Prenatal diagnosis of an aneurysm of the right atrium.

Congenital aneurysm of the right atrium was diagnosed in a 17-week fetus. It appeared as an outward bulge of the right atrium which doubled its size. The aneurysm was akinetic. Flow across the atrioventricular valves appeared unobstructed. The fetus had no evidence of cardiac failure. The patient elected to terminate the pregnancy. Autopsy results were confirmatory.

Unusual appearances of echogenic foci within the fetal heart: are they benign?

Nine fetuses with unusually appearing echogenic foci were selected from a series of 65 fetuses with intracardiac echogenic foci studied at the Fetal Diagnosis and Treatment Unit from January 1994 until February 1996. An echogenic focus or foci were defined as a structure or structures within the fetal heart with echogenicity similar to or greater that that of the surrounding bone. Unusually appearing foci were defined as lesions of unusual size, shape, structure or location. Three fetuses had unusually large echogenic foci, and four had multiple foci in both ventricles. In one fetus, two echogenic foci were very close to each other, creating an impression of a 'double' focus within the left ventricle. In another fetus, three echogenic foci were detected. Follow-up protocol for fetuses with echogenic foci included comprehensive ultrasound, amniocentesis and fetal echocardiography. All studied fetuses had normal karyotype. A fetal echocardiogram failed to reveal congenital heart defects. The neonatal outcome was uneventful in seven out of nine cases; one patient decided to terminate her pregnancy for reasons unrelated to the ultrasound findings, and one delivered prematurely at 34 weeks of pregnancy. In conclusion, we failed to find any correlation between unusually appearing echogenic foci and adverse perinatal outcome.

Feasibility of a two-dimensional echocardiographic method for the clinical assessment of right ventricular volume and function in children.

The relative ease of acquisition and safety of two-dimensional echocardiography has established it as the mainstay for routine cardiac imaging. Translation of imaging data into useful quantitative information, however, requires fitting the ventricle to a specific geometric model. Because of its complex shape and anterior position, many attempts at right ventricular quantitation by two-dimensional echocardiography have been criticized as impractical and not reproducible. A simple method incorporating subcostal and apical imaging was introduced in 1984. This approach appeared to combine accuracy and practicability but was never validated in a clinical setting because of the difficulties of subcostal imaging in adults. This study assessed the feasibility and accuracy of this technique in the pediatric population. Results of volume comparison to values derived by magnetic resonance imaging were r = 0.96, standard error of the estimate (SEE) = 19.3 ml, and mean difference = 15 +/- 19.4 ml and r = 0.97, SEE = 12.3 ml, and bias = 5 +/- 11.8 ml for diastolic and systolic volumes, respectively. Comparison of estimates of ejection fraction with magnetic resonance imaging demonstrated r = 0.90, SEE = 5.9%, and bias = 3% +/- 5.7%. Interobserver and intraobserver variability was 9.9% and 8.2%, respectively, for systolic volumes and 11.5% and 8.9%, respectively, for diastolic volumes. Evaluation of right ventricular size and function by this approach is comparable to determinations by magnetic resonance imaging and may be clinically useful in the management of pediatric patients.

Natural history of echogenic foci within ventricles of the fetal heart.

Echogenic foci within the fetal heart have been reported in association with cardiac tumors and chromosomal abnormalities. They have been observed also as a normal variant of cardiac development. The goal of this study was to analyze the frequency, distribution and natural history of echogenic foci within the fetal heart. A total of 1139 patients referred for targeted ultrasound were studied. Patients with positive findings (presence of the echogenic foci) were referred for serial fetal echocardiographic examinations at 26-28 weeks and 34-36 weeks of pregnancy. Neonatal follow-up examinations were performed within the first 3 months of life in 27 cases. Ventricular echogenic foci were seen in 3.6% of fetuses. The locations of the echogenic foci were as follows: left ventricle, 92.8%; right ventricle, 4.8%; both ventricles, 2.4%. All fetuses had a normal karyotype. Echogenic foci remained present in all infants who underwent echocardiographic examination within the first 3 months of life. Echogenic intracardiac foci probably represent a normal variant of the development of papillary muscles and chordae tendinae.

Cardiac size and function during adrenocorticotropic hormone-induced systolic systemic hypertension in infants.

The effects of adrenocorticotropic hormone (ACTH) on systolic blood pressure, and echocardiographic indexes of heart size and function were investigated in 14 infants. After 25 days (range 13 to 46) of treatment with ACTH, systolic blood pressure increased from 93 +/- 9 to 118 +/- 20 mm Hg (p < 0.001; mean +/- 1 SD). Systolic hypertension (systolic blood pressure greater than the 95th percentile for age) developed in 10 of 14 infants and was associated with an increase in left ventricular (LV) shortening fraction from 41 +/- 5% to 52 +/- 8% (p < 0.001). Myocardial hypertrophy and an increase in echocardiographic indexes of myocardial contractility were observed also. To assess the temporal relation between the onset of systolic hypertension and these cardiac changes, data from 8 infants with serial echocardiograms and blood pressure determinations were examined. After a mean 14 days (range 8 to 18) of ACTH, LV shortening fraction increased from 39 +/- 6% to 53 +/- 8% (p < 0.01), whereas systolic blood pressure remained normal in 7 of 8 infants. In addition, a decrease in LV end-systolic dimension was observed during this early phase. This report documents myocardial changes in individual patients, which occur before and during the development of systolic hypertension.