The broad clinical utilization of the internal thoracic artery (ITA), including the role of its branches in supplying circulation to the sternum, requires explicit anatomic knowledge of this vessel. Fifty‐six ITAs (28 right, 28 left) were dissected from their point of origins after injection with a mixture of contrast medium and latex after perfusion with saline and immersion in 4% formaldehyde. All ITA branches were studied according to their course, size, and distribution within intercostal spaces with the aid of an operating microscope. The branches were divided in two main groups: proper (solitary) branches and common trunks. The proper branches consisted of four types: sternal, perforating, intercostal, and mediastinal. The four types of common trunks were: sternal/perforating, sternal/intercostal, perforating/intercostal, sternal/perforating/intercostal. Points of most frequent origin from main trunk of the vessel were established for each type. Mean external diameter of proper branches was 0.72 mm and common trunks was 1.06 mm. Mean length of common trunks was 3.0 mm. Those parameters (adequate diameter and length) allow for ligation of the common trunks close to the ITA so that their points of division can be preserved. This fact is crucial for creation of collateral blood supply to the sternum after bilateral ITA mobilizations. Clin. Anat. 12:307–314, 1999. © 1999 Wiley‐Liss, Inc.

Forty upper limbs (20 right and 20 left) of spontaneously aborted human fetuses were examined to determine the branching patterns of the musculocutaneous nerve. The mean age of the fetuses was 21.3 weeks. We identified three branching patterns of the musculocutaneous nerve to the biceps muscle. Type I with a single primary branch occurred in 47.5% of cases. Type II with two primary branches each to a separate head of the biceps muscle was observed in 42.5% of cases. Type III consisted of two primary branches, the proximal dividing into two branches, each to a different head of the biceps, and the distal branch supplying the common belly. Type III was present in 10% of cases. We found only one branching pattern for the brachialis muscle, a single primary branch. In our material communicating branches between the median and musculocutaneous nerves were found in 20% of specimens. We measured the distances between the acromion and the exit points of the first and second branch to the biceps, which averaged 36.3% for the first branch regardless of the type of branching pattern, 54.2% for the second branch in Type II, 60.7% for the second branch in Type III and 60.9% for the branch to brachialis, expressed as a percentage of the distance between the acromion and the lateral epicondyle.

Background: Congenital heart disease is present in 44-56% of fetuses with Down syndrome (DS). There are, however, signs that hearts in DS without apparent structural heart defects also differ from those in the normal population. We aimed to compare the atrioventricular (AV) septum and valves in 3 groups: DS without AV septal defect (DS no-AVSD), DS with AVSD (DS AVSD) and control hearts. Methods: The ventricular septum, membranous septum and AV valves were examined and measured in histological sections of 15 DS no-AVSD, 8 DS AVSD and 34 control hearts. In addition, the ventricular septum length was measured on ultrasound images of fetal (6 DS AVSD, 9 controls) and infant (10 DS no-AVSD, 10 DS AVSD, 10 controls) hearts. Results: The membranous septum was 3 times larger in DS no-AVSD fetuses compared to control fetuses, and valve dysplasia was frequently (64%) observed. The ventricular septum was shorter in patients with DS both with and without AVSD, as compared to the control group. Conclusion: DS no-AVSD hearts are not normal as they have a larger membranous septum, shorter ventricular septum and dysplasia of the AV valves as compared to control hearts.

This article presents the technical aspects of the Polish fetal cardiac interventions (FCI) program, including preparation of the team and modifications in the technique of the procedure that aim to increase its safety for the mother and the fetus. Over 9 years, 128 FCI in 113 fetuses have been performed: 94 balloon aortic valvuloplasties (fBAV), 14 balloon atrioseptoplasties (fBAS) with stent (BAS+), 5 balloon atrioseptoplasties without stent placement (BAS−), and 15 fetal pulmonary valvuloplasties (fBPS). The technical success rate ranged from 80% (BAS−) to 89% (fBAV), while the procedure-related death rate (defined as death within 72 hours following the procedure) ranged from 7% (fBAV and fBPV) to 20% (BAS). There were 98 live births after all FCI (3 pregnancies continue). Median gestational age at delivery was 39 weeks in our center and 38 weeks in other centers.

This paper presents a new method of treatment in fetal LUTO What are the clinical implications of this work? According to our results, urethroplasty with a balloon catheter constitutes a promising option of prenatal treatment for fetuses with PUVs. Probably due to its safety urethroplasty could be complementary to fetoscopic laser ablation of VAS and could be offered also in less severe cases of LUTO, in which other methods would not be indicated.

Objectives: Fetal lower urinary tract obstruction (LUTO), most often associated with presence of posterior urethral valves, poses high risk of perinatal mortality or postnatal renal failure. Looking for a method of causative treatment we have developed a technique of fetal urethroplasty with a coronary angioplasty balloon catheter inserted under an ultrasonographic guidance via an 18-gauge needle introduced transabdominally to fetal bladder. Material and methods:We have used this procedure in three women with singleton pregnancies (two primiparas and one multipara, 32-35 years of age), diagnosed with fetal megacystis at 12-16 weeks of gestation. Urethral catheterization was carried out at 16-18 weeks and an unobstructed urine flow was achieved in all three cases immediately after the procedure, followed by a resolution of megacystis and normalization of amniotic fluid volume. Results:In all three cases, the post-procedure period was uneventful. In the first two fetuses, amniotic fluid volume remained normal until 30 weeks of gestation when a gradual development of oligohydramnios and some signs of renal cystic dysplasia were observed. Nevertheless, both pregnancies were continued till term (37 and 39 weeks, respectively) and two boys without signs of pulmonary hypoplasia were delivered. The third patient is currently 25 weeks pregnant; volume of amniotic fluid in her fetus is normal and no signs of urinary flow obstruction or renal dysplasia have been recorded thus far. Conclusions:Although some technical aspects of the procedure still need to be established, it seems worth consideration as a form of potentially least traumatic intrauterine intervention in fetuses with lower urinary tract obstruction.

The aim of fetal cardiac interventions (FCI), as other prenatal therapeutic procedures, is to bring benefit to the fetus. However, the safety of the mother is of utmost importance. The objective of our study was to evaluate the impact of FCI on maternal condition, course of pregnancy, and delivery. 113 mothers underwent intrauterine treatment of their fetuses with critical heart defects. 128 percutaneous ultrasound-guided FCI were performed and analyzed. The patients were divided into four groups according to the type of FCI: balloon aortic valvuloplasty (fBAV), balloon pulmonary valvuloplasty (fBPV), interatrial stent placement (IAS), and balloon atrioseptoplasty (BAS). Various factors: maternal parameters, perioperative data, and pregnancy complications, were analyzed. There was only one major complication—procedure-related placental abruption (without need for blood products transfusion). There were no cases of: procedure-related preterm prelabor rupture of membranes (pPROM), chorioamnionitis, wound infection, and anesthesia associated complications. Tocolysis was only necessary only in two cases, and it was effective in both. None of the patients required intensive care unit intensive care unit admission. The procedure was effective in treating polyhydramnios associated with fetal heart failure in six out of nine cases. Deliveries occurred at term in 89%, 54% were vaginal. The results showed that FCI had a negligible impact on a further course of pregnancy and delivery.

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