Echogenic foci in fetal heart from a pediatric cardiologists point of view.

OBJECTIVES: To evaluate the occurrence and the significance of echogenic foci in the fetal heart and to assess the prognosis of the fetus and child. SETTING: Department of Pediatrics and Prenatal Cardiology, Department of Pediatrics, University Hospital, Faculty of Medicine, Ostrava. DESIGN: Original article. METHODS: A retrospective study was conducted between 2008-2017. Fetal echocardiography was performed in the second trimester of pregnancy in the study population. The identification of echogenic heart foci, and their follow up during and after the pregnancy were performed by a pediatric cardiologist. RESULTS: In the monitored period, a total of 27,633 fetuses were examined. Isolated cardiac hyperechogenic foci were detected in 3% (829/27,633) of the fetuses. The foci was found in 93%, 5%, and 2% in the left ventricle, mainly in valvular apparatus of the mitral valve, in the both ventricles, and in the right ventricle, respectively. In 1% (11/829) of the fetuses with cardiac echogenic foci, the others concomitant pathologies (tricuspid regurgitation, extrasystoles, renal pathology) were found. No genetic abnormalities were detected in the fetuses with cardiac hyperechogenic foci. CONCLUSION: The echogenic focus in fetal heart is a relatively common, mostly insignificant finding, with any serious consequences for the fetus and the child.

[Development of prenatal diagnostics of congenital heart defects, profit of standardized scanning planes]. / Vývoj prenatální diagnostiky vrozených srdecních vad, zisk z jednotlivých ultrazvukových projekcí.

OBJECTIVE: To audit the development and success rate of prenatal detection of congenital heart defects (CHDs), and to evaluate the effectiveness of diagnostics performed in standardized scanning planes. SETTING: Department of Pediatrics, University Hospital Ostrava. DESIGN: Retrospective study. METHODS: Ultrasound examination of fetal heart (fetal echocardiography) was performed in the second trimester pregnancy. The observed region was the Moravian-Silesian region; the assessment was performed in the retrospective study performed between 2000- 2016. The knowledge of all significant heart defects in the region, processing of data from genetic reporting, further examination of all prenatal pathologies by a pediatric cardiologist, presence of a pediatric cardiologist at all autopsies, with a precise description of the defect, birth of a pathological new-born at a specialized centre. Analysis of detected CHDs was performed in relation to the ultrasound scans used. RESULTS: During the monitored 17-year period, a total of 748 (3.8 cases per 1,000 foetuses) of prenatally identified and postnatally significant CHDs were observed in the total population of 198,300 foetuses. There were 53% (393/748) CHDs detected prenatally and 47% (355/748) of cases were not prenatally recognized. The effectiveness of CHD screening has improved progressively, from the initial 10% up to the current 74%. The best results were obtained using the basic four-chamber (4CH) scan; the results in practice gradually decreased, from the basic 4CH projection to the aortic arch. CONCLUSION: The effectiveness of prenatal detection of congenital heart defects gradually improves, namely in cases of hypoplasia and significant ventricular anomalies, with up to 100% prenatally detected cases in the past three years. The level of detection statistically decreases, from the four-chamber projection to out-flow tracts, great arteries and the aortic arch. Congenital heart defect is generally well detectable prenatally, and is usually observed as an isolated anomaly. The most important factors include a precise diagnosis, overall examination of the pregnancy and correct counselling provided for the affected family.

[Rare forms of feto-fetal transfusion in a clinical practice]. / Vzácné formy feto-fetální transfuze v klinické praxi.

OBJECTIVE: To analyze monochorionic twin pregnancies with twin anemia polycythemia sequence (TAPS) and acute peripartal twin to twin syndrome (aTTTS), to compare their prenatal management and perinatal outcome. METHODS: Retrospective analysis of monochorionic biamniotic twin pregnancies without signs of chronic TTTS within a period 10/2010 to 10/2013. Further selection of cases with haemoglobin difference in neonates greater than 50 g/l was made, type of feto-fetal haemorrhage was determined and their prenatal and postnatal characteristics were described. RESULTS: Based on the criteria described above we selected four cases out of 55 monochorionic pregnancies. One case of prenatally diagnosed spontaneous TAPS which fulfilled all the diagnostic criteria with typical angioarchitecture inclusive, one case of spontaneous TAPS diagnosed postnatally, a case of postlaser TAPS with a spontaneous resolution and one unusual case of feto-fetal haemorrhage which does not fully meet criteria of TAPS or aTTTS. All the pregnancies were delivered by caesarean section. All the anaemic neonates required blood transfusion postpartum and two of the polycythemic neonates needed partial exsanguination. CONCLUSION: Rare forms of feto-fetal transfusion syndrome form a heterogenous group and it may be difficult to distinguish between TAPS and aTTTS in certain cases. A recommendation for a management of TAPS cases was published in recent literature. However, correct interpretation of dopplerometric measurments belongs to the hands of experienced ultrasonographers in perinatal centers.

[Ectopia cordis - case report]. / Ektopie srdce - kazuistika.

OBJECT: Case report of ectopia cordis in a fetus at 23 weeks gestation. DESIGN: Case repor. SETTING: Obstetrics and Gynecology Clinic, University of Ostrava and University Hospital in Ostrava. METHODS AND RESULTS: We report a case of pentalogy of Cantrell variant in a 23-week fetus with an ultrasound finding of ectopia cordis, associated intracardial defects and omphalocele containing liver and guts. The patient opted for termination of pregnancy by using prostaglandins. Autopsy of the fetus revealed a cleft sternum and thoracic wall defect with nude ectopic heart-thoracic type and omphalocele containing liver and guts. Detailed examination of the heart revealed a double outlet right ventricle with a complete atrioventricular septal defect. Our study describes typical ultrasound findings in a correlation with autopsy findings. CONCLUSION: Ectopia cordis is a rare congenital malformation with an estimated incidence of 1:100 000 live births in developed countries. It is characterized by abnormal heart placement outside the thorax, mostly on the thoracoabdominal side. This form is often associated with pentalogy of Cantrell.

[Fetal tricuspid regurgitation]. / Trikuspidální regurgitace u plodu.

AIMS: To study the incidence and significance of fetal tricuspid insufficiency (TI). Evaluation of this incidence of physiological fetuses and of fetuses with congenital heart defects (CHDs). Possibility of prediction the other significant heart pathology or pathology of fetal circulation of fetuses with tricuspid regurgitation (TR). METHODOLOGY: The study was undertaken between June 2006 and 2010. Fetal echocardiography in the Moravian-Silesian region was mostly performed as a primary screening in the second term of pregnancy. The diameters of the right side of the heart (tricuspid valve annulus, pulmonary valve annulus, surface of the right atrium and diastolic size of the right ventricle) of fetuses with and without TI were evaluated. The pathology of the pregnancy was generally examined and delivery of the newborn was planned. The fetuses with TI were monitored and examined after delivery. RESULTS: In the observed period, 8 896 pregnancies were examined and we diagnosed 90 significant CHDs. TR occurred in 178 (2%) fetuses. Out of them 20 (11%) fetuses had a defined CHD or significant heart arrhythmia. The most critical CHD with TR was hypoplastic left heart syndrome. TI was insignificant in 158 (89%) fetuses. Progression of the significance of TR with the color Doppler mapping correlated with increased speed of flow. The parameters of the right side of the heart of fetuses with TI do not significantly differ from that of fetuses with a normal tricuspid valve. After the delivery of fetuses with TI, no CHD or chromosomal aberrations were confirmed. CONCLUSIONS: The detection of fetal TI during pregnancy is possible. In some fetuses, there is TI connected with some other CHDs which might be detected by fetal echocardiography what provides us detailed description and diagnosis. TI was always insignificant after a CHD had been eliminated and this TR in the fetus did not significantly affect haemodynamics and did not predict any pathology.