Spontaneous premature closure of the human fetal ductus arteriosus is an uncommon event that often results in significant morbidity and mortality. We present a case of a fetus with prenatal previously not detected bone defect that presented with idiopathic intrauterine closure of the ductus arteriosus. A 23-year-old mother at 39 weeks of gestation was admitted to the hospital because of an abnormal findings in four chamber screening view of the fetal heart on routine ultrasonography. The fetal echocardiography showed no detectable flow through the ductus arteriosus. Cesarean section was performed 1 hour later. A female newborn weighing 2640g with Apgar scores of 0, 2, 4 and 6 at 1, 3, 5, and 10 minutes, respectively, was delivered.
The study case is a foetus with a diagnosed heart tumor in week 23 of pregnancy. The tumor was found in the right ventricle with a concomitant local change of echogenicity of the right atrial wall; it did not cause any haemodynamic disturbances, impair systolic function or disturb inflow into the right ventricle. Foetal check-up in week 30 has shown a complete regression of the lesion in the right ventricular lumen. Because of no foetal movements felt, in week 36 the pregnant patient reported to the hospital where foetal heart asystole was diagnosed and the pregnancy was terminated by labour induction. Foetal autopsy has shown no nodose lesions in the heart or any other lesions which could have been the cause of an abrupt foetal death in utero.
D-type transposition of the great arteries (d-TGA) is a critical heart defect lesion, that should be diagnosed prenatally, as early postnatal management greatly relies on this information. Recently, in Poland more heart defects of this type are diagnosed prenatally. However, there is a lack of data regarding the diagnosis of d-TGA at the time of nuchal translucency measurement at 11-13+6 weeks of pregnancy. We present a case of d-TGA that was detected and properly diagnosed during the first trimester scan. The diagnostic plane that enabled the diagnosis was the three vessel-trachea view (3VT) presenting one, wide vessel instead of a typical V-sign.
To investigate attitude towards fetal echocardiography among mothers, who gave birth to a newborn with congenital heart defect (CHD).
Material & Method:
The study group was formed of mothers, whose newborns were hospitalized in the Cardiology Department of the Polish Mother’s Memorial Hospital in years 2005, 2006, 2011 and 2012, due to CHD. Mothers answered the survey concerning their experience and opinion about fetal echocardiography.
72 mothers answered the survey, and each of them had at least 1 routine USG scan performed during gestation. Fetal echocardiography was performed on 35/69 (50,7%), and was not performed on 34/69 (49,3%) of mothers.
33/72 (45,8%) of congenital heart defects were diagnosed prenatally and 39/72 (54,2%) were not.
34/37 (91,9%) of the mothers preferred to be aware of CHD before delivery and 3/37 (8,1%) did not.
Among mothers who preferred to be aware of CHD before delivery, 18/26 (69,2%) preferred to receive diagnosis in 13.- 14th. week of gestation, 6/26 (23,1%) at 18.-20th. week and 2/26 (7,7%) at 32.-34th. week.
Majority of mothers showed interest in prenatal diagnosis of CHD. (34/37; 91,9%) of mothers wanted to be aware of CHD in prenatal period. Despite of this fact, only 50,7% of mothers underwent fetal echocardiography.
These results suggest, that routine USG examination did not detect CHD sufficiently in the studied group. The factors limiting number of performed fetal echocardiographic examinations need to be investigated
Basic fetal echocardiography as part of the routine anatomy scan is very useful in showing both normal fetal hearts and abnormal cardiovascular physiology and anatomy. In maternal fetal and pediatric cardiology centers where fetal echo is routinely performed, over 97 % of significant anatomic and physiologic anomalies and arrhythmias can be identified. However, most fetuses with these issues are missed at the routine fetal anatomy scan for a variety of reasons. It is therefore incumbent upon those who are facile with the techniques of fetal echo to teach and promote the use of simple training methods by examples. We highly recommend the use of video clips of the fetal heart to show the anatomic and functional relationships of the veins, atria, ventricles and great arteries.
Hypoplastic Left Heart Syndrome (HLHS) is the most common heart defect in the population of fetuses and majority of Polish women deceided to continue their pregnancies despite prenatal diagnosis.
The aim of the study:
Are there any differences in newborns with HLHS after prenatal diagnoses and with postnatal diagnoses, operated on in ICZMP (Polish Mother’s Memorial Hospital) in Lodz in the years 2005-2010.
Material and Methods:
A retrospective analysis of medical records of 155 newborns from the subdivision of Anaesthesiology and Paediatric Intensive Care (ICZMP) in two groups: prenatally diagnosed (n = 87) and without prenatal diagnosis (n = 68).
Newborns were born with normal birth weights, in two groups prenatal and postnatal (3109.5 ± 494.8g vs. 3258.6 ± 443.1 g, p = 0.06 ). Most of them (85%) were born on time and in good condition (9-10 points on the Apgar). The surgery was performed earlier in prenatal group (p = 0.0364). The chance of surgery between 6th and 10th day after birth in prenatal group was twice as high as in the group diagnosed after birth (OR = 2.0 [0.9 - 4.3]). The infant’s average length of stay in the ICU after the first stage of treatment was 8 days and was almost the same in both groups (8,0 [5,0 - 20,5] vs. 8,0 - 16,0]; NS). Total mortality was 19.4% and it did not differ in both groups (p = 0.4596). The risk of death in prematurity group was 5x higher than in group of newborns delivered at term (p=0,0073). In prenatal group cardiac surgery was earlier than in group diagnosed after delivery (p=0,0364). Neonates with late surgery had longer hospitalization, compared with early surgery (44 days vs 33 days, p=0,0073). Longer hospital stay means higher hospital cost (for cardiac surgery department circa 3000 zł per 1 patient with HLHS, meaning 90 000 zl per year for 30 patients).
1) The neonatal outcome of newborns with HLHS in ICU, in our center in years 2005-2010, in two groups: after prenatal diagnoses and in postnatal diagnoses, were similar.
2) The main differences were a) an increased risk of death in case of premature delivery (p=0,0073) b) earlier I stage Norwood in prenatal group (p=0,0364) meaning lower costs for single institution, meaning lower costs for the National Health System.
Wolf-Hirschhorn syndrome (WHS, MIM 194190) is caused by the loss of the genetic material of the distal segment of chromosome 4p. We present a case of the fetus diagnosed in the second trimester of pregnancy by genetic amniocentesis which was prompted by abnormalities detected on ultrasound.
Noonan syndrome is a frequent genetic disorder with autosomal dominant transmission. It is mainly characterized by congenital heart defects, short stature, and a variable degree of developmental delay. Its symptoms can be observed during fetal life, but most of them are not specific for Noonan syndrome. Cardiac symptoms such as pulmonary stenosis or hypertrophic cardiomyopathy seems to be the most specific. We present a case of Noonan syndrome monitored during fetal live using prenatal echocardiography with a brief review of the literature.