[Diagnosis and prognosis of fetal ebstein anomaly]. / Diagnóstico y pronóstico fetales de la anomalía de Ebstein.

BACKGROUND: Fetal echocardiography is possible to confirm with great certainty the diagnosis, in utero, Ebstein's anomaly, as well as determine its perinatal prognosis. OBJECTIVE: Review the experience of 16 cases diagnosed with Ebstein's anomaly, using fetal echocardiography, analyzing "forecast echocardiographic parameters" set by Pavlova, Huhta and Barre. MATERIAL AND METHOD: retrospective and descriptive analysis. We analysed echocardiographic parameters and its correlation with the perinatal development of 16 cases diagnosed with Ebstein's anomaly. RESULTS: Maternal age of our patients was 27.94 +/- 5.7 years, gestational age 31.3 +/- 3.6.) Mortality: in-utero 37.5% (n = 6), neonatal 50% (n = 8), survived 12.5% (n = 2). Cardiothoracic index 0.61 +/- 0.074, relationship foramen oval/heart atrial 0.6 +/- 0.015; obstruction to the way out of the right ventricle in 14 cases (87.5%). The deceased 81% presented degree of valvular displacement > 2.5; relationship RV/LV 2.24 +/- 0.37). CONCLUSIONS: Cardiothoracic index fetal stage > 0.55, relationship oval foramen/interatrial septum < 0.3, obstruction to the way out and a degree of valvular displacement > 2.5, absence of back flow in arteriosus ductus and a ratio RV/LV > 2 are poor prognostic factors for Ebstein's anomaly.

[Fetal diagnosis and prognosis of Ebstein's anomaly]. / Diagnóstico y pronóstico fetal de la anomalía de Ebstein.

BACKGROUND: Currently fetal echocardiography may confirm the diagnosis in utero of Ebstein anomaly, as well as determine the perinatal outcome with high certainty. OBJECTIVE: To review 16 cases diagnosed with Ebstein anomaly, by fetal echocardiography, analyzing prognostic echocardiographic parameters set by Pavlova and colleagues. MATERIAL AND METHOD: A descriptive, observational, retrospective study was done in patients with fetal diagnosis of Ebstein anomaly, during January 2001 to December 2011. Echocardiographic parameters are analyzed and its correlation to perinatal evolution of 16 cases of Ebstein anomaly. RESULTS: Maternal age was of 27.94 + 5.7 years, gestational age was 31.3 +/- 3.6 weeks. In utero mortality represented 37.5% (n = 6), and neonatal mortality 50% (n = 8), two patients (12.5%) survived. Cardiothoracic index was of 0.61 +/- 0.074, ratio foramen ovale-atrial septal was of 0.6 +/- 0.015, obstruction of the outflow tract of the right ventricle was seen in 14 (87.5%) patients; 81% of the deceased had a degree of displacement valve > 2.5; ratio right ventricle-left ventricle 2.24 +/- 0.37. The umbilical vein was throbbing in 64% of the deceased, the tricuspid insufficiency was severe in 15 cases (94%, 21.62 +/- 2.82 mmHg), hydrops affected 18.7% of patients. CONCLUSIONS: The following factors are of bad prognosis in fetal stage of Ebstein anomaly: cardiothoracic index > 0.55, relative foramen ovale-atrial septal <0.3, the obstruction to the outflow tract, a degree of valve displacement > 2.5, absence of reverse flow in the duct arteriosus, ratio right ventricle-left ventricle > 2. The Ebstein anomaly diagnosed in utero has a perinatal mortality of 87.5%.

[Diagnostic and frequency of fetal heart disease by echocardiography in pregnancies with high-risk factors]. / Diagnóstico y frecuencia de cardiopatía fetal mediante ecocardiografía en embarazos con factores de alto riesgo.

BACKGROUND: Fetal heart diseases are increasingly frequent. These are part of birth defects and, therefore, appear in early phases of the gestation. Diagnosis or early detection of functional and structural abnormalities of the heart allows to the obstetrician and the pediatric cardiologist to plan, in a timely manner, the treatment and prenatal and postnatal monitoring with the purpose of preventing complications. OBJECTIVE: To determine the types and frequencies of heart diseases in pregnancies with high-risk factors. PATIENTS AND METHOD: It was analized an observational, descriptive and retrospective series of cases. From January 2003 to June 2006, fetal echocardiograms were made in women with pregnancies longer than 15 weeks and with high-risk factors. At childbirth was made a cardiovascular evaluation. Analysis was carried out through descriptive statistics. RESULTS: maternal age average was of 27.3 +/- 6.8 years; gestational age was of 31 +/- 5 weeks. In total, there were carried out 275 fetal echocardiograms (FE) in 208 patients; in 56 of them, was made one fetal ecocardiogram, two in 37 and three in 15. Risk factors of reference to the specialized medical unit were: abnormalities detected through obstetrical ultrasound (35.1%), tachycardia-bradycardia-arrhythmia (29.8%), probable chromosomic anomalies (13.9%), oligohydramnios or polyhydramnios (4.8%), familiar antecedents of congenital heart diseases (3.8%), others (12.6%). Heart disease was diagnosed by fetal echocardiogram in 55 patient (26.4%): unique ventricle (n = 5), hypoplastic right ventricle (n = 3), hypoplastic left ventricle (n = 4), congenital complete heart block (n = 1), Ebstein and dysplasia of the mitral and tricuspid valves (n = 12), tumor (n = 5), ectopia cordis (n = 2), auriculoventricular channel (= 1), supraventricular tachycardia (n = 4), supraventricular extrasystole (n = 3) and other. Diagnosis was confirmed at childbirth in 99.5% of the cases. The treatment was initiated in uterus for arrhythmia and cardiac insufficiency in 19 patients. The patients with high-risk cardiopathy (at birth) were evaluated at beginning through specialized cardiological treatment and then they were transferred to the service of pediatric cardiology. CONCLUSIONS: Frequency of fetal heart diseases in patients with high-risk factors is of 25.4%. In these patients, the fetal echocardiogram (prenatal and postnatal) allows planning the optimal cardiological and obstetric treatment as well as to inform to the relatives.

Balloon angioplasty in aortic coarctation: a multicentric study in Mexico.

OBJECTIVES: To analyze immediate and long-term results of balloon dilation for aortic coarctation in a three-center experience in Mexico, and to determine factors associated with increased risk. BACKGROUND: Results demonstrated that the procedure is effective and safe, however its use in some groups is still controversial, specially in neonates and infants. METHODS: In a ten-year period, 333 patients with aortic coarctation on underwent balloon dilation with an immediate success rate of 93.7% and a major complication incidence of 1.8%. Of the total cohort, 272 patients were followed for a period of 24.3 +/- 20 months. Demographic and procedural data were analyzed to determine factors related to a poor outcome or to sustained high blood pressure. RESULTS: Cox regression analysis found age (risk ratio 3.42 p = 0.0001), isthmic hypoplasia (risk ratio 4.64, p < 0.0001), and post-dilation gradient (risk ratio 2.19, p = 0.0113) as independent risk factors for a follow-up event, mainly restenosis. Age at dilation was the only independent factor related to sustained hypertension with a seven-fold increase in the risk. CONCLUSIONS: Balloon dilation is an effective and safe alternative to treat aortic coarctation. Patients younger than one year of age, with severe isthmic hypoplasia and a post-dilation gradient > 20 mmHg have the highest risk to develop an event in the follow-up period. When the dilation procedure is performed in patients older than 10 years of age, and specially those older than 20 years, the probability that they remain or develop high blood pressure is increase.