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Alexis C. Gimovsky, Brianne Whitney, Dennis Wood and Stuart Weiner

Abstract

BACKGROUND: The Myocardial Performance Index (MPI) is a Doppler derived myocardial function tool and can be used to evaluate systolic and diastolic function in fetuses. The objectives of this study were to investigate the MPI during labor and compare it to values in non-laboring women.

METHODOLOGY: 40 women with uncomplicated, term, singleton pregnancies were recruited to this prospective observational study at Thomas Jefferson University Hospital. Controls were a retrospective cohort of women > 34 weeks who underwent third trimester fetal echocardiography. Fetal left and right sided isovolumic contraction time, isovolumic relaxation time and ejection time were recorded before, during and after contractions. Right and left sided MPI was then calculated.

RESULTS: Laboring patients and non-laboring patients were comparable for age, race, gravidity and parity. During labor the average left MPI was 0.63 ± 0.17 and the average right MPI was 0.62 ± 0.20. The coefficient of correlation between MPI and cervical dilation was 0.15 for left MPI Index and 0.14 for right MPI. When comparing non-laboring to laboring women, the average left MPI for non-laboring women was 0.34 ± 0.04, p = <0.001.

CONCLUSIONS: Myocardial Performance Index is a non-invasive, easily attainable measure of cardiac function that can be obtained during labor and does not change with cervical dilation. MPI is significantly different between laboring and non-laboring women. The fetal MPI may help define fetal status in labor.

Open access

Bettina F. Cuneo

Abstract

The hydropic fetus with atrial flutter has high risk of fetal demise. In utero treatment is not as successful as SVT with 1:1 conduction. Even after conversion to sinus rhythm, close follow-up of the pregnancy is required for several reasons..

Case Report:

A 25 year old primigravida, at 26 wks of gestation had a fetal ultrasound which showed a tachycardic hydropic fetus with AFI 49. The rhythm was atrial flutter: AR 400 bpm and VR 200 bpm. The heart was structurally normal. Transplacental antiarrhythmic treatment with sotalol was started and 24 hours later, the fetus was still primarily in flutter with rare episodes of sinus rhythm and frequent PAC. Sotalol was increased but the mother’s QTc increased to > 500 ms, so the sotalol dose was reduced. On day 4th direct i.m. of digoxin was given and fetus was in sinus rhythm. Pharmacotherapy was continued. On the 16th day of sinus rhythm (at 33 wks), a marked change in FHR variability was seen. An US revealed the fetus was in sinus rhythm with a normal FHR. Because of the decreased FHR variability, the fetus was delivered by CS and the cord pH was 7.19, Apgars 1, 9 and 9. The neonate received no antiarrhythmic medications. On day 6 of postnatal life, an AV re-entrant tachycardia (AVRT) developed and sinus rhythm was successfully restored with sotalol and digoxin. The infant was treated for 18 months with no episodes of SVT or atrial flutter.

Open access

Joanna Płużańska, Jacek Więcek, Michał Krekora, Jolanta Kiełbasicz-Binikowska, Tomasz Talar, Maciej Słodki and Maria Respondek-Liberska

Abstract

We present the case of aneurysm of the muscular intraventricular septum with accompanying cardiomegaly and abnormal venous flow patterns requiring emergency cesarean section and specialized neonatal treatment. At the age of 8 months our patient has no clinical symptoms with a 6 mm scar in intraventricular muscular septum..

Open access

Maria Respondek-Liberska

Abstract

Four cases of missed prenatal diagnosis by an experienced ultrasonographer and a fetal cardiologist from a tertiary teaching hospital are presented: 3-mm peri-membrane ventricular septal defect; hypoplastic aortic arch requiring prostin infusion after delivery; esophageal atresia with tracheal fistula; and right-sided diaphragmatic hernia. Freezed frames and cine loops of the prenatal ultrasound scans indicated that the missed anomalies were not visible in midgestation, suggesting that in the future, repeat ultrasound scans should be performed before delivery to reduce the occurrence of such diagnostic errors.

Open access

Alexander N. Goel, Camila Reyes, Shauna Mclaughlin, Mark Wittry and Andrew C. Fiore

Abstract

Retroesophageal course of the left brachiocephalic vein is a rare variant seen in patients with congenital heart disease. However, this anomaly without associated cardiac or aortic abnormalities is nearly unheard of, with only one prior case described in the literature. We present an infant with anomalous retroesophageal left brachiocephalic vein that was an incidental finding on computed tomography (CT). We also briefly discuss its embryologic and clinical significance.

Open access

Katarzyna Zych-Krekora, Anna Wójtowicz, Michał Krekora, Maciej Słodki, Hugues Gentillon and Maria Respondek-Liberska

Abstract

It was the second pregnancy of an otherwise healthy married couple. The fetus (male) had detailed echocardiography monitoring in the second half of the pregnancy due to progression of cardiomegaly, and echocardiographic features of congestive heart failure. Marfan syndrome was suspected based on cardiac anomalies. For the first time, the rupture of aneurysm of aortic sinus Valsalva was documented. Despite transplacental treatment with digoxin there was fetal demise at the 34th week of gestation and postmortem newborn phenotype confirmed prenatal diagnosis.

Marfan Syndrome is a rare genetic anomaly which can be diagnosed prenatally by detailed echocardiography, usually with bad prognosis (just opposite to “benign” case diagnosed later on in life span). The most common prenatal cardiac manifestations are cardiomegaly with signs of cardiac insufficiency. We present the case with new echocardiographic features.

Open access

Arkadiusz Michalak, Marta Witczak, Elżbieta Kukawczyńska, Marek Niwald and Maria Respondek-Liberska

Abstract

Our clinical report describes a rare finding of a prenatally-detected congenital atrioventricular (AVB) block without associated maternal antibodies, which progressed from 1st/2nd degree AVB to complete heart block during second half of pregnancy. Obstetrical ultrasound at 12th week did not reveal any abnormalities and prenatal echocardiography (due to VSD in afamily member) at the 18th week of gestation detected 1st degree block, then bigeminy and bradycardia. Transplacental treatment with B-2-mimetics was introduced. The delivery was organized in a tertiary center and a pacemaker for the newborn baby was secured and implanted in 15th day of life. Currently the boy`s condition is good and stable. Before therapy with B-2-mimetics the mother underwent echocardiography and ECG which revealed clinically silent structural and conduction heart abnormalities. Literature findings suggest that parents of children with non-immune congenital or childhood AVB are more likely to carry clinically silent conduction abnormalities than general population. Given the corresponding findings in the mother and her son, they should be good candidates for genetic testing.

Open access

Joanna Płużańska, Kinga Jaguszewska, Jolanta Binikowska, Adam Oleś, Maciej Łukaszewski and Maria Respondek-Liberska

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.

Open access

Hanna Romanowicz, Ewa Czichos, Katarzyna Zych-Krekora, Michał Krekora, Maciej Słodki and Maria Respondek-Liberska

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.)

Open access

Maciej Słodki and Maria Respondek-Liberska