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1.
J Am Heart Assoc ; 12(11): e029706, 2023 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-37259984

RESUMO

Background Fetal diagnosis of congenitally corrected transposition of the great arteries (ccTGA) has been increasingly reported; however, predictors of clinical outcomes remain underexplored. We undertook a multicenter, retrospective study to investigate natural history, associated anomalies, and outcomes of fetal ccTGA. Methods and Results Fetuses with ccTGA diagnosed from January 2004 to July 2020 within 20 North American programs were included. Fetuses with severe ventricular hypoplasia thought to definitively preclude biventricular repair were excluded. We included 205 fetuses diagnosed with ccTGA at a median gestational age of 23 (interquartile range, 21-27) weeks. Genetic abnormalities were found in 5.9% tested, with extracardiac anomalies in 6.3%. Associated cardiac defects were diagnosed in 161 (78.5%), with atrioventricular block in 23 (11.3%). On serial fetal echocardiogram, 39% demonstrated a functional or anatomic change, most commonly increased tricuspid regurgitation (6.7%) or pulmonary outflow obstruction (11.1%). Of 194 fetuses with follow-up, 26 were terminated, 3 experienced fetal death (2 with atrioventricular block), and 165 were live-born. Of 158 with postnatal data (median follow-up 3.7 years), 10 (6.6%) had death/transplant before 1 year. On univariable analysis, fetal factors associated with fetal death or death/transplant by 1 year included ≥ mild tricuspid regurgitation, pulmonary atresia, aortic obstruction, fetal arrhythmia, and worsening hemodynamics on serial fetal echocardiogram (defined as worse right ventricular function, tricuspid regurgitation, or effusion). Conclusions Associated cardiac lesions and arrhythmias are common in fetal ccTGA, and functional changes commonly occur through gestation. Worse outcomes are associated with fetal tricuspid regurgitation (≥mild), any arrhythmia, pulmonary atresia, aortic obstruction, and worsening hemodynamics on serial echocardiograms. These findings can inform prenatal counseling and perinatal management planning.


Assuntos
Bloqueio Atrioventricular , Cardiopatias Congênitas , Atresia Pulmonar , Transposição dos Grandes Vasos , Insuficiência da Valva Tricúspide , Feminino , Humanos , Gravidez , Lactente , Transposição das Grandes Artérias Corrigida Congenitamente , Transposição dos Grandes Vasos/diagnóstico por imagem , Transposição dos Grandes Vasos/cirurgia , Transposição dos Grandes Vasos/complicações , Insuficiência da Valva Tricúspide/complicações , Bloqueio Atrioventricular/complicações , Estudos Retrospectivos , Seguimentos , Diagnóstico Pré-Natal , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Cardiopatias Congênitas/complicações , Coração Fetal/diagnóstico por imagem , Coração Fetal/patologia , Arritmias Cardíacas/complicações , Morte Fetal
3.
Pediatr Radiol ; 53(2): 198-209, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36198870

RESUMO

BACKGROUND: Fetal cardiac magnetic resonance imaging (MRI) requires high spatial and temporal resolution and robustness to random fetal motion to capture the dynamics of the beating fetal heart. Slice-to-volume reconstruction techniques can produce high-resolution isotropic images while compensating for random fetal motion. OBJECTIVE: The objective of this study was to evaluate image quality for slice-to-volume reconstruction of four-dimensional balanced steady-state free precession (bSSFP) imaging of the fetal heart. MATERIALS AND METHODS: A cohort of 13 women carrying fetuses with congenital heart disease were imaged with real-time bSSFP sequences. Real-time bSSFP sequences were post-processed using a slice-to-volume reconstruction algorithm to produce retrospectively gated 4-D sequences with isotropic spatial resolution. Two radiologists evaluated slice-to-volume reconstruction image quality on a scale from 0 to 4 using 11 categories based on a segmental approach to defining cardiac anatomy and pathology. A score of 0 corresponded to cardiac structures not visualized at all and four corresponded to high quality and distinct appearance of structures. RESULTS: In 11 out of 13 cases, the average radiologist score of image quality across all categories was 3.0 or greater. In the remaining two cases, slice-to-volume reconstruction was not possible due to insufficient image quality in the acquisition. CONCLUSION: Slice-to-volume reconstruction has the potential to produce isotropic images with high spatial and temporal resolution that can display the anatomy of the fetal heart in arbitrary imaging planes retrospectively. More rapid, motion-robust acquisitions may be necessary to successfully reconstruct the fetal heart in all patients.


Assuntos
Cardiopatias Congênitas , Interpretação de Imagem Assistida por Computador , Humanos , Feminino , Estudos Retrospectivos , Interpretação de Imagem Assistida por Computador/métodos , Coração , Cardiopatias Congênitas/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Feto , Coração Fetal/diagnóstico por imagem , Coração Fetal/patologia
4.
Pediatr Radiol ; 52(3): 513-526, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34842935

RESUMO

BACKGROUND: Increasing evidence supports an association among congenital heart disease (CHD), structural brain lesions on neuroimaging, and increased risk of neurodevelopmental delay and other structural anomalies. Fetal MRI has been found to be effective in demonstrating fetal structural and developmental abnormalities. OBJECTIVE: To determine the contribution of fetal MRI to identifying cardiovascular and non-cardiovascular anomalies in fetuses with CHD compared to prenatal US and fetal echocardiography. MATERIALS AND METHODS: We performed a retrospective study of fetuses with CHD identified by fetal echocardiography. Exams were performed on 1.5-tesla (T) or 3-T magnets using a balanced turbo field echo sequence triggered by an external electrocardiogram simulator with a fixed heart rate of 140 beats per minute (bpm). Fetal echocardiography was performed by pediatric cardiologists and detailed obstetrical US by maternal-fetal medicine specialists prior to referral to MRI. We compared the sensitivity of fetal MRI and fetal echocardiography for the diagnosis of cardiovascular anomalies, as well as the sensitivity of fetal MRI and referral US for the diagnosis of non-cardiac anomalies. We performed statistical analysis using the McNemar test. RESULTS: We identified 121 anomalies in 31 fetuses. Of these, 73 (60.3%) were cardiovascular and 48 (39.7%) involved other organ systems. Fetal echocardiography was more sensitive for diagnosing cardiovascular anomalies compared to fetal MRI, but the difference was not statistically significant (85.9%, 95% confidence interval [CI] 77.8-94.0% vs. 77.5%, 95% CI 67.7-87.2%, respectively; McNemar test 2.29; P=0.13). The sensitivity of fetal MRI was higher for diagnosing extracardiac anomalies when compared to referral US (84.1%, 95% CI 73.3-94.9% vs. 31.8%, 95% CI 18.1-45.6%, respectively; McNemar test 12.9; P<0.001). The additional information provided by fetal MRI changed prognosis, counseling or management for 10/31 fetuses (32.2%), all in the group of 19 fetuses with anomalies in other organs and systems besides CHD. CONCLUSION: Fetal MRI performed in a population of fetuses with CHD provided additional information that altered prognosis, counseling or management in approximately one-third of the fetuses, mainly by identifying previously unknown anomalies in other organs and systems.


Assuntos
Cardiopatias Congênitas , Diagnóstico Pré-Natal , Criança , Feminino , Coração Fetal , Feto/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Gravidez , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos , Ultrassonografia Pré-Natal/métodos
5.
J Am Heart Assoc ; 10(12): e019713, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34098741

RESUMO

Background Tetralogy of Fallot with absent pulmonary valve is associated with high mortality, but it remains difficult to predict outcomes prenatally. We aimed to identify risk factors for mortality in a large multicenter cohort. Methods and Results Fetal echocardiograms and clinical data from 19 centers over a 10-year period were collected. Primary outcome measures included fetal demise and overall mortality. Of 100 fetuses, pregnancy termination/postnatal nonintervention was elected in 22. Of 78 with intention to treat, 7 (9%) died in utero and 21 (27%) died postnatally. With median follow-up of 32.9 months, no deaths occurred after 13 months. Of 80 fetuses with genetic testing, 46% had chromosomal abnormalities, with 22q11.2 deletion in 35%. On last fetal echocardiogram, at a median of 34.6 weeks, left ventricular dysfunction independently predicted fetal demise (odds ratio [OR], 7.4; 95% CI 1.3, 43.0; P=0.026). Right ventricular dysfunction independently predicted overall mortality in multivariate analysis (OR, 7.9; 95% CI 2.1-30.0; P=0.002). Earlier gestational age at delivery, mediastinal shift, left ventricular/right ventricular dilation, left ventricular dysfunction, tricuspid regurgitation, and Doppler abnormalities were associated with fetal and postnatal mortality, although few tended to progress throughout gestation on serial evaluation. Pulmonary artery diameters did not correlate with outcomes. Conclusions Perinatal mortality in tetralogy of Fallot with absent pulmonary valve remains high, with overall survival of 64% in fetuses with intention to treat. Right ventricular dysfunction independently predicts overall mortality. Left ventricular dysfunction predicts fetal mortality and may influence prenatal management and delivery planning. Mediastinal shift may reflect secondary effects of airway obstruction and abnormal lung development and is associated with increased mortality.


Assuntos
Ecocardiografia Doppler em Cores , Morte Fetal/etiologia , Coração Fetal/diagnóstico por imagem , Valva Pulmonar/diagnóstico por imagem , Tetralogia de Fallot/diagnóstico por imagem , Ultrassonografia Pré-Natal , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Canadá , Coração Fetal/anormalidades , Coração Fetal/fisiopatologia , Humanos , Valor Preditivo dos Testes , Prognóstico , Valva Pulmonar/anormalidades , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tetralogia de Fallot/complicações , Tetralogia de Fallot/mortalidade , Tetralogia de Fallot/fisiopatologia , Estados Unidos , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/mortalidade , Disfunção Ventricular Direita/fisiopatologia
6.
Ann Thorac Surg ; 97(6): e175-7, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24882337

RESUMO

We present one of the first reported cases of a neonate with a prenatal diagnosis of large left ventricular rhabdomyoma obstructing the outflow tract that underwent a hybrid procedure with stenting of the patent duct arteriosus and bilateral pulmonary artery banding.


Assuntos
Neoplasias Cardíacas/cirurgia , Rabdomioma/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Neoplasias Cardíacas/complicações , Humanos , Recém-Nascido , Rabdomioma/complicações , Obstrução do Fluxo Ventricular Externo/etiologia
7.
Paediatr Anaesth ; 17(8): 793-9, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17596225

RESUMO

The natriuretic peptide system plays an active role in the regulation of fluid balance and systemic vascular resistance. Assays of these peptides are now available and may be used for both diagnostic and prognostic purposes. Despite its primary use in adults, it may have a diagnostic role in the Pediatric ICU as well. The basic physiology of the natriuretic system is discussed and the potential applications of B-type natriuretic peptide (BNP) monitoring as a diagnostic tool in various clinical scenarios in infants and children in the Pediatric ICU setting is reviewed.


Assuntos
Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Monitorização Fisiológica/métodos , Peptídeo Natriurético Encefálico/fisiologia , Adolescente , Adulto , Humanos , Masculino , Peptídeo Natriurético Encefálico/sangue
8.
Congenit Heart Dis ; 1(6): 340-2, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18377506

RESUMO

This is a report of a magnetic resonance imaging with delayed contrast enhancement on an adult patient with double-inlet left ventricle and L-transposition of the great arteries who has undergone staged ventricular septation in childhood. This report is unique demonstration of delayed contrast enhancement of the synthetic Teflon septum.


Assuntos
Bioprótese , Cardiopatias Congênitas/patologia , Cardiopatias Congênitas/cirurgia , Imagem Cinética por Ressonância Magnética , Septo Interventricular/patologia , Septo Interventricular/cirurgia , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Meios de Contraste , Feminino , Humanos , Sobreviventes , Fatores de Tempo , Transposição dos Grandes Vasos/cirurgia
10.
Am J Cardiol ; 95(7): 909-11, 2005 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-15781032

RESUMO

We analyzed 211 consecutive plasma B-type natriuretic peptide (BNP) measurements in 59 pediatric heart transplant patients along with echocardiographic and right ventricular endomyocardial biopsy samples. Patients with a biopsy specimen negative for rejection had significantly lower BNP levels than those patients with a biopsy positive (p

Assuntos
Rejeição de Enxerto/sangue , Transplante de Coração/efeitos adversos , Miocárdio/patologia , Peptídeo Natriurético Encefálico/sangue , Adolescente , Adulto , Biomarcadores/sangue , Biópsia , Criança , Pré-Escolar , Feminino , Rejeição de Enxerto/etiologia , Humanos , Lactente , Masculino
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