K. Janiak

F131The role of fetal echocardiography during maternal pharmacological treatment

Background

P09.18: The neonatal outcome in monochorionic twins after laser therapy

Objectives: Twin to twin transfusion syndrome occurs In 15% of monochorionic twin pregnancies. Untreated, TTTS has traditionally been quoted to have a mortality of nearly 100%. The aim of the project was the investigation of the most optimal way of the diagnostic and therapeutic procedure in pregnancies complicated with TTTS and show antenatal and postnatal follow-up with at least 12 months of age. Methods: 64 pregnant women with twin to twin transfusion syndrome were assigned to laser therapy using diode laser. They underwent laser procedure at mean gestational age of 22 weeks of gestation at Quintero stages II–IV. Fetal echocardiography was performed before and after laser procedure; chosen parameters characterizing pregnancy were detailed described and analysed. Results: Survival rate of at least one twin was observed in 48 cases /48/64/ /considering at least 12 months follow-up/and it was equal to 75%. Neurological complications were observed in 4% /3/64/ in neonates at 6 months of age. Conclusions: Currently, preferred and the only method, which touches the cause of disease is endoscopic laser coagulation of anastomoses.

OC07.03: The significance of foramen ovale view in fetuses with prenatal diagnosis of complete transposition of the great arteries (d-TGA)

Objectives: To assess the impact of routine transplacental fetal treatment (TFT) for anti-Ro antibody-mediated complete heart block (CHB) ± endocardial fibroelastosis (EFE). Maternal dexamethasone from CHB diagnosis until birth, β-stimulation for fetal bradycardia <55 beats/minute, and intravenous immune globulin for EFE has been routinely used at our institutions to improve outcomes of these babies. The benefit of this approach has been questioned by 2 retrospective studies (Lopes Circulation 2008; Eliasson Circulation 2011). Methods: We reviewed 88 consecutive fetuses with isolated CHB in a multicenter setting (1997–2010) and compared the findings with Eliassons’ and Lopes’ studies. Results: The table compares our CHB cohort (‘‘current’’) with the 2 prior studies with inconsistent fetal therapy. Median follow-up of our patients is 6 years. Conclusions: We demonstrate that routine TFT was associated with significantly better survival rates when compared to occasionally treated fetal cohorts with CHB ± EFE. TFT improves outcomes and lowers the rate of late-onset cardiomyopathy likely by limiting the maternal anti-Ro antibody-mediated insult on the fetal heart.

P26.05: The echocardiographic features in prenatal diagnosis of l- transposition of the great arteries (l-TGA): abnormal heart axis might be a clue?

Objectives: The prenatal detection of the fetal aberrant right subclavian artery (ARSA) can be achieved by transverse, longitudinal and coronal views at the fetal thorax. The objective is to describe the frequency of visualization of fetal ARSA in a coronal view after its detection in the common axial plane. Methods: A series of 25 fetuses in which ARSA was diagnosed using transverse views was found in a group of pregnant women (between 16–36 weeks of pregnancy) attending our Fetal Medicine Unit for ultrasound examination (Figure 1A). After its detection in a transverse view, fetal ARSA was visualized in the coronal view by sweeping the probe at the level of the fetal thorax in a coronal plane anterior to the spine (Figure 1B). In this plane we were able to see the thoracic descending aorta and the origin of the aberrant vessel in a distal position. Color and Pulsed Doppler was used to define the course of the ARSA and distinguish it from other vessels. Results: The visualization of ARSA in the coronal view was possible in 25 cases (100%). In this view ARSA shows as a vessel arising from the aorta and following an oblique course towards the right shoulder (Figure 1B). Unlike in the transverse view, where confusing ARSA with the azigos vein is possible, in the coronal view the azygos courses parallel to the right side of the aorta, while ARSA arises from the aorta and follows an oblique course to reach the right arm. Highly sensitive color Doppler with a low-velocity range (10–15 cm/s) helps to define the course of the ARSA and pulsed Doppler is useful to distinguish ARSA from the azygos vein in both transverse and coronal views. Conclusions: Ultrasound assessment of fetal ARSA in a coronal view was possible in all cases and complemented the prenatal diagnosis of this anomaly in the usual transverse view.

OP03.07: Echocardiographic and sonographic markers of fetal Turner syndrome in second half of pregnancy

S. Jaudi1, N. Fries2, S. Tézenas du Montcel3, J. Nizard1, V. Halley Desfontaines4, M. Dommergues1 1Obstetrics and Gynecology, Groupe Hospitalier Pitié Salpêtrière, APHP and Université Paris 6 UPMC, Paris, France; 2Collège Français d’Echographie Fœtale, Paris, France; 3Department of Medical Statistics, ER4 Modeling in Clinical Research UPMC, APHP and Université Paris 6 UPMC, Paris, France; 4Paris 6 UPMC, Paris, France

P03.17: Tetralogy of Fallot (ToF) in a series of 40 cases in a fetal cardiology center in Lodz in years 1994–2009

S. Forys1, K. Janiak2, A. Zarkowska2, M. Slodki1, M. Respondek-Liberska1,2, A. Sysa3 1Department of Diagnosis and Prophylaxis of Congenital Malformations, Institute of Polish Mother Memorial Hospital, Lodz, Poland; 2Department of Diagnosis and Prophylaxis of Congenital Malformations, Institute of Polish Mother Memorial Hospital & Medical University, Lodz, Poland; 3Department of Pediatric Cardiology, Institute of Polish Mother Memorial Hospital, Lodz, Poland

P04.06: Cardiomegaly in fetus: a powerful indicator of fetal and neonatal demise

Objective: The objective of this study was to analyze the reasons of fetal cardiomegaly and prenatal and neonatal outcome. Material and methods: Between 2000 and 2008 over 10.000 pregnancies were referred to our department for fetal echocardiography and detailed anomaly scan. All examinations were performed with Voluson 730 Expert and Philips HDI 5500. We measured heart size dividing heart area by chest area (HA/CA). An inclusion criteria was HA/CA ratio 0,45 or more. There were 3 study groups in our series: 1. Cardiomegaly with normal heart anatomy (NHA), and no extracardiac malformations (ECM) 2. Cardiomegaly with congenital heart disease (CHD) without or with ECM, 3. Cardiomegaly and ECM with NHA. Results: Cardiomegaly was identified in 99 fetuses. Of the 99 fetuses we lost follow up in 21 fetuses. Of 78 fetuses 31 hearts were normal with no ECM (Group 1). In this group the most common reason of cardiomegaly were: intrauterine infection (n=10), 40% of demise, twin-twin transfusion syndrome (n=10), 67% of demise, intrauterine growth restriction (n=7) 43% of demise, and arrhythmias (n=5) 60% of demise. Total fetal and neonatal demises in group 1 was 52%. Group 2 (n=28): 12 fetuses had aortic stenosis (42% of demises), 8 fetuses had Ebstein anomaly (75% of demises), 2 fetuses had pulmonary stenosis (100% of demises), and 6 fetuses had complex CHD (67% of demises). The total demises in group 2 was 53%. Group 3: n= 19. There was renal agenesis in 8 fetuses (100% of demises), skeletal malformations in 5 fetuses (80% of demises), 6 fetuses with another fetal malformations including 4 fetuses with urinary tract disease (100% of demises). Conclusion: Cardiomegaly is a serious problem and it’s connected with high rate of demises, independently of the reason of cardiomegaly. All fetuses with cardiomegaly should be referred as soon as possible for fetal cardiology centre for haemodynamic assessment.

P26.05: Sonographic and echocardiographic features in fetuses with meconium peritonitis and ileus

method. These parameters were compared to age matched normal fetuses from our data base. Results: We reviewed echocardiograms of 31 fetuses with isolated GSC. None of the fetuses had structural heart defects consistent with congenital heart disease. There were no functional abnormalities. There was no statistical difference between the GSC group and normal fetuses by measurement of our FECHO parameters. In five (16%) fetuses, we identified left axis shift of 45 to 75 degrees off the sternum to spine axis within the left chest. Conclusions: Structural and functional cardiac abnormalities are rare in fetuses with isolated GSC. The axis shift of the heart within the thorax is likely associated with amount of bowel that is outside the abdomen. This axis shift is also seen with omphalocele where the larger the omphalocele the greater the shift.

OP22.05: In Twin to Twin Transfusion Syndrome (TTTS) there is improvement in CVPS of the recipient

defect simultaneously with removal of the operative cannula to create a gelatin seal of membrane defect. Iatrogenic premature prelabor rupture membranes (PPROM) was defined as gross rupture with vaginal pooling, a positive nitrazine test and confirmation by ultrasound of reduced amniotic fluid volume in the recipient twin’s sac. A complicated procedure was defined as development of intraoperative hemorrhage, septostomy, multiple puncture or preoperative reduce cervical length (< 25 mm). Results: The median gestational age of intervention was 20.1 wks (16–26.4 wks). In 39 (95%) the place of the gelatin plug was successful. PPROM < 32 weeks occurred in 6 (15%). Complicated procedures occurred in 3/6 (50%) PPROM and 9/33 (27%) nonPPROM cases. This difference was not statistically significant, P = 0.19. (Fisher Exact test). There were no adverse maternal, fetal or neonatal outcomes attributable to the placement of the gelatin seal. Conclusions: The rate PPROM < 32 wks reported here, 15%, was similar to that reported without gelatin seal, 17%. (Robyr et al2006). The PPROM cases in our study had a tendency to be associated with complicated procedures. Before gelatin seal is considered a routine clinical part of fetal intervention, a randomized controlled trial is necessary to demonstrate safety and efficacy.

P31.03: Giant bilateral hydrothorax treated in utero and monitored by fetal echocardiography ‐ Case report

Fetus with giant hydrothorax and ascites was diagnosed at 25th week of pregnancy. Fetal echocardiography revealed normal heart anatomy with 8 points in Cardiovascular Profile Score (CVPS), (minus one for ascites and hydrothorax). At 26th week of pregnancy pleurocenthesis and amniocenthesis for fetal karyotype were performed. Fetal karyotype was normal however there was re-accumulation of the pleural effusion next week, so at 27th week of pregnancy pleuroamniotic shunt was established. Based on fetal echocardiography CVPS was 8 due to ascites and hydrothorax. Two weeks later there was again re-accumulation of pleural effusion and CVPS was still 8 points. At 29th week of pregnancy second pleuroamniotic shunt was implemented. Four days after second shunting there was no ascites and only rim of hydrothorax. At 31st week of pregnancy the fetus had again fetal echo and hyperoxygenation test which was positive. At 34th week of pregnancy there was still only rim of pleural effusion and no ascites (CVPS was 9). At 35th week there was spontaneous rupture of membrane, however the newborn was delivered by Cesarean section with birth weight 2200g and Apgar scores of 5 and 7. There was only small pleural effusion in left pleural cavity after delivery. The newborn was discharge home at 21 days. Conclusions: Despite dramatic fetal presentation and rapid reaccumulation of hydrothorax, monitoring by fetal echocardiography examinations had shown a safety of repeated fetal needling and double shunting.