Objective: To test the hypothesis that identical twins show no inter-twin differences in cardiovascular structure or physiology in fetal life unless there has been twin-twin transfusion syndrome. Design: Unselected prospective case-control observational study of fetoplacental haemodynamics including echocardiography at a median of 24 (16.7 to 32.3) weeks, with postnatal confirmation of congenital heart disease or normality. Setting: Fetal medicine unit. Patients: 136 women with monochorionic diamniotic twin pregnancies, of which 47 fetal twin pairs (35%) had twin-twin transfusion syndrome. Results: There were no haemodynamic differences between the bigger fetus (twin 1) and the smaller co-twin (twin 2) in uncomplicated monochorionic diamniotic pairs. In twin-twin transfusion syndrome, recipient fetuses had increased aortic and pulmonary velocities compared with their donor co-twins (mean (SD): 0.73 (0.23) m/s and 0.63 (0.14) m/s), respectively, v 0.53 (0.16) m/s and 0.48 (0.10) m/s in donor twins; p = 0.003 (aortic) and < 0.0001 (pulmonary)), and also in comparison with twin 1 and twin 2. The overall prevalence of congenital heart disease was increased above that in singletons (3.8% v 0.56%; 6.9% in twin-twin transfusion v 2.3% in uncomplicated monochorionic diamniotic twins), with inter-twin discordance for defects. The prevalence in recipient twins was 11.9% (p = 0.014 v uncomplicated control twins). Conclusions: Fetuses with an identical genome but no circulatory imbalance have similar cardiovascular physiology but discordant phenotypic expression of congenital heart disease. The high prevalence of congenital heart disease in monochorionic diamniotic twins merits detailed fetal echocardiography.
Objective: To compare ventricular long axis function in fetuses of diabetic mothers (FDM) with contemporaneously studied normal controls (N) and to assess the effect of pre-pregnancy diabetic control on these measurements. Design: Long axis function was compared in 41 FDM and 159 N fetuses in a cross sectional observational study. Setting: Fetal medicine unit. Methods and results: Echocardiography confirmed structural normality. Pulsed wave valvar Doppler velocimetry, lengthening and shortening myocardial velocities, and amplitude of ventricular long axis movement were recorded at the base of the left and right ventricular free walls and septum. Periconceptual diabetic control was assessed by haemoglobin A1c (HbA1c) in early pregnancy. Doppler and myocardial velocities were negatively related and myocardial thickness was positively related with HbA1c. In both cohorts all variables except mitral and tricuspid late filling (A wave) velocities were dependent on gestational age. FDM gestational age related values were higher for most variables and robust analysis of covariance showed significantly different maturation patterns in mitral valve E:A ratio (p = 0.036) and pulmonary velocity (p = 0.04), late lengthening myocardial velocities (left p = 0.016 and right p = 0.066), left myocardial shortening velocities (p = 0.008), and left free wall (p = 0.03) and septal (p = 0.04) amplitude of motion. FDM septal thickness was significantly increased throughout gestation (p , 0.0001). Conclusion: Periconceptual diabetic control influences fetal cardiac performance and myocardial hypertrophy but, unlike the pathophysiology of adult ventricular hypertrophy, is accompanied by functional adaptation. It is unlikely to explain the increased rate of late stillbirth observed in diabetic pregnancies.
The track and trigger scoring system has proved useful in assessing patients and alerting staff if their condition is deteriorating. It has ensured, when necessary, timely, appropriate and safe transfer of patients to the district general hospital. The scoring system has been extended to determine appropriateness of accepting patients from the district general hospital to the community hospital.
The track and trigger scoring system has proved useful in assessing patients and alerting staff if their condition is deteriorating. It has ensured, when necessary, timely, appropriate and safe transfer of patients to the district general hospital. The scoring system has been extended to determine appropriateness of accepting patients from the district general hospital to the community hospital.
Persistent left-sided superior caval veins (SVC) are present in 0.4% of the population. In the majority of cases, the persistent left SVC drains into the right atrium via the coronary sinus, but direct connection to the left atrium is also recognized. Previous reports have described re-opening of persistent left SVCs in patients with congenital heart disease following bidirectional cavopulmonary connection or Fontan-type procedures, suggesting that the lumen of the left SVC obliterates during embryological development, rather than disappears. The case described in this report is, to our knowledge, the first description of obliteration of the left SVC in post-natal life, associated with spontaneous closure of a ventricular septal defect. Our observation lends further support to the hypothesis that venous structures obliterate but do not completely disappear in foetal life.
Virtual poster abstractsdefect was detected at 32 weeks. While bidirectional blood flow was clearly seen across the small defect in the ventricular septum, the defect was not apparent on gray-scale imaging. Conclusions: Radiant-flow imaging assists in the evaluation of fetal heart abnormalities from the first to third trimester.
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