Echocardiographic Risk Stratification of Fetuses with Sacrococcygeal Teratoma and Twin-Reversed Arterial Perfusion

Byrne, Francesca A.; Lee, Hanmin; Kipps, Alaina K.; Brook, Michael M.; Moon-Grady, Anita J.

doi:10.1159/000330762

Cited by 37 publications

(26 citation statements)

References 64 publications

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“…181 Assessment of the cardiovascular impact of sacrococcygeal teratomas and determination of prognosis can be performed with serial evaluation of heart size and cardiac output measures via Doppler interrogation of left and right outflow tracts. 524,525 Doppler interrogation of umbilical arterial flow with the finding of diminished or reversed diastolic flow reflecting competitive "steal" from the placenta to the sacrococcygeal teratoma is a marker for poor outcome.…”

Section: Sacrococcygeal Teratomasmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

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979

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Sacrococcygeal Teratomasmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

Self Cite

979

543

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“…These include the development of cardiac failure, a large placenta or hydrops fetalis [6, 9, [12][13][14][15][16], and the underlying pathophysiological mechanism is thought to be substantial arteriovenous shunting, high cardiac output, cardiac decompensation and -failure [12,23]. In two…”

Section: Prenatal Detection and Early Predictors Of A Complicated Outmentioning

confidence: 99%

Sacrococcygeal teratoma: A population-based study of incidence and prenatal prognostic factors

Hambraeus

Arnbjörnsson

Börjesson

et al. 2016

Journal of Pediatric Surgery

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“…As the heart is a central organ in fetal adaptative mechanisms, evaluation of cardiac function has been proposed to predict outcomes and to monitor fetal well-being in several cardiac [2,3] and extracardiac pathologies such as fetal hypoxia [4,5,6], hyperglycemia [7,8], pressure or volume overload [9,10], or cardiac compression [11]. Traditionally most echocardiographic methods were based on interrogating blood flow by Doppler or myocardial motion by M-mode [1,12].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Reproducibility of a Standard Protocol for 2D Speckle Tracking and Tissue Doppler-Based Strain and Strain Rate Analysis of the Fetal Heart

Crispi¹,

Sepulveda-Swatson²,

Cruz‐Lemini³

et al. 2012

Fetal Diagn Ther

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Purpose: Assessment of cardiac function in the fetal heart is challenging because of its small size and high heart rate, restricted physical access to the fetus, and impossibility of fetal ECG recording. We aimed to standardize the acquisition and postprocessing of fetal echocardiography for deformation analysis and to assess its feasibility, reproducibility, and correlation for longitudinal strain and strain rate measurements by tissue Doppler imaging (TDI) and 2D speckle tracking (2D-strain) during pregnancy. Methods: Echocardiography was performed in 56 fetuses. 2D and color TDI in apical or basal four-chamber views were recorded for subsequent analysis. Caution was taken to achieve a frame rate >70 Hz for speckle tracking and >150 Hz for TDI analysis. For each acquisition, 7.5 s of noncompressed data were stored in cine loop format and analyzed offline. Since fetal ECG information is by definition not available, aortic valve closure was marked from aortic flow and the onset of each cardiac cycle was manually indicated in the 2D images. Sample volume length was standardized at the minimum size. Two observers measured the left and right ventricular peak systolic longitudinal strain and strain-rate. Results: Strain and strain rate measurements were feasible in 93% of the TDI and 2D-strain acquisitions. The mean time spent on analyzing TDI images was 18 min, with an intraclass agreement coefficient of 0.86 (95% CI 0.77–0.92), 0.83 (95% CI 0.72–0.90), 0.96 (95% CI 0.93–0.98), and 0.86 (95% CI 0.76–0.92) for basal left and right free wall peak systolic strain and strain rate, respectively. Agreement between observers using tissue Doppler also showed high reliability. The mean time spent for 2D-strain analysis was 15 min, with an intraclass agreement coefficient of 0.97 (95% CI 0.95–0.98), 0.94 (95% CI 0.89–0.96), 0.96 (95% CI 0.93–0.98), and 0.84 (95% CI 0.73–0.90) for basal left and right free wall peak systolic strain and strain rate, respectively. Agreement between observers also showed a high reliability that was similar for TDI and 2D-strain. There was a weak correlation between TDI and 2D-strain measurements. Conclusions: A standard protocol with fixed acquisition and processing settings, including manual indication of the timing events of the cardiac cycle to correct for the lack of ECG, was feasible and reproducible for the evaluation of longitudinal ventricular strain and strain rate of the fetal heart by TDI as well as 2D-strain analysis. However, both techniques are not interchangeable as the correlation between them is relatively poor.

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Echocardiographic Risk Stratification of Fetuses with Sacrococcygeal Teratoma and Twin-Reversed Arterial Perfusion

Cited by 37 publications

References 64 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

Sacrococcygeal teratoma: A population-based study of incidence and prenatal prognostic factors

Feasibility and Reproducibility of a Standard Protocol for 2D Speckle Tracking and Tissue Doppler-Based Strain and Strain Rate Analysis of the Fetal Heart

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