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1.
Medicine (Baltimore) ; 100(8): e24912, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663125

RESUMO

RATIONALE: Right atrial isomerism (RAI) is one of the most severe forms of congenital heart disease. This case of RAI was so complex that it incorporated 7 heart defects. It can be challenging to display the spatial relationship between different anatomical structures using conventional two-dimensional and color ultrasound (2D-Doppler imaging); therefore, we used spatio-temporal image correlation (STIC) and high definition live flow imaging technology to vividly display this case of RAI in a stereoscopic mode. PATIENT CONCERNS: A 24-year-old woman was referred to our tertiary center at 24 weeks of gestation. The woman had difficult conceiving. Once pregnant, she was opposed to abortion, even if there was a possibility of deformity. DIAGNOSIS: The fetus presented with an atrioventricular septal defect, persistent left superior vena cava, supra-cardiac total anomalous pulmonary venous connection (TAPVC), double outlet right ventricle, right ductus arteriosus, right aortic arch (RAA) with mirror image branching, and aortic arch dysplasia. INTERVENTIONS: After consulting a pediatric cardiologist, the woman requested an abortion and consented to an autopsy. OUTCOMES: Autopsy supported the echocardiographic findings. LESSONS: Accurate diagnosis of RAI is essential for clinical and parent decision making. 2D-Doppler imaging combined with STIC-HD live flow can be used to visualize the spatial morphology of blood vessels, including the cardiac chambers and great vessels of the fetal heart, and smaller peripheral vessels.


Assuntos
Ecocardiografia Quadridimensional/métodos , Coração Fetal/diagnóstico por imagem , Síndrome de Heterotaxia/diagnóstico por imagem , Aborto Eugênico , Autopsia , Feminino , Coração Fetal/patologia , Síndrome de Heterotaxia/patologia , Humanos , Gravidez , Ultrassonografia Pré-Natal
2.
Medicine (Baltimore) ; 100(4): e24427, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530242

RESUMO

ABSTRACT: The quality control of fetal sonographic (FS) images is essential for the correct biometric measurements and fetal anomaly diagnosis. However, quality control requires professional sonographers to perform and is often labor-intensive. To solve this problem, we propose an automatic image quality assessment scheme based on multitask learning to assist in FS image quality control. An essential criterion for FS image quality control is that all the essential anatomical structures in the section should appear full and remarkable with a clear boundary. Therefore, our scheme aims to identify those essential anatomical structures to judge whether an FS image is the standard image, which is achieved by 3 convolutional neural networks. The Feature Extraction Network aims to extract deep level features of FS images. Based on the extracted features, the Class Prediction Network determines whether the structure meets the standard and Region Proposal Network identifies its position. The scheme has been applied to 3 types of fetal sections, which are the head, abdominal, and heart. The experimental results show that our method can make a quality assessment of an FS image within less a second. Also, our method achieves competitive performance in both the segmentation and diagnosis compared with state-of-the-art methods.


Assuntos
Feto/diagnóstico por imagem , Redes Neurais de Computação , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Ultrassonografia Pré-Natal/normas , Abdome/diagnóstico por imagem , Abdome/embriologia , Feminino , Coração Fetal/diagnóstico por imagem , Coração Fetal/embriologia , Cabeça/diagnóstico por imagem , Cabeça/embriologia , Humanos , Gravidez , Padrões de Referência
3.
Cardiovasc Pathol ; 50: 107295, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33002584

RESUMO

Congenital ventricular diverticulum is a rare anomaly with an unclear pathology. Here, we report a male fetus at 24 weeks of gestation, diagnosed with right ventricular diverticulum associated with tetralogy of Fallot and absent pulmonary valve. The diverticulum was located at the anterosuperior wall of the right ventricle and faced into the massive pulmonary regurgitation flow jet. Intrauterine fetal death from heart failure resulted at 26 weeks of gestation. An autopsy revealed significant subendocardial fibrosis in the diverticular wall without inflammatory cell infiltration. Clinical and pathologic features suggested that the regurgitative blood flow contributed to the formation of the right ventricular diverticulum.


Assuntos
Divertículo/congênito , Coração Fetal/anormalidades , Ventrículos do Coração/anormalidades , Hemodinâmica , Circulação Pulmonar , Valva Pulmonar/anormalidades , Tetralogia de Fallot/complicações , Autopsia , Divertículo/diagnóstico por imagem , Divertículo/fisiopatologia , Ecocardiografia Doppler em Cores , Evolução Fatal , Morte Fetal/etiologia , Coração Fetal/diagnóstico por imagem , Coração Fetal/fisiopatologia , Idade Gestacional , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/fisiopatologia , Ultrassonografia Pré-Natal
4.
Zhonghua Fu Chan Ke Za Zhi ; 55(12): 837-842, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33355758

RESUMO

Objective: To summarize the experience of perioperative management strategy of fetal pulmonary valvuloplasty (FPV) for hypoplastic right heart syndrome (HRHS). Methods: In the retrospective study of perioperative data, 13 fetuses of HRHS were treated with FPV in Qingdao Women and Children's Hospital from July 2018 to June 2019. Results: (1) The evaluation indexes of the right ventricle in 13 fetuses before FPV: the mean ratio of tricuspid/mitral annulus, right/left ventricular length, pulmonary/aortic annulus, and tricuspid inflow time/cardiac cycle were 0.81±0.04, 0.56±0.14, 0.69±0.06, and 0.35±0.03, respectively. (2) All pregnant mothers underwent general anesthesia. The basic fetal heart rate was (156±12) beats per minutes before FPV, and 9 fetuses showed bradycardia during the operation, and recovered to normal after drug resuscitation. On the first day after FPV, two cases had bradycardia and pregnancy was terminated. The fluctuation of systolic blood pressure of pregnant mother was less than 20%, and there was no significant difference between preoperative and intraoperative pulse pressure [(36.0±5.6) vs (35.8±6.9) mmHg (1 mmHg=0.133 kPa); t=8.102, P=0.951]. (3) All cases of HRHS fetus successfully underwent FPV. The average gestational age was (27.3±0.8) weeks. The average operation time was (23.2±1.0) minutes. The ratio of tricuspid to mitral annulus (t=-2.513, P=0.022) and the ratio of right to left ventricular length (t=-3.373, P=0.003) were significantly improved at 6 weeks postoperatively. Ten fetuses were delivered, and there was no death after early intervention. (4) Of 13 pregnant women, 3 cases were nausea and vomiting on the day of FPV operation, the treatment of the symptoms was improved by tropisetron; one case had tolerable abdominal pain and improved without special treatment. Pregnant women had no major complications such as cardiac failure, abortion and death. (5) Chromosome karyotype analysis and microarray analysis of amniotic fluid was retained during the operation. No typical chromosome abnormality or other abnormal genetic diagnosis was found. Conclusions: FPV colud be used as an effective intervention measure to promote the development of right ventricle in HRHS fetuses. The scientific management of multidisciplinary professional technical team in perioperative period is particularly important to ensure the success of FPV and the safety of pregnant women and fetuses.


Assuntos
Coração Fetal/cirurgia , Cardiopatias Congênitas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Ultrassonografia Pré-Natal/métodos , Procedimentos Cirúrgicos Cardíacos , Criança , Feminino , Coração Fetal/diagnóstico por imagem , Idade Gestacional , Cardiopatias Congênitas/diagnóstico por imagem , Doenças das Valvas Cardíacas/congênito , Humanos , Assistência Perioperatória , Gravidez , Estudos Retrospectivos , Resultado do Tratamento
6.
Nat Commun ; 11(1): 4992, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33020487

RESUMO

Prenatal detection of congenital heart disease facilitates the opportunity for potentially life-saving care immediately after the baby is born. Echocardiography is routinely used for screening of morphological malformations, but functional measurements of blood flow are scarcely used in fetal echocardiography due to technical assumptions and issues of reliability. Magnetic resonance imaging (MRI) is readily used for quantification of abnormal blood flow in adult hearts, however, existing in utero approaches are compromised by spontaneous fetal motion. Here, we present and validate a novel method of MRI velocity-encoding combined with a motion-robust reconstruction framework for four-dimensional visualization and quantification of blood flow in the human fetal heart and major vessels. We demonstrate simultaneous 4D visualization of the anatomy and circulation, which we use to quantify flow rates through various major vessels. The framework introduced here could enable new clinical opportunities for assessment of the fetal cardiovascular system in both health and disease.


Assuntos
Coração Fetal/diagnóstico por imagem , Coração Fetal/fisiologia , Tomografia Computadorizada Quadridimensional/métodos , Imagem Cinética por Ressonância Magnética/métodos , Velocidade do Fluxo Sanguíneo , Vasos Sanguíneos/diagnóstico por imagem , Vasos Sanguíneos/fisiologia , Feminino , Idade Gestacional , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Humanos , Imagens de Fantasmas , Gravidez , Diagnóstico Pré-Natal
7.
Int J Cardiovasc Imaging ; 36(11): 2165-2172, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32642877

RESUMO

The main objective of this study was to investigate the diagnostic performance of FINE in generating and displaying 3 specific abnormal fetal echocardiography views such as left ventricular outflow tract (LVOT) view, right ventricular outflow tract (RVOT) view, and 3-vessels and trachea (3VT) view in fetuses with double-outlet right ventricle (DORV). In this prospective study, thirty fetuses diagnosed with DORV by fetal echocardiography in the second and third trimesters were enrolled. One or more STIC volume data-sets were collected from the 4-chamber view as initial view for each fetus, one optimal volume per fetus was selected for on-line analysis using FINE, and the diagnosis plane image was optimized using the Virtual Intelligent Sonographer Assistance (VIS-assistance).The visualization rates of 3 specific abnormal fetal echocardiography views of DORV and key diagnostic elements were calculated. One or more STIC volumes (n = 30 total) were obtained in 25 patients. A single STIC volume per patient was analyzed using the FINE method. FINE was able to successfully generate and display 3 specific abnormal fetal echocardiography views. The display rates of the 3 specific abnormal fetal echocardiography views (3VT, LVOT, RVOT) were 84.0%, 76.0% and 84.0%, respectively. By applying intelligent navigation technology to STIC volume data-sets, the FINE method can successfully generate three specific abnormal cardiac fetal echocardiography diagnostic views in fetuses with DORV, the FINE method can be used for screening and remote consultation of fetal DORV.


Assuntos
Inteligência Artificial , Diagnóstico por Computador , Dupla Via de Saída do Ventrículo Direito/diagnóstico por imagem , Ecocardiografia Quadridimensional , Coração Fetal/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Pontos de Referência Anatômicos , Dupla Via de Saída do Ventrículo Direito/fisiopatologia , Feminino , Coração Fetal/anormalidades , Coração Fetal/fisiopatologia , Idade Gestacional , Humanos , Interpretação de Imagem Assistida por Computador , Valor Preditivo dos Testes , Gravidez , Reprodutibilidade dos Testes , Análise Espaço-Temporal , Adulto Jovem
8.
PLoS One ; 15(6): e0233179, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584813

RESUMO

Currently available fetal echocardiographic reference values are derived mainly from North American and European population studies, and there is a lack of reference z-score for fetal echocardiographic measurement in Asian populations. The aim of this study was to establish normal ranges of echocardiographic measurements and z-scores in healthy Asian fetuses. A total of 575 healthy pregnant Taiwanese with an estimated gestational age from 14 to 38 weeks were enrolled voluntarily for this observational study. Standard two-dimensional echocardiography was performed to obtain measurements of the cardiac chambers and great arteries of the developing fetuses. In contrast to past studies, our sample was more evenly distributed for estimated gestational age (p<0.001). We present percentile graphs for 13 fetal echocardiographic measurements from the knowledge of estimated gestational age, biparietal distance, head circumference, abdominal circumference, and femur length. Most cardiac structures and developmental markers had linear models as the best-fitting, except for transverse aortic isthmus by estimated gestational age and transverse ductus arteriosus by femur length. Our findings indicate that estimated gestational age was generally the best model for fetal heart development, while head circumferences could be used as an optimal developmental marker to predict left atrium, right atrium, right ventricle, pulmonary annulus, and ductus arteriosus. Lastly, we developed nomograms for each of the 13 fetal heart measurements by each developmental markers. This is the first study providing echocardiographic reference ranges and nomograms for Asian fetuses. Computing z-scores from nomograms helps in standardizing comparisons and adds additional prognostic information to the diagnosis of congenital heart disease.


Assuntos
Ecocardiografia/normas , Monitorização Fetal/métodos , Grupo com Ancestrais do Continente Asiático , Ecocardiografia/métodos , Feminino , Desenvolvimento Fetal , Coração Fetal/diagnóstico por imagem , Idade Gestacional , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Modelos Lineares , Gravidez , Valores de Referência , Ultrassonografia Pré-Natal/métodos
9.
J Am Soc Echocardiogr ; 33(6): 658-665, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32503702
11.
Pediatr Cardiol ; 41(6): 1125-1134, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32367304

RESUMO

To assess the fetal cardiac function and ventricular volumes by three-dimensional (3D) ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods in fetuses from pre-gestational diabetic women. This was a prospective and cross-sectional study that evaluated 53 fetuses from pre-gestational diabetic women and 53 fetuses from healthy mothers between 20 and 34 weeks of gestation. Only fetuses with no structural or genetic abnormalities and singleton pregnant women were included in this study. The fetal cardiac volumes were assessed by STIC and VOCAL methods. The ejection fraction, stroke volume, and cardiac output were calculated from these measurements to evaluate fetal cardiac function. The Mann-Whitney U test was performed to compare the two groups. For calculation of intra- and interobserver reproducibility's, we used concordance correlation coefficients. The mean differences in the right atrial volumes between the diabetic and normal groups ranged from 0.05 mL to 0.1 mL (p = 0.917 and 0.355, respectively). The median of left atrium (LA) volume measurement in pre-gestational diabetic group was significantly lower than healthy mothers (LA: 0.62 vs. 0.68 mL; p < 0.001). The fetal right and left ventricular volumes were similar in both groups. No significant differences in ejection fraction, stroke volume and cardiac output were observed (p value range 0.086-0.815). The majority of fetal atrial/ventricular volumes showed good intra- and interobserver reliabilities. Conversely, the majority cardiac function parameters showed poor intra- and interobserver agreements. STIC and VOCAL methods gave reproducible quantitative results for fetal atrial and ventricular volumes. Significant differences in fetal left atrial volumes were observed between the two groups, which be related to LA atrial dysfunction and /or left ventricle (LV) compliance, reflecting earlier stages of cardiac dysfunction.


Assuntos
Diabetes Gestacional/fisiopatologia , Ecocardiografia Tridimensional/métodos , Coração Fetal/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Volume Cardíaco , Estudos de Casos e Controles , Estudos Transversais , Diabetes Gestacional/diagnóstico por imagem , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Volume Sistólico , Adulto Jovem
12.
Pediatr Cardiol ; 41(5): 979-984, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32328669

RESUMO

We prospectively performed remote fetal cardiac screening using the spatio-temporal image correlation (STIC), and examined the usefulness and problems of remote screening. We performed heart screening for all pregnant women at four obstetrics clinics over the three years from 2009 to 2014. The STIC data from 15,404 examinations in normal pregnancies (16-27 weeks, median 25 weeks) were analyzed. Obstetricians and sonographer collected STIC data from four-chamber view images. Eight pediatric cardiologists analyzed the images offline. A normal heart was diagnosed in 14,002 cases (90.9%), an abnormal heart was diagnosed in 457 cases (3.0%), and poor images were obtained in 945 cases (6.1%). 138 cases had congenital heart disease (CHD) after birth, and severe CHD necessitating hospitalization occurred in 36 cases. We were not able to detect CHD by screening in 12 cases. The sensitivity and specificity of STIC in CHD screening was 50% and 99.5%, respectively. The sensitivity and specificity of STIC in screening for severe CHD was 82% and 99.9%, respectively. The STIC method was useful in fetal remote screening for CHD. However, the fact that > 10% of images that could not be analyzed by this method was a problem.


Assuntos
Ecocardiografia Quadridimensional/métodos , Coração Fetal/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico , Ultrassonografia Pré-Natal/métodos , Feminino , Cardiopatias Congênitas/epidemiologia , Humanos , Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , Sensibilidade e Especificidade , Telemedicina/métodos , Ultrassonografia Pré-Natal/normas , Ultrassonografia Pré-Natal/estatística & dados numéricos
13.
Am J Obstet Gynecol ; 223(4): 574.e1-574.e15, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32335051

RESUMO

BACKGROUND: Gestational diabetes mellitus is associated with early-onset cardiovascular disease and increased incidence of adverse cardiovascular outcomes in mothers and their offspring. Few studies with a limited number of patients have reported subclinical cardiac changes in association with gestational diabetes mellitus; however, it remains unclear whether the mother and the fetus respond in a similar fashion to gestational diabetes mellitus; thus, by assessing the heart of one, we can estimate or predict changes in the other. OBJECTIVE: This study aimed to compare maternal and fetal cardiovascular functions in the third trimester between women with gestational diabetes mellitus and women with uncomplicated pregnancy and to explore whether gestational diabetes mellitus affects to the same extent the maternal and fetal heart. STUDY DESIGN: This was a cross-sectional study of maternal and fetal echocardiography for assessment of cardiovascular function in the third trimester in women with singleton pregnancies who received a diagnosis of gestational diabetes mellitus and the control group with uncomplicated pregnancies. RESULTS: In this study, we included 161 women with gestational diabetes mellitus and 483 women with uncomplicated pregnancies. Compared with women in the control group, women with gestational diabetes mellitus were older (34.5, standard deviation, 5.3 years] vs 32.5, standard deviation, 4.8 years]; P<.001), had higher body mass index (31.3 kg/m2 [standard deviation, 5.8] vs 28.6 kg/m2 [standard deviation, 4.4]; P<.001), had lower weight gain during pregnancy (8.3 [interquartile range, 4.8-11 kg] vs 10.8 [interquartile range, 8.2-13.5 kg]; P<.001), and delivered babies with lower birthweight (P<.001). After multivariable analysis, accounting for differences in maternal characteristics and fetal weight, mothers with gestational diabetes mellitus had lower left ventricular diastolic and systolic (tissue Doppler systolic [s'] wave) functional indices (P<.01 for both) compared with those of mothers in the control group. The noted cardiac changes did not fulfill the adult criteria for clinical cardiac dysfunction. No differences in hemodynamic indices (cardiac output and peripheral vascular resistance) and left ventricular mass were noted between the groups. Fetuses of mothers with gestational diabetes mellitus had more globular-shaped hearts with increased right and left ventricular sphericity indices (P<.001 for both) and reduced global longitudinal right and left ventricular systolic functional indices (P<.001 for both). The effect of gestational diabetes mellitus on maternal and fetal hearts was different, and there was no clear association between the two. CONCLUSION: In the third trimester, in pregnancies with gestational diabetes mellitus, there were subclinical cardiac changes in both the mother and the fetus, but there was no significant difference in any of the fetal cardiac parameters between women with and women without unfavorable cardiac profile. This suggests that the stimulus for cardiovascular responses in the mother and fetus may not be the same in pregnancies with gestational diabetes mellitus.


Assuntos
Diabetes Gestacional/fisiopatologia , Coração Fetal/diagnóstico por imagem , Coração/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Adulto , Estudos de Casos e Controles , Diabetes Gestacional/diagnóstico por imagem , Diástole , Ecocardiografia , Ecocardiografia Doppler , Feminino , Coração Fetal/fisiologia , Ganho de Peso na Gestação , Coração/fisiologia , Humanos , Obesidade Materna , Gravidez , Terceiro Trimestre da Gravidez , Sístole , Ultrassonografia Pré-Natal
14.
Int J Cardiovasc Imaging ; 36(7): 1237-1247, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32232625

RESUMO

The aim of this study was to evaluate the impact of pregestational diabetes mellitus (DM) on fetal cardiac function two-dimensional parameters using spectral and tissue Doppler. Pregnant women between 20 and 36 + 6 weeks gestation were divided into three groups: controls, type I DM, and type II DM. The right ventricle (RV) and left ventricle (LV) annular velocity peaks were measured using spectral (E, A) and tissue (E', A', S') Doppler. The myocardial performance index was calculated as (isovolumetric contraction time [ICT] + isovolumetric relaxation time [IRT])/ejection time using tissue (MPI') and the spectral Doppler (MPI). A general linear model, with fetal heart rate as a covariant, was used to evaluate the effect of DM on the fetal heart function assessment parameters. To assess the association of type I and II DM with adverse perinatal outcomes, Fisher's exact test was used. A receiver operating characteristic curve was used to determine the best cutoff for fetal cardiac function assessment parameters to identify the neonatal composite outcomes. The sample comprised 179 pregnant women. DM had significant effect on RV and LV A peak velocities (p = 0.026 and p = 0.011, respectively). LV ICT (p < 0.001) and LV MPI (p < 0.001) were significantly affected by maternal DM. Fetuses from pregnant women with type II DM showed significantly higher LV MPI (0.492 vs. 0.459, p = 0.006) and RV S' (7.2 vs. 6.44 cm/s, p = 0.024) than controls. Fetuses from type I DM pregnant women showed increase in cardiac parameters that evaluated the LV and RV diastolic function (LV IRT' p < 0.001 and RV MPI' p = 0.044). Type I and II DM were associated with adverse perinatal outcomes: neonatal intensive care unit stay (p < 0.0001), macrosomia (p < 0.0001), hyperbilirubinemia (p < 0.0001), and hypoglycemia (p < 0.0001). The LV MPI' showed significant but moderate sensitivity in identifying the composite neonatal outcomes (AUC: 0.709, 95% CI 0.629-0.780, p < 0.001). Tissue Doppler and MPI parameters can be useful to detect subclinical cardiac dysfunction in the fetal heart of pregestational DM pregnant women.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Ecocardiografia Doppler , Coração Fetal/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Gravidez em Diabéticas , Ultrassonografia Pré-Natal , Função Ventricular Esquerda , Função Ventricular Direita , Adolescente , Adulto , Estudos de Casos e Controles , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Coração Fetal/fisiopatologia , Idade Gestacional , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Frequência Cardíaca , Humanos , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
15.
Arch Cardiovasc Dis ; 113(2): 121-128, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32113817

RESUMO

Fetal cardiac intervention (FCI) is a novel and evolving technique that allows for in utero treatment of a subset of congenital heart disease. This review describes the rationale, selection criteria, technical features, and current outcomes for the three most commonly performed FCI: fetal aortic stenosis with evolving hypoplastic left heart syndrome (HLHS); HLHS with intact or restrictive atrial septum; and pulmonary atresia with intact ventricular septum, with concern for worsening right ventricular (RV) hypoplasia.


Assuntos
Cateterismo Cardíaco , Procedimentos Cirúrgicos Cardíacos , Coração Fetal/cirurgia , Terapias Fetais , Cardiopatias Congênitas/terapia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/terapia , Cateterismo Cardíaco/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ecocardiografia , Feminino , Coração Fetal/anormalidades , Coração Fetal/diagnóstico por imagem , Coração Fetal/fisiopatologia , Terapias Fetais/efeitos adversos , Idade Gestacional , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico por imagem , Síndrome do Coração Esquerdo Hipoplásico/fisiopatologia , Síndrome do Coração Esquerdo Hipoplásico/terapia , Gravidez , Atresia Pulmonar/diagnóstico por imagem , Atresia Pulmonar/fisiopatologia , Atresia Pulmonar/terapia , Fatores de Risco , Resultado do Tratamento , Ultrassonografia Pré-Natal
16.
Am J Obstet Gynecol ; 222(6): B2-B9, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32114082

RESUMO

Congenital heart defects are a leading cause of neonatal morbidity and mortality. Accurate prenatal diagnosis of congenital heart defects can reduce morbidity and mortality by improving prenatal care, facilitating predelivery pediatric cardiology consultation, and directing delivery to facilities with resources to manage the complex medical and surgical needs of newborns with congenital heart defects. Unfortunately, less than one half of congenital heart defect cases are detected prenatally, resulting in lost opportunities for counseling, shared decision-making, and delivery at an appropriate facility. Quality improvement initiatives to improve prenatal congenital heart defects detection depend on the ability to measure the rate of detection at the level of providers, facilities, or populations, but no standard metric exists for measuring the detection of congenital heart defects at any level. The need for such a metric was recognized at a Cooperative Workshop held at the 2016 Annual Meeting of the Society for Maternal-Fetal Medicine, which recommended the development of a quality metric to assess the rate of prenatal detection of clinically significant congenital heart defects. In this paper, we propose potential quality metrics to measure prenatal detection of critical congenital heart defects, defined as defects with a high rate of morbidity or mortality or that require surgery or tertiary follow-up. One metric is based on a retrospective approach, assessing whether postnatally diagnosed congenital heart defects had been identified prenatally. Other metrics are based on a prospective approach, assessing the sensitivity and specificity of prenatal diagnosis of congenital heart defects by comparing prenatal ultrasound findings with newborn findings. Potential applications, limitations, challenges, barriers, and value for both approaches are discussed. We conclude that future development of these metrics will depend on an expansion of the International Classification of Diseases system to include specific codes that distinguish fetal congenital heart defects from newborn congenital heart defects and on the development of record systems that facilitate the linkage of fetal records (in the maternal chart) with newborn records.


Assuntos
Coração Fetal/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Indicadores de Qualidade em Assistência à Saúde , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Prospectivos , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal
17.
Pediatr Cardiol ; 41(3): 479-485, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32198586

RESUMO

Fetal cardiac interventions (FCI) offer the opportunity to rescue a fetus at risk of intrauterine death, or more ambitiously to alter disease progression. Most of these fetuses require multiple additional postnatal procedures, and it is difficult to disentangle the effect of the fetal procedure from that of the postnatal management sequence. The true clinical impact of FCI may only be discernible in large-volume institutions that can commit to a standardized postnatal approach and have sufficient case volume to overcome their FCI learning curve.


Assuntos
Cardiologia/normas , Coração Fetal/cirurgia , Fetoscopia/normas , Feminino , Coração Fetal/diagnóstico por imagem , Humanos , Gravidez , Ultrassonografia Pré-Natal
18.
Pediatr Cardiol ; 41(4): 772-780, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32034462

RESUMO

Coarctation of the aorta (COA) is suspected prenatally when there is ventricular asymmetry, arterial disproportion, and hypoplasia of the aortic arch/isthmus. The presence of fetal shunts creates difficulty in prenatal confirmation of the diagnosis so serial echocardiography after birth is necessary to confirm or refute the diagnosis. The first neonatal echocardiogram in prenatally suspected cases of COA was assessed for prediction of neonatal COA repair (NCOAR). This included morphological assessment, measurement of the aortic arch and calculation of the distal arch index (DAI = distance between left common carotid and left subclavian artery/diameter of the distal arch). NCOAR was undertaken in 23/60 (38%) cases. Transverse arch, aortic isthmus z-score, and DAI had an area under the receiver operator curve of 0.88 (95% CI 0.77-0.98), 0.86 (95% CI 0.75-0.96), and 0.84 (95% CI 0.74-0.95), respectively for the prediction of NCOAR. Using transverse arch z-score threshold < - 3 gave sensitivity 100%, NPV: 100%, specificity 76%; aortic isthmus z-score < - 3: NPV 92%, specificity 62% and DAI > 1.4: NPV 88%, specificity 78%. The size of the distal aortic arch in infants with a common origin of the innominate artery and left common carotid artery who did not require COA repair was similar to the NCOAR cases (p = 0.22). The early postnatal assessment of the size and morphology of the aortic arch can assist in risk stratification for development of neonatal COA. The branching pattern of the head/neck vessels impacts on the size of the distal aortic arch adding to the complexity of predicting COA based on vessel size.


Assuntos
Aorta Torácica/diagnóstico por imagem , Coartação Aórtica/diagnóstico por imagem , Ecocardiografia/métodos , Aorta Torácica/patologia , Coartação Aórtica/patologia , Feminino , Coração Fetal/diagnóstico por imagem , Coração Fetal/patologia , Humanos , Lactente , Recém-Nascido , Valor Preditivo dos Testes , Gravidez
19.
Radiology ; 295(2): 273, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31990266

RESUMO

Online supplemental material is available for this article.


Assuntos
Coração Fetal/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Feminino , Idade Gestacional , Humanos , Gravidez
20.
Pediatr Cardiol ; 41(4): 687-694, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31919591

RESUMO

To improve the understanding of the pathophysiology of transposition of the great arteries with intact ventricular septum (TGA/IVS) and the cardiac remodeling occurring from fetal to neonatal life, we performed a morphometric and functional echocardiographic assessment in fetuses and newborns. This was a prospective case-control study performed in a tertiary referral center, which included fetuses and newborns with a diagnosis of TGA/IVS between 2011 and 2018. Morphometry and systolic and diastolic function parameters were compared with age and body surface-matched healthy controls. Twenty-one TGA/IVS patients were included during the study period and morphometric and functional echocardiographic data were recorded. TGA/IVS patients showed morphometric and functional changes of increased overall volume and output, predominantly in the aortic component from fetus to newborn, probably due to compensatory mechanisms secondary to brain hypoxia.


Assuntos
Ecocardiografia/métodos , Transposição dos Grandes Vasos/diagnóstico por imagem , Septo Interventricular/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Coração Fetal/diagnóstico por imagem , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Transposição dos Grandes Vasos/fisiopatologia
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