L. Franceschetti

4D Fetal Echocardiography

Congenital heart defects (CHD) are the most frequent malformation in the human fetus and are the leading cause of mortality due to malformations in the first year of life. Despite its clinical importance screening performed by ultrasonographic examination during the second trimester of pregnancy has shown disappointingly low detection rates mainly due to the difficulties in obtaining an adequate examination of the fetal heart. Four-dimensional (4D) ultrasound of the fetal heart has been recently suggested as a tool to improve the detection rate of CHD by decreasing the dependency on operator skills required in two-dimensional ultrasound scans but up to now no practical manuals are available in describing its application in clinical practice for the study of fetal heart. The objective of this Ebook is to explain the role of 4D during second trimester examination and in fetuses with CHD. The technique of obtaining 4D volume of the fetal heart, how to navigate in the volume to obtain diagnostic planes and how to use semiautomatic and automatic software of analysis are described. We believe that after reading this book the standard fetal cardiac anatomy survey can be performed in the second trimester fetus by 4D in both normal and abnormal hearts. This approach may reduce the operator dependency in diagnosis CHD. This Ebook should prove to be a valuable resource for obstetricians, sonographers and pediatric cardiologists.

OP24.07: 3D ultrasound and MRI of fetal cervical cystic lymphangioma for intrapartum treatment planning

Objectives: To describe early changes in fetal cardiac function after laser treatment in severe twin–twin transfusion syndrome (TTTS). Methods: A prospective study was conducted over a fivemonth period. Cardiac function was assessed in 49 consecutive monochorionic pregnancies presenting with severe TTTS and referred for fetoscopic selective laser coagulation (FSLC) of placental anastomoses as first-line treatment. Echocardiography was performed on admission and after laser treatment (median = 1 day, IQR = 1–3). The studied parameters included cardiac output, myocardial performance index, shortening fraction (SF), and heart dimensions. Results: Median gestational age was 21 weeks (IQR = 19–23). Distribution across Quintero stages was as follow: 32.7%, 18.4%, 46.9% and 2.0% for stages 1, 2, 3 and 4 respectively. Cardiac output significantly increased after laser treatment in both donor (+33%) and recipient twins (+24%). In the recipient twin, a significant increase in LV SF was also found. The increase in cardiac output was not significantly correlated with Quintero stage, the volume of amniotic fluid drained, or gestational age. Conclusions: As early as 24 h after laser treatment, a significant increase in systolic function was found in both twins. These changes seem to be unrelated to initial severity of the syndrome.

OC71: Isolated mild ventriculomegaly (10–12 mm): very long-term prognosis

Methods: We considered 58 consecutive single pregnancies referred to our Centre for Prenatal Diagnosis with a lateral ventricle measurement between 9.5 and 9.9 mm. For all cases we obtained perinatal and long-term follow-up (> 24 months). Results: In 14 cases (24%) associated malformations were present: four aneuploidies (two trisomy 21, one trisomy 13 and one triploidy), one complex malformation, three spina bifida with myelomeningocele, one transposition of great arteries, two Beckwith syndromes, one Zellweger syndrome, one case of epilepsy associated with liver dysfunction, one renal pelvic dilatation. Among the 44 cases of isolated ventriculomegaly, one pregnancy was terminated because of psychiatric indication, 42 infants (97%) were healthy at more than 24 months of life, and only one newborn showed severe neurological dysfunction (neurodevelopmental delay and motor deficit) caused by a demyelinating disease of the white matter not diagnosable in utero. Conclusions: These data, comparable to those obtained for ventriculomegaly between 10 and 12 mm, suggest that the cut-off for mild ventriculomegaly should be lowered to 9.5 mm.

P05.16: Interobserver repeatability of transabdominal 3D ultrasound of the fetal brain

and those who didn’t(19 ± 7 mm vs 23 ± 8 mm, p > 0.1); 3) Severe ventriculomegaly (> 15 mm) was more common in cases who didn’t have associated abnormalities than in those who did(100%(5/5) vs 50%(5/10); p=0.1), and in cases who didn’t develop serious postnatal outcome than in those who did(89% vs 33%; p=0.09), without statistical significance; 4) All cases(n=6) with serious postnatal outcome had associated abnormalities. Conclusion: The presence of severe ventriculomegay wasn’t associated with the occurrence of serious postnatal outcome in liveborn cases diagnosed postnatally with ACC.

OP18.02: Fetal echocardiographic monitoring in fetuses at risk for congenital heart block

treatment for placenta accreta or percreta) are at high risk for hemorrhage or systemic infection. The objective of this preliminary study was to evaluate radio-frequency (RF) efficiency and safety for trophoblast or placenta ablation. Methods: Several RF procedures (RITA medical systems, Starbust SDE) were tested on 50 pregnant ewe placental units in order to define two optimal procedures. Reproducibility of these two optimal procedures was then evaluated on 20 other pregnant ewe placental units. Each procedure was also tested twice on 10 human term placenta placed in an in-vitro model after normal delivery. Results: When tested on pregnant ewes, low-power (100 watts) and low target temperatures (80 and 60◦C) had to be applied in order to obtain homogeneous tissue destruction, without any myometrial lesion. Reproducibility of these two procedures was excellent for the 20 other pregnant ewes. No bleeding was observed in any of the 70 procedures. Lesions displayed the same pattern when RF was applied to human placentae. The ablation volume correlated with the time of deployment, and thus can be correctly targeted. Conclusions: RF seems to be an adequate method for ablation of retained trophoblast or placenta, with an optimal control of tissue destruction.

P38.14: Corpus callosum: comparision between bidimensional and volumetric ultrasound

for mild unilateral ventriculomegaly (1.14 cm). A rescan was done at 22 weeks, 26 weeks, 28 weeks and 30 weeks, respectively. It only revealed mild unilateral ventriculomegaly. We arranged MRI at 22 weeks’ gestation and 32 weeks’ gestation, respectively. There was just multicystic encephalomalacia at 32 weeks’ gestation. Finally, she decided to termination of the pregnancy after feticide. Discussion: Prenatal sonography are valuable tools for the early finding of intracranial lesions and need fetal MRI to confirm the brain lesion. We suggest the fetal MRI optimal time for brain lesion may be at 30–34 weeks.

OP13.08: Corpus callosum abnormalities: 2D, 3D ultrasound and MRI

S. Boito1, A. Righini2, L. Ramenghi3, L. Mandia1, P. Ficarazzi1, R. Fogliani1, G. Pardi1 1Obstetrics and Gynecology Inst., IRCCS Policlinico, Mangiagalli and Regina Elena Foundation, University of Milan, Italy, 2Radiology and Neuroradiology, IRCCS Policlinico, Mangiagalli and Regina Elena Foundation, University of Milano, Italy, 3Neonatal Intensive Care Unit, IRCCS Policlinico, Mangiagalli and Regina Elena, University of Milan, Italy

P32.17: Real‐time 3D ultrasound using a matrix array transducer: a case of agenesis of the ductus venosus

Heterotaxy syndrome is a rare congenital disorder that appears in 2 different types: right isomerism (asplenia syndrome) and left isomerism (polysplenia syndrome). It occurs in approximately 0.8% of patients with congenital heart disease. Characteristics of the disease are an incomplete or inappropriate lateralisation of atria, thoracic organs and abdominal viscera; an associated hydrops can be found. We report a case of a 34-year-old gravida 2, para 1 with sonographic signs of fetal heterotaxy syndrome at the second trimester scan. Ultrasound examination revealed left isomerism with a complex heart anomaly including a ventricular septal defect and atrioventricular block, a hypertrophic cardiomyopathy, a continuing vena azygos and an interrupted inferior vena cava. The fetal liver was located in a central position. The prognosis was even worse due to a generalized hydrops. Because of the diagnosis the woman decided not to continue with the pregnancy. Labor was induced at 24 weeks of gestation after fetocide by intraamniotic instillation of 0.8 mg Digoxin. Postpartal autopsy verified the prenatal diagnosis of ventricular septal defect, left isomerism of the lungs and atrias. It also showed a venoatrial disconnection on the right side with pulmonary venous drainage into the superior vena cava and into the right atrium. In the abdomen an absent retrohepatic vena cava, pancreas in a central position, non-rotation of the intestines and eleven 4 mm-sized spleens on the left side of the body confirmed the prenatal diagnosis of left isomerism. With high resolution ultrasound it is possible to diagnose left isomerism antenatally. Paidopathologic examination is recommended to confirm the diagnosis of this complex congenital anomaly in detail.

OC161: Persistent left superior vena cava in fetuses at risk for congenital heart defects: associations and outcome

anomalies, 12 of which were 22q11 deletions, occurring in 2/25 of the isolated group and 10/48 of the complex group, with a further 2 complex cases probably 22q11 deletion. There were 29 pregnancy interruptions, 4 intrauterine deaths, 31 live-births, 4 neonatal deaths and 3 patients lost to follow-up. The remaining 4 pregnancies are continuing. Conclusion: The diagnosis of a right-sided aortic arch can be made by fetal echocardiography, either as an isolated lesion or in association with other cardiac malformations, from as early as 12 weeks gestation. It can be difficult to distinguish from a double arch. Its increasing incidence in our series probably indicates that the diagnosis was previously overlooked. Karyotyping in the absence of other abnormal findings may be unnecessary in every case, but establishment of 22q11 micro-deletion status in those cases with other anomalies is important.