Kai-Sven Heling

Three‐dimensional (3D) and 4D color Doppler fetal echocardiography using spatio‐temporal image correlation (STIC)

Color Doppler echocardiography is used to visualize three transverse planes: the four‐chamber, five‐chamber, and three vessels and trachea views. Color Doppler spatio‐temporal image correlation (STIC) is a new three‐dimensional (3D) technique allowing the acquisition of a volume of data from the fetal heart that is displayed as a cineloop of a single cardiac cycle. The aim of the study was to examine the potential of color Doppler STIC to evaluate normal and abnormal fetal hearts.

Small biparietal diameter in fetuses with spina bifida on 11–13‐week and mid‐gestation ultrasound

To assess whether, at 11–13‐week and mid‐trimester ultrasound examinations, the biparietal diameter (BPD) in fetuses with open spina bifida is smaller than the reference range.

Aortic arch with four vessels: aberrant right subclavian artery

In early gestation, the aortic arch undergoes complex development1 that normally results in the formation of a left aortic arch from which three arteries originate: 1) the brachiocephalic artery, bifurcating into the right common carotid and right subclavian arteries, 2) the left common carotid artery and 3) the left subclavian artery (Figure 1). Development of the aortic arch is abnormal in approximately 1–2% of human fetuses, and may involve complex cardiac defects (e.g. interruption or tubular hypoplasia of the aortic arch, aortic coarctation

Three-dimensional ultrasound in prenatal diagnosis.

Purpose of review Several technological advances have greatly improved three-dimensional sonography, which have improved acquisition and display capabilities. This review describes these technical changes as well as current applications of 3D sonography in prenatal diagnosis. Recent findings Recently published papers have emphasized the potential of getting a precise ‘any plane of choice’ from a three-dimensional volume, as a new way of scanning, based on the off-line analysis of a volume dataset. Surface mode has been used to demonstrate malformations and genetic diseases. The maximum rendering mode, which highlights bones, has great potential for imaging the nasal bones and the frontal bones with the metopic suture. Organ volume can be measured, but the utility of this in clinical practice remains to be determined. Three-dimensional ultrasound needs to be standardized. Summary Three-dimensional ultrasonography is the most rapidly developing technique in fetal imaging. New features will permit the transition from the era of ‘sonography in two-dimensional planes’ to ‘volume ultrasound’.

Agnathia‐otocephaly with holoprosencephaly on prenatal three‐dimensional ultrasound

Otocephaly – also called agnathia-otocephaly or agnathia-microstomia-synothia – is an extremely rare lethal anomaly. Since its first description by Kerckring in 17171, more than 140 affected individuals have been reported2,3. This sporadic abnormality is characterized by an absent or hypoplastic mandible, a small or absent mouth (microstomia) and a midfacial location of the ears in the form of auricular malposition called melotia and/or auricular fusion called synotia3. Otocephaly occurs commonly in association with severe midline defects including holoprosencephaly, cyclopia, proboscis and other cerebral malformations. It has been reported to occur in fewer than 1 in 70 000 births2,3. However, Blaas et al.4 found 10% of all holoprosencephalies in their series to have otocephaly and suggested that the true incidence is underestimated. We would like to contribute to the literature with a description of an additional extreme case detected at 21 weeks’ gestation, and emphasize the role of three-dimensional (3D) ultrasound in demonstrating the facial features.

Sonographische Messungen der Durchmesser der Aorta und des Truncus pulmonalis beim Feten

Fetal cardiac measurements derived in the five-chamber and the short-axis view were performed in uncomplicated pregnancies between the 20th and the 40th week of gestation. Using cine loop and zoom techniques, the diameters of the aortic and pulmonary valve were measured (n = 157) and the pulmonary trunk/aorta ratio calculated. Normal ranges for both parameters were constructed and correlated with gestational age. Both diameters showed a linear increase during gestation (aorta r = 0.87, pulmonary trunk r = 0.91). The mean pulmonary trunk/aorta ratio had a constant value of 1.25 and showed no changes throughout pregnancy. In 128 fetuses the heart width was further measured and the vessel diameters were presented in correlation to the heart width.

Fetal trisomy 10 mosaicism : Ultrasound, cytogenetic and morphologic findings in early pregnancy

We report the ultrasound, cytogenetic and morphologic findings in a case of trisomy 10 mosaicism prenatally detected by chorionic villus sampling (CVS). CVS sampling was carried out at the 13th week of gestation because of ultrasound diagnosis of hydrops fetalis and hygroma colli. Trisomy 10 mosaicism was diagnosed in cells from the cytotrophoblast (short‐term culture) and the chorionic villus core (long‐term culture). Fetal mosaicism was confirmed after termination of pregnancy in umbilical cord cells, placenta and fetal skin fibroblasts. Copyright

Dilated cavum septi pellucidi in fetuses with microdeletion 22q11

The cavum septi pellucidi (CSP) is an easily recognizable landmark in the fetal brain. CSP disappears after birth to form the septum pellucidum. Children with microdeletion 22q11 (del. 22q11) were, however, reported to have a persistent dilated CSP. This study was designed to examine whether the CSP is dilated in fetuses with del.22q11.

OC043: Basal cardiac view on 3D/4D fetal echocardiography for the assessment of AV-valves and great vessels arrangement

Objective: With 3D/4D fetal echocardiography new views can be demonstrated, which cannot be seen on 2D scan. The ‘‘basal cardiac (BC) view’’ is a en-face view to the atrioventricular valves (AV) showing at the same time a cross section of the embedded aorta and the anterior coursing pulmonary artery. In this study we evaluated the utility of this new plane in describing cardiac defects involving the AV-valves and/or the great arteries. Patients and methods: A Voluson 730 Expert system 3D/4D was used to acquire volume data set of fetal hearts in the second half of pregnancy. The examination was performed with following modes: 3D-static, gray scale and color Doppler STIC and live 4D. We included in this evaluation study volume data set from 20 normal and 25 fetuses with cardiac anomalies. Volumes were evaluated off-line on a work station (4D-view). Results: Volumes acquired from an apical four-chamber view offered the best possibility of ‘‘BC view’’ rendering. This view is easier demonstrated when Color or Power Doppler are combined with 3D/4D rendering. The BC-view was useful in cases with abnormal AV-valves (N = 11) and in cases with malpositions of the great vessels (N = 9). BC view was not reliably rendered in 5 abnormal hearts with a volume acquisition from a lateral view. Comments: The BC-view is a new view on 3D fetal echo simultaneously demonstrating both the AV and semilunar valves. It can be useful in cardiac defects affecting the valves and the arrangement of the great vessels. During volume acquisition the examiner should be aware about the post processing rendering in order to obtain optimal views.

Prenatal diagnosis of an intracranial arteriovenous fistula in the posterior fossa on the basis of color and three-dimensional power Doppler ultrasonography

Intracranial arteriovenous (AV) fistulas are rare vascular malformations mostly involving the vein of Galen but also occurring in other regions of the brain. 1-4 The reported incidence is approximately 1 per 100,000; however, it seems to be higher with respect to the many prenatally diagnosed cases reported in the recent literature. 1,5-10 The main reason is probably the widespread availability of improved diagnostic tools such as color and power Doppler ultrasonography, which provide very precise imaging of vascular anatomic features. 1,6,11-14 Most reports on aneurysms of the vein of Galen describe first the detection of an intracranial cyst, which turns out to be a vessel when Doppler ultrasonography is performed. We report a rare case of an intracranial AV malformation not involving the vein of Galen and not appearing as a hypoechoic intracranial structure. Indirect signs of cardiac high-output failure led to the targeted application of color Doppler ultrasonography and to the detection of the vessel malformation.