Fetal Autopsy: The Most Important Contribution of Pathology in a Center for Perinatal Medicine

Tennstedt, C.; Hufnagl, Peter; Körner, H.; Vogel, M; Dietel, Manfred; Chaoui, R.

doi:10.1159/000053945

Cited by 7 publications

(3 citation statements)

References 11 publications

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“…From the clinical perspective high demands are made on the diagnosis of malformations. Increasingly, autopsies have to be performed on fetuses from the early weeks of pregnancy [10,11]. There are few experts in this area in Germany who are available for consultation.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Congenital Heart Malformations – Possibilities for the Employment of Telepathology

Tennstedt

Sunkel-Wehrstedt²,

Vogel³

et al. 2000

Analytical Cellular Pathology

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Goal: In a study of 10 autopsy cases with congenital cardiac malformations we investigated whether obtaining a second opinion by means of telepathology could satisfy quality standards for the diagnosis of cardiac malformations and what the advantages and disadvantages of such a procedure might be. Material: The investigatory samples were 10 formalin‐fixed hearts with complex malformations from 9 fetuses and one newborn on which autopsies had been performed at the Pathological Institute of the Charité Hospital. The requests for a second opinion, which included text and image data, were sent in the form of Microsoft PowerPoint presentations to 5 experts in 4 countries. Per case the number of images that were sent was between 3 and 7. The size of the files was between 439 and 942 kb. The time required for preparation of the cases for sending them to the specialists was between 1 and 2 hours: this encompassed the time for putting the notation on the images, compressing them, creating a file that included both the images and the clinical data and then sending the case file. Results: All 10 cardiac malformations were correctly identified. In 8 of the 10 cases at least one expert had questions. After these questions had been answered and further images had been sent final correct diagnoses were made in all cases. All experts said that the quality of the images was very good. Use of a standardized findings questionnaire, which also included the marking of anatomic structures and of pathological findings in the images, proved useful. Standardized findings forms facilitate orientation during interpretation of the cases and should be used generally to avoid misunderstandings in telepathological communication. Conclusions: In general it is possible to obtain an effective and reliable diagnosis of congenital heart malformations by means of telepathology. It is far quicker to get a second opinion by this means than by conventional means.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of Congenital Heart Malformations – Possibilities for the Employment of Telepathology

Tennstedt

Sunkel-Wehrstedt²,

Vogel³

et al. 2000

Analytical Cellular Pathology

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“…The heart is the first organ to form in the embryo, and congenital cardiovascular anomalies are responsible for between 16-45% of prenatal deaths (38,54,55). With the increased use of echocardiography in newborns and the advent of fetal ultrasound, the incidence of congenital heart defects (CHD) is now estimated as between 1.2-1.4% of all live births (Table 1) (25).…”

Section: Valve Development and Congenital Heart Diseasementioning

confidence: 99%

Ras-Related Signaling Pathways in Valve Development: Ebb and Flow

2005

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Heart valve formation during vertebrate embryogenesis is characterized by the initial formation of endocardial cushions in the atrioventricular (AV) canal and outflow tract (OFT), followed by the proliferation of heart valve progenitor cells and the remodeling of primordial valves (3,44,48). At the end of this process, the mature valves consist of elongated leaflets composed primarily of stratified extracellular matrix (ECM) layers and supporting structures. The early stages of endocardial cushion formation and remodeling are similar, but not identical, for the arterial semilunar valves and for the tricuspid and mitral AV valves. In both the AV canal and OFT, endocardial cushions form through an epithelial-to-mesenchymal transition (EMT) in which a subpopulation of endothelial cells transdifferentiates into mesenchyme in response to signals secreted from the myocardium (44). These cushions then go through a highly proliferative phase and fuse to form highly cellular undifferentiated valve primordia that contain the precursors of the individual valves (13, 36). The valve primordia undergo a process of remodeling characterized by reduced proliferation and generation of organized collagen-, elastin-, and proteoglycan-rich ECM strata of the elongated leaflets. Although the mature structures of the semilunar valve cusps are different from the AV valve leaflets and supporting chordae tendineae, the stratification of the valve ECM compartments is similar for both sets of valves relative to the direction of blood flow in the mature heart. However, the semilunar and AV valves differ in the cells that migrate into these structures from extracardiac sources in the embryo, with neural crest cells contributing to the OFT and epicardial-derived cells incorporating into the AV canal.Formation of the semilunar and AV valves is dependent on common signaling pathways, although the specific components of each pathway may be different for the individual valves. Studies in mouse, chicken, and zebrafish embryos as well as human genetic analyses have implicated several sig-390 1548-9213/05 8.00 ©2005 Int. Union Physiol. Sci./Am. Physiol. Soc. Valve Development and Congenital Heart DiseaseThe heart is the first organ to form in the embryo, and congenital cardiovascular anomalies are responsible for between 16-45% of prenatal deaths (38,54,55). With the increased use of echocardiography in newborns and the advent of fetal ultrasound, the incidence of congenital heart defects (CHD) is now estimated as between 1.2-1.4% of all live births (Table 1) (25). Newborn death due to CHD is second only to infection, and 38% of children diagnosed with a defect will undergo surgical or catheterization-based interventions at least once in their lifetime.Valvular defects account for 20-25% of CHD (25, 37) and include bicuspid aortic valve, pulmonary, or tricuspid atresia and Ebstein's anomaly. Congenital heart valve disease can be caused by genetic or environmental factors, and, with rare exceptions, the specific etiologies of the lesions are unknown. ...

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“…Studies have shown that manipulating digitised 3D/4D data may also play a complementary role in autopsy by performing a virtual necropsy to locate (suspected) malformations before a real necropsy, which usually destroy the intactness of the specimens (Tennstedt et al, 2001), and by retrieving the malformation that has been missed in the prenatal (Michailidis et al, 2001b) or even at post-mortem examination.…”

Section: Interactive Teaching Telemedicine and Intervention Guidancementioning

confidence: 99%

New fetal cardiac imaging techniques

Deng

Rodeck

2004

Prenatal Diagnosis

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Rapid advances in graphics computing and micro-engineering have offered new techniques for prenatal cardiac imaging. Some of them can be non-invasively applied to both clinical and laboratory settings, including dynamic three-dimensional echocardiography, myocardial Doppler imaging, harmonic ultrasound imaging, and B-flow sonography. With clinical constraints, a few others have been mainly used in laboratories, such as endoscopic ultrasound, magnetic resonance imaging and biomicroscopy. Appropriate use and co-use of these new tools will not only provide unique information for better clinical assessment of fetal cardiac disease but also offer new ways to improved understanding of cardiovascular development and pathogenesis.

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Fetal Autopsy: The Most Important Contribution of Pathology in a Center for Perinatal Medicine

Cited by 7 publications

References 11 publications

Diagnosis of Congenital Heart Malformations – Possibilities for the Employment of Telepathology

Diagnosis of Congenital Heart Malformations – Possibilities for the Employment of Telepathology

Ras-Related Signaling Pathways in Valve Development: Ebb and Flow

New fetal cardiac imaging techniques

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