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Echocardiographic Methods of Fetal Heart Size Assessmentheart to Chest Area Ratio and Transversal Heart Diameter


Introduction: Ultrasound assessment of fetal heart size (FHS) is widely used and recommended in many guidelines of fetal echocardiography due to its clinical value. The aim of this study was an analysis of some fetal heart measurements: ratio of heart area to chest area (HA/ CA) and transversal diameter of heart (AP) and their correlation to gestational age.

Material and methods: This retrospective study was based on database of records of ultrasound and echocardiographic examinations performed in our unit and included fetuses between 15th and 39th week of gestation with no evidence of heart defect or any abnormality.

Results: 609 ultrasound examinations were analyzed. The mean HA/CA was 0,30 ± 0,015, with no statistical difference between female and male (p>0,05), and seemed to be relatively constant with slight increase with advancing gestational age. The AP diameter in whole group correlated with gestational age (r=0,94) and there was no difference related to the fetuses gender.

Conclusion: The correlation of AP diameter and relative constancy of HA/CA ratio with gestational age presented in our normograms could be used for monitoring fetal development, but also for fetal cardiomegaly assessment.

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4D Ultrasound in the Study of Fetal Heart

;26:1181-8; quiz 9-90 17. Devore GR, Polanko B. Tomographic ultrasound imaging of the fetal heart: A new technique for identifying normal and abnormal cardiac anatomy. J Ultrasound Med. 2005;24:1685-1696. 18. Goncalves LF, Espinoza J, Romero R, et al. Four-dimensional ultrasonography of the fetal heart using a novel tomographic ultrasound imaging display. J Perinat Med. 2006;34:39-55. 19. Rizzo G, Capponi A, Muscatello A, et al. Examination of the fetal heart by four-dimensional ultrasound with spatiotemporal image correlation

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Fetal myocardial index during labor


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.

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Fetal Triploidy; Two Case Reports with Particular Emphasis on Echocardiographic Assessment and Literature Review

References 1. McFadden DE, Kwong LC, Yam IY, Langlois S. Parental origin of triploidy in human fetuses: evidence for genomic imprinting. Hum Genet 1993;92:465-469 2. Daniel A, Wu Z, Bennetts B, Slater H, Osborn R, Jackson J, Pupko V, Nelson J, Watson G, Cooke-Yarborough C, Loo C. Karyotype, phenotype and parental origin in 19 cases of triploidy. Prenat Diagn 2001;21:1034-1048 3. McFadden DE, Kalousek DK. Two different phenotypes of fetuses with chromosomal triploidy: correlation with parental origin of the extra

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The follow up of 114 fetuses and newborns (without chromosomal aberrations) with echogenic intracardiac focus detected in prenatal USG


Introduction: The majority of research regarding echogenic intracardiac focus (EIF) concentrates on its weak correlation with the occurrence of Down syndrome. The aim of our research was to approach this problem from a wider perspective and to find out, if the prenatal diagnosis of EIF is connected with the occurrence of other abnormalities of prenatal and postnatal period.

Materials & Methods: The data of 114 patients with prenatally diagnosed EIF were analyzed retrospectively. No fetal or neonatal chromosomal abnormalities were included.

Results: In 13/114 (11,4%) fetuses cardiological abnormalities other then EIF were diagnosed: 8/114 (7%) cases of congenital heart defects and 7/114 (6,1%) cases of tricuspid valve regurgitation. Extracardiac malformations were diagnosed in 11/114 (8,8%) of fetuses. In 7/114 (6,1%) of the cases the abnormal volume of amniotic fluid was diagnosed. In 4/114 (3,5%) of pregnancies the premature rapture of membranes (PROM) occurred. Six, 6/114 (5,3%) of pregnancies were at risk of intrauterine asphyxia in perinatal period. 12/114 (10,5%) newborns were delivered before 37th week of gestation, stillbirth occurred in 1/114 (0,9%) case. Most newborns (86/114; 75,4%) birth weight >3000g. In 19/114 (16,7%) of newborns birth weight was 2500g-3000g. In 9/114 (7,9%) of newborns birth weight was <2500g

Conclusions: Fetuses with EIF without chromosomal aberrations may present heart defects which are hard to diagnose in basic obstetrical USG scan. Therefore, those patients should be directed to prenatal cardiology facilities for evaluation of the fetal heart.

Prenatal EIF in fetuses without chromosomal aberrations may indicate low birth weight (<2500g) in the future. Further research of this matter is needed.

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Comparison of the clinical status and the effects of treatment of newborns with interrupted aortic arch diagnosed prenatally and postnatally in the "Polish Mother's Memorial" Institute in Lodz in the years 2003-2012


Material and Methods: A retrospective analysis of 41 patients with congenital heart defect IAA from ICZMP in Lodz in the years 2003-2012, including 15 (36.6%) after prenatal diagnosis.

Results: An average of 4 newborns with IAA were operated annually, in the years 2003 -2009 postnatal diagnosis dominated, from 2010 prenatal diagnosis. In the group, n = 15 fetuses with IAA, heart size was normal: Avg 0.33 + / -0.05 HA / CA. Cardiovascular endurance in the CVPS : 8 - 10 points Avg. 9.56 + / -0.73. Infants in the "prenatal" group were often delivered by CS (64.3%), and infants diagnosed postnatally, often by spontaneous delivery (76.9%). In the prenatal group 100% of newborns received prostaglandin E1 from day one, and the "postnatal" group at an average of 6th day. In the "prenatal" group the dose of PGE: 0.02 ug / kg / min, in the "postnatal" group the average dose was> 2 x higher 0,042 mg / kg / min. A statistically significant relationship was shown: between the day of administering prostaglandin E1 and the number of postoperative recovery hospitalization days of the newborn with IAA.

Di George Syndrome occurred in 40% in the "prenatal" and in 15.4% in the "postnatal" group. Cardiac operations in the "prenatal" group were performed at average 19th day, and at average 21st day in the "postnatal" group. Infants in the "prenatal" group remained in the postoperative recovery room an average of 7.85 + / -3.98 days, and those from the “postnatal” group an average of 8.38 + / -3.94 days (p = 0.6212). There were 3 deaths (7.3%): 1 patient diagnosed prenatally and 2 postnatally. Neonates with IAA in the "prenatal" group remained in the hospital on average: 43.69 + / - 4.82 days and 39.54 + / -3.75 days in the "postnatal" group. After cardiac surgery, hospitalization in the "prenatal" group amounted to an average of 25.2 days in the "postnatal" 26.7 days.

Conclusions: 1. The prenatal diagnosis of IAA was grounds to start the administration of prostaglandin E1 on the first day of life, and in the "postnatal" group the administration of prostaglandin followed on average 6 days after birth, the "postnatal" dose was 2 x higher. 2. A statistically significant correlation was demonstrated between the day of prostaglandin E1 commencement and the number of hospitalization days of the newborn with IAA in the postoperative recovery room, the length of hospital stay in the ICU and sometimes full hospitalization.

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Case report. Retroesophageal Left Brachiocephalic Vein in an Infant Without Cardiac Anomalies

;39:343-347. 4. Balkman J, Zahka K, Gilkeson R. Retroesophageal Innominate Vein in a Tetralogy of Fallot Patient. Pediatr Cardiol. 2010;31:733-734. 5. Karl K, Sinkovskaya E, Abuhamad A, et al. Intrathymic and other anomalous courses of the left brachiocephalic vein in the fetus. Ultrasound Obstet Gynecol. 2016;48:464-469. 6. Chern MS, Ko JS, Tsai A, et al. Aberrant left brachiocephalic vein: CT imaging findings and embryologic correlation. Eur Radiol. 1999;9:1835-1839. 7. Chen SJ, Liu KL, Chen HY, et al. Anomalous brachiocephalic

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Evaluating the fetal heart: How do we improve?

. Schneider C, McCrindle BW, Carvalho JS, HornbergerLK, McCarthy KP, Daubeney PE. Development of z-scores for fetal cardiac dimensions from echocardiography. Ultrasound Obstet Gynecol 2005;26:599-605 31. Gonçalves LF, Lee W, Chaiworapongsa T, Espinoza J, Schoen ML, Falkensammer P, Treadwell M, Romero R. Four-dimensional ultrasonography of the fetal heart with spatiotemporal image correlation. Am J Obstet Gynecol 2003;189:1792-802 32. Falkensammer CB, Paul J, Huhta JC. Fetal congestive heart failure: correlation of Tei-index and Cardiovascular

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Can Inflammatory Markers Diagnosed Upon Ultrasound Examination During Pregnancy Regress After Administration of Vaginal Treatment? – A Pilot Study

labour. BJOG 2005, 1: 48-50 8. Hamza A, Herr M, Solomayer M, Meyberg-Solomayer G.: Polyhydramnios: Causes, Diagnosis and Therapy. Geburtshilfe und Frauenhei/kunde 2013, 12: 1241-1246 9. Golan A, Wolman I, Sagi J.: Persistence of polyhydramnios during pregnancy - its significance and correlation with maternal and fetal complications. Gynecol Obstet Invest 1994, 37: 18 10. Pri-paz S, Khalek N, Fuchs K.M, Simpson LL.: Maximal amniotic fluid index as a prognostic factor in pregnancies complicated by polyhydramnios. Ultrasound

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An Outline of Cardiogenesis

References 1. Optiz JM, Yost J, Clark FB. Overview: syndromes, developmental fields, and human cardiovascular morphogenesis of conge heart disease: twenty years progress in genetics and developmental biology. New York: Futura Publishing; 2000. O 2. Lin AE, Pierpont ME (guest editors). Seminars in medical genetic aspects of cardiovascular malformations. Am J Med Genet 2000;97(4):235.O 3. Gilbert-Barness E, Debich-Spicer D. Embryo and fetal pathology, an atlas with ultrasound correlation, Ch. 16. Cambridge

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