new echo-cardiographic approach in assessing pulmonary vascular bed in patients with congenital heart disease

We thought to test whether the ratio of peak tricuspid regurgitant velocity [TRV, m/sec], to the right ventricular out flow tract time-velocity integral [TVIRVOT, Cm/sec] obtained by Doppler echocardiogrophy [TRV/TVI[RVOT]] provides a clinically reliable method to determine pulmonary vascular resistance [PVR]. Simultaneous Doppler echocadiographic examination and right-heart catheterization were performed in 25 patients. The ratio of TRV/TVI[RVOT] was then correlated with invasive PVR measurements using regression analysis. An equation was modeled to calculate PVR in wood units [WU], using echocardiography, and the results were compared with invasive PVR measurement using the Bland-Altman analysis. As calculated by Doppler echocardiography, TRV/TVI[RVOT] results correlated well [r=0.92] with invasive. PVR measurements the Bland-Altman analysis between PVR obtained invasively and that by echo cardiography, using the equation: PVR=TRV/TVI[RVOT] x 10 + 0.16, showed satisfactory limits of agreement. Doppler echocardiography may provide a reliable, non invasive method to determine PVR

Value of fetal echocardiographic screening for cardiac malformations

With advancing technology in ultrasound machines, examination of the fetal heart became available even at 14 weeks gestation. There are many reasons for referral for complete fetal echocardiographic assessment; the most common one is family history of congenital heart disease, while the most productive one is abnormal four chamber view. This study describes the value and accuracy of fetal echocardiographic screening for cardiac malformations in high-risk pregnancies. We studied 270 pregnant ladies who were referred for fetal echocardiography for several reasons e. g. family history of CHD, diabetes mellitus, inadequate or abnormal view of the heart [four chamber or great vessels], the presence of fetal abnormality on obstetric scanning and increased nuchal translucency thickness particularly in the first trimester. Antenatal fetal echocardiographic scanning of the heart was performed and compared with the postnatal one or compared with the histopathological finding of the specimen if termination of pregnancy took place. In cases where chromosomal abnormalities were detected, a chromosomal study was carried out. Our results showed a spectrum, of multiple cardiac abnormalities, both major and minor such as atrioventricular septal defect, hypoplastic left heart, aortic coarctation, large VSD, transposition of great vessels, cardiomyopathy and cardiac tumours. The most productive group of patients were those referred due to abnormal or inadequate four chamber view, the percentage of CHD in this group was 66.6% extended examination of the fetal heart [four chamber view and great vessel view] could detect about 75% of CHD. The percentage of chromosomal abnormalities in case with CHD was 20%. The accuracy of fetal echo is affected by the time during gestation when scanning is performed especially for valvular stenosis, coarctation of the aorta. Scanning in the first trimester is confined to the high risk patient