Winnie Savard

Severe left heart obstruction with retrograde arch flow influences fetal cerebral and placental blood flow

Decreased middle cerebral artery (MCA) pulsatility index (PI) is a marker of fetal brain‐sparing in placental insufficiency and it is also found in fetuses with severe congenital heart disease. This study sought to explore the impact of anatomical subtypes in fetal heart disease on MCA‐PI and head growth.

Changes in fetal cardiac axis between 8 and 15 weeks' gestation

To document changes in the normal embryonic/fetal cardiac axis in the late first and early second trimesters of pregnancy.

Population Trends in Prenatal Detection of Transposition of Great Arteries: Impact of Obstetrical Screening Ultrasound Guidelines

Dextro‐transposition of the great arteries (d‐TGA) is one of the most common critical neonatal heart defects, with a low detection rate antenatally. We sought to evaluate trends in the prenatal detection of d‐TGA with or without ventricular septal defect (VSD) in Alberta over the past 13 years, examining the potential impact of ultrasound guidelines incorporating screening of cardiac outflow tracts, updated in 2009–2010 and in 2013, and factors affecting detection of the condition.

The Incremental Benefit of Color Tissue Doppler in Fetal Arrhythmia Assessment

Background: Accurate fetal arrhythmia (FA) diagnosis is key for effective management. Currently, FA assessment relies on standard echocardiography‐based techniques (M mode and spectral Doppler), which require adequate fetal position and cursor alignment to define temporal relationships of mechanical events. Few data exist on the application of color Doppler tissue imaging (c‐DTI) in FA assessment. The aim of this study was to examine the feasibility and clinical applicability of c‐DTI in FA assessment in comparison with standard techniques. Methods: Pregnancies with diagnosed FA were prospectively recruited to undergo c‐DTI following fetal echocardiography. Multiple‐cycle four‐chamber clips in any orientation were recorded (mean frame rate, 180 ± 16 frames/sec). With offline analysis, sample volumes were placed on atrial (A) and ventricular (V) free walls for simultaneous recordings. Atrial and ventricular rates, intervals (for atrial‐ventricular conduction and tachyarrhythmia mechanism), and relationships were assessed to decipher FA mechanism. FA diagnosis by c‐DTI, conventional echocardiographic techniques, and postnatal electrocardiography and/or Holter monitoring were compared. Results: FA was assessed by c‐DTI in 45 pregnancies at 15 to 39 weeks, including 16 with atrial and/or ventricular ectopic beats; 18 with supraventricular tachyarrhythmias, including ectopic atrial tachycardia in 11, atrioventricular reentrant tachycardia in four, atrial flutter in two, and intermittent atrial flutter and junctional ectopic rhythm in one; three with ventricular tachycardias; and eight with bradycardias or atrioventricular conduction pathology, including five with complete atrioventricular block (AVB), one with first‐degree AVB evolving into complete AVB, one with second‐degree AVB, and one with sinus bradycardia. After training, FA diagnosis by c‐DTI could be made irrespective of fetal orientation within 10 to 15 min. FA diagnosis by c‐DTI concurred with standard techniques in 41 cases (91%), with additional findings identified by c‐DTI in 10. c‐DTI led to new FA diagnoses in four cases (9%) not definable by standard techniques. FA diagnosis by c‐DTI was confirmed in all 20 with persistent arrhythmias after birth, including three with new diagnoses defined by c‐DTI. c‐DTI was particularly helpful in deciphering SVT mechanism (long vs short ventricular‐atrial interval) in all 18 cases, whereas standard techniques permitted definition in only half. Conclusions: c‐DTI with offline analysis permits rapid and accurate definition of FA mechanism, providing new information in nearly one‐third of affected pregnancies. HIGHLIGHTSAn innovative method of evaluating fetal arrhythmia is proposed.This method proved to be fast and accurate in this study.Color TDI contributes to fetal arrhythmia diagnoses made by standard echo techniques.

Parameters of fetal pulmonary vascular health: baseline trends and response to maternal hyperoxia in the second and third trimesters

Several parameters, including branch pulmonary artery (PA) diameter and Doppler‐derived PA acceleration‐to‐ejection time ratio (AT/ET), peak late‐systolic/early‐diastolic reversed flow (PEDRF) and pulsatility index (PI) response to maternal hyperoxia, have been used to investigate fetal pulmonary health. Lower AT/ET, increased PEDRF and lack of PI response to hyperoxia have been observed in fetuses with severe lung hypoplasia and are considered markers of pulmonary vascular resistance. We sought to further define the evolution of PA diameter and Doppler parameters and their response to maternal hyperoxia in healthy fetuses.

IMPACT OF MATERNAL DIABETES ON FIRST & EARLY SECOND TRIMESTER FETAL CARDIOVASCULAR HEALTH

Background: Maternal diabetes mellitus (DM), which affects 6-7% of pregnancies, is associated with fetal myocardial hypertrophy and altered diastolic function later in gestation, but its impact on the fetal heart earlier in gestation has received minimal attention. We sought to determine if maternal

EVOLUTION OF THE FETAL ATRIOVENTRICULAR (AV) INTERVAL FROM 6-40 WEEKS OF GESTATION

Fetal atrioventricular (AV) conduction can be indirectly assessed by measuring the Doppler-derived AV interval (AVI) at fetal echocardiography. Normal values have been published from 16-18 weeks gestational age (GA) to term. We sought to investigate the evolution of the AV interval from 6 to 40

ALTERED UMBILICAL ARTERIAL BLOOD FLOW IN THE 3RD TRIMESTER AND ITS ASSOCIATION WITH CLINICAL AND NEURODEVELOPMENTAL OUTCOMES IN CHILDREN WITH HYPOPLASTIC LEFT HEART SYNDROME

Children with hypoplastic left heart syndrome (HLHS) are at increased risk of compromised clinical and neurodevelopmental (ND) outcomes. Recently, placental pathology with late gestation onset has been found to be common in HLHS. In the present study, we investigate the relationship of umbilical