FETAL ECHOCARDIOGRAPHY AS A ROUTINE ANTENATAL SCREENING TOOL FOR DETECTION OF FETAL CONGENITAL CARDIAC STRUCTURAL ANOMALIES.

Background: Fetal echocardiography plays a pivotal role in detecting congenital cardiac structural anomalies. Though foetal echocardiography is mostly reserved for high risk pregnant women, its role as a routine prenatal screening tool needs to be dened. To evaluate the role of fetal echocardiography as a routine Objectives: antenatal screening tool for detection of congenital cardiac structural anomalies.To compare the prevalence of congenital cardiac structural anomalies by fetal echocardiography in antenatal women with low risk and high risk factors for cardiac structural anomalies. The study was carried out in the department of radiodiagnosis, SNMC, Agra. Materials and methods: 500 fetal hearts between 18-26 weeks gestation were evaluated through fetal echocardiography.They were categorised into two groups -low risk (Group I) and high risk (Group II) and scanned through four chamber , LVOT , RVOT and three vessel view. Result: The prevalence of fetal congenital cardiac structural anomalies in this study is 14/1000.Fetal echocardiography had a sensitivity of 85% & specicity of 99%. PPV is 85% and NPV is 99%. The incidence of congenital cardiac structural anomalies in high risk and low risk group was 12 % & 14.8 % per 1,000 respectively. based on these ndings it is highly Conclusion: suggestive that every pregnant woman should be subjected to a detailed fetal echocardiography. Fetal echocardiography should be included as a part of routine antenatal screening irrespective of risk factors for congenital cardiac structural anomalies.

Evaluación prenatal del síndrome de heterotaxia por ecografía fetal / Prenatal assessment of heterotaxy syndrome by fetal ultrasound

Resumen El síndrome de heterotaxia es una entidad de baja prevalencia, que tiene su origen durante el desarrollo embrionario, que afecta a diversos órganos y sistemas. Es por ello que su diagnóstico representa un reto durante la gestación. El pronóstico dependerá principalmente de las malformaciones cardiacas asociadas. Se presenta el caso de un paciente con diagnóstico de síndrome de heterotaxia durante el primer trimestre. Se detallan los patrones ecográficos obtenidos durante el tamizaje del primer trimestre que auxiliaron a integrar el diagnóstico de esta entidad, así como las anomalías cardiacas asociadas. El manejo debe contemplar a un equipo multidisciplinario, el cual brinde un manejo oportuno, que será principalmente quirúrgico, enfocado en las malformaciones cardiacas.

Abstract Heterotaxy syndrome is a low prevalence entity, which originates during embryonic development, affecting diverse organs and systems. That is why its diagnosis represents a challenge during pregnancy. The prognosis depends mainly on the associated cardiac malformations. The case of a patient with a diagnosis of heterotaxy syndrome during the first trimester is presented. The ultrasound patterns obtained during the first trimester screening that helped to integrate the diagnosis of this entity are detailed, as well as the associated cardiac anomalies. Management must contemplate a multidisciplinary team, which provides timely management, which will be mainly surgical, focused on cardiac malformations.

Fetal echocardiography audit in a tertiary hospital in Ibadan, Nigeria

Delayed detection of congenital heart diseases in low- and middle-income countries (LMICs) contributes to the poor outcome of infants with cardiac anomalies. Fetal echocardiography (FE) can detect heart defects in-utero as early as the 18th gestational week (GA), giving parents and medical professionals time to prepare for the baby's delivery and appropriate treatment. University College Hospital, Nigeria, is one of the few centres in Nigeria where FE is performed. Objectives: To examine the indications for referral for FE and the diagnoses made in our first four years of performing FE. Methods: FE was performed in the antenatal clinic of the University College Hospital, Ibadan, Nigeria, using the GE Voluson P6 machine with a 2-6-RS probe. Demographic information was obtained from the antenatal clinic records of the women who had FE using a semi-structured questionnaire. FE diagnoses were retrieved from the FE register. Results: A total of 129 women whose records were available were studied. The mean age of the women was 31.7±5.5 years. Forty-two women (32.6%) were referred because of echogenic foci, making this the most common indication for FE. Twenty-nine (22.5%) fetuses had structural heart defects, the most common being Ventricular Septal Defect. Conclusion: There is a need for Obstetricians and Paediatricians to be aware of the indications for fetal echocardiography and refer women appropriately

Diagnóstico prenatal de aneurisma del septo interauricular: reporte de dos casos / Prenatal diagnosis of atrial septal aneurysm: report of two cases

Resumen INTRODUCCIÓN: El aneurisma del septo interauricular es una deformación sacular del tejido delgado del septo interatrial situado, generalmente, en la zona del foramen oval, cuya deformación puede ocurrir hacia las aurículas derecha, izquiera o ambas. Es un hallazgo raro durante la exploración ecocardiográfica fetal, con prevalencia del 0.6 al 1.7%. CASOS CLÍNICOS: Caso 1: Paciente de 20 años. En la exploración ecográfica cardiaca a las 36 semanas se encontró un situs solitus con eje cardiaco a 40 grados, área cardiotorácica 0.25-0.35 normal, frecuencia cardiaca fetal de 134 latidos por minuto, ritmo regular, sin derrame pericárdico. En la ecocardiografía transtorácica posnatal se encontraron: situs solitus, conexiones concordantes, sin evidencia de cortocircuitos intra o extracardiacos. Caso 2: Paciente de 20 años. En la exploración ecográfica cardiaca avanzada a las 37 semanas se encontraron: situs solitus, eje cardiaco a 47 grados, área cardiotorácica normal, frecuencia cardiaca fetal de 140 latidos por minuto, ritmo regular, sin derrame pericárdico. La ecocardiografía transtorácica posnatal reportó: situs solitus, conexiones concordantes, sin evidencia de cortocircuitos intra o extracardiacos. CONCLUSIONES: Si bien los aneurismas del septo interauricular suelen ser un hallazgo aislado en la ecocardiografía fetal, se consideran un proceso benigno y transitorio. Algunas veces se asocian con otras anomalías cardiacas, por lo que al tener la sospecha diagnóstica debe practicarse una ecocardiografía básica y avanzada para descartar anomalías asociadas.

Abstract BACKGROUND: Atrial septal aneurysm is a saccular deformation of the thin tissue of the interatrial septum usually located in the foramen ovale, whose deformation can occur toward the right atrium, left atrium or both. It is a rare finding during fetal echocardiographic examination, with a prevalence of 0.6 to 1.7%. CLINICAL CASES: Case 1: 20-year-old female patient. On cardiac echocardiographic examination at 36 weeks a situs solitus was found with cardiac axis at 40 degrees, cardiothoracic area 0.25-0.35 normal, fetal heart rate 134 beats per minute, regular rhythm, no pericardial effusion. Postnatal transthoracic echocardiography showed: situs solitus, concordant connections, without evidence of intra or extracardiac shunts. Case 2: 20-year-old patient. Advanced cardiac ultrasound examination at 37 weeks found: situs solitus, cardiac axis at 47 degrees, normal cardiothoracic area, fetal heart rate of 140 beats per minute, regular rhythm, no pericardial effusion. Postnatal transthoracic echocardiography reported: situs solitus, concordant connections, without evidence of intra or extracardiac shunts. CONCLUSIONS: Although interatrial septal aneurysms are usually an isolated finding in fetal echocardiography, they are considered a benign and transient process. Sometimes they are associated with other cardiac anomalies, so when the diagnosis is suspected, basic and advanced echocardiography should be performed to rule out associated anomalies.

Síndrome de Edwards: desde el diagnóstico prenatal hasta el neonatólogo

RESUMEN El síndrome de Edwards o síndrome de trisomía 18 es un trastorno cromosómico autosómico que se caracteriza por la presencia de un cromosoma 18 extra, con rasgos clínicos distintivos. Se presenta un caso con diagnóstico prenatal basados en la ecografía morfológica obstétrica que condujeron a la realización ecocardiografía fetal donde resalta la displasia de la válvula pulmonar con doble lesión y la comunicación interventricular. Posteriormente se realiza cordocentesis para realización del cariotipo y asesoramiento genético.

ABSTRACT Edwards' syndrome, or trisomy 18 syndrome, is an autosomal chromosomal disorder characterized by the presence of an extra chromosome 18, with distinctive clinical features. We present a case with a prenatal diagnosis based on obstetrical morphological ultrasound that led to the performance of a fetal echocardiography with findings of a pulmonary valve dysplasia with double injury and interventricular communication. Subsequently, cordocentesis is performed for karyotyping and genetic counseling.

Vena umbilical drenando directamente a la aurícula derecha: Informe de un caso

RESUMEN La agenesia de ductus venoso es una afección infrecuente asociada con resultados perinatales adversos. Se presenta el caso de un feto con 23,4 semanas estudiado en el servicio de Cardiología Fetal del Cardiocentro Pediátrico William Soler, donde se le realizó estudio ecocardiográfico que demostró la presencia de cardiomegalia con predominio de cavidades derechas en la vista transversal de cuatro cámaras y, al realizar un corte longitudinal del feto, con uso del Doppler color superpuesto a la imagen bidimensional, se definió el recorrido de la vena umbilical drenando directamente en la aurícula derecha. Al recién nacido se le realizó una tomografía y se diagnosticó la presencia de defectos digestivos congénitos. Ante la sospecha de ausencia de ductus venoso resulta importante precisar la variante de drenaje, identificar «microarreglos» y buscar malformaciones estructurales y enfermedades genéticas, ya que el pronóstico dependerá de todos estos factores.

ABSTRACT The ductus venosus agenesis is a rare condition associated with adverse perinatal outcomes. We present the case of a fetus of 23.4 weeks that was studied at the Department of Fetal Cardiology in the Cardiocentro Pediátrico William Soler. The four-chamber cross-sectional view echocardiogram showed cardiomegaly with a predominance of right chambers. After performing a longitudinal section of the fetus by color Doppler superimposed on the two-dimensional image, we could trace the course of the umbilical vein draining directly into the right atrium. The newborn underwent a CT scan and the presence of congenital digestive defects was diagnosed. In the case of suspected absence of ductus venosus it is important to determine the drainage variant, identify "microarrays", and look for structural malformations and genetic diseases since prognosis will depend on all these factors.

Diagnóstico prenatal de la vena cava superior izquierda persistente / Prenatal diagnosis of persistent left superior vena cava

RESUMEN Introducción: La persistencia de la vena cava superior izquierda (VCSIP) es la anomalía más común del sistema venoso torácico y puede estar asociadas a otras malformaciones cardiacas. Objetivo: Describir las características ecocardiográficas de la VCSIP y su relación con los factores de riesgo y anomalías asociadas. Método: Se realizó un estudio descriptivo, longitudinal y retrospectivo, con el propósito de contribuir al estudio del diagnóstico prenatal de la VCSIP mediante el análisis de diferentes indicadores. La muestra estuvo conformada por 62 casos con diagnóstico prenatal de VCSIP, en fetos entre 22 y 35 semanas, examinados en el Servicio de Ecocardiografía Fetal del Cardiocentro Pediátrico William Soler, durante el período comprendido desde enero de 2008 hasta mayo de 2012. Resultados: La VCSIP se presentó asociada a cardiopatías congénitas en 33 de los 62 casos. Dentro de estas, las más frecuentes fueron las anomalías troncoconales (38,46%). Conclusiones: La VCSIP es de fácil reconocimiento mediante el ultrasonido de pesquisa y constituye un hallazgo importante para el diagnóstico de las cardiopatías congénitas; por lo cual, ante su sospecha -debido a su frecuente asociación con cardiopatías congénitas- se sugiere ofrecer a la gestante una evaluación detallada del corazón fetal.

ABSTRACT Introduction: The persistence of the left superior vena cava (PLSVC) is the most common anomaly of the thoracic venous system and may be associated with other cardiac malformations. Objective: To describe the echocardiographic characteristics of PLSVC and its relationship with risk factors and associated abnormalities. Method: A descriptive, longitudinal and retrospective study was carried out, in order to contribute to the study of the prenatal diagnosis of PLSVC through the analysis of different indicators. The sample consisted of 62 cases with a prenatal diagnosis of PLSVC, in fetuses between 22 and 35 weeks, examined in the Fetal Echocardiography Department of the Cardiocentro Pediátrico William Soler, during the period from January 2008 to May 2012. Results: The PLSVC was associated with congenital heart disease in 33 of the 62 cases. Among these, the most frequent were conotruncal heart defects (38.46%). Conclusions: The PLSVC is easily recognized by screening ultrasound and represents an important finding for the diagnosis of congenital heart disease; therefore, given its suspicion -due to its frequent association with congenital heart disease- it is suggested to offer the pregnant woman a detailed evaluation of the fetal heart.

Fetal Echocardiography: A Screening Tool for Congenital Heart Disease in Maternal Diabetes

Background: The imbalance of the adipoinsular axis has been shown recently to predispose to cardio renal syndromes. Epigenetics, which deals with the metabolic influences on genetic signaling, is a new concept. Diabetes during gestation can also cause an inflammatory response in placenta. The levels of leptin/adiponectin in the neonate of a mother with diabetes can affect post insulin signaling leading to fuel mediated teratogenicity. The reactive oxidative species generated at the maternal-fetal interface can alter inhibitory or permissive gene expression resulting in chromatin epigenetic remodeling of genes in multiple organs dysfunction, including the pancreas, kidney, heart, and the muscle. The fetal cardiac malformations can be mediated by these modifications of the transcriptome. Objectives: The primary objective of the study was to explore the relationship between maternal type II diabetes mellitus and gestational diabetes with congenital heart disease in new-borns. The secondary outcome of the study was to do pre-conception counseling and emphasize the importance of peri-conceptional sugar control. Materials and Methods: This prospective study involved cardiovascular system examination of 229 single pregnancies with pre-gestational and gestational diabetes (19 pregnant women were lost for follow up in control group). Two hundred twenty nine non-diabetic women of were taken as matched controls. The case and control group were comparable with no significant differences in maternal age, ethnicity and parity. Diabetic pregnant women were also offered fetal echocardiography at 24-28 weeks of gestation in second trimester. Results: In this study, 1 out of 78 gestational diabetes and 7 out 132 pregnancies with type 2 diabetes mellitus resulted in Congenital Heart Defects. Overt diabetes mellitus (p value significant) as compared to gestational diabetes was found to be a more likely risk factor associated with CHD. There were two cases of Ventral Septal Defect (VSD) in non-diabetic pregnant women diagnosed postnatally. Conclusion: Community education programmes should be initiated in high-risk population to promote better fetal surveillance in diabetic mothers for early in utero detection of cardiac defects. Maternal counseling for peri-conceptional control of blood glucose, adequate weight maintenance, intake of Insulin and exercise is needed to prevent CHD. Fetal echocardiography is a useful tool to screen high-risk fetus that require tertiary neonatal set up and emergency cardiac surgical interventions.

Accuracy of prenatal diagnosis of congenital cardiac malformations / Acurácia do diagnóstico pré-natal de cardiopatias congênitas

Abstract Objective To evaluate the accuracy of the diagnosis of fetal heart diseases obtained through ultrasound examinations performed during the prenatal period compared with the postnatal evaluation. Methods A retrospective cohort study with 96 pregnant women who were attended at the Echocardiography Service and whose deliveries occurred at the Complexo Hospitalar Santa Casa de Porto Alegre, in the state of Rio Grande do Sul, Brazil. Risk factor assessment plus sensitivity and specificity analysis were used, comparing the accuracy of the screening for congenital heart disease by means of obstetrical ultrasound and morphological evaluation and fetal echocardiography, considering p < 0.05 as significant. The present study was approved by the Research Ethics Committee of the Institution. Results The analysis of risk factors shows that 31.3% of the fetuses with congenital heart disease could be identified by anamnesis. The antepartum echocardiography demonstrated a sensitivity of 97.7%, a specificity of 88.9%, and accuracy of 93% in the diagnosis of congenital heart disease. A sensitivity of 29.3% was found for the obstetric ultrasound, of 54.3% for themorphological ultrasound, and of 97.7% for the fetal echocardiography. The fetal echocardiography detected fetal heart disease in 67.7% of the cases, the morphological ultrasound in 16.7%, and the obstetric ultrasound in 11.5% of the cases. Conclusion There is a high proportion of congenital heart disease in pregnancies with no risk factors for this outcome. Faced with the disappointing results of obstetric ultrasound for the detection of congenital heart diseases and the current unfeasibility of universal screening of congenital heart diseases through fetal echocardiography, the importance of the fetal morphological ultrasound and its performance by qualified professionals is reinforced for a more appropriate management of these pregnancies.

Resumo Objetivo Avaliar a acurácia do diagnóstico de cardiopatias congênitas obtidos por meio das ecografias realizadas durante o pré-natal comparativamente à avaliação pósnatal. Métodos Estudo de coorte retrospectivo com 96 gestantes atendidas no Serviço de Ecocardiografia cujos partos ocorreram no Complexo Hospitalar Santa Casa de Porto Alegre, RS, Brasil. Utilizou-se a avaliação de fatores de risco e a análise de sensibilidade e especificidade, comparando-se a acurácia do rastreamento de cardiopatia congênita por meio da ecografia obstétrica, da avaliação morfológica e da ecocardiografia fetal, considerando-se como significativo um p < 0,05. O referido estudo foi aprovado pelo Comitê de Ética em Pesquisa da Instituição. Resultados A análise de fatores de risco demonstra que 31,3% dos fetos com cardiopatia congênita poderiam ser identificados pela anamnese. As ecografias anteparto possuem sensibilidade de 97,7%, especificidade de 88,9% e acurácia de 93,0% no diagnóstico da cardiopatia congênita. Ao se analisar cada tipo de ecografia separadamente, encontrou-se sensibilidade de 29,3% para a ecografia obstétrica, de 54,3% para ecografia morfológica, e de 97,7% para ecocardiografia fetal. A ecocardiografia fetal definiu a cardiopatia fetal em 67,7% dos casos, a ecografia morfológica em 16,7%, e a ecografia obstétrica em 11,5%. Conclusão Demonstra-se uma elevada proporção de cardiopatia congênita em gestações sem fatores de risco para esse desfecho. Frente aos resultados desanimadores da ecografia obstétrica para a detecção de cardiopatias congênitas e na atual inviabilidade de rastreamento universal de cardiopatias congênitas por meio da ecocardiografia fetal, reforça-se a importância da ecografia morfológica fetal e sua realização por profissionais qualificados para esse fim de forma a permitir o manejo mais adequado destas gestações.

Application value of fetal heart ultrasound intelligent navigation technique in display of key diagnostic elements in rapid screening views of fetal echocardiography / 中华医学超声杂志（电子版）

Objective To evaluate the application value of fetal heart echocardiography intelligent navigation (5D Heart) in the display of key diagnostic elements in five rapid screening fetal echocardiographic views.Methods Three hundred and eighty-four 3D volume datasets of 220 normal singleton fetuses in the second and third trimesters were acquired.After processing the datasets using 5D Heart,five rapid screening views were acquired,and 21 key diagnostic elements of the five cardiac diagnostic sections were graded.The 2 test was used to compare the difference in the key diagnostics elements of the five rapid screening views between 5D heart and the traditional technique.Pearson correlation was used to compare the detection rate of key diagnostic elements between 5D Heart technique and traditional two-dimensional echocardiography in normal fetuses and fetuses with congenital heart disease.The rank sum test was used to detect the consistency and reliability of the results.Results A total of 384 fetal volume datasets were obtained from 220 fetuses,of whom 317 heart volume datasets were available for analysis,with a success rate of 82.6％.There was no difference in the key diagnostic elements of the five rapid screening views between 5D heart and the traditional technique (x2=5.17,P=0.27).Compared with the abnormal fetal heart group (89.6％),the detection rate of diagnostic elements in the normal fetal heart group was 85.2％ (r=0.94,P=0.02).No significant differences were found when comparing the grading results of one observer in different periods of time,the grading results between two experienced doctors,or the grading results among the experienced doctor and one relatively inexperienced doctor (P ＞ 0.05).Conclusions Fetal cardiac ultrasound intelligent navigation technique has high reliability and repeatability in obtaining fetal rapid screening views and displaying fetal elemental diagnostic information.It has tremendous potential in standardized data collection and analysis of cardiac diagnostic sections in fetuses with congenial heart disease,as well as in training and teaching,remote medical consultation,and screening in primary hospitals.

Diagnóstico prenatal y repercusiones perinatales de la persistencia de vena cava superior izquierda. Serie de casos y revisión bibliográfica / Prenatal diagnosis and perinatal results of the persistent left superior vena cava. Cases series and literature review

Resumen Objetivo Describir las anomalías asociadas y las repercusiones perinatales de la persistencia de la vena cava superior izquierda en el feto y revisar la bibliografía. Materiales y métodos Estudio descriptivo, transversal y retrospectivo efectuado de enero de 2009 a diciembre 2012 en la Unidad de Diagnóstico Prenatal del Departamento de Obstetricia y Ginecología del Hospital Universitario Miguel Servet de Zaragoza, España. El estudio incluyó a todos los fetos con diagnóstico prenatal de persistencia de la vena cava superior izquierda establecido durante los controles gestacionales ecográficos. Resultados Se diagnosticaron 21 casos de persistencia de la vena cava superior izquierda entre las 20 y 35 semanas de embarazo. El 29% de los casos se detectó en la ecografía de las 20 semanas; 9 casos (43%) tuvieron anomalías cardiacas o extracardiacas asociadas y en 2 casos (10%) se encontró, además, trisomía 21, ambos con anomalías cardiacas asociadas. En 4 casos (19%) no hubo vena cava superior derecha. En los casos aislados la evolución fue favorable. Conclusiones Puesto que la persistencia de la vena cava superior izquierda se asocia, frecuentemente, con anomalías cardiacas y extracardiacas está justificada la ecografía morfológica fetal detallada y una ecocardiografía con posterior seguimiento antenatal. Si es aislada, la evolución obstétrica y el pronóstico perinatal serán favorables, como ha sucedido en los casos de persistencia de la vena cava superior izquierda aislados, con ausencia de vena cava superior derecha.

Abstract Objective To describe the associated anomalies and perinatal results in fetuses diagnosed with persistence of the left superior vena cava and to conduct a review of the literature. Materials and methods A descriptive, cross-sectional, retrospective study conducted between January 2009 and December 2012 in the Prenatal Diagnostic Unit of the Obstetrics and Gynecology Department at the Miguel Servet University Hospital in Zaragoza, Spain. The study included all fetuses with prenatal diagnosis of persistence of the left superior vena cava performed during gestational ultrasound controls in that period. Results 21 cases of persistence of the left superior vena cava were diagnosed between 20 and 35 weeks. Only 29% of the cases were detected on ultrasound at 20 weeks. 9 cases (43%) had associated cardiac or extracardiac anomalies and two cases (10%) associated trisomy 21, both with associated cardiac anomalies. In 4 cases (19%) there was an absence of right superior vena cava. In isolated cases, the evolution was favorable. Conclusions The presence of persistence of the left superior vena cava is frequently associated with cardiac and extracardiac abnormalities, so in the case of diagnosis, detailed fetal morphological ultrasound and echocardiogram are justified with subsequent antenatal follow-up. In the case of being isolated, it has an obstetric evolution and a favorable perinatal prognosis, results that were also presented in isolated persistence of the left superior vena cava cases with absence of right superior vena cava.

Prevalence of Hypertrophic Cardiomyopathy in Fetuses of Mothers with Gestational Diabetes before Initiating Treatment / Prevalência de miocardiopatia hipertrófica em fetos de mães com diabetes gestacional antes do tratamento

ABSTRACT Objective: To evaluate the prevalence of hypertrophic cardiomyopathy (HCM) in fetuses of pregnant women with gestational diabetes mellitus (GDM) in the beginning of the treatment. Methods: A cross-sectional study was performed between July 1, 2013, and Decem-ber 20, 2013, in a public maternity clinic in southern Brazil. The subjects were 63 fetuses of mothers with gestational diabetes, with a single pregnancy and no other associated pathologies. We diagnosed HCM through a fetal echocardiography before treatment and evaluated the maternal and fetal characteristics. Results: The average age of the pregnant women was 32.32 (±6.2) years, and the average gestational age at the time of the evaluation was 30.59 (±2.27) weeks. The interventricular septum thickness showed a standard deviation of more than two in 50.8% of the fetuses (95% confidence interval [95%CI]: 38.1-63.5%). The left ventricular wall thickness showed a standard deviation of more than 2 in 13 (20.6%) fetuses (95%CI: 11.1-30.2%). The HCM was confirmed in 54% of the fetuses (95%CI: 41.3-65.1%). The fetal abdominal circumference was normal in 46 (73%) fetuses, and 50% of these fetuses had HCM. Conclusion: The prevalence of hypertrophic cardiomyopathy in fetuses of pregnant women with GDM before treatment was of 54% (95%CI: 41.3-65.1%).

RESUMO Objetivo: Avaliar a prevalência de miocardiopatia hipertrófica em fetos de gestantes com diabetes mellitus gestacional antes do início do tratamento. Métodos: Foi realizado um estudo de corte transversal, no período de 1o de julho de 2013 até 20 de dezembro de 2013, em uma maternidade pública. Foram objetos do estudo 63 fetos de gestantes portadoras de diabetes mellitus gestacional (DMG), em gestação única e sem outras patologias associadas. Foi realizada ecocardiografia fetal antes do início do tratamento do diabetes. O diagnóstico de miocardiopatia hipertrófica (MH) foi realizado quando a medida do septo interventricular ou da parede ventricular estava superior a dois desvios-padrão. O desfecho primário avaliado foi presença de MH. Resultados: As gestantes apresentavam idade média de 32,32 (±6,2) anos, e a idade gestacional média no momento da avaliação foi de 30,59 (±2,27) semanas. A medida do septo interventricular estava acima de 2 desvios-padrão em 50,8% (intervalo de confiança de 95% [IC95%]: 38,1-63,5%). A parede do ventrículo esquerdo estava acima de 2 desvios-padrão em 13 fetos, totalizando 20,6% (IC95%: 11,1-30,2%). A MH estava presente em 54% dos fetos (IC95%: 41,3-65,1%). A circunferência abdominal fetal estava normal em 46 (73%) fetos, e destes, 50% apresentavam MH. Conclusão: A prevalência de MH em fetos de gestantes portadoras de DMG antes do tratamento foi de 54% (IC95% 41,3-65,1%).

Clinical value of fetal intelligent navigation echocardiography (5D Heart) in the display of key diagnostic elements in basic fetal echocardiographic views / 中华超声影像学杂志

Objective To evaluate the clinical value of fetal intelligent navigation echocardiography (5D Heart) in the display of key diagnostic elements in basic fetal echocardiographic views.Methods Using volume probe,3D volume datasets of the 209 normal singleton fetuses in the second and third trimesters were acquired from a four-chamber view.After processing the datasets by using 5D Heart,9 cardiac diagnostic planes were acquired and then the image qualities of key diagnosis elements of the heart and great vessels were graded by 3 doctors with different experiences of performing fetal echocardiography.Results Two hundred and sixty-two volume datasets were acquired from 209 normal fetuses,including 53 volume datasets collected when cardiac apex was in different directions,satisfactory datasets failed to be acquired in 27 fetuses because of the maternal obesity,the artifacts of fetal movement,or other influencing factors.Two hundred and thirty-one volume datasets of 182 fetuses could be used for 5D Heart analyzing and displaying,and the displaying rate of 9 standard diagnostic views was up to 88.2％.No significant difference was found when comparing the grading results of one observer in different periods of time,the grading results between two experienced doctors and the grading results among the experienced doctor and one relatively inexperienced doctor (P ＞ 0.05).Conclusions 5D Heart has high reliability and repeatability in obtaining fetal echocardiographic diagnosis views and displaying fetal elemental diagnostic information.

Prenatal diagnosis of aberrant right subclavian artery in an unselected population

PURPOSE: The purpose of this study was to determine the frequency of aberrant right subclavian artery (ARSA) among unselected fetuses and to evaluate its association with chromosomal abnormalities and other congenital anomalies. METHODS: In all, 7,547 fetuses (gestational age, 20 to 34 weeks) were examined using routine antenatal sonography at our institution between April 2014 and September 2015. The right subclavian artery was assessed using grayscale and color Doppler ultrasonography in the transverse 3-vessel and tracheal view, and confirmed in the coronal plane. RESULTS: ARSA was found in 28 fetuses (0.4%). Further, 27 of these 28 fetuses were euploid (96.4%). Trisomy 18 was the only chromosomal anomaly (3.6%) found in the study sample. ARSA was an isolated finding in 23 of the 28 cases (82.1%). In the remaining three cases (10.7%), ARSA was accompanied with extracardiac anomalies. Other cardiac defects were present in three cases (10.7%). CONCLUSION: Isolated ARSA does not seem to be associated with a significantly increased risk of aneuploidy. However, the possibility of fetal karyotyping, which is a more invasive procedure, should be discussed in the light of the overall risk of the fetus.

Anormalidades del tamaño del corazón fetal / Anomalies in the fetal heart disease

Introducción: el corazón fetal es la víscera más difícil de estudiar, debido a que es un órgano móvil con una anatomía compleja y presenta un número importante de anomalías posibles. Objetivos: exponer al alcance de los especialistas dedicados al diagnóstico prenatal una revisión de las posibles causas que modifican el tamaño del corazón fetal. Métodos: la evaluación de su tamaño se realiza a partir de la vista ecocardiográfica de las cuatro cámaras la cual es obtenida realizando un barrido ultrasonográfico desde el abdomen hasta el tórax. Cuando el tamaño es normal, ocupa un tercio del tórax fetal y la circunferencia cardíaca equivale aproximadamente a la mitad de la circunferencia torácica durante todo el curso del embarazo. Resultados: las anomalías del tamaño del corazón pueden ser ocasionadas por disminución o por incremento del radio cardiotorácico. En relación con su incremento es muy importante definir si este es debido a un crecimiento global del corazón o si está afectada una cavidad auricular, ventricular o ambas. En cuanto a la disminución del tamaño este siempre será debido a compresiones intratoráxicas. Conclusiones: la evaluación ecocardiográfica del corazón fetal resulta posible en casi la totalidad de los casos y aporta un elemento de valor al examen prenatal del feto(AU)

Introduction: Fetus heart is the most difficult viscera to be studied, due to the fact that it is a moving organ with a complex anatomy and an important amount of possible anomalies. Objective: To provide the specialists devoted to the prenatal diagnose with a review of the possible causes that modify the fetus heart size. Methods: The heart size is evaluated from an echocardiographic image of its four chambers, which is obtained in an ultrasonic scanning¨from the abdomen to the thorax. When the size is normal, it occupies one third of the fetal thorax and the cardiac circumference is roughly equal to half the thorax circumference throughout the pregnancy. Results: Heart size anomalies could be caused by a drop or an increase of the cardiothoracic radius. It is very important to define whether the increase is due to a global growth of the heart or to an affected atrial or ventricular cavity, or both. Size decreases will always be connected to an intrathoracic compression. Conclusions: Echocardiographic assessment of the fetal heart is possible in almost all cases and provides a valuable element to the fetus prenatal testing(AU)

Comparison of coronary sinus diameter Z-scores between normal fetuses and fetuses with persistent left superior vena cava / 中华超声影像学杂志

Objective To establish normal reference ranges of Z-score of coronary sinus CS diameter in normal fetuses and to explore the diagnostic value of CS Z-score in fetuses with persistent left superior vena cava PLSVC Methods A retrospective cross-sectional study of 227 singleton normal fetuses and 30 fetuses with PLSVC were involved Non-cardiac biometrical parameters included biparietal diameter BPD femoral length FL heart area HA and an assessment of gestation age GA based on menstrual age GA Systolic diameter of CS CSDs and diastolic diameter of CS CSDd were measured at the end of systole and diastole CSDs and CSDd Z-score models were constructed by linear regression analysis with GA FL HA and BPD as independent variables Subsequently Z-scores between normal fetuses and fetuses with PLSVC were compared Results Correlations between fetal CSDs and CSDd and four independent variables BPD FL HA and GA were excellent GA had close correlation with CSDs and CSDd CSDd Z-score= the actual measurement of CSDd- prediction of CSDd based on GA BPD FL or HA SD forecast CSDd CSDs Z-score= actual measurement CSDs-prediction CSDs based on GA BPD FL or HA SD forecast CSDs Normal reference value of CSDd and CSDs in 227 normal fetuses could be predicted as followings with GA as independent variable CSDd and CSDs were 0 139 ~ 0 3 19 cm and 0 046~0 166 cm respectively For BPD CSDd and CSDs were 0 128 ~0 303 cm and 0 040~0 1 59 cm respectively For FL CSDd and CSDs were 0 135~0 307 cm and 0 046~0 164 cm respectively For HA CSDd 0 1 57~ 0 323 cm and CSDs 0 059 ~ 0 1 75 cm respectively With GA as independent variable CSDd Z-score and CSDs Z-score were -0 906~1 256 and -0 920~0 895 respectively For BPD CSDd Z-score and CSDs Z-score were -1 168~1 196 and -0 864~0 899 respectively For FL CSDd Z-score and CSDs Z-score were -1 478~ 1 546 and -1 297~ 1 3 10 respectively For HA CSDd Z-score and CSDs Z-score were -0 832 ~ 0 610 and -0 619 ~ 0 688 respectively CSD Z-scores of 30 PLSVC fetuses as followings with GA as independent variable CSDd Z-score and CSDs Z-score were 5 263 ~ 1 1 659 and 2 846~9 923 respectively For BPD CSDd Z-score and CSDs Z-score were 4 469 ~ 1 1 000 and 2 3 10 ~9 1 14 respectively For FL CSDd Z-score and CSDs Z-score were 5 473 ~ 13 056 and 3 234 ~ 13 135 respectively For HA CSDd Z-score and CSDs Z-score were 1 922~5 701 and 1 359~5 723 respectively Z-scores of PLSVC fetuses were far away from the normals Conclusions Development of normal fetal CSDs and CSDd Z-score reference ranges is realized The CSDs and CSDd Z-scores can provide quantitative evidence in prenatal diagnosis of PLSV.

Diagnóstico intrauterino de cardiopatia: implicações terapêuticas / Intrauterine diagnosis of heart disease: therapeutic implications

O diagnóstico através da ecocardiografia fetal especializada tem sido cada vez mais detalhado com a melhora dos equipamentos de ultrassom e principalmente com o advento da tecnologia tridimensional. A referência precoce para o cardiologista pediátrico permite que os pais compreendam melhor a cardiopatia em questão. Quando uma cardiopatia congênita fetal é diagnosticada é necessária a coordenação pelo cardiologista fetal do nascimento com o obstetra, neonatologista, intensivista, incluindo serviços de cardiologia especializada como hemodinâmica, ritmologia e cirurgia. Embora seja importante considerar os benefícios potenciais da intervenção cardíaca com cateter balão para casos selecionados, tais como estenose aórtica crítica e atresia pulmonar com septoventricular íntegro, os benefícios em longo prazo e os resultados destes procedimentos são ainda desconhecidos, sendo necessários mais estudos para determinar com mais precisão suas indicações.

Diagnosis by means of specialized fetal echocardiography has become increasingly detailed, not only because of modern ultrasound machines, but also due to the advent of three-dimensional technology. Early referral to a pediatric cardiologist gives parents a better understanding of this disease. When a fetal congenital heart disease is diagnosed,the cardiologist must do the coordination of the birth, with an obstetrician, neonatologist, and intensivist, including specialized cardiology services such as hemodynamics, rhythmology and surgery. Although it is important to consider the potential benefits of fetal cardiac intervention with balloon catheter in selected cases, such as critical aortic stenosis and pulmonary atresia with intact ventricular septum, the long-term benefits and outcomes of these procedures are still unknown, and further studies are needed to determine their indications more precisely.

Ecocardiografía fetal: situación actual de diagnóstico en el Hospital Obrero Nº 2, CNS / Fetal echocardiography: Current situation of diagnostics in the Hospital Obrero Nº 2, CNS

DESCRIPCIÓN: las cardiopatías congénitas constituyen las malformaciones fetales más frecuentes, con una incidencia mundial de 6 a 8 por mil nacidos vivos y 27 por mil nacidos muertos. Representa una de las principales causas de muerte en los primeros 30 días de vida postnatal. En los estudios ecográficos de rutina en embarazadas, son las anomalías estructurales que más se pasan por alto. OBJETIVOS: determinar la situación del diagnóstico prenatal de las cardiopatías congénitas en un sector de la población que tiene seguro de salud dependiente principalmente de la Caja Nacional de Salud. MÉTODOS: estudio descriptivo observacional retrospectivo de corte longitudinal. La población estudiada fue 9 030 pacientes con partos atendidos en el Hospital Obrero Nº2 de la CNS, de estos, el 1,1 % fueron atendidos en el Centro Médico Quirúrgico Boliviano Belga. El período comprende el año 2 009 hasta el 2 012. RESULTADOS: se ha detectado, 32 fetos con patología cardiaca aislada o como principal anomalía (3,5 por 1 000 nacimientos). Se obtuvo la confirmación posnatal en el 94 %; en cinco (15%) pacientes se encontró otros defectos cardiacos adicionales en la exploración neonatal. CONCLUSIONES: el diagnóstico prenatal de cardiopatías congénitas complejas puede modificar el pronóstico posnatal ya que permite planificar la vía de parto, la preparación adecuada para recibir al neonato y/o derivación a un centro especializado por lo que está plenamente justificado todo esfuerzo que mejore su detección.

Description: Congenital heart diseases are most frequent fetal malformations, with a worldwide incidence of 6-8 for 1000 born alive and 27 for 1 000 stillborn. It represents one of the main causes of death in the first 30 days of postnatal life. In studies in ultrasound studies of routine in pregnant women routine ultrasound, are structural anomalies which most overlooked. Objectives: to determine the situation of prenatal diagnosis of congenital heart diseases in a sector of the population that is dependent on the Caja Nacional de Salud. Methods: Retrospective observational and descriptive study of longitudinal cut. The population studied was 9030 patients with births attended in the Hospital Obrero N°2 CNS; 1.1% of the patients were assisted in the Centro Médico Quirúrgico Boliviano Belga. The period includes the year 2009-2012. Results: it has detected, 32 fetuses with isolated cardiac pathology or as main anomaly (3.5 per 1 000 live births). Obtained the postnatal confirmation in 94%; in five (15%) patients found other additional heart defects in the neonatal exploration. Conclusions: the antenatal diagnosis of complex congenital heart diseases can modify the postnatal prognosis and it allows to schedule the birth canal adequate preparation to receive the newborn or sending to a specialized center and is fully justified all efforts that improve its detection.

Ethical Suggestions for Fetal Echocardiography Examination and Counseling Service / 中国医学伦理学

The application of fetal echocardiography in clinical is increasing , more and more patients need de-tailed consulting services .The following suggestions are made:Echocardiographic doctors should set up the consulting service consciousness , provide consulting with patience , popularity and carefulness; the doctors should understand the patients and their family′s emotions and also pay attention to the psychological care;environmental requirements for patients′echocardiographic examination and counseling service;encouraging multidisciplinary join the participa-tion of consulting services .

Screening cardíaco fetal: estandarización de imágenes ecográficas: propuesta para sentar las bases de una futura norma de estudio e informe / Fetal heart screening: standardization of ultrasound images: motion to lay foundations for standards in future study and report

Durante los últimos años, ha habido un avance significativo en el área técnica y teórica en el rastreo ecográfico de cardiopatías congénitas, sin embargo, la tasa de detección no ha sufrido cambios. El objetivo de esta revisión es sistematizar la iconografía mínima, del corazón fetal, para las ecografías realizadas en el segundo y tercer trimestre. Se efectuó una revisión bibliográfica de los cortes habitualmente utilizados para el screening prenatal de cardiopatías congénitas. Si bien existe consenso sobre la técnica a implementar, no hay citas específicas sobre el registro gráfico que debiera ser mandatorio para respaldar el informe. Se propone una serie de fotos obligatorias, de algunos cortes ecográficos, para adjuntar en todos los informes.

Despite the theoretical and technical advances in ultrasound screening for congenital heart diseases, the detection rate has not improved. The aim of this report is to systematize the iconography of the fetal heart for ultrasound in second and third trimesters. A bibliographic review of the common views for prenatal screening in congenital heart diseases was performed. There is consensus on the technique to be implemented but there are not specific data about the chart record to support the report. A series of mandatory photos to attach in all reports is proposed.