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Comments on a report of the aorto-pulmonary window (APW ) type I coexisting with pulmonary valve stenosis and occluded arterial duct, detected prenatally at 26 weeks of gestation
Więckowska K, Węgrzynowski J, Zych - Krekora K, Kwiatkowska J, Słodki M, Respondek- Liberska M. Antenatal echocardiographic diagnosis of an aortopulmonary window combined with pulmonary stenosis in neonate. A case report. Prenat Cardio. 2015 Sep;5(3):33-37

Summary

In the article a case of a little APW coincidented with pulmonary stenosis (the first such description in Poland) in 26-week-old fetus of a thirty-two-year-old woman, gravida 3, was presented1.

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Polish National Registry for Fetal Cardiac Malformations (www.orpkp.pl) and negative verifications during the 10 years

Abstract

Polish National Registry for Fetal Cardiac Malformations ( initiated in 2004) was opened for primary practicioners as well as for the referral centers performing or basic fetal heart evaluation or targeted fetal echocardiography. None of the physicians until current era had regular education of fetal cardiology . It was necessary to create an audit - veryfication system, which was provided as a checking each record by the 3 most experienced fetal cardiologists in Poland, using randomised computer system. The aim of this analysis was a retrospective evaluation of „Negatively Verified”

Material and methods: The total number of fetuses in Registry during 2004 and 2013 was 5682 and there were 170 negative verified cases. Every „negative case” was analyzed and qualified to one of five categories: An error in classification of the severity of CHD ; computer mistakes , reported other prenatal problems but not CHD, different interpretation of the images (freezed frames or cine loops) and bad order of the labels of cardiac anomalies.

Results: The percentage of negative verifications was similar every year and total number of negative verification was 2,9% . The main reason for negative was first of all unproper fetal heart classification in 71 cases (42%). In majority the differences in interpretations were minor: but there were 5 huge differences between primary and secondary interpretation.

Conclusions:

1) Fetal heart cardiology requires prenatal heart classification instead of pediatric classification

2) Computer mistakes (missing fields, missing diagnoses, lack of freezed frames or cine-loops) shoud be picked up by the system during up-loading of the cases

3) The different interpretation of the images could be used for teaching purpose of fetal cardiology .

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Retrospective analysis of prenatal echcardiography findings in cases of congenital heart defects: comparison with postnatal pulmonary hypertension revealed by lungs histopathology (2010-2015)

Abstract

Introduction:

It was retrospective analysis of prenatal echocardiography findings in fetuses with congenital heart defects, who died in our institution and had an autopsy exams in years 2010 - 2015.

Material and methods:

Among total 115 deaths the pulmonary hypertension based on histopathology criteria was present in 83 cases (72%) as a leading cause of their deaths. Out of 83 neonates 40 underwent prenatal echo, 43 did not, however in both groups there were similar types of heart defects.

Results:

The prenatal echo findings from study group (n=40), from the last echo before the delivery were compared with control group and group of HLHS who did survive neonatal surgery and were discharged from hospital. There were statistical differences between pulmonary artery/aorta ratio in fetuses in control group and fetuses in study group („pulmonary hypertension” after birth) (p=0,044). There were statistical differences between pre-delivery pulmonary artery/aorta ratio in fetuses in study group (with „pulmonary hypertension” after birth) and in group of fetuses with HLHS, alive & well after first surgery (p=0,027). There were no differences between pulmonary artery/ aorta ratio fetuses in control group and fetuses with HLHS, alive & well after first surgery (p=0,38)

Conclusion:

1) Pulmonary hypertension was a frequent cause of neonatal deaths among our series of congenital heart defects

2) Dilatation of pulmonary artery (and increased pulmonary/artery ratio ) in fetal echo just before delivery may be an important risk factor for poor neonatal outcome in congenital heart defects.)

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Right Atrial Thrombosis in the Fetus with Dilatation of the Right Atrium with in Utero Spontaneous Resolution - A Case Report with Neonatal Follow-Up

Abstract

We present an extraordinary case of congenital enlargement of the right atrium diagnosed at 31 weeks of gestation. This case emphasizes the fact that timing of the detection of this particular cardiac malformation is of capital importance to tract the optimal treatment strategy in order to monitor further progression (in this case accompanying thrombosis) and prevent complications.

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Antenatal echocardiographic diagnosis of an aortopulmonary window combined with pulmonary stenosis in neonate. A case report

Abstract

In this report a case of aortopulmonary window (APW) diagnosed at 26 hbd is presented. APW supported the pulmonary circulation in neonate afflicted with pulmonary stenosis. To our knowledge, this is the first report in the literature referring to observing their coincidence in fetal life.

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Early neonatal surgery for congenital heart defects after prenatal diagnosis of restricted foramen ovale as the priority procedure?

Abstract

From 2012-2014 we selected fetuses who had an isolated congenital heart defect and restriction of the foramen ovale defined as its diameter of 4 mm or less, shunt across foramen ovale, V max > 70 cm/sec along with a typical harsh sound during fetal ausculation during echocardiography and reversal flow in pulmonary veins, no extracardiac anomalies, singleton pregnancies and delivery > 37 weeks of gestation. It was retrospective analysis of 16 cases: There were 10 non-survivors and 6 survivors The only significant difference between survivors and non-survivors pertained to the fraction of newborns operated on up to 11th day, which was significantly higher among the survivors (5/6 vs. 2/8, p=0.031).

Conclusions:

1) In the event of prenatal restriction of the foramen ovale early surgery by day 10 had a statistically better outcome in terms of survival compared to cases that underwent surgery at a later period at our Institute.

2) Prenatal restriction of the foramen ovale was more often related to male gender and in 75% of cases in our series had complicated follow-up: neonatal death or prolonged hospital stay.3) Information from prenatal echocardiography regarding restriction of the foramen ovale should be taken into consideration as valuable information suggesting priority for early cardiac surgery.

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How "fast" reading of prenatal cardiac diagnosis may badly influence the neonatal management - case report from tertiary center in 2015 and literature review

Abstract

Complains about prenatal diagnoses usually touch late diagnosis, missed diagnosis or uncomplete diagnosis. Prenatal diagnose provides usually important information for parents, obstetrician and neonatologist. Successful perinatal care is based on a good cooperation of the perinatal team. This time we present a peculiar situation when improper reading of prenatal diagnosis had caused a lot of troubles for the patient, parents and hospital staff.

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New classifications of prenatally diagnosed congenital heart defects and their influence of neonatal survivability

Abstract

Attempts to adapt the classifications of pediatric congenital heart defects (CHD) to prenatal cardiology have been lasting for many years. The paediatric cardiology CHD classifications are mainly based on anatomic details and/or pulmonary blood flow and are not always useful in fetal medicine. Because of these reasons and also many more, adaptation attempts of congenital heart defects of children, from pediatric to prenatal cardiology have not brought desired effects.Clinical course in utero and at delivery can now be predicted, and as a consequence, fetal medicine specialists are being asked to consider the fetus as a patient and the transition to postnatal life is an important part of care. The new prenatal classifications of CHD shows new particular group of CHD, requiring emergent procedure after birth. Thanks to organizing special delivery room with special team of specialist we can much more improve the outcome, especially in severest CHD.

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On outcome of five consecutive pregnancies with heart defects detected in 1st trimester of pregnancy

Abstract

The aim of this study was an analysis of cardiac assessment in the first trimester, their outcomes, and comparison with literature data. Five cases were analysed from the year 2014. The exams were performed between 11-13 + 6 weeks. The analysis confirmed that the detection of CHD in 1 st trimester was possible and was verified by an early fetal echocardiogram. The most common symptoms of abnormal heart images in the early screening assessment were: axis, heart size and color Doppler assessment of the chambers and V sign. The outcome of pregnancies with early detection of fetal heart defects was poor. There was only one surviver

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