M. C. Cruz Lemini

P24.02: Reproducibility of fetal renal blood perfusion as measured by fractional moving blood volume using power Doppler ultrasound

Case: We report a series of 12 consecutive TRAP cases referred to our institution since January 2006. Among these cases, 9 were monochorionic/diamniotic twin pregnancies, whereas three were dichorionic/triamniotic triplet pregnancies with an affected monochoric/dimaniotic twin pair. Prenatal karyotyping was performed in 5 of the 12 cases revealing 4 euploid pump twins and 1 case of mosaic 46XX/45X. Detailed prenatal sonographic and echocardiographic assessment of the pump twin was performed in all cases, and three (25%) of the pump twins were noted to have fetal skeletal malformations. In case 1, the pump twin was noted to have an abnormal calvarial contour, markedly shortened fetal long bones and small chest circumference suggestive of a lethal skeletal dysplasia. In case 2, the pump twin was noted to have a single umbilical artery, abnormal 4th and 5th digits of the upper extremities. In case 3, marked angulation of the lower thoracic/upper lumbar spine was noted consistent with hemivertabrae. This pump twin was noted to also have a 1 cm perirenal cyst consistent with a urinoma, but no other major structural malformations were detected among any of the pump twins. Conclusion: TRAP is a rare complication of monochorionic twinning that results not only in the growth of a non-viable acardiac twin, but also in an increased risk of chromosomal abnormalities and structural malformations among pump twins. In addition, we noted a 25% incidence of fetal skeletal malformations among pump twins.

P21.01: Comparison of different ultrasound equipments for the evaluation of tissue Doppler parameters in fetuses

knowing the strengths and weaknesses of alternate biometric standards. Varied choices of fetal biometry charts 1. disrupt continuity of care for pregnant women 2. magnify the likelihood of false positive abnormal fetal biometry 3. produce ‘‘noise’’ which can obscure true signal of abnormal fetal biometry thus obscuring conditions such as fetal growth restriction, macrosomia, microcephaly and skeletal dysplasia. Practitioners recognise these hazards but require guidance to minimise them. As no ideal Australasian fetal biometry chart have been published, new, regionally appropriate reference range should be developed from a representative sample, using sound statistical techniques, especially to model the clinically important extremes of reference ranges i.e. 3rd centile and standard deviation for head circumference, abdominal circumference and femur length.

P10.06: Reproducibility of cardiothoracic ratio and ventricular sphericity indices in the evaluation of fetal cardiac remodeling

chromosomal abnormality in the study population. The depth of the pericardial effusion was not related to the clinical course of isolated pericardial effusion. All studied babies were alive and healthy when this study was prepared. Conclusions: There were no adverse outcomes or chromosomal anomalies among fetuses diagnosed with isolated pericardial effusion. Most cases of fetal isolated pericardial effusion resolved spontaneously. If no other abnormality is detected upon meticulous inspection, our results will be reassuring to patients who have a fetus diagnosed with isolated pericardial effusion.

OC12.06: Aortic and carotid wall thickness in term small‐for‐gestational age newborns with normal and abnormal fetal cerebroplacental Doppler ratio

cardiac function, carotid artery diameter, IMT and stiffness nor in endothelial function. Conclusions: ARED flow seems to contribute to an irreversible restriction of aortic growth persisting into adulthood, while the carotid artery, an adjacent elastic artery, has unchanged geometry and mechanical properties. Even if no altered left ventricular geometry or function were revealed at present, the smaller diameter and higher systolic pressure reflection in the central aorta might have negative consequences for left ventricular performance in the future by increasing aortic impedance.

OC12.04: Cardiovascular characteristics at 6 months of life in infants suffering intrauterine growth restriction

cardiac function, carotid artery diameter, IMT and stiffness nor in endothelial function. Conclusions: ARED flow seems to contribute to an irreversible restriction of aortic growth persisting into adulthood, while the carotid artery, an adjacent elastic artery, has unchanged geometry and mechanical properties. Even if no altered left ventricular geometry or function were revealed at present, the smaller diameter and higher systolic pressure reflection in the central aorta might have negative consequences for left ventricular performance in the future by increasing aortic impedance.

OP22.05: Estimated weight centile as predictor of cardiac dysfunction in small-for-gestational-age pregnancies with normal fetoplacental Doppler

and VBF/kg were increased in FGR for RA (P = 0.04, P < 0.001 respectively). UA flow was decreased at 24 and 28 weeks in FGR (P = 0.01). FA VBF was unchanged in FGR. Conclusions: Fetal VD’s are similar or increased in FGR fetuses, suggesting generalised vasodilation or preserved circulatory development with hyperdynamic arterial circulation in FGR. Increased VBF in FGR was demonstrated in the AA, IC and MCA, with similar VBF to the renal and femoral arteries in FGR and AGA. Decreased placental flow in early onset FGR may reflect placental vasoconstriction. Although increased cerebral VBF occurs in FGR, this may be a sign of compromise rather than adaptation.

OC07.06: Fetal echocardiography for prediction of postnatal cardiovascular programming due to intrauterine growth restriction

Objectives: The double outlet of the right ventricle (DORV) has a complex hemodynamic intracardiac component, which are associated with the characteristic that both great arteries are connected with the right ventricle. The aim of this study was to describe the anatomic intracardiac variables related with the prognosis of fetuses with prenatal diagnosis of DORV. Methods: We analyze our database with 1843 cases of congenital anomalies between 2003 to March of 2012. The diagnosis of DORV was made if both great arteries were predominantly arising form the right ventricle. Fetuses with diagnosis of DORV were identified and reviewed the fetal echocardiography and the anatomical characteristics were dividing in:

OC07.07: Cardiac remodeling in utero in early‐ and late‐onset intrauterine growth restriction

Objectives: The double outlet of the right ventricle (DORV) has a complex hemodynamic intracardiac component, which are associated with the characteristic that both great arteries are connected with the right ventricle. The aim of this study was to describe the anatomic intracardiac variables related with the prognosis of fetuses with prenatal diagnosis of DORV. Methods: We analyze our database with 1843 cases of congenital anomalies between 2003 to March of 2012. The diagnosis of DORV was made if both great arteries were predominantly arising form the right ventricle. Fetuses with diagnosis of DORV were identified and reviewed the fetal echocardiography and the anatomical characteristics were dividing in:

OP35.11: Influence of equipment and settings on repeatability of myocardial performance index

Objectives: The aims of this study were to investigate the role of TUI-STIC in the sequential segmental analysis of conotruncal defects. Methods: Four-dimensional volumes from 120 cases of confirmed fetal congenital heart disease diagnosed and managed at our hospital were evaluated using TUI-STIC. To select the best interslice distance for adequate display of the cardiovascular connections, each volume was opened and the TUI mode activated, having as a reference the ventricular outlet. The number of slices was set at nine. The volume was then scrolled until the most significant echocardiographic views were displayed on the screen windows. Results: Among the 120 CHD fetuses, 25 fetuse were diagnosed as conotruncal defects by TUI-STIC, including 5 transposition of the great vessels, 9 tetralogy of Fallot, 3 truncus arteriosus and 5 double outlet respectively, 3 pulmonary stenosis. Postnatal eehocardiography or autopsy confirmed. The sensitivity, specificity,positive predictive valve of these features to indicate conotruncal defects were 97.6%, 99.5% respectively. Conclusions: Abnormal in arrangement, size, origin or nondisplaying of pulmonary artery and aorta in TUI-STIC has a high specificity and sensitivity in predicating conotruncal defects. TUI-STIC allows a complete sequential analysis of conotruncal defects in the fetus and could improve the prenatal diagnosis rate.

OC12.02: *Presence of post-systolic shortening as a sign of cardiac adaptation to chronic pressure overload in intrauterine growth restriction

K. Melchiorre1,4, G. Sutherland2, M. Liberati3, B. Thilaganathan1 1Fetal Maternal Medicine Unit, Department of Obstetrics and Gynecology, St Georges Hospital, University of London, London, United Kingdom; 2Department of Cardiology and Cardiothoracic Surgery, St Georges Hospital, University of London, London, United Kingdom; 3University of Chieti, Chieti, Italy; 4Department of Obstetrics and Gynaecology, Spirito Santo Hospital, Pescara, Italy