Paweł Własienko

Echocardiographic evaluation of right ventricular function in preterm infants with bronchopulmonary dysplasia

To evaluate right ventricular function in preterm infants with and without bronchopulmonary dysplasia.

Evaluation of left ventricular function in preterm infants with bronchopulmonary dysplasia using various echocardiographic techniques

Echocardiographic evaluation of left ventricular function in preterm infants with and without bronchopulmonary dysplasia.

Myocardial performance index (Tei index) in term and preterm neonates during the neonatal period

BACKGROUND The myocardial performance index (MPI) is a noninvasive method to measure global systolic and diastolic myocardial function. In both term and premature neonates, changes in the systolic and diastolic function of the left ventricle (LV) and right ventricle (RV) reflect the degree of neonatal myocardial immaturity and the co-existence of foetal circulation. AIM To assess MPI (or Tei indices) of both ventricles in term and preterm newborns, and to observe MPI trends throughout the neonatal period. METHODS Heart ultrasound imaging was performed on the first day of life (DOL), after patent ductus arteriosus (PDA) closure, and on the 28th DOL, in 29 term and 29 preterm newborns. RVMPI and LVMPI were measured within the preterm group at 40 weeks of post-conception age (PCA). RESULTS A statistically significant reduction in RVMPI was observed in both term and preterm newborns. In term newborns, the RVMPI value on the first DOL was 0.42 ± 14, dropping to 0.29 ± 0.09 after PDA closure, and finally reaching 0.22 ± 0.09 on the 28th DOL. The respective RVMPI values for the preterm newborns were 0.44 ± 0.15, 0.30 ± 0.12, and 0.21 ± 0.08. Little variability in the mean values of LVMPI was observed in both groups throughout the neonatal period. The LVMPI for term neonates in successive measurements was 0.37 ± 0.10, 0.39 ± 0.07, and 0.37 ± 0.11, respectively, and for the preterm neonates it was 0.37 ± 0.10, 0.35 ± 0.09, and 0.36 ± 0.10, respectively. The MPI values from preterm newborns taken at 40 weeks PCA (RVMPI = 0.28 ± 0.09; LVMPI = 0.37 ± 0.05) were comparable to those measured in term newborns after PDA closure. CONCLUSIONS Observed postnatal changes in RVMPI correspond to changes in ventricular function, reflecting the haemodynamic changes of the transitional circulation. The relatively small postnatal changes in LVMPI in term and preterm newborns may reflect an immature myocardium. The RVMPI and LVMPI values at 40 weeks PCA in preterm newborns correlate best with MPI values in term newborns just after PDA closure.

[Familial congenital diaphragmatic hernia with anencephly-exencephaly and spina bifida].

Congenital Diaphragmatic Hernia (CDH) occurs with an estimated incidence of 1 to 2500 live births. Even though the exact etiology is still unknown, more and more often current research points out genetic factors as the possible cause of the defect. According to the latest data and the own experience 50-60% of CDH cases are isolated. The rest forms a group of CDH complicated by an additional anatomic defect or a genetic syndrome caused by a mutation of a single gene or the whole chromosome. We have presented a case study of a 32 years-old multigravida para 3, who has been referred to the Reference Centre of Prenatal Cardiology in 30 weeks of gestation due to the diagnosis of acrania with exencephaly, spina bifida and suspicion for CDH in a fetus. Although the patients first child died due to CDH, the patient neither before nor during the pregnancy was getting a folic acid supplementation. Moreover, she has not agreed on a further cytogenetic testing or an advanced consultation with a clinical geneticist. The child died after delivery in a local hospital. The case was described to indicate the problem that the CDH diagnostic procedure is still missing a molecular genetic analysis especially in the cases of recurrent CDH. By saying that in the cases of CDH we should always strive to complete the molecular testing having in mind that by discovering pathogenesis and genes responsible for the formation of CDH we not only might improve the therapeutic methods but also find a way to prevent its development.

775 Myocardial Performance Index (Tei Index) in Preterm Neonates without Bpd

Background To define age-related changes in left (LV) and right (RV) ventricular function by using myocardial performance index (Tei Index) in preterm neonates. Materials and Methods 18 newborn infants were selected from preterm neonates with the gestational age of 24–32 weeks, mean birth weight 917.5 g (min. 520, max. 1920 g). The Tei Index is a Doppler-derived myocardial performance tool which can be used to evaluate the systolic and diastolic function. The first measurement was taken as soon as possible after birth, the second one was taken on day 3 of life, the third one at the 40 th wk post-conceptional age (pca). Results The higher Tei index was obtained in the RV (mean value - 0.39; SD +/–0.15) then the LV (mean value - 0.36; SD +/–0.10) in the first day of life. In the LV the Tei index was constant during the neonatal period and at 40 wks pca (from mean value 0.36-day 1, 0.35 day 3 and at 40 wks pca.), and we observed the conversion in the RV between the first and the third day of life and at 40 wks pca (mean value 0.39- day 1 to 0.30 -day 3 and to 0.28 at 40 wks pca). Conclusion The higher mean value of the Tei index in the RV might be reflecting the “persistent” fetal status of this ventricle in the first day of life. Although constant value of the Tei index in the LV reflect the degree of neonatal myocardial immaturity. Grant- MNiSW No. 407414336.

P12.08: Ductus venosus and umbilical vein flows in fetuses with atrial flutter and atrial fibrillation

women were referred for fetal cardiac screening, the remainder for suspected abnormalities. Fetal Cardiac abnormalities were diagnosed in 16/375 (4.3%) of ‘high risk’ screened women. They included 3/61 (5%) screened women with maternal cardiac disease, 9/166 (5.4%) previous child/sibling? with CHD, 4/34 (11.8%) of screened women with diabetes mellitus. Fetal cardiac abnormalities were identified in 18/375 (4.8%) women who had multiple risk factors. There were no obvious fetal cardiac defects among screened groups with a history of paternal CHD, previous child with CHD, maternal antibodies, and history of drug intake. Conclusions: The rate of antenatally diagnosed cardiac defects is higher than expected among our screened population. However, subgroup analysis revealed that it may vary between groups. Future studies are required to evaluate the implication of implementation of routine fetal cardiac screening policy on the antenatal detection rate of CHD and its management.

OP28.07: Lethal anomalies in fetuses—the role of perinatal palliative care

report series of 4 cases of termination of pregnancy done on the basis of ultrasound diagnosis of bilateral renal agenesis and ahydramnios during the period of 365 days. We describe interesting epidemiology of two variants of these cases and difficult early prenatal diagnosis in the first trimester anomaly scan which should be the aim to minimize the trauma related to the termination of pregnancy at advanced gestation.

P22.04: Premature constriction of the ductus arteriosus in both fetuses of dizygotic twin pregnancy following maternal non‐steroidal anti‐inflammatory drugs application

from January 2006 should include extended cardiac examination (including 4-chamber view, three vessel view and outflow tract views, including colour doppler). However, this should only be performed when possible without extending the standard examination time (30 minutes). All screening procedures were performed by sonographers, specially trained in 2nd trimester ultrasound. All examinations were registered in a fetal medicine database (Astraia), and the proportion of women having a complete extended cardiac examination was monitored quarterly, and reviewed at regular meetings. In Q1 and Q2, 2009, all sonographers at the department completed a two day ‘hands-on course’ in extended cardiac screening. Results: The quarterly proportion of women having an extended cardiac screening is shown on the graph. The time for full implementation was 3 2 year. Conclusions: Implementation of 2nd trimester extended cardiac screening is feasible without extending the examination time of 30 minutes for a complete 2nd trimester examination. The proportion of accomplished extended cardiac screening only exceeded 98% after dedicated ‘hands-on’ training for all sonographers. Monitoring, supervision and early ‘hands-on’ training seem to be of importance in the implementation process.

OP33.03: Fetal heart measurement assessed by 4D ultrasound using STIC combined with inversion mode - preliminary results

Results: In normal fetuses, it was possible to identify the respective position of the inferior vena cava and the descending aorta in all cases. In the 3 cases with left atrial isomerism, it was possible to identify the azygos continuation adjacent to the descending aorta and the abnormal stomach position. In no case could the multiple spleens be identified. In the 3 cases with right atrial isomerism, it was possible to identify the abnormal central position of the inferior vena cava and the displacement of the stomach to the left. The abnormal liver morphology consistent with left and right isomerism could be identified in 5/6 cases. Discussion: Identification of fetal situs has so far been carried out by assessing the position of the abdominal vessels on an axial view of the fetal abdomen. Using the coronal plane of the fetal trunk from three-dimensional volumes, it was possible to identify visceral anatomic patterns consistent with a diagnosis of situs solitus or ambiguous (left or right isomerim) independently from the type of congenital heart disease present. This may be of help in difficult cases to tag the type of cardiosplenic syndrome.

P31.04: Atrial flutter with atrio‐ventricular block 2 : 1—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.