G. Rognoni

Reliability of the first-trimester cardiac scan by ultrasound-trained obstetricians with high-frequency transabdominal probes in fetuses with increased nuchal translucency.

To examine prospectively the reliability of ultrasound‐trained obstetricians performing a first‐trimester fetal cardiac scan with high‐frequency transabdominal probes, by confirming normal or abnormal heart anatomy, in pregnancies referred for increased nuchal translucency thickness (NT).

Spatial velocity profile changes along the cord in normal human fetuses: can these affect Doppler measurements of venous umbilical blood flow?

Several studies have assumed a parabolic velocity profile through the umbilical vein (UV) to derive the mean spatial velocity that is indispensable for flow rate calculations. However, the structure and arrangement of the umbilical cord suggest that velocity profiles may vary. The aim of this study was to evaluate UV spatial flow velocity profiles at different sites along the umbilical cord.

Color-doppler velocimetry of uterine arteries in pregnant and nonpregnant patients during multiovulation induction for IVF

ObjectivesTo evaluate uterine artery resistance during multiovulation induction in relation to the implantation rate in patients attendingin vitro fertilization (IVF) cycles.PatientsMultiovulation induction for IVF was monitored by daily determination of the pulsatility index (PI) of the uterine arteries, obtained by a transvaginal probe (6.5 MHz) implemented with color-flow imaging. Doppler data were obtained from 5 days before hCG administration to the day of follicular aspiration. One IVF cycle was monitored in 70 patients. In 17 patients, 41 IVF cycles were monitored until a successful attempt occurred.ResultsIn the 70 patients studied during one IVF attempt, the PI of the uterine arteries significantly varied (P < 0.001) in the different phases of the cycle. In the 24 patients who conceived, a significantly lower PI (P < 0.03) was found throughout the cycle. This result was mainly due to a highly significant difference of PI values observed the day after hCG administration (P < 0.005). In the 17 patients who conceived after 1 to 4 negativein vitro fertilizations, no significant difference in PI was observed in the uterine artery resistance in cycles in which implantation was or was not successful.ConclusionsUterine artery resistance varies significantly during phases of the induction therapy. Uterine artery resistance is lower throughout the course of multiovulation induction in patients with higher pregnancy rates. The PI on the day after hCG administration was the best index of pregnancy rate. Low uterine artery resistance was present even in negative attempts in patients who eventually achieved a successful implantation. PI values ⩽3 can be considered a favorable prognostic factor for future IVF cycles.

OP12.03: First trimester cardiac parameters in the early screening of congenital heart disease (CHD) using high resolution flow imaging mode (e-flow)

In Flanders (the Dutch speaking Northern part ofBelgium) the prenatal detection rate of congenital heart diseases(CHD) is very low. The primary goal of this retrospective study is todetermine the sensitivity, positive and negative predictive value (PPVand NPV) of nuchal translucency (NT) measurement for prenatalCHD diagnosis in a general low risk population and to consider ifNT measurement is an effective screening tool for CHD.

OC219: Changes in distribution of cardiac output in human macrosomic fetuses

Methods: 36 fetuses with HLHS, from two cardiology referral centers. Results: Mean gestational age of the first exam was 28,5 weeks. 27 fetuses were referred because of abnormal 4-chamber view. 18 mothers were from high-risk group. There was positive family history in 7 cases. Foramen ovale was small with dominantly left to right shunt in all cases, restrictive in 25, atretic in 2 fetuses. In 3 cases big hypokinetic left ventricle progressed into HLHS toward the end of pregnancy. Karyotype was evaluated in 25 fetuses (69%) and was normal in 21 (84%). There was Turner syndrome in 1, Patau syndrome in 1 and deletion of the chromosome 11 in 1 case. In 3 fetuses signs of heart failure increased, 1 died in utero. In 1 fetus severe arrhythmia with heart failure resolved during pregnancy. Two neonates died just after delivery. Four mothers decided to terminate the pregnancy (2 of them had previously children with HLHS). Six mothers decided to withhold treatment in neonates. 14 newborns were operated on in two cardiac surgery centers. In 7 of them classical Norwood procedure was performed, all of them died. During last 1,5 years modified Norwood was performed in 7 neonates: 1 in the first center and he died, 6 in the second center, of which 5 survived. One who died had to be transferred between two towns. Comparison between classical and modified Norwood procedure showed statistically significant difference in survival. Conclusions: 1. Majority of fetuses with HLHS was referred due to abnormal 4-chamber view, but half of all were from high-risk group. 2. HLHS can change in utero-from big hypokinetic ventricle toward hypoplastic one. 3. Tricuspid insufficiency is dangerous sign for the future of fetuses with HLHS. 4. Results of modified Norwood procedure were better than classical Norwood, so it can change the policy for fetuses with HLHS.

OP12.07: Prenatal detection of CHD in the first trimester: diagnostic and clinical problems

14+6 weeks gestation in morphologically normal fetuses and fetuses with congenital heart abnormalities. Methods: Fetal echocardiogram was performed on 247 women between 11+0 and 14+6 weeks of gestation. Exclusion criteria included maternal age < 18, BMI > 30, and multifetal gestations. Combined transabdominal and transvaginal ultrasound was used for cardiac evaluation. The cardiac examination included assessment of the following eight planes: abdominal circumference (situs), four-chamber view, left ventricular outflow tract, right ventricular outflow tract, three-vessel-trachea view, aortic arch, ductal arch, and bicaval view. Successful visualization rate of each cardiac plane as well as full cardiac examination using 2D, 2D+ color Doppler and 2D+ HD color Doppler was evaluated. Results: CHD were diagnosed in 41 cases. Successful visualization of each diagnostic cardiac plane as well as a complete exam increased with gestational age. Use of HD color Doppler in addition to 2D ultrasound was associated with the highest visualization rate of the fetal cardiac anatomy at each gestational age in both normal fetuses and fetuses with CHD. Conclusions: High-definition color Doppler provides significant advantages in cardiac imaging between 11+0 and 14+6 weeks gestation and may help improve the detection of congenital heart anomalies in early gestation.

OP21.03: Efficacy of complete morphological screening for chromosomal anomalies at the time of nuchal translucency measurement

the intra-observer difference expressed as a percentage (or z score) are 3.2% (0.72) for head circumference (HC), 5.4% (0.81) for abdominal circumference (AC) and 6.8% (1.01) for femur length (FL), respectively. The corresponding values for the inter-observer differences were 5.1% (1.00) for HC, 8.9% (1.37) for AC and 12.0% (1.60) for FL. Conclusions: Although intraand interobserver variability increases with gestation when expressed in centimeters, both are constant as a percentage of the fetal dimensions or as a z score. Measurement variability should be considered when interpreting fetal growth rates.

OC26.07: Doppler evaluation in fetuses with right ventricular prevalence: a contribution to the diagnosis of coarctation of aorta

CCO ml/min 413 ± 281 1052 ± 388 461 ± 337 1226 ± 591 QLV ml/min (% of CCO) 185 ± 140 (44%) 443 ± 177 (42%) 267 ± 197* (58%) 746 ± 494** (60%) QRV (% of CCO) 234 ± 147 (56%) 608 ± 227 (57%) 194 ± 150 (42%) 480 ± 172* (39%) QDA (% of CCO) 159 ± 107 (38%) 335 ± 171 (31%) 130 ± 91 (28%) 327 ± 176 (26%) QFO (% of CCO) 104 ± 141 (38%) 170 ± 145 (31%) 130 ± 91 (28%) 327 ± 76** (26%) Qlungs (% of CCO) 74 ± 42 (18%) 272 ± 94 (26%) 136 ± 120* (29%) 418 ± 472 (29%)

OP04.10: Role of cardiac output redistribution in maintaining cardiac function in fetuses with isolated congenital heart diseases (CHD)

post-processing, isovolumetric and ejection periods were measured according to valve status. 4D-MPI results were compared to conventional Mod-MPI. Results: 30 healthy fetuses were examined to establish normal range of values for 4D-MPI at 24–32 weeks. MPI measured in both methods remained relatively stable during pregnancy. In 13 cases of evolving cardiac compromise (agenesis of ductus venosus with extrahepatic connection-4, cardiomyopathy-2, SVT-2, diaphragmatic hernia-1, fetal anemia [before treatment]-2, pulmonary-venous shunt-1, CMV infection-1), conventional Mod-MPI and 4D-MPI showed similar results. The difference between them did not exceed ±0.05 (clinically insignificant). Conclusions: 4D-MPI is useful for direct evaluation of fetuses with suspected cardiac compromise, and provided results comparable to those obtained with conventional Mod-MPI. 4D-MPI may form part of the 3D/4DUS exam performed on these fetuses.

OP18.08: Evidence of changes in the third-trimester cardiac outputs of fetuses with increased nuchal translucency

Objectives: To measure right and left cardiac output in fetuses with enlarged NT and normal karyotype in the second and third trimesters and to verify whether hemodynamic changes could occur in these fetuses in comparison to fetuses with normal NT. Methods: Echocardiography (Aloka SSD alpha10) was performed in 40 fetuses with NT ≥ 95th percentile, normal cardiac and extracardiac anatomy and normal karyotype (Group A) at 20–22 and 30–32 weeks of gestational age (GA). Diameters of the aorta (Ao) and pulmonary artery (Pa), time averaged maximum velocities in Ao and Pa, immediately downstream from the valves, were obtained in order to measure left (LCO) and right cardiac output (RCO). RCO/LCO ratios and combined CO (RCO + LCO) (CCO) were calculated and compared to reference values obtained in 42 normal fetuses with normal NT at comparable weeks (Group B). Results: Mean GA at birth and mean neonatal weight in Group A were 40 weeks and 3430 g, in Group B 39 weeks and 3195 g. No significant differences were found between cardiac output of Group B and Group A at 20 weeks, whereas the Table shows the high statistical differences between cardiac output in Group A and B at 30–32 weeks, with a strong positive correlation with nuchal enlargement.