Accuracy of the Fetal Echocardiography in the High Risk Pregnancies

Ahmed, Badreldeen; Stanojevic, M.; Kopjar, Tomislav

doi:10.5005/jp-journals-10009-1088

Cited by 5 publications

(4 citation statements)

References 56 publications

(148 reference statements)

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“…Without surgical treatment the patients' mortality rate is 100% [4,5,16]. HLHS is diagnosed in 40-85% of cases during prenatal development [6,7]. Pregnant women management protocol suggests routine ultrasound examination from pregnancy week 18, when congenital disorders of the fetus may be identified.…”

Section: український журнал серцево-судинної хірургії 2021 1 (42)mentioning

confidence: 99%

Hypoplastic Left Heart Syndrome: Prognostic Significance of Morphological Variants of the Heart in the Choice of Treatment Approach

Zakharova

Savchuk

Truba

et al. 2021

ujcvs

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Hypoplastic left heart syndrome (HLHS) is one of the most complicated congenital heart defects which leads to the inevitable fatal outcome in the natural course of the disease. Currently, Norwood procedure and fetal aortic valvuloplasty are considered the major approaches for surgical treatment of HLHS. However, the prognosis of such surgeries is often unpredictable. The aim. To study morphological variations of the left ventricle (LV) in HLHS and evaluate the prognostic significance of each of them in the choice of surgical approach. Materials. The main group included 63 hearts of newborns with HLHS, the comparison group included 53 hearts of newborns without cardiac pathology. Methods. The methods used were survey microscopy, as well as macro- and micromorphometry of various parameters of the heart, calculation of the ratio of their absolute values (indices) with subsequent statistical data processing. Results. Five types of LV were identified in HLHS patients based on the size and shape of the cavity, wall thickness, presence or absence of fibroelastosis: slit-like hypoplastic (Type I) (n = 10; 15.9%); slit-like hypertrophic (Type II) (n = 19; 30.2%); cylindrical (Type III) (n = 22; 34.9%); lacunar (Type IV) (n = 6; 9.5% ); lacunar-cylindrical (Type V) (n = 6; 9.5%). In Type I left ventricles, the interventricular index (IVI) (the ratio of the areas of the free walls of the left and right ventricles on the cross sections of the heart) was the smallest: 0.13 ± 0.03 units versus normal 1.96 ± 0.31 units. In Type II left ventricles, the value was equal to 1.69 ± 0.23 units; in Type III it was 1.59 ± 0.64 units; in Type IV it was 1.31 ± 0.03 units; in Type V it was 1.05 ± 0.52 units. The index of the working area of the right ventricular myocardium (RVI) (the ratio of the area of the free wall of the right ventricle to the sum of the areas of the free wall and interventricular septum) in Type I LV was the highest: 81.3 ± 5.7% versus normal 57.1 ± 2.02%; in Type II it was 49.7 ± 6.4%; in Type III it was 39.8 ± 2.9%; in Type IV it was 69.7 ± 16.1%; in Type V it was 41.3 ± 24.4%.Type III–V LVs have always been associated with fibroelastosis, in contrast to Type I and II LVs. Conclusions. In HLHS, Type I hearts are the most eligible for the Norwood procedure, since the LV, due to its minimal size, is not an excess ballast for the working right ventricle. Type II LV is optimal for the fetal aortic valvuloplasty, since during the II-III trimesters of gestation they can join the circulatory system due to remodeling. HLHS with LV fibroelastosis (Types III, IV, V) seem to be the least favorable for both pre- and postnatal surgery, especially in the presence of fibroelastosis of the right ventricle.

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Section: український журнал серцево-судинної хірургії 2021 1 (42)mentioning

confidence: 99%

Hypoplastic Left Heart Syndrome: Prognostic Significance of Morphological Variants of the Heart in the Choice of Treatment Approach

Zakharova

Savchuk

Truba

et al. 2021

ujcvs

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“…Although the most frequent congenital malformations, CHDs are among the most frequently missed [18,55]. The efficiency of the cardiac scan is reported with great variation, depending Congenital Abnormalities of the Fetal Heart http://dx.doi.org/10.5772/intechopen.74077 on the scanning protocol, examiner experience, equipment quality and scanning conditions [18,[56][57][58]. It appears that the use of 4CV alone detects up to 77% of CHD, while adding OTV increases prenatal detection to 83-92% of major abnormalities.…”

Section: Efficiency Of the Fetal Cardiac Scanmentioning

confidence: 99%

Congenital Abnormalities of the Fetal Heart

Iliescu¹,

Tudorache²,

Nemescu³

et al. 2018

Congenital Anomalies - From the Embryo to the Neonate

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Congenital heart defects (CHDs) are the most frequent congenital malformations, the costliest hospital admissions for structural defects and the leading cause of infant general and malformations related mortality. Fetal echocardiography represents a skilled ultrasound examination, because of the complexity, physiological and structural particularities of the fetal heart. The efficiency of the cardiac scan is reported with great variation, depending on the scanning protocol, examiner experience and equipment quality but CHDs remains among the most frequently missed congenital abnormalities.

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“…102 Also, tricuspid and ductus venosus flow patterns proved useful in early detection of CHD. 57,79,83,85,[103][104][105][106][107] The Examination Protocol of the Fetal Heart During the last decades, five scan protocols for fetal CHD diagnosis have been commonly used: four chamber view (4 CV), 4 CV + outflow tracts view (OTV)/three vessels and trachea view (3 VTV), 4 CV + OTV + 3 TV, extended cardiac echography examination (ECEE) and 4D spatiotemporal image correlation (STIC). In ST scan 4 CV alone detects up to 77% of prenatally developed CHD, while OTV increases prenatal detection rate between 83 and 92%.…”

Section: Imaging Techniquementioning

confidence: 99%

“…In ST scan 4 CV alone detects up to 77% of prenatally developed CHD, while OTV increases prenatal detection rate between 83 and 92%. 107 Using only the 4 CV for fetal heart examination is insufficient as many anomalies may not be detected, thus imaging of the outflow tracts is mandatory. 108 Most of MA are detected by imaging the great vessels such in a coarctation of the aorta, hypoplastic left heart, tetralogy of Fallot, double outlet right ventricle, truncus arteriosus, corrected or noncorrected transposition of great vessels.…”

Section: Imaging Techniquementioning

confidence: 99%

Challenges in Sonographic Detection of Fetal Major Structural Abnormalities at the First Trimester Anomaly Scan

Antsaklis¹,

Antsaklis²,

Paulescu³

et al. 2015

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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First-trimester (FT) ultrasound examination appears to have a very good sensitivity in the detection of fetal abnormalities, especially when an extended protocol that is achievable with reasonable resources of time, personnel and ultrasound equipment, is used. It has been shown that the efficiency of the routine anomaly scan varies widely between the studies performed both in early or mid-pregnancy. The analysis of technique and study designs reveals that in each gestational age, the extension of the investigational protocol is the most important factor in modulating the detection rate. Moreover, the use of similar basic checklists at the FT and second trimester (ST) examinations revealed comparable anomaly detection rates in large population groups. First trimester combined test have been demonstrated as a useful screening tool for genetic syndromes and consecutively the FT ultrasound scan became a routine examination in most prenatal diagnostic centers. Its performance in structural abnormalities detection has been communicated in high-, medium-risk populations or unselected low-risk variable number of patients and compared to the ST anomaly scan effectiveness. A detailed first-trimester anomaly scan using an extended protocol is an efficient screening method to detect major fetal structural abnormalities in low-risk pregnancies. It is a method that it is feasible at 12 to 13 + 6 weeks with ultrasound equipment and personnel already used for routine first-trimester screening. Rate of detection of severe malformations is greater in early- than in mid-pregnancy and on postnatal evaluation. Early heart investigation could be improved by an extended protocol involving use of color Doppler. How to cite this article Iliescu D, Cara M, Tudorache S, Antsaklis P, Ceausu I, Paulescu D, Novac L, Cernea N, Antsaklis A. Challenges in Sonographic Detection of Fetal Major Structural Abnormalities at the First Trimester Anomaly Scan. Donald School J Ultrasound Obstet Gynecol 2015;9(3):239-259.

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Accuracy of the Fetal Echocardiography in the High Risk Pregnancies

Cited by 5 publications

References 56 publications

Hypoplastic Left Heart Syndrome: Prognostic Significance of Morphological Variants of the Heart in the Choice of Treatment Approach

Hypoplastic Left Heart Syndrome: Prognostic Significance of Morphological Variants of the Heart in the Choice of Treatment Approach

Congenital Abnormalities of the Fetal Heart

Challenges in Sonographic Detection of Fetal Major Structural Abnormalities at the First Trimester Anomaly Scan

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