Analysis of the Effect of the Size of the Medial Femoral Condyle and Medial Tibial Condyle on the Tear of Medial Meniscus Posterior Horn Root / 대한정형외과학회잡지

Purpose@#Many studies have been conducted on the cause of the medial meniscus posterior horn root (MMPHR) tears. A previous study reported that the relatively large size of the medial femoral condyle (MFC) compared to the size of the medial tibial condyle (MTC) could cause a tear of the MMPHR. The authors conducted a study to confirm that this was correct. @*Materials and Methods@#Patients who underwent magnetic resonance imaging of the knee at our Hospital from March 2011 to April 2019 were divided into a group with a tear of MMPHR and a control group without a tear. The size (MFC, MTC) and relative size ratio of the MFC and the MTC (MFC/MTC) were measured and compared to determine if there was any correlation with the tear of MMPHR. @*Results@#The mean MFC size of the 175 patients with MMPHR tear was 24.6±2.1 mm (0°), 23.5±2.1 mm (30°), 24.1±2.2 mm (60°), and the mean MTC size was 28.2±2.2 mm. The mean size of the MFC of the 147 control subjects was 25.2±2.4 mm (0°), 23.9±2.3 mm (30°), and 24.5±2.6 mm (60°), and the mean size of the MTC was 29.0±2.6 mm. The mean ratios (MFC/MTC) of the 175 patients with MMPHR tears were 0.87±0.05 (0°), 0.83±0.04 (30°), and 0.85±0.05 (60°) for each location. The corresponding mean ratios (MFC/MTC) of the 147 control subjects were 0.87±0.05 (0°), 0.83±0.04 (30°), and 0.85±0.05 (60°). There was no significant difference between the patient group and the control group. @*Conclusion@#The size and relative ratio of MFC and MTC do not appear to be related to a tear of the MMPHR.

Medial Patellofemoral Ligament Reconstruction Using Adjustable Tensioning under Arthroscopic Visualization Provides Satisfactory Radiographic and Clinical Outcomes / 대한스포츠의학회지

Purpose@#Recurrent patellar dislocation required a surgical reconstruction of medial patellofemoral ligament (MPFL) in many cases. During MPFL reconstruction, over-tension of medial construct altered the patellofemoral kinematics which may result in pain, patellofemoral joint degeneration, or graft failure. Thus, it is important to confirm appropriate tension intraoperatively. The purpose of this study was to evaluate the clinical and radiographic outcomes of MPFL reconstruction with use of an adjustable tensioning under arthroscopic direct visualization of patellofemoral joint. @*Methods@#This retrospective study included 11 MPFL reconstructions (nine patients) from 2013 to 2020. All the patients received the same surgical procedures by a single surgeon. Final graft tension was determined after confirming patellar position to the trochlear groove at 60° knee flexion under arthroscopic exam. Patient demographics, pre- and postoperative radiographic results including congruence angle and Insall-Salvati ratio, and clinical outcomes were compared. @*Results@#The congruence angle was significantly changed from 32.8°±21.1° preoperatively to 8.4°±11.5° postoperatively (p=0.003), and the Insall-Salvati ratio was 1.16°±0.15° and 1.10°±0.13° respectively (p=0.02). Clinical scores were significantly improved between pre- and postoperatively; Kujala score (33.2±18.3 to 88.8±4.7, p=0.04), Lysholm score (30.2±15 to 79.0±5.2, p=0.005), and Tegner level (2.2±1.1 to 4.4±1.7, p=0.04). There was no recurrence of patellar dislocation. @*Conclusion@#MPFL reconstruction using adjustable tensioning under arthroscopic direct visualization could obtain satisfactory outcomes after surgery.

Clinical Characteristics of Primary and Secondary Osteoporotic Fractures: Data from Single Referral Center Emergency Department

BACKGROUND: To investigate the characteristics of patients with osteoporotic fractures (OF) who visited the emergency room, we analyzed the frequency and distribution of primary and secondary OF.METHODS: From March 2015 to April 2017, 406 patients with OF were assigned to wrist (W; n=132), spine (S; n=78), and hip (H; n=196) according to the site. All subjects were classified as having primary fracture or secondary fracture. Age, fracture site, the risk of future fracture using Fracture Risk Assessment Tool (FRAX) were compared.RESULTS: The mean age at fracture site was significantly different among the 3 groups, groups W (66.57±10.03), S (73.50±9.07), and H (78.50±7.72). The most common site of OF were in the order of wrist, spine, and hip with the increase of age. The FRAX scores significantly increased (P<0.001) in the order of W (8.35±5.67), S (10.74±6.99), and H (13.88±7.98) in total patient, and same in primary fracture group (W, 7.50±4.18; S, 9.76±5.91; H, 11.93±6.61; P<0.001). The main site of prior fractures in secondary fracture was same lesion, which means that the prior fracture of secondary wrist fracture was wrist fracture such as spine for spine, hip for hip.CONCLUSIONS: We determined that as age increasing, the major sites of OF were different and FRAX scores increased. The most common site for secondary fracture was the same one. Hence, the risk of subsequent fracture in same site should be noted after patient suffered OF.

Influence of nano-structured alumina coating on shear bond strength between Y-TZP ceramic and various dual-cured resin cements

PURPOSE: The purpose of this study was to evaluate the effect of nano-structured alumina surface coating on shear bond strength between Y-TZP ceramic and various dual-cured resin cements. MATERIALS AND METHODS: A total of 90 disk-shaped zirconia specimens (HASS CO., Gangneung, Korea) were divided into three groups by surface treatment method: (1) airborne particle abrasion, (2) tribochemicalsilica coating, and (3) nano-structured alumina coating. Each group was categorized into three subgroups of ten specimens and bonded with three different types of dual-cured resin cements. After thermocycling, shear bond strength was measured and failure modes were observed through FE-SEM. Two-way ANOVA and the Tukey's HSD test were performed to determine the effects of surface treatment method and type of cement on bond strength (P<.05). To confirm the correlation of surface treatment and failure mode, the Chi-square test was used. RESULTS: Groups treated with the nanostructured alumina coating showed significantly higher shear bond strength compared to other groups treated with airborne particle abrasion or tribochemical silica coating. Clearfil SA Luting showed a significantly higher shear bond strength compared to RelyX ARC and RelyX Unicem. The cohesive failure mode was observed to be dominant in the groups treated with nano-structured alumina coating, while the adhesive failure mode was prevalent in the groups treated with either airborne particle abrasion or tribochemical silica coating. CONCLUSION: Nano-structured alumina coating is an effective zirconia surface treatment method for enhancing the bond strength between Y-TZP ceramic and various dual-cured resin cements.

Complication and management of implant-assisted removable partial denture with distal extension: a clinical report

Implant supported removable partial denture (ISRPD) using the implants enables favorable rehabilitation by complementing biomechanical limitations of the conventional removable partial denture (RPD). However, continuous recall check is necessary for evaluation of the mechanical and biological complications to ensure good long-term prognosis of ISRPD. This clinical report describes the complication and management in patient of Kennedy class I edentulism with ISRPD using healing abutment. The wear and fracture of healing abutment occurred at 36 months after delivery. So, healing abutment was replaced by connecting Locator® abutment for altering into the implant retained partial overdenture.

Comparative Study of Bipolar Hemiarthroplasty for Femur Neck Fractures Treated with Cemented versus Cementless Stem / 대한고관절학회지

PURPOSE: To compare and analyze clinical and radiologic outcomes of cemented versus cementless bipolar hemiarthroplasty for treatment of femur neck fractures. MATERIALS AND METHODS: A total of 180 patients aged 65 years and over older who underwent bipolar hemiarthroplasty for treatment of displaced femur neck fractures (Garden stage III, IV) from March 2009 to February 2014 were included in this study. Among the 180 patients, 115 were treated with cemented stems and 65 patients with cementless stems. Clinical outcomes assessed were: i) postoperative ambulatory status, ii) inguinal and thigh pain, and iii) complications. The radiologic outcome was femoral stem subsidence measured using postoperative simple X-ray. RESULTS: The cemented group had significantly lower occurrence of complications (postoperative infection, P=0.04) compared to the cementless group. There was no significant difference in postoperative ambulatory status, inguinal and thigh pain, and femoral stem subsidence. CONCLUSION: For patients undergoing bipolar hemiarthroplasty, other than complications, there was no statistically significant difference in clinical or radiologic outcomes in our study. Selective use of cemented stem in bipolar hemiarthroplasty may be a desirable treatment method for patients with poor bone quality and higher risk of infections.

Evaluation of effect of galvanic corrosion between nickel-chromium metal and titanium on ion release and cell toxicity

PURPOSE: The purpose of this study was to evaluate cell toxicity due to ion release caused by galvanic corrosion as a result of contact between base metal and titanium. MATERIALS AND METHODS: It was hypothesized that Nickel (Ni)-Chromium (Cr) alloys with different compositions possess different corrosion resistances when contacted with titanium abutment, and therefore in this study, specimens (10 x 10 x 1.5 mm) were fabricated using commercial pure titanium and 3 different types of Ni-Cr alloys (T3, Tilite, Bella bond plus) commonly used for metal ceramic restorations. The specimens were divided into 6 groups according to the composition of Ni-Cr alloy and contact with titanium. The experimental groups were in direct contact with titanium and the control groups were not. After the samples were immersed in the culture medium - Dulbecco's modified Eagle's medium[DMEM] for 48 hours, the released metal ions were detected using inductively coupled plasma mass spectrometer (ICP-MS) and analyzed by the Kruskal-Wallis and Mann-Whitney test (P<.05). Mouse L-929 fibroblast cells were used for cell toxicity evaluation. The cell toxicity of specimens was measured by the 3-{4,5-dimethylthiazol-2yl}-2,5-diphenyltetrazolium bromide (MTT) test. Results of MTT assay were statistically analyzed by the two-way ANOVA test (P<.05). Post-hoc multiple comparisons were conducted using Tukey's tests. RESULTS: The amount of metal ions released by galvanic corrosion due to contact between the base metal alloy and titanium was increased in all of the specimens. In the cytotoxicity test, the two-way ANOVA showed a significant effect of the alloy type and galvanic corrosion for cytotoxicity (P<.001). The relative cell growth rate (RGR) was decreased further on the groups in contact with titanium (P<.05). CONCLUSION: The release of metal ions was increased by galvanic corrosion due to contact between base metal and titanium, and it can cause adverse effects on the tissue around the implant by inducing cytotoxicity.

Evaluation of effect of galvanic corrosion between nickel-chromium metal and titanium on ion release and cell toxicity

PURPOSE: The purpose of this study was to evaluate cell toxicity due to ion release caused by galvanic corrosion as a result of contact between base metal and titanium. MATERIALS AND METHODS: It was hypothesized that Nickel (Ni)-Chromium (Cr) alloys with different compositions possess different corrosion resistances when contacted with titanium abutment, and therefore in this study, specimens (10 x 10 x 1.5 mm) were fabricated using commercial pure titanium and 3 different types of Ni-Cr alloys (T3, Tilite, Bella bond plus) commonly used for metal ceramic restorations. The specimens were divided into 6 groups according to the composition of Ni-Cr alloy and contact with titanium. The experimental groups were in direct contact with titanium and the control groups were not. After the samples were immersed in the culture medium - Dulbecco's modified Eagle's medium[DMEM] for 48 hours, the released metal ions were detected using inductively coupled plasma mass spectrometer (ICP-MS) and analyzed by the Kruskal-Wallis and Mann-Whitney test (P<.05). Mouse L-929 fibroblast cells were used for cell toxicity evaluation. The cell toxicity of specimens was measured by the 3-{4,5-dimethylthiazol-2yl}-2,5-diphenyltetrazolium bromide (MTT) test. Results of MTT assay were statistically analyzed by the two-way ANOVA test (P<.05). Post-hoc multiple comparisons were conducted using Tukey's tests. RESULTS: The amount of metal ions released by galvanic corrosion due to contact between the base metal alloy and titanium was increased in all of the specimens. In the cytotoxicity test, the two-way ANOVA showed a significant effect of the alloy type and galvanic corrosion for cytotoxicity (P<.001). The relative cell growth rate (RGR) was decreased further on the groups in contact with titanium (P<.05). CONCLUSION: The release of metal ions was increased by galvanic corrosion due to contact between base metal and titanium, and it can cause adverse effects on the tissue around the implant by inducing cytotoxicity.

Second-Look Arthroscopic Results after Repair of Medial Meniscus Root Tears / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the healing rate of medial meniscus root repair according to the duration of symptom and to determine the association between healing status and the clinical result after medial meniscus root repair. MATERIALS AND METHODS: Eighty-four patients who underwent arthroscopic meniscal root repair and second-look arthroscopy were included. Second-look arthroscopy evaluation of meniscal healing status was performed by dividing medial meniscal posterior root into the anterior half and posterior half and classifying by contact degree on the surface of the tibia and continuity. Clinical results were analyzed according to International Knee Documentation Committee (IKDC) subjective scores and Lysholm scores. In addition, after dividing cases according to acute group and chronic group by six-month symptomatic period, differences were evaluated. RESULTS: Significant differences in post-operative clinical results were observed between the acute group and chronic group. A significant difference in meniscal healing status was observed between the two groups (p<0.001). A higher postoperative IKDC score and Lysholm score was observed for the completely healed group, as confirmed by second-look arthroscopy, than for the other groups. CONCLUSION: In the aspect of improving the clinical result, arthroscopic medial meniscal posterior root repair is a good treatment modality. Early repair of medial meniscal posterior root may lead to improvements in the clinical result such as meniscal healing status.

Prevalence of Congenital Heart Defects Associated with Down Syndrome in Korea

Congenital heart defect (CHD) is common in infants with Down syndrome (DS), which is the principle cause of mortality. However, there is no data available for the frequency and types of CHD in infants with DS in Korea. We investigated the frequency of CHD in infants with DS in Korea. After the survey on birth defects was conducted throughout the country, the prevalence of CHD in DS in 2005-2006 was calculated. This study was conducted based on the medical insurance claims database of the National Health Insurance Corporation. The number of total births in Korea was 888,263 in 2005-2006; of them, 25,975 cases of birth defects were identified. The prevalence of DS was 4.4 per 10,000 total births, accounting for 1.5% of all birth defects. Of the 394 infants with DS, 224 (56.9%) had a CHD. Atrial septal defect was the most common defect accounting for 30.5% of DS followed by ventricular septal defect (19.3%), patent duct arteriosus (17.5%), and atrioventricular septal defect (9.4%). Our study will be helpful to demonstrate the current status of DS and to identify the distribution of CHD in infants with DS in Korea.

Implantable cardioverter defibrillator therapy in pediatric and congenital heart disease patients: a single tertiary center experience in Korea / 소아과

PURPOSE: The use of implantable cardioverter defibrillators (ICDs) to prevent sudden cardiac death is increasing in children and adolescents. This study investigated the use of ICDs in children with congenital heart disease. METHODS: This retrospective study was conducted on the clinical characteristics and effectiveness of ICD implantation at the department of pediatrics of a single tertiary center between 2007 and 2011. RESULTS: Fifteen patients underwent ICD implantation. Their mean age at the time of implantation was 14.5+/-5.4 years (range, 2 to 22 years). The follow-up duration was 28.9+/-20.4 months. The cause of ICD implantation was cardiac arrest in 7, sustained ventricular tachycardia in 6, and syncope in 2 patients. The underlying disorders were as follows: ionic channelopathy in 6 patients (long QT type 3 in 4, catecholaminergic polymorphic ventricular tachycardia [CPVT] in 1, and J wave syndrome in 1), cardiomyopathy in 5 patients, and postoperative congenital heart disease in 4 patients. ICD coils were implanted in the pericardial space in 2 children (ages 2 and 6 years). Five patients received appropriate ICD shock therapy, and 2 patients received inappropriate shocks due to supraventricular tachycardia. During follow-up, 2 patients required lead dysfunction-related revision. One patient with CPVT suffered from an ICD storm that was resolved using sympathetic denervation surgery. CONCLUSION: The overall ICD outcome was acceptable in most pediatric patients. Early diagnosis and timely ICD implantation are recommended for preventing sudden death in high-risk children and patients with congenital heart disease.

Traumatic Dislocation of the Hip with a Femoral Head Fracture / 대한고관절학회지

PURPOSE: This study was designed in order to evaluate the clinical results and frequency of complications of patients who underwent surgical treatment for traumatic dislocation of the hip with a femoral head fracture. MATERIALS AND METHODS: Eighteen cases of Thompson-Epstein type V femoral head fracture with dislocation of the hip from November 2002 to November 2011 were analyzed retrospectively. We divided the cases into two groups according to availability of closed reduction and reduction time, and analyzed the clinical results according to Epstein criteria and frequency of avascular necrosis of the femoral head and posttraumatic osteoarthritis. RESULTS: Among all patients, the observed complications included three cases of avascular necrosis and one case of posttraumatic osteoarthritis. The data showed that 14 cases were available for closed reduction; otherwise, there were four cases of failure. Significant differences were observed in clinical results and frequency of complications. Results regarding reduction time showed that 10 cases took 6 hours, and the other eight cases took more than 6 hours. There were no differences in clinical results, but, better results were achieved with a reduction time in 6 hours. However, significant differences were observed in frequency of complications. CONCLUSION: The availability of closed reduction would be an important factor for achievement of good clinical results in traumatic dislocation of the hip with a femoral head fracture. In order to obtain better clinical results, closed reduction should be performed as rapidly as possible.

Bisphosphonate Related Atypical Femoral Fracture / 대한고관절학회지

PURPOSE: We attempted to determine the differences in frequency, as well as clinical, radiologic characteristics of atypical femoral fracture between groups of patients who have taken bisphosphonate and those who have not by conduct of a retrospective analysis of patients with low energy subtrochanteric and shaft fractures of the femur. MATERIALS AND METHODS: We conducted a retrospective study of 44 cases of 41 female patients over 60 years old who underwent surgery due to femoral shaft/subtrochanteric fractures from August 2001 to October 2011. The patients were divided into two groups: Group A, 22 cases in 19 patients with a history of bisphosphonate treatment; Group B, 22 cases in 22 patients without a history of bisphosphonate treatment as a control group. We assessed the duration of bisphosphonate treatment, presence of prodromal symptoms, and radiological results, and compared age, BMD results, union period, and nonunion rate between the two groups. RESULTS: Mean medication period was 56.8 months(12-132 months) and prodromal symptoms were observed in one case. Lateral cortical thickening and transverse fracture with a medial cortical bone beak were observed in all patients of Group A, and contralateral cortical hypertrophy of the femur was noted in 15 patients(17 cases) (77.3%). Mean age was 73.2 years in Group A and 78.2 years in Group B, which showed significant difference (P=0.021), while no difference was observed in BMD, union period, and nonunion rate. CONCLUSION: An atypical femoral fracture can occur in the subtrochanteric or shaft of the femur. The typical radiological characteristics of this fracture are lateral cortical thickening and transverse fracture with a medial cortical bone beak and contralateral abnormality of cortical bone. Findings of this study suggest that medical practitioners should be careful of atypical fractures with osteoporosis patients who use prolonged bisphosphonate.

Sudden Cardiac Arrest during Anesthesia in a 30-Month-Old Boy with Syndactyly: A Case of Genetically Proven Timothy Syndrome

Timothy syndrome, long QT syndrome type 8, is highly malignant with ventricular tachyarrhythmia. A 30-month-old boy had sudden cardiac arrest during anesthesia induction before plastic surgery for bilateral cutaneous syndactyly. After successful resuscitation, prolonged QT interval (QTc, 0.58-0.60 sec) and T-wave alternans were found in his electrocardiogram. Starting beta-blocker to prevent further tachycardia and collapse event, then there were no more arrhythmic events. The genes KCNQ1, KCNH2, KCNE1 and 2, and SCN5A were negative for long QT syndrome. The mutation p.Gly406Arg was confirmed in CACNA1C, which maintains L-type calcium channel depolarization in the heart and other systems.

A Case of Progressive Ductal Constriction in a Fetus

The ductus arteriosus is a normal and essential structure in fetal circulation. Since the introduction of fetal echocardiography, there have been reports of ductal constriction, many of which were related to maternal use of some medications. However, there have been some reports of idiopathic ductal constriction, which usually present in later gestation. Recently we experienced a case, which initially showed an S-shaped ductus with mild narrowing at 23 weeks and 27 weeks gestation and developed severe ductal constriction at 33 weeks. Soon after birth, ductus was searched for but no ductus was found in 2-D and color images. The neonate required mechanical ventilation with supplemental oxygen for 3 days. All echocardiographic abnormalities were normalized in 7 months. We report progressive ductal constriction in an S-shaped ductus and emphasize the importance of continuous follow up extending to the third trimester and even immediately after birth.

A Case of Progressive Ductal Constriction in a Fetus

The ductus arteriosus is a normal and essential structure in fetal circulation. Since the introduction of fetal echocardiography, there have been reports of ductal constriction, many of which were related to maternal use of some medications. However, there have been some reports of idiopathic ductal constriction, which usually present in later gestation. Recently we experienced a case, which initially showed an S-shaped ductus with mild narrowing at 23 weeks and 27 weeks gestation and developed severe ductal constriction at 33 weeks. Soon after birth, ductus was searched for but no ductus was found in 2-D and color images. The neonate required mechanical ventilation with supplemental oxygen for 3 days. All echocardiographic abnormalities were normalized in 7 months. We report progressive ductal constriction in an S-shaped ductus and emphasize the importance of continuous follow up extending to the third trimester and even immediately after birth.

Analysis of Risk Factors for the Posterolateral Articular Depression and Status of Posterolateral Fragment in Lateral Condylar and Bicondylar Tibial Plateau Fractures with Joint Depression

PURPOSE: To evaluate risk factors of posterolateral articular depression and characteristics of the posterolateral fragment in lateral condylar and bicondylar tibial plateau fractures with joint depression. MATERIALS AND METHODS: We reviewed 48 patients of Schatzker type II and type V (type II 34, type V 14) and evaluated risk factors of posterolateral articular depression according to the posterolateral fragment, fibular fracture, and Schatzker classification. We evaluated the position of articular depression and anterolateral fracture line of the posterolateral fragment and measured anterior to posterior lengths of the posterolateral fragment. RESULTS: Posterolateral articular depression was found in 20 of 34 cases (59%) with coexisting posterolateral fragment and in 16 of 21 cases (76%) with coexisting fibular fracture. There was a significant difference in the occurrence of posterolateral articular depression with the existence of the posterolateral fragment and fibular fracture (p<0.001). Multivariate regression analysis revealed that fibular fracture increased the occurrence of posterolateral articular depression (odds ratio 24.5, 95% confidence interval 2.2-267.2). Fifty-seven percentage of the anterolateral fracture line of the posterolateral fragment existed posterior to the anterior margin of the fibular head. CONCLUSION: This study showed that fibular fracture affects posterolateral articular depression in Schatzker type II and V tibial plateau fractures. Selecting a fixation device and performing fracture reduction requires a careful consideration since the anterolateral fracture line of the posterolateral fragment exists posterior to the anterior margin of the fibular head.

Hip Arthroplasty Using Collarless Polished Tapered Stem: Minimum 2 Years Follow-up Results

PURPOSE: This study evaluated the clinical and radiologic results of total hip arthroplasty and bipolar hemiarthroplasty using collarless polished tapered femoral stem. MATERIALS AND METHODS: We retrospectively reviewed the results of 33 patients who underwent THA and BHA using cemented CPT femoral stem from November 2006 to April 2009. The mean follow-up period was 33 months. The clinical results were evaluated with a Harris Hip Score (HSS), and radiographic results were assessed with cement grade, osteolysis, loosening, stress shielding and subsidence methods. RESULTS: Mean HSS improved with 91 points. Postoperative cement grade was A in 14 cases, B in 14 cases, C1 in 5 cases and D in none. Aseptic loosening was not found, while focal radiolucency in zone 8 was found. 70% of stems showed grade 1 and 2 stress shielding according to Engh's criteria. Subsidence of the femoral stem was less than 1 mm in 32 cases, and was 1.47 mm in another case. Ectopic ossification was observed in 13 cases, class I in 11 cases, and class II in 2 cases, using Brooker's classification. CONCLUSION: This study showed the good clinical and radiographic results of THA and BHA with a cemented CPT femoral stem at the mid-term follow-up. However, a long-term follow-up study will be needed to evaluate the more precise clinical and radiographic outcomes.

A Case of Reye Syndrome Following Treatment of Kawasaki Disease with Aspirin / 소아감염

Reye syndrome is a rapidly progressive encephalopathy with hepatic dysfunction, which often begins several days after apparent recovery from a viral illness, especially varicella or influenza A or B. Salicylate use was identified as a major precipitating factor for the development of Reye syndrome. With the recommendation to avoid use of salicylates in children, Reye syndrome has virtually disappeared in recent years. We report a case of Reye syndrome in a 5-month-old infant who had been treated with intravenous immunoglobulin and aspirin under the diagnosis of Kawasaki disease, and showed symptoms of sudden onset of irritability, rigidity, decreased activity, vomiting, poor appetite, lethargy, liver dysfunction without jaundice, coagulopathy, and hyperammonemia.

Recent Trends in Indications of Fetal Echocardiography and Postnatal Outcomes in Fetuses Diagnosed as Congenital Heart Disease

BACKGROUND AND OBJECTIVES: We hypothesized that fetal echocardiography (echoCG) is an accurate diagnostic tool reflecting well postnatal echoCG findings and outcomes. SUBJECTS AND METHODS: We reviewed the medical records of 290 pregnant women, including 313 fetuses, who were examined by fetal echoCG at the Seoul National University Children's Hospital from January 2008 through April 2011. RESULTS: The mean gestational age at diagnosis was 26.2+/-5.2 weeks. The mean age of mothers at diagnosis was 31.7+/-3.8 years. We identified indications for fetal echoCG in 279 cases. The most common indication was abnormal cardiac findings in obstetrical screening sonography (52.0%). Among the 313 echoCG results, 127 (40.6%) were normal, 13 (4.2%) were minor abnormalities, 35 (11.2%) were simple cardiac anomalies, 50 (16.0%) were moderate cardiac anomalies, 60 (19.2%) were complex cardiac anomalies, 16 (5.1%) were arrhythmias, and 12 (3.8%) were twin-to-twin transfusion syndrome. The most common congenital heart disease was tetralogy of Fallot (23 fetuses, 15.9%). One hundred forty-eight neonates were examined by echoCG. We analyzed differences between fetal echoCG and postnatal echoCG. In 131 (88.5%) cases, there was no difference; in 15 (10.1%), there were minor differences; and in only 2 (1.4%) cases, there were major differences. CONCLUSION: There is a recent increase in abnormal cardiac findings of obstetric ultrasonography screenings that indicate fetal echoCG. Fetal echoCG is still a good, accurate diagnostic method for congenital heart disease.