Prenatal measurement of cardiothoracic ratio in evaluation of heart disease.

Paladini, D.; Chita, Sunder K.; Allan, L D

doi:10.1136/adc.65.1_spec_no.20

Cited by 139 publications

(111 citation statements)

References 2 publications

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“…168,228,229 The cardiac size relative to the thorax may be evaluated from cross-sectional images through the fetal chest with measurements of cardiothoracic diameter, cardiothoracic area, and cardiothoracic circumference ratios. 228,229 From a cross-sectional view of the thorax, the heart area is usually about one third the size of the thorax. Although quantitative assessment is not necessary if qualitatively there is a normal cardiothoracic ratio, measurement may be useful in the assessment of fetuses with structural or functional CHD or in those at risk for myocardial dysfunction or high cardiac output states.…”

Section: Cardiac Function Assessmentmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

990

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: Cardiac Function Assessmentmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

990

543

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“…Studies were recorded on videotape for further analysis. The following parameters were routinely measured in all fetuses according to techniques described previously: cardiothoracic ratio, 18 PIUA, 14 the pulsatility index (PI) and peak systolic velocity of the middle cerebral artery (MCA), 19 left ventricular shortening fraction (LVSF), and end-diastolic interventricular septal thickness (IVST). 20 Ventricular myocardial performance index (MPI), defined as the isovolumetric period (sum of isovolumetric contraction and relaxation times) divided by the ventricular ejection time, 21 was also measured.…”

Section: Ultrasound Studiesmentioning

confidence: 99%

Early Intertwin Differences in Myocardial Performance During the Twin-to-Twin Transfusion Syndrome

et al. 2004

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Background-In the twin-to-twin transfusion syndrome (TTTS), pressure rather than volume overload is increasingly considered as a key factor in the pathogenesis of the cardiomyopathy of the recipient twin. If this is the case, cardiac dysfunction should be among the first signs observed with TTTS. The objective of this study was to determine whether intertwin differences in myocardial function are modified early in the course of TTTS and whether they can help to differentiate this condition from intrauterine growth restriction (IUGR). Methods and Results-Eight variables were analyzed on the first fetal echocardiography on 21 pairs of twins with TTTS and 11 with IUGR. No difference was found between the 2 groups for the cardiothoracic ratio, pulsatility indices in the umbilical and middle cerebral arteries, and peak velocity of the middle cerebral artery. Significant difference was found for ventricular septal thickness, but with no association with the conditions under study. With TTTS, left ventricular shortening fraction was consistently greater in the donor twins, and myocardial performance indices (MPIs) were elevated in the recipient twins. This increase in MPI was caused by a lengthening of the isovolumic periods compared with those of the donor twin: left ventricular and right ventricular isovolumic periods 0.105Ϯ0.047 and 0.097Ϯ0.026 seconds, respectively, for the recipient twins versus 0.0561Ϯ0.46 and 0.065Ϯ0.03 seconds, respectively, for the donor twins (PϽ0.001). These changes in the isovolumic periods were mainly due to significant prolongation of isovolumic relaxation times. A change in left ventricular MPI Ն0.09 combined with a change in right ventricular MPI Ն0.05 would identify a TTTS with a sensitivity of 75% and a false-positive rate of 9%. Conclusions-The observed diastolic function impairment goes along with the pressure-overload pathogenic concept proposed in TTTS. Assessment of intertwin difference in MPI is a valuable tool for early differential diagnosis between TTTS and isolated IUGR.

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“…However, we speculated that the presence of a wide aortic root might be of help for the surgical correction, should the systolic function of the left ventricle not be irremediably compromised. In addition, the possibility of pulmonary hypoplasia secondary to the severe cardiac enlargement has to be taken into account, as in all cases of a severely elevated cardiothoracic ratio 8 . Intrauterine ultrasound-guided balloon valvuloplasty, which has been utilized in a few cases of critical aortic stenosis 11 , is not indicated in this lesion.…”

Section: Discussionmentioning

confidence: 99%

“…On fetal echocardiography, there were normal atrioventricular and ventriculoarterial connections. Severe cardiomegaly, with a cardiothoracic ratio of 0.81 8 , was noted. The left ventricle was considerably dilated and showed marked eccentric myocardial hypertrophy and severe hypocontractility ( Figure 1).…”

Section: Case Reportmentioning

confidence: 99%