Juan Carlos Sabogal

P39.15: The hyperoxygenation test shows persistent pulmonary vasoconstriction in fetuses with severe growth restriction

The test for pulmonary vascular reactivity in the fetus compares changes in branch pulmonary artery Doppler flow patterns with the mother breathing room air with maternal hyperoxygenation. A normal response to oxygen is to increase the pulmonary flow patterns and is seen in fetuses greater than 30 weeks’ gestation. Fetuses with severe growth restriction have redistribution of cardiac output to the brain, coronary and adrenal circulations. In fetuses greater than 30 weeks’ gestation with absent or reversed diastolic flow in the free loop of the umbilical artery and increased diastolic flow in the middle cerebral artery, the pulsatility of the flow in the branch pulmonary artery did not change with maternal hyperoxygenation. This indicates a fixed pulmonary vasoconstriction similar to what is seen in fetuses with pulmonary hypoplasia, yet these fetuses had normal respiratory function for gestational age after delivery. In fifteen fetuses hospitalized for growth less than 10% of prediction for age with abnormal umbilical artery Doppler flow patterns, the hyperoxygenation test was offered to mothers after obtaining consent. The results from these studies were compared to 15 fetuses whose mothers were hospitalized for pre-eclampsia, premature rupture of the membranes and abruption. Those fetuses whose growth biometry was within normal limits had normal pulmonary vascular response to the maternal hyperoxygenation test while those with severe growth restriction did not. Of those fetuses who had received antenatal steroids prior to the hyperoxygenation test, there was no effect on pulmonary vasodilatation in those with severe growth restriction but those fetuses with normal growth appeared to have an exaggerated positive response.

P39.14: The ductus venosus is responsive to maternal hyperoxygenation in fetuses with severe growth restriction

Postvalvular dilatation was detected in the main pulmonary artery. The brachiocephalic trunk was enlarged relative to the aortic arch and color Doppler imaging revealed reverse flow in the aortic arch. Therefore, coarctation of the aorta was suspected. No other structural anomalies were detected. Karyotype analysis was declined. Follow-up scans were unremarkable. A female infant weighing 2910 g was delivered by Cesarean section at 39 weeks. The right arm, forearm and hand of the baby were enlarged with purple-red discoloration. Postnatal echocardiography did not confirm coarctation of the aorta. Doppler sonography, MR and CT angiography revealed dilated and tortuous brachiocephalic trunk, right subclavian, axillary and brachial arteries with diffuse collateral vessels. Right cephalic vein was also dilated while right brachial, axillary and subclavian veins were normal. No accompanying mass lesions were detected. Klippel-Trenaunay-Weber syndrome was diagnosed due to the macular vascular nevus, arteriovenous malformation and related hypertrophy of the bony structures. Interventional treatment was not recommended for the arteriovenous malformation. The baby was discharged on the 35th day, with digoxin and furosemide treatment. At present, the baby is two years old and doing well on digoxin and captopril therapy. In conclusion, prenatal detection of high cardiac output state should prompt a detailed, targeted examination for angiomatous malformations with careful examination of the limbs.

P39.13: Can the hyperoxygenation test predict neonatal pulmonary function after preterm birth?

Postvalvular dilatation was detected in the main pulmonary artery. The brachiocephalic trunk was enlarged relative to the aortic arch and color Doppler imaging revealed reverse flow in the aortic arch. Therefore, coarctation of the aorta was suspected. No other structural anomalies were detected. Karyotype analysis was declined. Follow-up scans were unremarkable. A female infant weighing 2910 g was delivered by Cesarean section at 39 weeks. The right arm, forearm and hand of the baby were enlarged with purple-red discoloration. Postnatal echocardiography did not confirm coarctation of the aorta. Doppler sonography, MR and CT angiography revealed dilated and tortuous brachiocephalic trunk, right subclavian, axillary and brachial arteries with diffuse collateral vessels. Right cephalic vein was also dilated while right brachial, axillary and subclavian veins were normal. No accompanying mass lesions were detected. Klippel-Trenaunay-Weber syndrome was diagnosed due to the macular vascular nevus, arteriovenous malformation and related hypertrophy of the bony structures. Interventional treatment was not recommended for the arteriovenous malformation. The baby was discharged on the 35th day, with digoxin and furosemide treatment. At present, the baby is two years old and doing well on digoxin and captopril therapy. In conclusion, prenatal detection of high cardiac output state should prompt a detailed, targeted examination for angiomatous malformations with careful examination of the limbs.

P01.26: The fetal abdominal varix is the result of an arterio‐venous malformation

Isolated ventricular non-compaction (IVNC), known as spongy ventricular myocardium, is a rare cardiomyopathy characterized by numerous ventricular trabeculations and deep intertrabecular recesses, due to an arrest in cardiac embryogenesis. The prognosis varies: from asymptomatic patients over progressive ventricular dysfunction, arrhythmias, systemic and pulmonary embolism to cardiac failure with neonatal demise. Prenatal diagnosis has been reported in less than 10 cases. We report a case of sonographic diagnosis of IVNC at 31.5 weeks’ gestation. First trimester screening revealed increased nuchal translucency but the parents declined invasive testing. Routine ultrasound at 31.5 weeks showed a marked cardiomegaly without other cardiac and extra-cardiac anomalies. Fetal 2D and 3D echocardiography revealed numerous trabeculations and deep intertrabecular recesses of both ventricles with restricted ventricular contractility and normal function of the AV-valves. Diagnosis of isolated ventricular non-compaction was made. Postnatal echocardiography confirmed the prenatal findings of IVCN with a dilated right and left ventricle. Contractility of the left ventricle was decreased. The parents declined any further genetic examinations, despite dysmorphic facial appearance, consanguinity and a family history of unknown metabolic disorder. At present the neonate is in a good condition and needs only inotropic support by oral therapy. Isolated ventricular non-compaction is a rare, but important differential in the diagnosis of left ventricular hypertrophy. IVNC has no associated cardiac lesions and persistent sinusoids are not seen. This congenital anomaly is a distinct entity of cardiomyopathy with a characteristic morphological pattern. Inheritance is both X linked (Xq28 region) and autosomal recessive. Prenatal diagnosis is made by echocardiography and color Doppler ultrasound, showing direct blood flow from the ventricular cavity into deep intertrabecular recesses.

Determinación perinatal de leptina en madres y neonatos con diagnóstico de retardo de crecimiento intrauterino (RCIU)

Perinatal determination of Leptin in mothers and neonates with diagnosis of retard of intra-uterine growth (RCIU) Recently it has been described that the leptin presents hormonal activity, acting on receivers and that it isinvolved in the regulation of the metabolic efficiency, spend energy and nutritious ingestion. Has been synthesizedin the sincitiotrofoblastos and it is secreted inside the maternal circulation. The leptin has also been related in thedeposit of fat. Since in the last trimester of the human pregnancy, in a characteristic way a relatively increaseddeposit of fat exists and that this leaves depletado evidently in the cases of RCIU, it is then probable that theleptin keeps relationship with the entity. The objective of this study was to investigate if differences exist among theleptinmensurations obtained in a group of healthy patients and with RCIU. The study was carried out in 12 patients with RCIU (cases) and 9 patients without RCIU (you control). For such a reason they took samples of maternal blood and blood cord and of amniotic liquid (THE). In the paired study (n=9) the leptin levels in children born with RCIU presented lower concentrations that the children control (p=0.05). The leptin concentrations in blood cord were correlated significantly with the weight of the neonate (p = 0.0002) and I weigh placentario (p = 0.048). It was not to significant correlation statistically of the leptin levels in maternal blood with the weight of the neonate and the placentario weight. The concentrations of amniotic liquid showed an inverse and statistically significant correlation with the weight neonatal (p = 0.035), but not with the placentario weight (p = 0.071). Inverse and statistically significant correlations were observed among: concentrations of maternal leptin and leptin in blood cord (p = 0.034); cord leptin with leptin in liquid amniotic (p = 0.011) and positive correlation between maternal leptin and leptin in the amniotic fluid (p = 0.01).