International Prenatal Cardiology Collaboration Group (IPCCG) links specialists from prenatal cardiology all over the world. In this recommendation we would like to focus on the fetal/prenatal echocardiography official report. So far many recommendations focused mainly on technical aspects of the fetal heart examination.
The purpose of this article is to show that fetal echocardiography should also be performed in the third trimester of pregnancy, both in normal and complicated pregnancies. The article presents a review of the current literature presenting the possibilities and goals of fetal echocardiography in the third trimester of pregnancy in situations such as: coarctation of the aorta, premature constriction of the ductus arteriosus, increased fetal lung vascular resistance, hypoplastic left heart syndrome, dextro-transposition of the great arteries, fetal growth restriction, pregestational diabetes mellitus, and gestational diabetes mellitus. A specific feature of fetal echocardiography in the third trimester is the emphasis on the assessment of fetal heart function; therefore, the article describes the current method of assessing it.
Introduction
Fetal echocardiography in third trimester is relatively rare reported and there is no data, what is the clinical meaning of the main pulmonary artery (MPA) dilatation in third trimester or before the delivery in fetuses with congenital heart defect. We analyzed the neonatal follow‐up in cases of significantly dilated MPA diameter to better understand its clinical significance.
Material and Methods
Retrospectively 238 healthy singleton fetuses were selected as a reference group. Consecutive percentiles for MPA diameter according to the gestational age were calculated. In second step, we selected cases whose MPA diameter measured at the level of three vessel trachea view (3VT view) was pointedly above 95th centile in third trimester of pregnancy, according to the obtained data of our healthy population.
Results
There were 11 fetuses, with dilated MPA diameter (range 12–13.5 mm), who had last echocardiography performed at 37.6 weeks of gestation. There were 11 isolated heart defects: 7 cases with HLHS, 2 with d‐TGA, and 2 cases with CoA. Mean neonatal weight was 3,345 g, with Apgar score 8–10. About 10 newborns out of 11 had cardiac surgery at the mean 12th day of the postnatal life and 8 of them died on the mean 23rd day. Autopsy was performed in 5 cases. In all of them histopathology reports described pulmonary hypertension in addition to cardiac structural abnormalities.
Conclusion
Severe dilation of the fetal MPA before the delivery suggested prenatal abnormal lung development and was a poor prognostic factor. In these cases postnatal pulmonary hypertension should be suspected.
Objectives
The subject of our analysis is the influence of umbilical cord collision around the fetal neck on the fetal heart function and cerebral circulation.
Methods
Our study was carried out on a group of 115 fetuses from single pregnancies with physiological course, during the 15th to 40th week of pregnancy. In our analysis, we examined the following parameters: Tei index for right ventricle, Tei index for left ventricle with Tei index components: isovolumetric contraction time, isovolumetric relaxation time, ejection time and cardiothoracic area ratio, middle cerebral artery peak systolic velocity (PS MCA), middle cerebral artery pulsatility index (PI MCA). Gestational age in our study was: 28+2±34. The study group of patients with fetal umbilical cord around neck group (fUCAN) included 38 fetuses (20 males, 18 females). The control group of patients with no fetal umbilical cord around neck group (NfUCAN) included 77 fetuses (43 males, 34 females).
Results
In our study, we found no significant differences in the values obtained: Tei LV in fUCAN: 0.5±0.1 vs. in NfUCAN: 0.5±0.1; p=0.42), Tei RV in fUCAN: 0.5±0.2 vs. in NfUCAN: 0.4±0.1; (p=0.2). Tricuspid valve regurgitation-TR was observed with the following frequency: fUCAN: 7/38, 18% vs. NfUCAN: 13/77, 17%; p=0.8. MCA PS in study fUCAN group was significantly higher than in NfUCAN (40.2±11.5 vs. 32.5±9.5; p=0.003), although other hemodynamic and clinical variables did not differ between the study and control groups.
Conclusions
The fetal nuchal umbilical cord collision did not affect the fetal heart function expressed as Tei index, at the time of fetal heart examination (at mean gestational age 29+4 weeks). The fUCAN group presented elevated PS MCA, which was not related to other hemodynamic and clinical variables between the study and control groups.
Electronic poster abstractsdiagnosis in 2011-2013 showed obvious abnormal findings of three vessel view and four chamber view with B mode. The detection rate of isolated ventricular septal defect (VSD) was elevated from 10% to 42.9% using colour Doppler in 2014-2016 because cases of isolated VSD became easier to detect. Conclusions: We revealed that the detection rate of CHDs especially isolated VSD was increased by using colour Doppler.We thought that appropriate setting of colour Doppler, confirmation of the image of crux and confirmation by clips are critical to improve the detection of VSDs. EP10.25 A specific prenatal 2D sonographic feature of truncus arteriosus and pulmonary atresia with ventricular septal defect: the Chinese vase sign
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