AC values fell within the normal range of normative curves. Fifty percent of fetuses with small AC were SGA at birth. Neonatal outcomes in patients with small AC are similar to those with a normal AC.
Three neonatal patients with left-sided congenital diaphragmatic hernia (CDH) were evaluated with echocardiography pre- and postsurgical correction using tissue Doppler imaging (TDI). Tissue Doppler imaging parameters demonstrated improvement after surgery in both left- and right-sided myocardial performance index (MPI); furthermore, both left and right MPI correlated with clinical course in these three patients. These studies suggest that TDI measurements may be prognostic in nature in this patient population, although further studies are needed using this modality in patients with CDH to determine if it may be useful in guiding treatment and to further delineate the reasons why left ventricular function improves.
Background: Yield of serial echocardiography in fetuses with atrioventricular septal defects (fAVSD) has not been well defined. The goal of this study was to document if any major changes occurred from initial fetal to initial postnatal echocardiogram in uncomplicated fAVSD. Methods: fAVSD were excluded if initial fetal scan documented complex CHD or any concerns. Changes in ventricular function, valvular regurgitation, or diagnosis between first fetal and first postnatal echocardiogram were recorded. Results: Fifty-seven fAVSD met criteria. Ninety-six fetal echocardiograms were done in 57 patients. Initial fetal scan was performed at 24.3 ± 3.7 weeks of estimated gestational age. All fAVSD had normal function, 38 had no atrioventricular valve regurgitation (AVVR), and 19 had mild AVVR. First postnatal echocardiogram was performed at 6.3 ± 15.3 days. Fifty-six patients had normal function, 1 patient had mild dysfunction, 16 patients had no AVVR, 36 had mild AVVR, and 5 had moderate AVVR. Three patients (5%) had an improvement in AVVR by one degree, 27 patients (47%) had no change in AVVR, 24 patients (42%) had an increase in AVVR by one degree, and 3 patients (5%) had an increase in AVVR by two degrees. There was no major missed anatomical diagnosis from first prenatal to first postnatal echocardiogram. Conclusion: In fAVSD that had no concerns on their initial fetal echocardiogram, the majority of patients had no major changes noted between their initial fetal echocardiogram and their first postnatal echocardiogram. Repeat fetal echocardiograms may not necessarily be needed in this cohort of patients. K E Y W O R D S atrioventricular septal defect, fetal echocardiogram 1 | INTRODUC TI ON Fetal diagnosis of congenital heart disease (CHD) allows families to prepare for and adjust to the future circumstances that may await them. 1-4 However, as stated by the American Heart Association fetal echocardiogram guidelines, "the necessity, timing, and frequency of serial assessment should be guided by the" underlying circumstances and possible treatment options. 5 Atrioventricular septal defects are one type of CHD that can be readily diagnosed in utero. 6 Fetuses with atrioventricular septal defects (fAVSD) may undergo serial fetal echocardiograms to reassess atrioventricular valve regurgitation (AVVR) and ventricular function | 2103 BELFRAGE Et AL.
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