Echocardiographic diagnosis of a large coronary artery fistula in a newborn.

Coronary artery fistula (CAF) is a rare cause of heart murmur in newborns, with a very heterogeneous clinical presentation and unpredictable natural history. We described the case of a large neonatal CAF in an asymptomatic newborn. The patient did not show any symptoms of heart failure during a three-month follow-up. In this case, echocardiography was as accurate as CT scan in describing the anatomy and the course of CAF.

Plasma concentrations of D-dimer and outcome of in vitro fertilization.

BACKGROUND: The activation of blood coagulation could contribute to the failure of in-vitro fertilization (IVF) techniques. The aim of this study was to assess the predictive value of D-dimer levels for pregnancy outcome in women undergoing IVF. FINDINGS: A prospective study was performed in 105 women undergoing IVF. D-dimer was measured before and one week after the administration of recombinant human chorionic gonadotropin (r-hCG). The primary outcome of the study was clinical pregnancy. The mean age was 36 years (range 26 to 43 years). The main indications for IVF were infertility due to a tubaric (n = 21, 20%) or male factor (n = 37, 35%) and idiopathic infertility (n = 30, 29%) which altogether accounted for 84% of the total. Clinical pregnancy was achieved by 40/105 (38%) women of whom 32 (80%) delivered a live child. On the day of r-hCG administration, D-dimer concentrations were significantly higher in patients not achieving a clinical pregnancy (141 ng/dL vs. 115 ng/dL, p = 0.035) which remained statistically significant after correction for age and indications for IVF in multivariable analysis (p = 0.032). One week after r-hCG, the levels of D-dimer were significantly increased both in women with and without a clinical pregnancy with no differences between the groups (748 ng/dL vs. 767 ng/dL, p = 0.88). CONCLUSIONS: D-dimer concentrations seem to predict a higher risk of pregnancy failure in women undergoing IVF. If confirmed in future prospective studies, D-dimer could help identifying a group of patients who could benefit from prophylaxis to increase the pregnancy success rate.

Impact of a single endometrial injury on assisted reproductive technology outcome: a preliminary observational study.

OBJECTIVE: To find a more acceptable strategy for our patients to improve endometrial receptivity in assisted reproductive technologies (ART) and to study the impact of a single endometrial sampling performed on day 21 of the spontaneous menstrual cycle. STUDY DESIGN: In this preliminary study, the possible beneficial effects on ART outcome of a single biopsy performed on the midluteal phase (day 21) of the spontaneous menstrual cycle preceding controlled ovarian stimulation was tested in a group of patients with 3 or more implantation failures. RESULTS: After endometrial biopsy 45.94% of patients with more than two failed ART cycles obtained clinical pregnancy. CONCLUSION: Although these preliminary results are encouraging, further investigation is needed to validate the study.