Juan De León-Luis

Fetal Aortic Arch Anomalies Key Sonographic Views for Their Differential Diagnosis and Clinical Implications Using the Cardiovascular System Sonographic Evaluation Protocol

Aortic arch anomalies are present in 1% to 2% of the general population and are commonly associated with congenital heart disease, chromosomal defects, and tracheaesophageal compression in postnatal life. The sonographically based detection of aortic arch anomalies lies in the 3‐vessel and trachea view. Although highly sensitive, this view alone does not allow identification of the aortic arch branching pattern, which prevents an accurate diagnosis. The systematic addition of a subclavian artery view as part of a standardized procedure may be useful in the differential diagnosis of these conditions. We describe the sonographic assessment of fetal aortic arch anomalies by combining 2 fetal transverse views: the 3‐vessel and trachea view and the subclavian artery view, which are included in the cardiovascular system sonographic evaluation protocol. We also review the sonographic findings and the clinical implications of fetal aortic arch anomalies.

Comparison of measurements of the transverse diameter and perimeter of the fetal thymus obtained by magnetic resonance and ultrasound imaging

To compare measurements of the fetal thymus obtained by magnetic resonance imaging (MRI) and ultrasound (US).

Prenatal Sonographic Features of a Double Aortic Arch Literature Review and Perinatal Management

A double aortic arch is a relatively uncommon anomaly occasionally associated with congenital heart disease or the chromosome 22q11 deletion. We report a case of prenatal diagnosis of a double aortic arch in which the sonographic features in the 3‐vessel and trachea view are highlighted. A PubMed‐based search was made to retrieve all cases of prenatal diagnosis of double aortic arch. A total of 13 articles and 35 cases were found. The average gestational age at diagnosis was 29 weeks. Six cases had associated cardiac anomalies. Only 1 case had the 22q11 deletion, showing extracardiac anomalies without cardiac defect. The postnatal evolution was characterized by symptoms of tracheoesophageal compression in 72.4% of the cases. Detection of a double aortic arch should be followed by a thorough fetal scan and echocardiography, and a chromosomal study should be considered when the sonographic findings are consistent with the 22q11 deletion.

Prenatal Diagnosis of an Aortopulmonary Window With an Interrupted Aortic Arch

A prenatal aortopulmonary window with an interrupted aortic arch was detected in a 22‐week‐old fetus. The 3‐vessel and trachea view showed a communication between the ascending aorta and the pulmonary artery. Early postnatal surgery was successful. A PubMed‐based search identified all cases of prenatal aortopulmonary windows between 2002 and 2015. Nine articles were identified. The average gestational age at diagnosis was 28 weeks (range, 22–33 weeks). The most frequent aortopulmonary window was type I (40%). All cases were associated with congenital heart defects, mainly an interrupted aortic arch (50%). No chromosomal or extracardiac abnormalities were seen. Prenatal echocardiography is useful for early diagnosis of an aortopulmonary window. The prognosis depends on the time of surgery and the nature of the associated anomalies.

Neonatal Magnetic Resonance Imaging as a Complementary Technique After Prenatal Diagnosis of an Aberrant Right Subclavian Artery

Nowadays, although prenatal sonography is the standard technique for the diagnosis of fetal anomalies,1 magnetic resonance imaging (MRI) is increasingly applied as a complementary technique during both the prenatal and neonatal periods. In infants, MRI is used to study structural malformations, whereas fetal MRI is mainly used to study central nervous system defects, diaphragmatic hernias, and placental anomalies.1 However, the application of MRI in the assessment of fetal congenital heart defects remains subject to limitations. A fetal aberrant right subclavian artery is a recently described sonographic marker of aneuploidy, congenital heart defects, or both.2,3 Given the technical limitations of postnatal sonographic evaluation of an aberrant right subclavian artery, MRI could enable us to better characterize this anomaly. To explore this possibility, we report a case of sonographically based prenatal diagnosis of a fetal aberrant right subclavian artery confirmed by postnatal MRI and compare both images in the same view. A 33-year-old woman in her 20th week of gestation was evaluated in our center. Sonographic evaluation of the fetal heart revealed a ventricular septal defect close to the cardiac apex associated with an aberrant right subclavian artery, which was detected in the axial and coronal views of the fetal thorax.3–5 At the level of the 3 vessels and trachea in the axial view, the aberrant right subclavian artery had an anomalous origin and followed a retrotracheal course toward the right arm (Figure 1A). In the coronal view, it was possible to visualize part of the descending aorta at the

Prenatal Diagnosis of Incomplete Bladder Duplication: Sonographic Features and Perinatal Management

Incomplete bladder duplication is a rare abnormality of the lower urinary tract in which the bladder is divided into two parts by a thick muscular septum.1 The term incomplete refers to absent duplication of the urethra, and it is associated with a better prognosis, unlike the complete variant, which is often associated with duplication of the hindgut and the external genitalia.1,2 Both types are not usually linked to an abnormal karyotype, and the prognosis depends on urinary obstruction/infection and possible associated malformations.3,4 Sonography can be useful to identify them prenatally. We report a case of incomplete bladder duplication and describe the prenatal and postnatal (presurgical and postsurgical) sonographic features of this anomaly. A 32-year-old pregnant woman was referred to our fetal medicine unit at 23 weeks’ gestation after megacystis and unilateral pyelic ectasia were found on her morphologic scan. The scan revealed a male fetus with an enlarged bladder of 28 × 34 × 34 mm and a complete sagittal septum

Performance Evaluation to Improve Training in Forceps-Assisted Delivery

The World Health Organization recommends a rate of cesareans inferior than 15%. However, the actual rates in the US double this value, while the use of obstetrical instruments, a recommended alternative to cesareans but which requires high skill and experience, has significantly decreased in the latest years. In this context there is a clear demand for simulators, with special interest in learning the correct use of Kielland’s forceps. In this work we present a virtual instrumented simulator to improve training in the correct use of forceps proposing a three-step protocol which guides users along the process while evaluating their performance. We validate this protocol, following principles based on previously published guidelines, on two types of manikins. Our results show that the proposed solution successfully detects the incorrect positioning of the forceps in most steps, guiding the user during the training process and providing feedback on wrong maneuvers.

Breast cancer during pregnancy: results of maternal and perinatal outcomes in a single institution and systematic review of the literature

Abstract To compare the maternal and the perinatal variables of the patients with pregnancy associated breast cancer (PABC) and the pregnant patients without breast cancer (PNABC), we retrospectively included 13 PABC cases and 66.265 PNABC patients. The PABC patients presented a lower mean gestational age at their delivery and had higher induction of labour and prematurity rates. A diagnosis was performed before stage III in 77% of the cases. The overall survival was 90%; moreover, we collected 16 manuscripts when gathering data from 1581 patients with PABC. The mean follow-up time was 70u2009±u20098u2009months. The mean maternal age at diagnosis was 34u2009years old. Most of the patients were at their second trimester of pregnancy. The gestational age at delivery was 35u2009weeks. A mastectomy was the most frequently used surgical approach. PABC should be managed by a multidisciplinary team, ensuring there is a rigorous oncological treatment, with foetal well-being. IMPACT STATEMENT What is already known on this subject? The malignant breast tumours diagnosed during pregnancy, or 1 year after a delivery are increasing, there is evidence supporting the treatment during a pregnancy with maternal and foetal safety. A PABC should be managed by a multidisciplinary team in a referral centre, ensuring that there is a rigorous oncological treatment with foetal well-being. What do the results of this study add? Our results show that the PABC patients in our centre had a mean maternal age older than the PNABC women, as well as a higher percentage of the induction of labour and prematurity. 48 Cancer was usually diagnosed in early stages, and the most common type was ductal infiltrating, with positive hormonal receptors. For those patients continuing their pregnancies, a mastectomy plus a lymphadenectomy was the most frequent chemotherapy, and was usually administered in the third trimester of pregnancy. What are the implications of these findings for future clinical practice and/or further research? Moreover, the number of publications concerning PABC has grown, series are still scarce. We understand the limitations of the low number of the cases on our population, but this study is the first which compare the PABC with the PNABC patients, allowing to describe and compare the obstetrical and perinatal variables. Finally, we consider it is of a paramount importance to create an international database to register in a prospective way all of the cases of PABC to increase our knowledge in this field.

Neonatal magnetic resonance imaging in double aortic arch diagnosed prenatally by ultrasound.

Congenital double aortic arch (DAA) is an uncommon vascular anomaly; however, its prenatal detection is associated with congenital heart defects and chromosomal abnormalities, including 22q11 deletion. We present a case of DAA diagnosed prenatally. DAA can be diagnosed by prenatal ultrasound in the transverse three vessel-trachea view, which shows a trident image formed by a complete vascular ring and the ductus arteriosus. Postnatal magnetic resonance images in this view correlate well with prenatal ultrasound images and help in confirmation of diagnosis, evaluation of the risk of airway or esophageal compression, and planning of surgery.

Prenatal diagnosis of omphalopagus conjoined twins with shared megacystis

Conjoined twins are a very rare complication of monozygotic pregnancies, with thoraco‐omphalopagus twins being the most common presentation. Prenatal diagnosis of this anomaly can be achieved in the early first trimester. The areas of union between the embryos and the presence of associated malformations should be carefully evaluated for parent counseling. We report a case of omphalopagus conjoined twins with shared megacystis and discuss the ultrasound findings and management of these cases.