M. Pan

Color Doppler twinkling artifact in fetuses with echogenic intracardiac foci: echocardiographic observation and clinical significance

To evaluate echocardiographic characteristics and clinical relevance of color Doppler twinkling artifacts in fetuses with isolated echogenic intracardiac foci (EIF).

Z -Score Reference Ranges for the Offset of the Tricuspid Septal Leaflet in Normal Fetuses

Objectives: To determine Z-score equations and reference ranges for mitral valve-tricuspid valve distance (MTD) and the MTD index in the fetal heart. Methods: A prospective cross-sectional study was performed in 899 normal singleton fetuses from 14 to 40 weeks’ gestation. The MTD and interventricular septum length (IVSL) were measured offline after electronic cardiac spatiotemporal image correlation volume acquisition. The MTD index was determined as the ratio of MTD to IVSL. Z-score reference ranges of these measurements were determined against gestational age (GA) and estimated fetal weight (EFW), using regression analysis of the mean and standard deviation (SD). Results: Strong positive correlations were found between the MTD and the independent variables. A simple linear regression model was the best description of the mean and SD of MTD based on GA, while a cubic regression best fitted the mean MTD against EFW. In contrast, the MTD index decreased progressively with the independent variables. Fractional polynomials best fitted the MTD index in terms of GA and EFW. Conclusion: Normal reference values and Z-scores of fetal MTD and MTD index were provided against GA and EFW, which may be useful tools for quantitative assessment of some cardiac and extracardiac diseases.

OP08.01: Assessment of fetal myocardial dynamics by using myocardial tissue Doppler velocity gradient

range 21–64). Both examinations were performed the same day and the ultrasound always before the OHSC. The on-site ultrasound opinions and the post-processing ultrasound diagnoses of saved 3Dvolumes were matched with the OHSC findings. Equipment used was a Medison Accuvix XQ (Medison Co, Ltd, Seoul, Korea) with a 3D transvaginal probe, the post-processing we made by the 3DXI Viewer (Medison). The referral diagnoses for OHSC were infertility (n = 36, 50.70%), bleeding disorder (n = 21, 29.58%), fibroid/polyp (n = 9, 12.68%), repeated pregnancy loss (RPL)/ uterine anomaly (n = 5, 7.04%). Results: The on-site GS ultrasound opinions were negative in 34 (47.89%) patients in contrast to the 32 (45.07%) negative OHSC results. Post-processing and further analysis of the digitally saved 3D-volumes detected lesions in seven additional cases (3 polyps and 4 uterine malformations). Overall, ultrasound failed to detect lesions of four patients (5.63%). However, the ultrasonography detected seven additional uterine pathologies, like intramural fibroids which were not visualized by hysteroscopy. In this study the GS ultrasound had a specificity of 88.89% and sensitivity of 73.58%, while the addition of the off-patient analysis of the 3D volume increased the specificity to 88.89% and a sensitivity to 90.70% in the detection of focal intrauterine lesions. Conclusions: Focal intrauterine lesions such as submucosal fibroids, polyps are often found in the background of common gynecologic disorders such infertility, bleeding disorders and RPL. Although hysteroscopy is regarded as gold standard in the diagnosis, analysis of the 3D ultrasound volume can reach the diagnostic level of hysteroscopy and offers an effective non-invasive diagnostic approach.

OP12.05: Full-volume three-dimensional echocardiographic assessment of right ventricular volume in normal fetuses

Objectives: To evaluate the fetal right ventricular function by using full volume real-time three-dimensional echocardiography (RT-3DE). Methods: One hundred and fifteen normal fetuses with a gestational age ranging from 20 to 40 weeks were studied. By using full volume RT-3DE, fetal right ventricular volumes were outlined and calculated by QLab analysis software. In 2DE the volumes were measured by Shimanaki rule and Simpson’s method. The right ventricular enddiastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and cardiac output (CO) measured by three different calculations were compared. Results: There were 109 fetuses were recruited into study, 6 fetuses with poor echocardiographic images were excluded. The result showed that there were significant difference between Shimanaki rule and Simpson’s method (P < 0.05). There were significant difference between Shimanaki rule and RT-3D (P < 0.05), too. There was no difference between Simpson’s and RT-3DE (P > 0.05). Conclusions: RT-3DE provides an accurate volume measuring method for irregular shaped RV for its independent of geometric assumption in calculating volumes. It may offer a useful approach for better understanding the characteristic of fetal myocardial properties during fetal heart development. Then they are useful to evaluate the changing of the fetal heart function along with the advancing gestational ages. RT-3DE evaluation of the fetal heart right ventricular function is feasible and reproducible.

OP12.06: Full‐volume three‐dimensional echocardiographic assessment of left ventricular volume in healthy human fetuses

Objectives: To evaluate the fetal right ventricular function by using full volume real-time three-dimensional echocardiography (RT-3DE). Methods: One hundred and fifteen normal fetuses with a gestational age ranging from 20 to 40 weeks were studied. By using full volume RT-3DE, fetal right ventricular volumes were outlined and calculated by QLab analysis software. In 2DE the volumes were measured by Shimanaki rule and Simpson’s method. The right ventricular enddiastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and cardiac output (CO) measured by three different calculations were compared. Results: There were 109 fetuses were recruited into study, 6 fetuses with poor echocardiographic images were excluded. The result showed that there were significant difference between Shimanaki rule and Simpson’s method (P < 0.05). There were significant difference between Shimanaki rule and RT-3D (P < 0.05), too. There was no difference between Simpson’s and RT-3DE (P > 0.05). Conclusions: RT-3DE provides an accurate volume measuring method for irregular shaped RV for its independent of geometric assumption in calculating volumes. It may offer a useful approach for better understanding the characteristic of fetal myocardial properties during fetal heart development. Then they are useful to evaluate the changing of the fetal heart function along with the advancing gestational ages. RT-3DE evaluation of the fetal heart right ventricular function is feasible and reproducible.

OC09.05: A quantitative study of fetal diastolic ventricular function: establishing normal values of color M-mode propagation velocity

A STIC volume was also acquired and saved. In post-processing, the volume was rotated to show an apical 4CV. M-mode was applied to the tricuspid annulus, and the amplitude of the resulting wave was measured (mm). Three TAPSE measures were taken and results averaged. Measurements were performed by two observers and interand intra-observer variations were calculated. Results: 50 women were recruited at 20 to 38 wks. STIC-TAPSE values were plotted against GA and estimated fetal weight, and these scatterplots compared to those obtained from conventional M-mode TAPSE. Good correlation was found between the two methods. Interand intra-observer variation in STIC-TAPSE were < 15%. Length of post-processing measurement was 30–60 seconds, and decreased following a learning curve. Conclusions: STIC-TAPSE is easy to perform and can be measured even on archival cases. We suggest that this measure may be added to the basket of tests of right heart function, such as ventricular volume, ventricular mass, ejection fraction, etc.