Our study has demonstrated that flecainide is an effective first-line treatment for fetal SVT with high success rate (88.2%), low side effect profile and relatively easy utilization. Based on the current study and recently published article results, flecainide can be recommended as the drug of first choice for treatment of fetal SVT cases.
The early diagnosis of a CSP (7-8 weeks gestation) with a β-hCG level <17.000 mIU/ml and a myometrial thickness >2 mm can be treated with suction curettage with or without placement of a uterine Foley balloon as curative treatment.
The incidence of gestational proteinuria was lower than the previous studies. Preeclampsia developed in 33% of patients with new onset proteinuria in pregnancy. In patients who developed PE had significantly higher proteinuria, lower delivery time and birth weight in their infants. Therefore, patients with new onset proteinuria should be followed-up for preeclampsia development and associated morbidities.
Congenital high airway obstruction syndrome (CHAOS) is an extremely rare life-threatening condition. Laryngeal atresia appears to be the most frequent cause. Generally the diagnosis is made with severely enlarged and highly echogenic lungs and additional ultrasound findings. The prognosis of the affected infants is often poor. Five cases are reported here that were diagnosed in a tertiary center between 2008 and 2014.
Left pulmonary artery sling (LPAS) is a very rare cause of large airway compression. In LPAS, the left pulmonary artery (LPA) arises from the proximal right pulmonary artery, coursing over the right mainstem bronchus, posterior to the trachea and anterior to the esophagus prior to reaching the left hilum. The aberrant course of the LPA results in anatomical obstruction of the right mainstem bronchus, the trachea, or both. Thirty percent of affected patients have major associated structural heart disease 1 which can importantly impact clinical outcome. 2 The clinical manifestation of LPAS after birth usually relates to the severity of airway obstruction and the associated cardiac pathology. Only a few reports present the prenatal features of LPAS. In the present report, we present the prenatal diagnosis of a case of LPAS in one of a set of identical twins in which the only feature was that of an abnormal course of the LPA on 3-vessel tracheal view.
| C A S E PRE S ENTATI ONA 30-year-old primigravida woman at 27 weeks' gestation was referred to our maternal fetal medicine unit given the presence of a set of monochorionic, diamniotic spontaneous twins. A full anatomical ultrasound examination performed in both fetuses demonstrated no pathology, and fetal echocardiography demonstrated no major structural heart disease in one twin. In the other twin, fetal echocardiography revealed on a 3-vessel tracheal view that the LPA originated from the right pulmonary artery, originating initially to the right side of the trachea, and turning sharply to course between the trachea and esophagus prior to joining the left hilum (Figure 1, Movie S1). The examination was performed transabdominally using a Voluson E 6 (GE healthcare Ultrasound, Milwaukee, WI, USA) ultrasound machine equipped with a RAB 6D (2-7 MHz) probe. With these findings, pediatric cardiology counseling was offered and LPAS was suspected. The remainder of the cardiac anatomy was Left pulmonary artery sling (LPAS) is a very rare cause of large airway compression.In LPAS, the left pulmonary artery (LPA) arises from the proximal right pulmonary artery, coursing over the right mainstem bronchus, posterior to the trachea and anterior to the esophagus prior to reaching the left hilum. The aberrant course of the LPA results in anatomical obstruction of the right mainstem bronchus, the trachea, or both. Only a few reports present the prenatal features of LPAS. In this report, we present the prenatal diagnosis of a case of LPAS in one of a set of identical twins in which the only feature was that of an abnormal course of the LPA on 3-vessel tracheal view. The cross-sectional view at the level of three vessels which includes both pulmonary artery branches is useful to detect this abnormality. Color and power Doppler may be helpful as well.
K E Y W O R D Sfetal echocardiography, left pulmonary artery, vascular imaging
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