R. Librizzi

OP36.05: Isolated intra-abdominal umbilical vein (IAUV) varix in 163 fetuses: antenatal management and postnatal outcomes

Y. Mivelaz1, K. I. Lim2, C. Templeton1, C. I. Andrew3, J. E. Potts1, G. G. Sandor1 1Division of Cardiology, Department of Pediatrics, BC Children’s Hospital, The University of British Columbia, Vancouver, BC, Canada; 2Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, BC Women’s Hospital, The University of British Columbia, Vancouver, BC, Canada; 3Division of Cardiac Surgery, Department of Surgery, BC Children’s Hospital, The University of British Columbia, Vancouver, BC, Canada

OC06.06: Fetal myocardial performance (Tei) index and left ventricular shortening fraction (LVSF)

Methods: Routine two dimensional fetal scans were performed in 123 consecutives singleton pregnancies during the second half of pregnancy. General Electric E8 ultrasound equipment was used in all cases. Mechanical PR interval was measured from the onset of the mitral A wave to the onset of the aortic ejection flow, using previously described technique for standard and modified Tei index. All measurements were taken twice by two different operators. For statistical analysis mean and standard deviation was used position measurement. For comparison between two groups and the inter observer agreement Least square analysis was performed. Results: The mechanical PR interval was easily obtained in all 123 cases. The mean gestational age was 25.5 weeks (18–38 weeks). The PR interval was 117,97ms (SD: 9.49 mseg), in standard Tei index group, and 119,11ms. (SD: 10.71 m seg) in modified Tei index group. There was a positive correlation between PR interval and gestational age (COV 2.48). There was no significant difference between both groups (t student 99%:261 > t calculated −0,068). Difference between Inter observer was not significant (t student 99%: 2,61 > t calculated −0.087). Conclusion: The pulsed Doppler assessment using standard and modified Tei index approach of the mechanical PR interval in the fetus, is a feasible and could be used to explore the fetal atrio ventricular conduction abnormalities. It is reproducible and easily obtained during the routine second half of gestation and the normal range is similar to that described with other methods.

OP04.20: The ductus venosus diameter and pulsatility index in fetuses with congenital heart disease

Objective: To present an investigation of range of the pulsatility index (PI) and the smallest diameter in the ductus venosus (DV) in normal fetuses with normal DV Doppler flow patterns (PI) throughout gestation. Methods: This was a cohort study performed by one sonographer between September 2004 and March 2006. The DV was identified by color aliasing of the vessel arising from the intraabdominal umbilical vein; the color scale then increased and the color gain reduced until the echogenic surfaces of the DV could be observed with near transparent color flow. At least 3 measurements were made in each fetus, all performed during fetal quiescence. SPSS software was used to create nomograms for DV size and PI against gestational age (GA) from 1000 cases of normal fetuses with normal outcomes. 1,175 normal fetuses age 12 to 40 weeks with average growth, were evaluated for Doppler flow in the DV after obtaining IRB approval. Results: 1039 cases (88.43%) of DV PI measurement and 1000 cases (85.11%) of DV size measurement were recorded as satisfactory measurements. A nomogram was constructed from the results, using the average of the three measurements for each fetus. The median size of the DV was linear across gestation. The DV PI was highest in first trimester. All of the fetuses were discharged after term delivery in normal condition.

P04.04: Benign fetal ventricular arrhythmias: Doppler and m‐mode findings

end of the systole was the minimum cavity size visualized during the cardiac cycle. E/A wave, aortic root, fetal heart rate and diameters longitudinal and transverse of the left ventricle were recorded too. Analysis data’s was made by Stata software. Results: Congenital cardiac anomalies EF% mean in left ventricle was reported in 51.93%. Low values 29.5%. Maximum value 84.2% with a standard deviation of 12.8. Mean ejection fraction in left ventricle fetuses with mothers who had gestational diabetes was reported with 55.29% with a low value in 39% and maximum value in 72% and standard deviation in 9.1. Conclusions: The ejection fraction on the fetal left ventricle by planimetric doesn’t change neither mothers diabetic compensated nor fetuses with cardiac congenital anomalies. More data’s have to be collected to correlated these findings.

P03.11: The role of the redundant septum primum in RV greater than LV disproportion

Objective: Ventriculocoronary connections (VCC) can be prenatally visualized in fetuses with pulmonary (PA) and aortic atresia (AA) and intact ventricular septum (IVS). After prenatal diagnosis an improvement of outcome may be achieved by modification of perinatal and operative management. Method: We identified retrospectively 13 fetuses with prenatally diagnosed VCC, 10 with PA-IVS and 3 with AA-IVS in our database between 2003 and 2008. Prenatal findings, perinatal management and outcome were analysed. Results: In fetuses with PA-IVS prenatal diagnosis of VCC was correlated with small right ventricle and tricuspid annulus and absence of tricuspid regurgitation. One fetus had an additional tricuspid atresia resulting into a back-and-forth blood flow via VCC between the hypoplastic right ventricle (RV) and thickened coronary arteries. Three fetuses with AA-IVS showed a hypoplastic left ventricle with endocardial fibroelastosis and two of those had a restrictive foramen ovale. Of the ten fetuses with PA-IVS, termination of pregnancy was performed in 1 fetus; 1 severely growth restricted fetus died as consequence of uteroplacental dysfunction and acute CMV-infection, 1 fetus died postoperatively during surgical commissurotomy: 1 fetus died days after BT anastomosis; four fetuses had single ventricle palliation and two fetuses a biventricular repair. Norwood procedure was successfully performed in the three fetuses with severe obstruction of the left ventricular outflow tract. Conclusions: Prenatal diagnosis of VCC has important implications for prenatal counselling. A special perinatal approach is required in fetuses with PA-IVS because hypoplastic RV and RV-dependent coronary circulation do not allow opening of the obstructed pulmonary valve resulting in a single ventricle repair. In fetuses with hypoplastic left heart the presence of VCC seems not to worsen the outcome of Norwood procedure.

P25.14: Does no offset of the atrioventricular valve heights in an otherwise normal fetal heart indicate trisomy 21?

Objective: The aim of the study was to compare value of two cardiovascular scores based on fetal echocardiography before and after laserotherapy in TTTS. Material and Methods: Between January 2006 and December 2008, 28 twin pregnancies were estimated by fetal echocardiography before and after invasive treatment (selective fetoscopic laser coagulation of vascular anastomoses on the placental surface) of TTTS performed at the Polish Mother’s Memorial Hospital Research Institute in Lodz. Fetal echocardiography was evaluated before procedure (24–48 h) and after. Fifty six fetuses (28 recipients and 28 donors) were included in the study. Mean maternal age was 28 (19–37y). In majority there were low risk pregnancies (25/28). Mean gestational age at the diagnosis was 19 weeks and 1 day (16–22w). Mean gestational age at fetoscopic laser coagulation was 20 weeks (18–25w). Mean Quintero stage at the fetal surgery was II (II–III). Cardiovascular Profile Score (CVPS, Huhta’s score) and Cardiovascular Score (CVS, Rychik’s score) were estimated for recipients and donors before and after procedure. Results: Overall mortality was 39% (22/56): 25% in recipients group (7/28, including 2 interauterine deaths – IUD and 54% donors group – 54% (15/28, including 10 IUD). In the recipients group changes adequate to outcome were observed at 93% in CVS and at 53% at CVPS. In the donors group changes adequate to outcome were noted at 11% in CVS and at 29% in CVPS. High percentage of IUD among donors unexplained neither by CVS (60%) nor CVPS (80%) rates draws attention. Conclusions: 1. CVP and CV scores proved their usefulness in the recipient cardiovascular assessment. 2. The CVS recipient score varies much more significantly than CVPS. 3. Facing lack of CVPS and CVS variability in the donor group new cardiovascular insufficiency assessment methods should be researched in this group, for the real reason for high IUD occurrence rate remains obscure.

OP04.04: The myocardial performance (Tei) index is more reliable than shortening fraction (LVSF) in early late trimester fetuses for determining ventricular function

M. Habli2,3, J. F. Cnota1, A. Divanovic1, T. M. Crombleholme3, M. Kinsel-Ziter1, R. Keller1, E. C. Michelfelder1 1Fetal Heart Program, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA; 2Division of Maternal Fetal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA; 3Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

P51.11: The practical use of 3D rendering for routine screening of the fetal spine

by subtracting the embryo volume from the gestational sac volume. If the amniotic cavity was visualized, the embryo volume was subtracted from it to obtain the amniotic fluid volume. Regression analysis was used to determine correlation between gestational age and gestational amniotic volume. The level of significance was set at P < 0.05. Results: Amniotic fluid volume increased from 4.42 to 24.36 cc from the 7th to the 10th week (P < 0.05), using the VOCAL TM technique and there was a correlation between gestational age and gestational amniotic fluid volume in the range from the 7th to the 10th week (VLA =2.641×GESTATIONAL AGE2 – 38.285×GESTATIONAL AGE +143.06, r2 = 71.12%). Conclusion: We have demonstrated that the gestational amniotic fluid volume, using the VOCAL TM technique, increases in the first trimester. In addition, we showed that the higher the gestational age, the larger the amniotic fluid.

OP04.27: The association between the active fetus, the septum primum, premature atrial contractions (PACs) and cocoa butter

patients there is no therapeutic standard treatment. The aim of this study was to present a therapeutic schema for the intrauterine treatment of fetal tachyarrhythmia based on literature and own experiences. Methods: Based on a metaanalysis from 2003 compiling articles until 2002, we analysed all further articles about intrauterine therapy of fetal tachyarrhythmia published from 2002 onwards. All the publications were analysed for the presence of hydrops fetalis, type of tachyarrhythmia, and the type and success rate of antiarrhythmic drugs used for first, second, and third line therapy in fetal tachyarrhythmia. Results: In non-hydropic fetuses treatment with Digoxin is successful in 63% of cases, whereas the success rate drops to 20% in fetuses with hydrops fetalis. In these cases of hydropic fetuses a combined primary antiarrhythmic drug therapy with Digoxin and either Flecainide (in supraventricular tachycardia) or Soltalol (in atrial flutter) is favorable. According to the literature conversion rate to sinus rhythm reaches 90%. In second-line therapy Amiodarone has a success rate of 50%, if used orally. Direct application of antiarrhythmic drugs (Adenosine, Amiodarone) via cordocentesis has been used just in few cases. Conclusions: Digoxin is still the drug of first choice in non-hydropic fetuses with tachyarrhythmia. In hydropic fetuses initial combined therapy – dependend on the type of tachyarrhythmia – with Digoxin and Flecainide or Soltalol are mostly successful. Amiodarone given orally is useful a second-line therapy. A prospective multicentre study is mandatory for further evaluation of intrauterine treatment of fetal tachyarrhythmia.

OC149: The size and pulsatility of the ductus venosus in normal fetuses and those with cardiac anomalies, heart failure or growth restriction

in the study period. In all cases we performed a complete fetal echocardiography with B – Mode and color Doppler. The threevessel views were stored with color Doppler. In the study period we were able to detect 36 congenital heart defects between 11 + 0 and 13 + 6 gw. We differentiate between the following groups: Coarctation aortae N = 10; AVSD (atrioventricular septal defect, one with right aortic arch) N = 8; Fallot N = 1; PA (pulmonary atresia) N = 2; HLHS (hypoplastic left heart) N = 4; DORV (double outlet right ventricle, one with right aortic arch) N = 3; right sided Aortic arch N = 8; Aortic stenosis N = 1, TAC (Truncus arteriosus communis) N = 1 (the TAC was together with right sided aortic arch). Results: It was possible to examine the three-vessel view in all normal cases with color Doppler during the study period. In 23 of the 36 (63%) detected congenital heart defects the three – vessel view was suspicious. The suspicious findings were the direction of blood flow, turbulences (together with small b-mode diameter and four-chamber-view findings) or the direction of the aortic arch. Some of these heart defects were not suspicious in the four-chamber view. In 10 cases of suspicious three-vessel view, the NT was in a normal range. In 5 cases the three-vessel view was suspicious without four-chamber-view findings. Conclusions: In an experienced hand the three vessel view have the same diagnostic weight as the four chamber view in detecting CHD. In the presented study there were 63% of the detected heart defects suspicious in the three vessel view.