Objective To evaluate the reproducibility of the fetal right modified myocardial performance index (Mod‐MPI) obtained by synchronizing the inflow and outflow images of the right ventricle (RV) and to evaluate its feasibility through clinical application to twin‐to‐twin transfusion syndrome (TTTS). Methods We prospectively evaluated 77 normal fetuses. Two experienced operators individually measured the right Mod‐MPI using two different methods: (1) separate recording of the RV inflow and outflow using pulsed‐wave Doppler (conventional method) and (2) synchronization of RV inflow and outflow images using the MPI + ™ function based on the closure click of the pulmonary valve (new method). To evaluate the clinical utility of the new method, we measured the right Mod‐MPI in 33 TTTS fetuses using the new method before and after the fetoscopic laser coagulation (FLC). Results There was no statistical difference in Mod‐MPI values between the two methods (p = .242). For both operators, the intra‐ and interoperator reproducibility of Mod‐MPI was high with both methods (ICCs >0.950). Among the components of Mod‐MPI measured using the new method, ejection time showed the highest reproducibility, whereas isovolumetric relaxation time demonstrated the lowest reproducibility. In TTTS fetuses, the Mod‐MPI significantly decreased after FLC in recipients, and there was no difference in MPI values before and after FLC in donors. Conclusion Right Mod‐MPI measurement after the synchronization of RV inflow and outflow images is a reliable technique for evaluating fetal right cardiac function. This novel method can also independently evaluate the systolic and diastolic functions of the right heart.
Objective To report our experience with management of fetuses with congenital high airway obstruction syndrome (CHAOS). Methods We retrospectively reviewed the cases of fetuses who were prenatally diagnosed and postnatally confirmed with CHAOS between 2010 and 2019 at Asan Medical Center, Seoul, Korea. Results Of 13 fetuses prenatally diagnosed with CHAOS, 7 were lost to follow-up and 6 were postnatally confirmed as having CHAOS. All fetuses, except one were delivered via cesarean section with an ex utero intrapartum treatment (EXIT) procedure. Two patients had coexisting congenital heart diseases requiring several cardiac surgeries following birth. Both of these patients demonstrated developmental delay; however, the remaining 4 had a normal development except for expressive language. Two infants died of respiratory complications, and the remaining 4 were alive at the end of the follow-up period. All 4 live patients underwent tracheostomy with planned reconstruction surgery. Three children are now able to phonate, and 1 can maintain a conservation. Conclusion The proper management of CHAOS using the EXIT procedure results in high survival and low hypoxemia-induced complication rates. Therefore, an accurate prenatal diagnosis is necessary for an appropriate perinatal management.
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