The construction and application of an ultrasound and anatomical cross-sectional database of structural malformations of the fetal heart.

OBJECTIVES: Establish a fetal heart anatomical cross-sectional database that correlates with screening transverse ultrasound images suggested by international professional organizations to detect congenital heart defects. METHODS: Fetuses with suspected congenital heart defects identified using the following cardiac image sequences obtained from transverse slices beginning from the upper abdomen and ending in the upper thorax were the subjects of this study: (1) four-chamber view, (2) left ventricular outflow tract view, (3) three-vessel right ventricular outflow tract view, and (4) the three-vessel tracheal view. A database of digital two-dimensional images of the transverse sweep was created for fetuses with confirmed congenital heart defects. In addition, using four-dimensional ultrasound spatial-temporal image correlation, selected transverse ultrasound images were acquired as part of the database. Ultrasound-detected congenital heart defects were confirmed postnatally from pathological specimens of the heart and lungs using a cross-sectional technique that mirrored the ultrasound images described above. When anatomical specimens were not available, prenatal ultrasound-detected congenital heart defects were confirmed using postnatal echocardiography and/or following surgery. RESULTS: The four screening views described in the Methods section identified 160 fetuses that comprised the database. Forty-five datasets consisted of both ultrasound and anatomical cross-sectional images. Thirteen percent (6/45) only had abnormalities of the four-chamber view (eg, endocardial cushion defects). Twenty-four percent (11/45) had abnormalities of the four-chamber view as well as right and left outflow tracts (eg, complex malformations). Of these, 10 of 11 had an abnormal tracheal view. Sixteen percent (7/45) had an abnormal four-chamber view and abnormal right outflow tract (eg, pulmonary stenosis). Thirty-three percent (15/45) had a normal four-chamber view but had abnormal right and left outflow tracts as well as an abnormal tracheal view (eg, tetralogy of Fallot, D-transposition of the great arteries). CONCLUSIONS: Combining both ultrasound and anatomical imaging may be of assistance in training imagers to recognize cardiovascular pathology when performing the screening examination of the fetal heart.

Histological component quantification for the evaluation of endometrial receptivity in women with natural cycles undergoing in vitro fertilization/intracytoplasmic sperm injection.

OBJECTIVE: Our aim was to evaluate the value of the volumetric fraction of vascular endothelial cells (EnVF) for determining endometrial receptivity in women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). MATERIALS AND METHODS: The records of women undergoing IVF/ICSI between 2006 and 2010 were retrospectively reviewed. An endometrial biopsy was performed in the cycle prior to IVF/ICSI. EnVF was calculated from endometrial biopsy staining. RESULTS: Twenty-seven patients who did not become pregnant, 8 who had a miscarriage, and 21 with a clinical pregnancy were included. The three groups were similar with respect to infertility and IVF characteristics. An EnVF ≤3.85 was associated with not becoming pregnant, an EnVF >5.29 with miscarriage, and a level between 3.86 and 5.29 was associated with clinical pregnancy (p = 0.001). CONCLUSIONS: EnVF examined in the prior cycle may be a marker of endometrial receptivity and predict the chance of pregnancy in women undergoing IVF/ICSI.

Continuous transverse scanning of the fetal heart using a cross-sectional image database of common fetal congenital heart deformities.

OBJECTIVE: To provide an anatomical basis for continuous transverse scanning of the fetal heart by analyzing the typical cross-sectional characteristics of different types of congenital heart deformities (CHDs) using an anatomical image database. MATERIALS AND METHODS: The database consisted of cross-sectional images obtained from 45 cases of common fetal CHDs, which were continuously displayed by the three-dimensional software Amira 5.3.1. The following anatomical parts were observed from the database of heart samples in a bottom-to-top manner: the coronary sinus, four chambers, left ventricular outflow tract, right ventricular outflow tract, and transverse ductal and aortic arches. The anatomical characteristics of these sections were analyzed and compared with the ultrasonic transverse views obtained from the same fetuses. RESULTS: During the display of the anatomical database of 45 cases of common fetal CHDs, the aforementioned typical cross sections were successively revealed, along with the corresponding pathological features. These sections also exhibited a very good correspondence with the ultrasonic transverse views of the same cases. CONCLUSION: The database of cross-sectional anatomical images of fetal CHDs provided an anatomical basis for continuous transverse scanning of the fetal heart.

The Application of an Anatomical Database for Fetal Congenital Heart Disease.

BACKGROUND: Fetal congenital heart anomalies are the most common congenital anomalies in live births. Fetal echocardiography (FECG) is the only prenatal diagnostic approach used to detect fetal congenital heart disease (CHD). FECG is not widely used, and the antenatal diagnosis rate of CHD varies considerably. Thus, mastering the anatomical characteristics of different kinds of CHD is critical for ultrasound physicians to improve FECG technology. The aim of this study is to investigate the applications of a fetal CHD anatomic database in FECG teaching and training program. METHODS: We evaluated 60 transverse section databases including 27 types of fetal CHD built in the Prenatal Diagnosis Center in Peking University People's Hospital. Each original database contained 400-700 cross-sectional digital images with a resolution of 3744 pixels × 5616 pixels. We imported the database into Amira 5.3.1 (Australia Visage Imaging Company, Australia) three-dimensional (3D) software. The database functions use a series of 3D software visual operations. The features of the fetal CHD anatomical database were analyzed to determine its applications in FECG continuing education and training. RESULTS: The database was rebuilt using the 3D software. The original and rebuilt databases can be displayed dynamically, continuously, and synchronically and can be rotated at arbitrary angles. The sections from the dynamic displays and rotating angles are consistent with the sections in FECG. The database successfully reproduced the anatomic structures and spatial relationship features of different fetal CHDs. We established a fetal CHD anatomy training database and a standardized training database for FECG. Ultrasound physicians and students can learn the anatomical features of fetal CHD and FECG through either centralized training or distance education. CONCLUSIONS: The database of fetal CHD successfully reproduced the anatomic structures and spatial relationship of different kinds of fetal CHD. This database can be widely used in anatomy and FECG teaching and training.

Establishment of a database of fetal congenital heart malformations and preliminary investigation of its clinical application.

OBJECTIVE: The aim of this study was to create a database of anatomical ultrathin cross-sectional images of fetal hearts with different congenital heart diseases (CHDs) and preliminarily to investigate its clinical application. MATERIALS AND METHODS: Forty Chinese fetal heart samples from induced labor due to different CHDs were cut transversely at 60-µm thickness. All thoracic organs were removed from the thoracic cavity after formalin fixation, embedded in optimum cutting temperature compound, and then frozen at -25°C for 2 hours. Subsequently, macro shots of the frozen serial sections were obtained using a digital camera in order to build a database of anatomical ultrathin cross-sectional images. RESULTS: Images in the database clearly displayed the fetal heart structures. After importing the images into three-dimensional software, the following functions could be realized: (1) based on the original database of transverse sections, databases of sagittal and coronal sections could be constructed; and (2) the original and constructed databases could be displayed continuously and dynamically, and rotated in arbitrary angles. They could also be displayed synchronically. The aforementioned functions of the database allowed for the retrieval of images and three-dimensional anatomy characteristics of the different fetal CHDs, and virtualization of fetal echocardiography findings. CONCLUSION: A database of 40 different cross-sectional fetal CHDs was established. An extensive database library of fetal CHDs, from which sonographers and students can study the anatomical features of fetal CHDs and virtualize fetal echocardiography findings via either centralized training or distance education, can be established in the future by accumulating further cases.