Journal of the American Society of Echocardiography, 2021
OBJECTIVE Doppler assessment ventricular filling and outflow tract velocities are an integral par... more OBJECTIVE Doppler assessment ventricular filling and outflow tract velocities are an integral part of the fetal echocardiogram, to assess diastolic function, systolic function and outflow tract obstruction. There is a paucity of prospective data from a large sample of normal fetuses in the published literature. We report reference ranges for pulsed wave Doppler flow of the mitral valve, tricuspid valve, aortic valve and pulmonary valve as well as heart rate, in a large number of fetuses prospectively examined at a single tertiary fetal cardiology centre. METHODS The study population comprised 7885 fetuses at 13 to 36 weeks' gestation with no detectable abnormalities from pregnancies resulting in normal live births. Prospective pulsed wave Doppler blood flow measurements were taken of the mitral, tricuspid, aortic and pulmonary valves. The fetal heart rate was recorded at the time of each assessment. Regression analysis, with polynomial terms to assess for linear and nonlinear contributors, was used to establish the relationship between each measurement and gestational age. RESULTS The measurement for each cardiac Doppler measurement was expressed as a z score (difference between observed and expected value divided by the fitted SD corrected for gestational age) and percentile. Analysis included calculation of gestation-specific SDs. Regression equations are provided for the cardiac inflow and outflow tracts. CONCLUSIONS The study establishes reference ranges for fetal cardiac Doppler measurements and heart rate between 13 to 36 weeks' gestation that may be useful in clinical practice.
In this retrospective, observational study of fetuses diagnosed with a laterality disturbance we ... more In this retrospective, observational study of fetuses diagnosed with a laterality disturbance we describe the findings and outcome of fetuses diagnosed between 1980 and 2017 at a tertiary fetal-pediatric cardiology unit. In addition we sought to identify features which impact on outcome. Left atrial isomerism (LAI) was diagnosed in 177 babies and right atrial isomerism (RAI) in 100. Major structural heart disease was present in all cases of RAI and 91% with LAI. Complete heart block (CHB) was present in 40% of LAI. For surviving live-born infants a biventricular circulation was feasible in 3% with RAI and 43% with LAI. The median survival for live-borns with LAI was 13 months (range 0 to 272 months) and for RAI 19 months (range 0.3 to 292 months). The median postnatal survival with CHB was 0.2 months (range 0 to 228 months) compared to 44 months with sinus rhythm (interquartile range 0 to 272 months; p <0.0001). The 5-year survival was 1980 to 1989, RAI 0%, LAI 0%; 1990 to 1999, ...
Background The aberrant right subclavian artery (ARSA) is the most common branching abnormality o... more Background The aberrant right subclavian artery (ARSA) is the most common branching abnormality of the aortic arch, with an estimated prevalence of 0.5–2% of the population. This anomaly is defined anatomically by the unusual course of the right subclavian artery (RSA), which arises as a fourth vessel from the descending aorta, arriving at the right arm via a path looping behind the trachea and the oesophagus. ARSA is usually asymptomatic in children and poses no implications from the cardiovascular point of view. Pathological and clinical studies have shown the prevalence of ARSA to be significantly increased in individuals with congenital heart defects (CHD) and particularly so, in those with trisomy 21. Several papers have also suggested a strong association of ARSA with other chromosomal and genetic syndromes including 22q11.2.deletion. Objectives The aim of this study was to describe the prevalence of chromosomal and non-chromosomal syndromes and CHD in a series of 360 consecutive fetuses diagnosed with ARSA in our fetal cardiology clinic. Material and methods Retrospective analysis of fetuses diagnosed with ARSA during an eight years period (2006–2014). Diagnosis of ARSA was made in transverse three-vessels/arch view with colour flow mapping (Figure 1). Invasive prenatal diagnosis was discussed according to the risk for aneuploidies as adjusted for the presence of ARSA and/or associated cardiac and extra-cardiac abnormalities. Prenatal data were combined with outcome obtained from medical records, pathological examinations and telephone interviews with patients. Abstract P14 Figure 1 Prenatal ultrasound. The right and left subclavian arteries are seen in their normal position on colour flow mapping, just above the aortic arch level (A); The right subclavian artery arises from the descending aorta behind the trachea and below the level of the aortic arch (B). Results ARSA was an isolated cardiac finding in 78% (281/360) of cases and associated with a major CHD such as tetralogy of Fallot and hypoplastic left heart syndrome in 22% (79/360). A full karyotype was performed in 60% (217/360) of pregnancies, including 83% of those with ARSA and CHD (66/79) and 54% (151/281) of those where ARSA was an isolated cardiac finding. An abnormal karyotype including trisomy 21 and 22q11.2 deletion was found in 64% (42/66) of cases where ARSA was associated with complex CHD. Trisomy 21 was detected in 25% (37/151) of fetuses with ARSA as an isolated cardiac finding and other aneuploidies in further 7% (11/151) of cases. In our series, there were no cases with 22q11.2 deletion identified where ARSA was an isolated cardiac finding and the majority (76%; 213/281) were livebirths with uneventful postnatal outcome. Conclusions Our results are consistent with published literature, which suggests that finding of an ARSA should prompt referral to a specialist fetal cardiologist to rule out underlying cardiac defects. A detailed fetal anomaly scan should be performed in order to examine for features of chromosomal abnormalities and invasive testing should be discussed accordingly. If the fetal karyotype is normal and there are no significant cardiac/extracardiac defects, an isolated ARSA is a benign finding with a good postnatal outcome. There is insufficient data from our study to report on association of ARSA with 22q11.2deletion.
Background Fetal cardiac MRI offers the potential for a safe, radiation-free adjunct to echocardi... more Background Fetal cardiac MRI offers the potential for a safe, radiation-free adjunct to echocardiography. In practice, its use has been limited by the technical challenges imposed by the small size of the fetal heart, the lack of external gating, and gross fetal and maternal movements. We present our initial experience of 20 fetal cases assessed by MRI, referred after routine fetal cardiology assessment to resolve specific points of diagnostic uncertainty. Methods Referrals were based on the judgements of the attending fetal cardiologists between June 2014 and May 2015. Following a three-plane localiser, gross fetal movement was assessed with a balanced steady-state free precession (bSSFP) cine. Half-Fourier single-shot turbo spin echo (HASTE) and bSSFP gradient echo sequences were used for diagnostic imaging. The MRI diagnosis was subsequently compared with postnatal findings. Results 20 fetal cardiac MRI scans were performed over the referral period, at an average gestational age of 32+4 weeks, (range 26+4–38+1 weeks). 3 scans were abandoned due to excessive fetal movement or inadequate visualisation. The most frequent referral indications were suspected coarctation of the aorta/abnormal arch anatomy (n = 9), cardiac masses or diverticulums (n = 5), and assessment of pulmonary vasculature (n = 4). HASTE sequences produced T2-weighted “black-blood” images, useful for assessing extracardiac vasculature (figure 1). Balanced SSFP sequences showed good contrast between the blood pool and surrounding tissue and were useful for intracardiac structures; however these were more susceptible to motion artefacts. Real-time SSFP sequences allowed for dynamic assessment of moving structures (e.g. masses/diverticulums-figure 2). Using a combination of sequences we were able to accurately characterise rhabdomyomas in 3 patients. In total, of the 17 scans with useful data, MRI was diagnostic in 15. Neonatal coarctation was incorrectly predicted in one case, and no postnatal data was available in another due to fetal demise. Conclusions Certain fetal cardiovascular abnormalities may be difficult to diagnose with ultrasound alone, reflected in the referral pattern we observed for MRI. Our preliminary experience suggests that MRI can provide safe and useful complimentary imaging in this cohort within a tertiary fetal cardiac unit. As technical challenges continue to be addressed, prenatal MRI may develop a more prominent role in routine fetal cardiovascular assessment. Abstract P22 Figure 1 Single-shot turbo spin-echo (HASTE) “black blood” image of the aorta in a 32 week fetus with coarctation of the aorta, confirmed postnatally. A characteristic indentation in the region of the aortic isthmus (a “posterior shelf”) is clearly visualised (*). AA = aortic arch. Abstract P22 Figure 2 Still from a bSSFP cine (real-time) sequence in a 30 week fetus with a large RV diverticulum (arrowed). R = right ventricle, L = left ventricle.
A right aortic arch (RAA) with a left arterial duct (LAD) together encircle the trachea and have ... more A right aortic arch (RAA) with a left arterial duct (LAD) together encircle the trachea and have the potential to cause tracheobronchial compression and published guidelines recommend bronchoscopy in symptomatic patients. The aim of the study was to describe the incidence of tracheal compression in a cohort of prenatally diagnosed RAA and LAD. Retrospective review of clinical course and imaging of prenatal cases of RAA and LAD assessed with flexible bronchoscopy over an 11-year period. 34 cases of prenatally diagnosed RAA with LAD underwent bronchoscopy at median age of 9 months (range 0.4-123) of whom 11 had respiratory symptoms and 23 were asymptomatic. In the neonatal period, three cases demonstrated respiratory symptoms. An aberrant left subclavian artery (ALSA) was identified in 29 cases. Pulsatile tracheal compression was identified in 32/34 (94%) cases and two cases showed normal tracheal appearances. Significant tracheal compression (> 70% occlusion) was present in 25/34 ...
Background: Identifying fetuses at risk of severe neonatal coarctation of the aorta (CoA) can be ... more Background: Identifying fetuses at risk of severe neonatal coarctation of the aorta (CoA) can be lifesaving but is notoriously challenging in clinical practice with a high rate of false positives. Novel fetal 3-dimensional and phase-contrast magnetic resonance imaging (MRI) offers an unprecedented means of assessing the human fetal cardiovascular system before birth. We performed detailed MRI assessment of fetal vascular morphology and flows in a cohort of fetuses with suspected CoA, correlated with the need for postnatal intervention. Methods: Women carrying a fetus with suspected CoA on echocardiography were referred for MRI assessment between 26 and 36 weeks of gestation, including high-resolution motion-corrected 3-dimensional volumes of the fetal heart and phase-contrast flow sequences gated with metric optimized gating. The relationship between aortic geometry and vascular flows was then analyzed and compared with postnatal outcome. Results: Seventy-two patients (51 with suspe...
Cardiac fibromas are rare benign tumours of connective tissue that occur most frequently in child... more Cardiac fibromas are rare benign tumours of connective tissue that occur most frequently in children within the left ventricle. Spontaneous regression has not been observed, and surgical intervention is usually required. We have successfully treated a 1-year old girl with a giant fibroma of the right ventricle using the principles of the Batista procedure. The diagnosis was primarily made using transthoracic echocardiography.
Background: Assessment of the outflow tract views is an integral part of routine fetal cardiac sc... more Background: Assessment of the outflow tract views is an integral part of routine fetal cardiac scanning. For some congenital heart defects, notably coarctation of the aorta, pulmonary valve stenosis, and aortic valve stenosis, the size of vessels is important both for diagnosis and prognosis. Existing reference ranges of fetal outflow tracts are derived from a small number of cases. Methods and Results: The study population comprised 7945 fetuses at 13 to 36 weeks’ gestation with no detectable abnormalities from pregnancies resulting in normal live births. Prospective measurements were taken of (1) the aortic and pulmonary valves in diastole at the largest diameter with the valve closed, (2) the distal transverse aortic arch on the 3 vessel and trachea view beyond the trachea at the distal point at its widest systolic diameter, and (3) the arterial duct on the 3 vessel and trachea view at its widest systolic diameter. Regression analysis, with polynomial terms to assess for linear a...
Coronary artery fistula (CAF) is a very rare lesion occurring in approximately 1 in every 50,000 ... more Coronary artery fistula (CAF) is a very rare lesion occurring in approximately 1 in every 50,000 patients with congential heart disease, but at the same time CAF is the most common congenital anomaly of the coronary artery. CAF is characterized by a normal aortic origin of the coronary artery involved, but with a fistulous communication with the atria, ventricles or with the pulmonary artery, coronary sinus or vena cava. Two pediatric patients (3 years and 4 years) presented with multiple congenital coronary arterial fistulas. In both cases the fistulas entered the right ventricle. The fistulas in both patients were successfully closed surgically. Intraoperative transesophageal echocardiography with color flow Doppler was used for a precise location of the fistulous communication, selective de-monstration of vessels feeding the fistula and documentation of abolition of fistulous flow.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2006
To examine our experience of the detection of a right aortic arch in the fetus over an 8-year per... more To examine our experience of the detection of a right aortic arch in the fetus over an 8-year period. Between February 1998 and December 2005, all patients prospectively diagnosed with a right aortic arch at our center were identified from our database and the videotape reviewed. In addition, the videotapes of 300 normal and 110 abnormal arbitrarily selected fetal echocardiograms, as well as 123 cases of tetralogy of Fallot and nine of a common arterial trunk were reviewed. Data including indication for fetal echocardiography, gestational age at diagnosis, karyotype, nuchal translucency measurement and outcome were collected. A right aortic arch was diagnosed prospectively in 55 fetuses and in a further 20 on retrospective videotape review. There were 21 examples of isolated aortic arch and four thought to have a double arch. A right arch was found in association with additional intracardiac malformations in 50 cases. The detection rate of a right aortic arch increased over the stud...
To examine the feasibility of reconstructing three-dimensional (3D) echocardiographic views in fe... more To examine the feasibility of reconstructing three-dimensional (3D) echocardiographic views in fetuses with double outlet right ventricle, which might enhance prognostication with respect to the postnatal surgical approach. This was a retrospective blinded observational study. Our database was reviewed from January 2007 to June 2011 to identify fetuses with usual atrial arrangement, concordant atrioventricular connections, double outlet right ventricle and relatively balanced left and right ventricular size. Six fetuses, in which there was an intention to treat, were included. In all six cases, we identified important features, including location of the ventricular septal defect and its relation to the atrioventricular valves and great arteries. The postnatal surgical approach was predicted accurately in each case. In this group of fetuses with double outlet right ventricle, detailed evaluation by 3D fetal echocardiography enhanced visualization of the anatomy, leading to accurate prediction of the type of surgical repair. Prospective validation in a large cohort of fetuses is warranted.
To assess the accuracy of fetal echocardiography at 11-13 weeks performed by well-trained obstetr... more To assess the accuracy of fetal echocardiography at 11-13 weeks performed by well-trained obstetricians using a high-frequency linear ultrasound transducer. Fetal echocardiography was performed by obstetricians immediately before chorionic villus sampling for fetal karyotyping at 11-13 weeks. Digital videoclips of the examination stored by the obstetrician were reviewed offline by a specialist fetal cardiologist. The obstetrician suspected 95 (95%) of the 100 cardiac defects identified by the fetal cardiologist and made the correct diagnosis in 84 (84%) of these cases. In 54 fetuses, the defect was classified as major and in 46 it was minor. In 767 (86.6%) cases, the heart was normal and in 19 (2.1%) the views were inadequate for assessment of normality or abnormality. A subsequent second-trimester scan in the normal group identified major cardiac defects in four cases. Therefore, the first-trimester scan by the obstetricians and cardiologists identified 54 (93.1%) of the 58 major cardiac defects. A well-trained obstetrician using high-resolution ultrasound equipment can assess the fetal heart at 11-13 weeks with a high degree of accuracy.
Journal of the American Society of Echocardiography, 2021
OBJECTIVE Doppler assessment ventricular filling and outflow tract velocities are an integral par... more OBJECTIVE Doppler assessment ventricular filling and outflow tract velocities are an integral part of the fetal echocardiogram, to assess diastolic function, systolic function and outflow tract obstruction. There is a paucity of prospective data from a large sample of normal fetuses in the published literature. We report reference ranges for pulsed wave Doppler flow of the mitral valve, tricuspid valve, aortic valve and pulmonary valve as well as heart rate, in a large number of fetuses prospectively examined at a single tertiary fetal cardiology centre. METHODS The study population comprised 7885 fetuses at 13 to 36 weeks&amp;#39; gestation with no detectable abnormalities from pregnancies resulting in normal live births. Prospective pulsed wave Doppler blood flow measurements were taken of the mitral, tricuspid, aortic and pulmonary valves. The fetal heart rate was recorded at the time of each assessment. Regression analysis, with polynomial terms to assess for linear and nonlinear contributors, was used to establish the relationship between each measurement and gestational age. RESULTS The measurement for each cardiac Doppler measurement was expressed as a z score (difference between observed and expected value divided by the fitted SD corrected for gestational age) and percentile. Analysis included calculation of gestation-specific SDs. Regression equations are provided for the cardiac inflow and outflow tracts. CONCLUSIONS The study establishes reference ranges for fetal cardiac Doppler measurements and heart rate between 13 to 36 weeks&amp;#39; gestation that may be useful in clinical practice.
In this retrospective, observational study of fetuses diagnosed with a laterality disturbance we ... more In this retrospective, observational study of fetuses diagnosed with a laterality disturbance we describe the findings and outcome of fetuses diagnosed between 1980 and 2017 at a tertiary fetal-pediatric cardiology unit. In addition we sought to identify features which impact on outcome. Left atrial isomerism (LAI) was diagnosed in 177 babies and right atrial isomerism (RAI) in 100. Major structural heart disease was present in all cases of RAI and 91% with LAI. Complete heart block (CHB) was present in 40% of LAI. For surviving live-born infants a biventricular circulation was feasible in 3% with RAI and 43% with LAI. The median survival for live-borns with LAI was 13 months (range 0 to 272 months) and for RAI 19 months (range 0.3 to 292 months). The median postnatal survival with CHB was 0.2 months (range 0 to 228 months) compared to 44 months with sinus rhythm (interquartile range 0 to 272 months; p <0.0001). The 5-year survival was 1980 to 1989, RAI 0%, LAI 0%; 1990 to 1999, ...
Background The aberrant right subclavian artery (ARSA) is the most common branching abnormality o... more Background The aberrant right subclavian artery (ARSA) is the most common branching abnormality of the aortic arch, with an estimated prevalence of 0.5–2% of the population. This anomaly is defined anatomically by the unusual course of the right subclavian artery (RSA), which arises as a fourth vessel from the descending aorta, arriving at the right arm via a path looping behind the trachea and the oesophagus. ARSA is usually asymptomatic in children and poses no implications from the cardiovascular point of view. Pathological and clinical studies have shown the prevalence of ARSA to be significantly increased in individuals with congenital heart defects (CHD) and particularly so, in those with trisomy 21. Several papers have also suggested a strong association of ARSA with other chromosomal and genetic syndromes including 22q11.2.deletion. Objectives The aim of this study was to describe the prevalence of chromosomal and non-chromosomal syndromes and CHD in a series of 360 consecutive fetuses diagnosed with ARSA in our fetal cardiology clinic. Material and methods Retrospective analysis of fetuses diagnosed with ARSA during an eight years period (2006–2014). Diagnosis of ARSA was made in transverse three-vessels/arch view with colour flow mapping (Figure 1). Invasive prenatal diagnosis was discussed according to the risk for aneuploidies as adjusted for the presence of ARSA and/or associated cardiac and extra-cardiac abnormalities. Prenatal data were combined with outcome obtained from medical records, pathological examinations and telephone interviews with patients. Abstract P14 Figure 1 Prenatal ultrasound. The right and left subclavian arteries are seen in their normal position on colour flow mapping, just above the aortic arch level (A); The right subclavian artery arises from the descending aorta behind the trachea and below the level of the aortic arch (B). Results ARSA was an isolated cardiac finding in 78% (281/360) of cases and associated with a major CHD such as tetralogy of Fallot and hypoplastic left heart syndrome in 22% (79/360). A full karyotype was performed in 60% (217/360) of pregnancies, including 83% of those with ARSA and CHD (66/79) and 54% (151/281) of those where ARSA was an isolated cardiac finding. An abnormal karyotype including trisomy 21 and 22q11.2 deletion was found in 64% (42/66) of cases where ARSA was associated with complex CHD. Trisomy 21 was detected in 25% (37/151) of fetuses with ARSA as an isolated cardiac finding and other aneuploidies in further 7% (11/151) of cases. In our series, there were no cases with 22q11.2 deletion identified where ARSA was an isolated cardiac finding and the majority (76%; 213/281) were livebirths with uneventful postnatal outcome. Conclusions Our results are consistent with published literature, which suggests that finding of an ARSA should prompt referral to a specialist fetal cardiologist to rule out underlying cardiac defects. A detailed fetal anomaly scan should be performed in order to examine for features of chromosomal abnormalities and invasive testing should be discussed accordingly. If the fetal karyotype is normal and there are no significant cardiac/extracardiac defects, an isolated ARSA is a benign finding with a good postnatal outcome. There is insufficient data from our study to report on association of ARSA with 22q11.2deletion.
Background Fetal cardiac MRI offers the potential for a safe, radiation-free adjunct to echocardi... more Background Fetal cardiac MRI offers the potential for a safe, radiation-free adjunct to echocardiography. In practice, its use has been limited by the technical challenges imposed by the small size of the fetal heart, the lack of external gating, and gross fetal and maternal movements. We present our initial experience of 20 fetal cases assessed by MRI, referred after routine fetal cardiology assessment to resolve specific points of diagnostic uncertainty. Methods Referrals were based on the judgements of the attending fetal cardiologists between June 2014 and May 2015. Following a three-plane localiser, gross fetal movement was assessed with a balanced steady-state free precession (bSSFP) cine. Half-Fourier single-shot turbo spin echo (HASTE) and bSSFP gradient echo sequences were used for diagnostic imaging. The MRI diagnosis was subsequently compared with postnatal findings. Results 20 fetal cardiac MRI scans were performed over the referral period, at an average gestational age of 32+4 weeks, (range 26+4–38+1 weeks). 3 scans were abandoned due to excessive fetal movement or inadequate visualisation. The most frequent referral indications were suspected coarctation of the aorta/abnormal arch anatomy (n = 9), cardiac masses or diverticulums (n = 5), and assessment of pulmonary vasculature (n = 4). HASTE sequences produced T2-weighted “black-blood” images, useful for assessing extracardiac vasculature (figure 1). Balanced SSFP sequences showed good contrast between the blood pool and surrounding tissue and were useful for intracardiac structures; however these were more susceptible to motion artefacts. Real-time SSFP sequences allowed for dynamic assessment of moving structures (e.g. masses/diverticulums-figure 2). Using a combination of sequences we were able to accurately characterise rhabdomyomas in 3 patients. In total, of the 17 scans with useful data, MRI was diagnostic in 15. Neonatal coarctation was incorrectly predicted in one case, and no postnatal data was available in another due to fetal demise. Conclusions Certain fetal cardiovascular abnormalities may be difficult to diagnose with ultrasound alone, reflected in the referral pattern we observed for MRI. Our preliminary experience suggests that MRI can provide safe and useful complimentary imaging in this cohort within a tertiary fetal cardiac unit. As technical challenges continue to be addressed, prenatal MRI may develop a more prominent role in routine fetal cardiovascular assessment. Abstract P22 Figure 1 Single-shot turbo spin-echo (HASTE) “black blood” image of the aorta in a 32 week fetus with coarctation of the aorta, confirmed postnatally. A characteristic indentation in the region of the aortic isthmus (a “posterior shelf”) is clearly visualised (*). AA = aortic arch. Abstract P22 Figure 2 Still from a bSSFP cine (real-time) sequence in a 30 week fetus with a large RV diverticulum (arrowed). R = right ventricle, L = left ventricle.
A right aortic arch (RAA) with a left arterial duct (LAD) together encircle the trachea and have ... more A right aortic arch (RAA) with a left arterial duct (LAD) together encircle the trachea and have the potential to cause tracheobronchial compression and published guidelines recommend bronchoscopy in symptomatic patients. The aim of the study was to describe the incidence of tracheal compression in a cohort of prenatally diagnosed RAA and LAD. Retrospective review of clinical course and imaging of prenatal cases of RAA and LAD assessed with flexible bronchoscopy over an 11-year period. 34 cases of prenatally diagnosed RAA with LAD underwent bronchoscopy at median age of 9 months (range 0.4-123) of whom 11 had respiratory symptoms and 23 were asymptomatic. In the neonatal period, three cases demonstrated respiratory symptoms. An aberrant left subclavian artery (ALSA) was identified in 29 cases. Pulsatile tracheal compression was identified in 32/34 (94%) cases and two cases showed normal tracheal appearances. Significant tracheal compression (> 70% occlusion) was present in 25/34 ...
Background: Identifying fetuses at risk of severe neonatal coarctation of the aorta (CoA) can be ... more Background: Identifying fetuses at risk of severe neonatal coarctation of the aorta (CoA) can be lifesaving but is notoriously challenging in clinical practice with a high rate of false positives. Novel fetal 3-dimensional and phase-contrast magnetic resonance imaging (MRI) offers an unprecedented means of assessing the human fetal cardiovascular system before birth. We performed detailed MRI assessment of fetal vascular morphology and flows in a cohort of fetuses with suspected CoA, correlated with the need for postnatal intervention. Methods: Women carrying a fetus with suspected CoA on echocardiography were referred for MRI assessment between 26 and 36 weeks of gestation, including high-resolution motion-corrected 3-dimensional volumes of the fetal heart and phase-contrast flow sequences gated with metric optimized gating. The relationship between aortic geometry and vascular flows was then analyzed and compared with postnatal outcome. Results: Seventy-two patients (51 with suspe...
Cardiac fibromas are rare benign tumours of connective tissue that occur most frequently in child... more Cardiac fibromas are rare benign tumours of connective tissue that occur most frequently in children within the left ventricle. Spontaneous regression has not been observed, and surgical intervention is usually required. We have successfully treated a 1-year old girl with a giant fibroma of the right ventricle using the principles of the Batista procedure. The diagnosis was primarily made using transthoracic echocardiography.
Background: Assessment of the outflow tract views is an integral part of routine fetal cardiac sc... more Background: Assessment of the outflow tract views is an integral part of routine fetal cardiac scanning. For some congenital heart defects, notably coarctation of the aorta, pulmonary valve stenosis, and aortic valve stenosis, the size of vessels is important both for diagnosis and prognosis. Existing reference ranges of fetal outflow tracts are derived from a small number of cases. Methods and Results: The study population comprised 7945 fetuses at 13 to 36 weeks’ gestation with no detectable abnormalities from pregnancies resulting in normal live births. Prospective measurements were taken of (1) the aortic and pulmonary valves in diastole at the largest diameter with the valve closed, (2) the distal transverse aortic arch on the 3 vessel and trachea view beyond the trachea at the distal point at its widest systolic diameter, and (3) the arterial duct on the 3 vessel and trachea view at its widest systolic diameter. Regression analysis, with polynomial terms to assess for linear a...
Coronary artery fistula (CAF) is a very rare lesion occurring in approximately 1 in every 50,000 ... more Coronary artery fistula (CAF) is a very rare lesion occurring in approximately 1 in every 50,000 patients with congential heart disease, but at the same time CAF is the most common congenital anomaly of the coronary artery. CAF is characterized by a normal aortic origin of the coronary artery involved, but with a fistulous communication with the atria, ventricles or with the pulmonary artery, coronary sinus or vena cava. Two pediatric patients (3 years and 4 years) presented with multiple congenital coronary arterial fistulas. In both cases the fistulas entered the right ventricle. The fistulas in both patients were successfully closed surgically. Intraoperative transesophageal echocardiography with color flow Doppler was used for a precise location of the fistulous communication, selective de-monstration of vessels feeding the fistula and documentation of abolition of fistulous flow.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2006
To examine our experience of the detection of a right aortic arch in the fetus over an 8-year per... more To examine our experience of the detection of a right aortic arch in the fetus over an 8-year period. Between February 1998 and December 2005, all patients prospectively diagnosed with a right aortic arch at our center were identified from our database and the videotape reviewed. In addition, the videotapes of 300 normal and 110 abnormal arbitrarily selected fetal echocardiograms, as well as 123 cases of tetralogy of Fallot and nine of a common arterial trunk were reviewed. Data including indication for fetal echocardiography, gestational age at diagnosis, karyotype, nuchal translucency measurement and outcome were collected. A right aortic arch was diagnosed prospectively in 55 fetuses and in a further 20 on retrospective videotape review. There were 21 examples of isolated aortic arch and four thought to have a double arch. A right arch was found in association with additional intracardiac malformations in 50 cases. The detection rate of a right aortic arch increased over the stud...
To examine the feasibility of reconstructing three-dimensional (3D) echocardiographic views in fe... more To examine the feasibility of reconstructing three-dimensional (3D) echocardiographic views in fetuses with double outlet right ventricle, which might enhance prognostication with respect to the postnatal surgical approach. This was a retrospective blinded observational study. Our database was reviewed from January 2007 to June 2011 to identify fetuses with usual atrial arrangement, concordant atrioventricular connections, double outlet right ventricle and relatively balanced left and right ventricular size. Six fetuses, in which there was an intention to treat, were included. In all six cases, we identified important features, including location of the ventricular septal defect and its relation to the atrioventricular valves and great arteries. The postnatal surgical approach was predicted accurately in each case. In this group of fetuses with double outlet right ventricle, detailed evaluation by 3D fetal echocardiography enhanced visualization of the anatomy, leading to accurate prediction of the type of surgical repair. Prospective validation in a large cohort of fetuses is warranted.
To assess the accuracy of fetal echocardiography at 11-13 weeks performed by well-trained obstetr... more To assess the accuracy of fetal echocardiography at 11-13 weeks performed by well-trained obstetricians using a high-frequency linear ultrasound transducer. Fetal echocardiography was performed by obstetricians immediately before chorionic villus sampling for fetal karyotyping at 11-13 weeks. Digital videoclips of the examination stored by the obstetrician were reviewed offline by a specialist fetal cardiologist. The obstetrician suspected 95 (95%) of the 100 cardiac defects identified by the fetal cardiologist and made the correct diagnosis in 84 (84%) of these cases. In 54 fetuses, the defect was classified as major and in 46 it was minor. In 767 (86.6%) cases, the heart was normal and in 19 (2.1%) the views were inadequate for assessment of normality or abnormality. A subsequent second-trimester scan in the normal group identified major cardiac defects in four cases. Therefore, the first-trimester scan by the obstetricians and cardiologists identified 54 (93.1%) of the 58 major cardiac defects. A well-trained obstetrician using high-resolution ultrasound equipment can assess the fetal heart at 11-13 weeks with a high degree of accuracy.
Uploads
Papers by Vita Zidere