE and 16-slice MDCT was 1.34+/-0.32 cm(2) and 1.38+/-0.32 cm(2), respectively. Regression analysis showed that the AVA in patients with AS determined by 16-slice MDCT correlated well with those determined by 2-DE (r=0.96, p<0.001). Significant coronary artery stenosis of more than 50% diameter reduction was present in 48% of the study population. In patients with AS, the analysis of the severity of the AVA by 16-slice MDCT provides a feasible and accurate estimation with the concomitant evaluation of CAD.

Ciona intestinalis as a model for cardiac development

The primitive chordate Ciona intestinalis has emerged as a significant model system for the study of heart development. The Ciona embryo employs a conserved heart gene network in the context of extremely low cell numbers and reduced genetic redundancy. Here, I review recent studies on the molecular genetics of Ciona cardiogenesis as well as classic work on heart anatomy and physiology. I also discuss the potential of employing Ciona to decipher a comprehensive chordate gene network and to determine how this network controls heart morphogenesis.

Sudden cardiac death in athletes: the Lausanne Recommendations

This study reports on sudden cardiac death (SCD) in sport in the literature and aims at achieving a generally acceptable preparticipation screening protocol (PPSP) endorsed by the consensus meeting of the International Olympic Committee (IOC). The sudden death of athletes under 35 years engaged in competitive sports is a well-known occurrence; the incidence is higher in athletes (approximately 2/100,000 per year) than in non-athletes (2.5 : 1), and the cause is cardiovascular in over 90%. A systematic review of the literature identified causes of SCD, sex, age, underlying cardiac disease and the type of sport and PPSP in use. Methods necessary to detect pre-existing cardiac abnormalities are discussed to formulate a PPSP for the Medical Commission of the IOC. SCD occurred in 1101 (1966-2004) reported cases in athletes under 35 years, 50% had congenital anatomical heart disease and cardiomyopathies and 10% had early-onset atherosclerotic heart disease. Forty percent occurred in athletes under 18 years, 33% under 16 years; the female/male ratio was 1/9. SCD was reported in almost all sports; most frequently involved were soccer (30%), basketball (25%) and running (15%). The PPSP were of varying quality and content. The IOC consensus meeting accepted the proposed Lausanne Recommendations based on this research and expert opinions (http://multimedia.olympic.org/pdf/en_report_886.pdf). SCD occurs more frequently in young athletes, even those under the age of 18 years, than expected and is predominantly caused by pre-existing congenital cardiac abnormalities. Premature atherosclerotic disease forms another important cause in these young adults. A generally acceptable PPSP has been achieved by the IOC's acceptance of the Lausanne Recommendations.

Heart involvement in systemic lupus erythematosus, anti-phospholipid syndrome and neonatal lupus

Cardiac involvement is one of the main complications substantially contributing to the morbidity and mortality of patients suffering from systemic autoimmune diseases. All the anatomical heart structures can be affected, and multiple pathogenic mechanisms have been reported. Non-organ-specific autoantibodies have been implicated in immune complex formation and deposition as the initial triggers for inflammatory processes responsible for Libman-Sacks verrucous endocarditis, myocarditis and pericarditis. Anti-phospholipid antibodies have been associated with thrombotic events in coronary arteries, heart valve involvement and intra-myocardial vasculopathy in the context of primary and secondary anti-phospholipid syndrome. Antibodies-SSA/Ro and anti-SSB/La antigens play a major pathogenic role in affecting the heart conduction tissue leading to the electrocardiographic abnormalities of the neonatal lupus syndrome and have been closely associated with endocardial fibroelastosis.

P05.15: Diagnosis and treatment of triplet pregnancy complicated with twin reversed arterial perfusion—case report

Twin reversed arterial perfusion (TRAP) as complication of multiple pregnancies occurs in 1 : 100 monochorionic twins. Aim of this case was a description of diagnosis and treatment the triplets pregnancy complicated with TRAP. 32 year-old women (GII.PII) was diagnosed at the 20 weeks of gestation and the monochorionic diamniotic (MCDA) TRAP sequence combined with a singleton third fetus was recognized. The biometry of both normal triplets was equal to gestational age and the concordant their growth. Arterial and venous Doppler flows was normal in both fetuses, echocardiography examination revealed the normal heart anatomy and function also in both (cardiovascular profile score was – 10 points). Due to polyhydramnios in amniotic sac of pump twin we performed amniodrainage twice and the patient was qualified to invasive treatment in Leuven, Belgium. At 22 weeks of gestation was attempted the fetoscopy bipolar cord occlusion of a TRAP fetus, part of MCDA TRAP sequence. The polyhydramnios from the pump twin was drained (2090 ml) for that purpose, the other on infused (950ml). There were good well-being of pump and noninvolved twin through the procedure. After management patient was in good condition. In 23rd weeks of gestation has iatrogenic PROM developed, without any signs of intrauterine infection. Ultrasound examination performed at 26th weeks of gestation showed a normal, concordant growth, normal amniotic fluid and normal artery and venous Doppler, the same as echocardiography examination. Antibiotic therapy was applied. Amniopatching was planned, but at 26 weeks of gestation patients developed uterine contractions together with increasing leucocytosis and CRP elevation. A first injection of Celestone was administered (12mg). Infants were delivered vaginally at the same day with birth weigh 760g and 895g. Preterm newborns were admitted to the neonatal intensive care unit and discharged from the hospital after three months treatment without any complications.

ESC Textbook of Cardiovascular Medicine

John Camm, Thomas F. Luscher, Patrick W. Serruys, eds 1136 pages. Oxford, UK: Blackwell Publishing; 2006. $295. ISBN 1-4051-2695-7 Editor’s Note: In our effort to provide an insightful, balanced, and constructively critical review of the new first edition of the ESC Textbook of Cardiovascular Medicine edited by Drs A. John Camm, Thomas F. Luscher, and Patrick W. Serruys that was published under the auspices of the European Society of Cardiology by Blackwell Publishing Ltd (2006), we have obtained the opinions of 3 distinguished senior cardiologists, Drs Gottlieb Friesinger, Desmond Julian, and Elliot Rapaport, to serve as a Select Panel for Review. To ensure the book was read in its entirety, the text was divided into thirds and apportioned equally to each reviewer; all 3 reviewers were assigned 4 chapters in common to read as well. This summary review by 3 individuals, each of whom is internationally recognized for expertise in the broad field of general cardiology, is offered in the spirit of helping the ESC achieve its stated objective of providing a textbook that is successful in covering the knowledge that should be required of all general cardiologists. ### General Comments This textbook is primarily targeted at the specific audience of those wishing to be accredited with the European Board for Accreditation in Cardiology (EBAC). It is not intended to be a work of reference, but, as stated in the foreword, of producing “a clinically focused resource for general cardiologists and trainees.” It presents 36 chapters within 1092 pages, each authored by anywhere from 2 to 6 multinational collaborating members of the European Society of Cardiology. One of its remarkable achievements in addition to the high standard of writing is its superb illustrations, figures, and tables that appear on virtually every page. They are well placed within the text and contribute in making …

Role of Soluble Epoxide Hydrolase in Postischemic Recovery of Heart Contractile Function

Cytochrome P450 epoxygenases metabolize arachidonic acid to epoxyeicosatrienoic acids (EETs) which are converted to dihydroxyeicosatrienoic acids (DHETs) by soluble epoxide hydrolase (Ephx2, sEH). To examine the functional role of sEH in the heart, mice with targeted disruption of the Ephx2 gene were studied. Hearts from sEH null mice have undetectable levels of sEH mRNA and protein and cannot convert EETs to DHETs. sEH null mice have normal heart anatomy and basal contractile function, but have higher fatty acid epoxide:diol ratios in plasma and cardiomyocyte cell culture media compared with wild type (WT). sEH null hearts have improved recovery of left ventricular developed pressure (LVDP) and less infarction compared with WT hearts after 20 minutes ischemia. Perfusion with the putative EET receptor antagonist 14,15-epoxyeicosa-5(Z)-enoic acid (10 to 100 nmol/L) before ischemia abolishes this cardioprotective phenotype. Inhibitor studies demonstrate that perfusion with phosphatidylinositol-3 kinase (PI3K) inhibitors wortmannin (200 nmol/L) or LY294002 (5 micromol/L), the ATP-sensitive K+ channel (K(ATP)) inhibitor glibenclamide (1 micromol/L), the mitochondrial K(ATP) (mitoK(ATP)) inhibitor 5-hydroxydecanoate (100 to 200 micromol/L), or the Ca2+-sensitive K+ channel (K(Ca)) inhibitor paxilline (10 micromol/L) abolishes the cardioprotection in sEH null hearts. Consistent with increased activation of the PI3K cascade, sEH null mice exhibit increased cardiac expression of glycogen synthase kinase-3beta (GSK-3beta) phospho-protein after ischemia. Together, these data suggest that targeted disruption of sEH increases the availability of cardioprotective EETs that work by activating PI3K signaling pathways and K+ channels.

Dose-modeling study to compare external beam techniques from protocol NSABP B-39/RTOG 0413 for patients with highly unfavorable cardiac anatomy

The aim of this study was to select patients with heart anatomy that is specifically unfavorable for tangential irradiation in whole-breast radiotherapy (WBRT), to be used as an experimental cohort to compare cardiac dosimetric and radiobiological parameters of three-dimensional conformal external beam accelerated partial breast irradiation (3D-CRT APBI) to WBRT with techniques as defined by the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/Radiation Therapy Oncology Group (RTOG) 0413 clinical trial. A dosimetric modeling study that compared WBRT and 3D-CRT APBI was performed on CT planning data from 8 patients with left-sided breast cancer. Highly unfavorable cardiac anatomy was defined by the measured contact of the myocardium with the anterior chest wall in the axial and para-sagittal planes. Treatment plans of WBRT and 3D-CRT APBI were generated for each patient in accordance with NSABP B-39/RTOG 0413 protocol. Dose-volume relationships of the heart, including the V5min (minimum dose delivered to 5% of the cardiac volume), biological effective dose (BED) of the V5min, and normal tissue complication probability (NTCP) were analyzed and compared. Despite expected anatomic variation, significantly large differences were found favoring 3D-CRT APBI in cumulative dose-volume histograms (p < 0.01), dose to the entire heart (mean difference 3.85 Gy, p < 0.01), NTCP (median difference, 1.00 Gy; p < 0.01), V5min (mean difference, 24.53 Gy; p < 0.01), and proportional reduction in radiobiological effect on the V5min (85%, p < 0.01). Use of 3D-CRT APBI can demonstrate improved sparing of the heart in select patients with highly unfavorable cardiac anatomy for WBRT, and may result in reduced risk of cardiac morbidity and mortality.

Effect of cardiac motion on body surface electrocardiographic potentials: an MRI-based simulation study

This paper describes an electrical model of cardiac ventricles incorporating real geometry and motion. The heart anatomy and its motion through the cardiac cycle are obtained from segmentations of multiple-slice MRI time sequences; the special conduction system is constructed using an automated mapping procedure from an existing static heart model. The heart model is mounted in an anatomically realistic voxel model of the human body. The cardiac electrical source and surface potentials are determined numerically using both a finite-difference scheme and a boundary-element method with the incorporation of the motion of the heart. The electrocardiograms (ECG) and body surface potential maps are calculated and compared to the static simulation in the resting heart. The simulations demonstrate that introducing motion into the cardiac model modifies the ECG signals, with the most obvious change occurring during the T-wave at peak contraction of the ventricles. Body surface potential maps differ in some local positions during the T-wave, which may be of importance to a number of cardiac models, including those incorporating inverse methods.

Incidence of cardiovascular disease in the dissecting room: A valuable teaching asset

The purpose of this study was to determine the incidence of cardiovascular pathology in 50 cadavers in the dissecting room of the Department of Anatomy at Guy's Campus, King's College, London, and to demonstrate the importance of dissection in teaching the anatomy of normal and pathological hearts. After external evaluation of each heart the four chambers were dissected and studied. The features noted included evidence of coronary atherosclerosis, myocardial infarction, variations in coronary artery anatomy, valvular disease, variations in left ventricular wall thickness and atrial dimensions, and atrial anomalies. All the hearts studied had at least one pathology. The majority had severe coronary atherosclerosis (44) and aortic valve pathology (23). A large number had left ventricular hypertrophy (13) and left atrial enlargement (9). A small number showed evidence of myocardial infarction (4). Anatomical anomalies were also found, and included persistent foramen ovale (1), three coronary arterial ostia (3), and anatomical variations of the orientation of the main stem of the left coronary artery (2). This study demonstrates that dissection is not only an excellent way of studying normal cardiac anatomy, but also a valuable method for introducing common cardiac pathologies to the medical student.

Pairing of colored‐wax filled heart slices and CT images

The increasingly frequent use and great utility of advanced diagnostic imaging in medical practice calls for early, frequent and creative use of imaging in the medical curriculum. An anatomy instructor (DJE) noticed that students who have mastered cadaveric heart anatomy often have difficulty identifying the chambers, septae and valves of the heart on CT images. He then commented that there would be value in comparing thorax CT images to a cadaver heart that had been sliced in the transverse plane. Several students decided to pursue this novel dissection project. A superficially dissected heart was harvested from an embalmed cadaver. The right and left chambers were cleaned and filled with commercially available blue and red gel wax; then the heart was sectioned with a large knife at approximately 2 cm intervals in the transverse plane, starting at the inferior margin. After each slice, the heart was photographed while it was carefully positioned and held by hand adjacent to a photograph of a thorax CT slice. (The CT images were photographed with a Canon Rebel ® 35 mm film camera; these photographs were scanned, digitally edited and printed.) The resulting composite pictures were made available to all students as a computer slide-show. The project was repeated when another undissected heart became available three years later. This way of helping students to “visualize” the orientation and sequence of CT images enhances medical students’ education and prepares them for real world experiences.

Multislice Computed Tomography Evaluation 21 Years After Heterotopic Heart Transplantation

A 47-year-old man was investigated in the heart transplantation unit of our hospital almost 21 years after he had undergone a heterotopic heart transplantation at the Harefield Hospital (England). This is probably the longest-living heterotopic heart transplantation patient ever. In June 1983, he received heart transplant for end-stage heart failure resulting from dilated cardiomyopathy. Nowadays, heterotopic heart transplantation is hardly performed but may be indicated when the patient has irreversible pulmonary hypertension or when the donor heart is believed to be too small to support the recipient’s circulation. This donor heart came from a 16-year-old boy, and a full heterotopic transplantation was performed with the donor pulmonary artery inserted into the recipient pulmonary artery. After a successful operation and some initial signs of rejection, this patient has been living a reasonably normal life. He was initially managed with triple-therapy immunosuppression; currently, he receives cyclosporine monotherapy. Since 1999, he has been known …

Real‐time 3‐D echocardiographic evaluation of the fetal heart using instantaneous volume‐rendered display

Using new real-time 3-D fetal echocardiography with instantaneous volume-rendered display, we evaluated the heart anatomy of a number of normal fetuses during pregnancy. Eighteen normal fetuses in 17 pregnancies (16 singletons and one twin) at 18-38 weeks' gestation were studied using a transabdominal real-time 3-D ultrasound machine. This machine proved capable of providing continuous 3-D sonographic images every 0.05 and 0.035 s without the need for an external workstation or other additional, costly equipment. For each patient, the fetal heart was first monitored using conventional 2-D echocardiography and was monitored again within 10 min using real-time 3-D echocardiography. Consecutive real-time 3-D images showing a four-chamber view, long-axis view, short-axis view, and right ventricular outflow tract view were obtained in 100%, 66.6%, 38.8%, and 22.2% of fetuses in the study, respectively. Morphological changes to each atrium or ventricle could be observed clearly and in detail throughout the cardiac cycle. The opening and closing of each valve were clearly visible. Moreover, these observations could be made from any direction. Real-time 3-D echocardiography provides a novel means for evaluation of the fetal heart in 3-D in real time in the second and third trimester of pregnancy. Real-time 3-D echocardiography may be an important modality in future fetal cardiac research and in evaluation of congenital heart disease in the fetus.

The anatomy of hearts with double inlet ventricle

In the past, hearts with double inlet ventricle have been amongst the most contentious of congenital cardiac malformations. This is because, although most examples found with this particular atrioventricular connection have one big and one small chamber within the ventricular mass, for many years the variant most frequently encountered, with a dominant left ventricle, was usually described as exhibiting a single ventricle.1With the recognition that, in this particular variant, the small chamber is an incomplete right ventricle, and is never capable of supporting independently the pulmonary circulation, the anatomic situation has now been clarified, as explained in the previous review,2by recognising that the arrangement produces a functionally single ventricle, and that almost always patients with this lesion, if treated surgically, will be converted to the Fontan circulation. Even though, nonetheless, most patients with all variants of double inlet ventricle will likely end up with the Fontan circulation, it remains necessary to identify the functionally significant variants, namely those to be found in ventricular morphology, atrioventricular valvar morphology, ventriculo-arterial connections, and associated malformations.3

EL DIAGNÓSTICO PRENATAL DE CARDIOPATÍAS CONGÉNITAS MEJORA EL PRONÓSTICO NEONATAL

SUMMARY Congenital malformations are the main cause of neonatal death; in most of the cases they correspond to major congenital heart defects. Congenital heart defects have an incidence of 8/1,000 live newborns, corresponding half of them to major congenital heart defects. To reduce the mortality of this group of children routine evaluation of fetal heart anatomy by ultrasound is recommended, allowing neonatal care, of those fetuses with congenital heart defects, at the appropriate time and place. Here we attempt to verify if prenatal diagnosis of a congenital heart defect improves the perinatal outcome compare to postnatal diagnosis. We observed that the prenatal diagnosis of congenital heart defects, does not improve the neonatal outcome, except in certain congenital ductus dependent heart defects (transposition of great vessels, hypoplastic left heart syndrome and aortic coarctation), where a better outcome has been shown for those new born with prenatal diagnosis. We recommend routine evaluation of the fetal heart during prenatal ultrasound, and to carry out fetal echocardiography in high risk groups or when a defect is suspected.

P05.28: Evaluation of the fetal heart anatomy at 12 to 16 + 6 weeks of gestation

To establish the normal limits of FHR and reliability of fetal heart anatomy evaluation during obstetric scan at 12 to 16 + 6 weeks of gestation. Analysis of transabdominal ultrasound scans performed in 343 pregnant women at 12 to 16 + 6 weeks of gestation. 2D, M-mode and Doppler techniques were used. Gestational week was established on the basis of CRL, BPD, HC, AC and FL measurements. Demographic factors, obstetrical history and follow up of pregnancies were collected. All data were statistically reviewed (Chi test, Student T test, Mc Person correlation). Maternal age varied between 18 and 44 years (mean 32.7 ± 6) and paternal age: 22–62 years (mean 35.4 ± 7). There were 56% primigravidas, 18% women had a history of two or more deliveries and 14% had one or more abortions. FHR varied between 127 and 185 bpm (mean 151 ± 9). The statistically significant difference was found between FHR at 12 weeks (mean 160 ± 8) and following gestational weeks (149–155 bpm). The r—correlation ratio between FHR and gestational week was −0.41 (ns), maternal age—r = 0.40 (ns), paternal age r = 0.28 (ns) and nuchal translucency r = −0.11 (ns). The ultrasound visualization of four chamber view was possible from 12 weeks (72%) to 14 weeks—full evaluation of fetal heart structures could be done in about half of patients then (54%). The ratio between fetal heart area and fetal chest area varied from 0.22 to 0.29. There was no significant correlation between that ratio and gestational week. Fetal heart rate at 12 to 16 weeks was irrespective of the duration of gestation. Parents' age and nuchal translucency did not have influence on the fetal heart rate. It is possible to evaluate fetal heart anatomy as early as at 12 to 16 weeks. The fetal heart size is then smaller than later in pregnancy.

P05.29: Evaluation of PR interval in fetuses of Anti Ro positive pregnancies

Objective: To establish the normal limits of FHR and reliability of fetal heart anatomy evaluation during obstetric scan at 12 to 16 + 6 weeks of gestation. Material and methods: Analysis of transabdominal ultrasound scans performed in 343 pregnant women at 12 to 16 + 6 weeks of gestation. 2D, M-mode and Doppler techniques were used. Gestational week was established on the basis of CRL, BPD, HC, AC and FL measurements. Demographic factors, obstetrical history and follow up of pregnancies were collected. All data were statistically reviewed (Chi test, Student T test, Mc Person correlation). Results: Maternal age varied between 18 and 44 years (mean 32.7 ± 6) and paternal age: 22–62 years (mean 35.4 ± 7). There were 56% primigravidas, 18% women had a history of two or more deliveries and 14% had one or more abortions. FHR varied between 127 and 185 bpm (mean 151 ± 9). The statistically significant difference was found between FHR at 12 weeks (mean 160 ± 8) and following gestational weeks (149–155 bpm). The r – correlation ratio between FHR and gestational week was −0.41 (ns), maternal age – r = 0.40 (ns), paternal age r = 0.28 (ns) and nuchal translucency r = −0.11 (ns). The ultrasound visualization of four chamber view was possible from 12 weeks (72%) to 14 weeks – full evaluation of fetal heart structures could be done in about half of patients then (54%). The ratio between fetal heart area and fetal chest area varied from 0.22 to 0.29. There was no significant correlation between that ratio and gestational week. Conclusions: Fetal heart rate at 12 to 16 weeks was irrespective of the duration of gestation. Parents’ age and nuchal translucency did not have influence on the fetal heart rate. It is possible to evaluate fetal heart anatomy as early as at 12 to 16 weeks. The fetal heart size is then smaller than later in pregnancy.