Sep 28, 2016 - The DRs in the different groups of aorta-pulmonary positions were not .... Prenatal Cardiology, Polish Mother Memorial Hospital. Research ...
25–28 September 2016, Rome, Italy introduction of the three vessel view (3VV) in 2012. Furthermore we explored if DRs are dependent on the spatial relationship of aortic and pulmonary artery position, as this may influence the appearance of the 3VV. Methods: All pre- and postnatal TGA ± VSD cases were extracted from our regional congenital heart defects registry (2007–2015). The methods of data collection was previously described (BJOG. 2016 feb; 123(3):400–7). Aorta-pulmonary positions were retrieved from surgical reports (Ao right anterior to PA / Ao right sided of PA / Ao anterior to PA / Ao left anterior to PA). Results: Of the 94 TGA, 20 (21%) had a VSD. In total 59 (63%) had a prenatal diagnosis. DRs increased significantly over time (linear regression 7.2%/year, p < 0.05). After introduction of 3VV the DR averaged 85%. The DRs in the different groups of aorta-pulmonary positions were not statistically different. Conclusions: A nationally organised prenatal screening program with a quality monitoring system and a uniform protocol, including 3VV, enabled a DR of 85% for TGA. This level of DRs have never been described before in a population based cohort setting. A significant relationship between DRs and Ao-PA positions was not present, but this comparison might be underpowered.
Supporting information can be found in the online version of this abstract
OP20.08 Examination of 16 prenatal neonates diagnosed with simple coarctation of the aorta T. Tanaka, N. Inamura Department of Pediatric Cardiology, Osaka Medical Centre and Research Institute for Maternal and Child Health, Izumi Osaka, Japan Objectives: Coarctation of the aorta (CoA) is disorder that causes shock in the early neonatal stage, with many cases being reported; therefore, detecting the disease in fetuses is important. The objective of study was to make an index for simple characterisation of CoA for postnatal treatment. Methods: The subjects were 16 neonates born premature between 2012 and 2015 and suspected to have CoA, which was not complicated by a ventricular septal defect. Of the 16 cases, 6 required postnatal surgery (Surgery group: S group), while 10 did not require surgery (None group: N group). According to a past report, aortic (AO) and pulmonary artery (PA) diameters, and left and right ventricle transverse diameters (LVD and RVD, respectively), and aortic, pulmonary, mitral, and tricuspid valve diameters (AVD, PVD, MVD, and TVD, respectively) were measured. From those measured values, AO/PA, LVD/RVD, AVD/PVD, MVD/TVD, and z-scores of AO, PA, LVD, RVD, AVD, PVD, MVD, and TVD were calculated. Univariate analyses were performed between S and N groups, and receiver operating characteristic (ROC) curve analyses and multivariate analyses were performed; the multivariate analysis only included variables identified to display significant differences between S and N groups in the univariate analysis. Results: Significant differences were detected in the size of AO (z-score), AO/PA ratio, AVD (z-score), and AVD/PVD ratio upon comparing two groups. The cut-off values obtained by ROC curve were AO (z-score) < −1.2 (sensitivity, 83%; specificity, 80%), AO/PA ratio < 0.66 (sensitivity, 100%; specificity, 90%), AVD (z-score) < −0.8 (sensitivity, 100%; specificity, 80%), and AVD/PVD ratio < 0.65 (sensitivity, 100%; specificity, 90%). Significant differences in AO/PA ratio and AVD (z-score) were obtained when multivariate analysis, which included the four variables that were found to be significantly different between S and N group in the univariate analyses, was performed.
Short oral presentation abstracts Conclusions: AO/PA ratio and AVD z-score measurements are useful in postnatal prognosis for fetuses suspected to have simple CoA.
OP20.09 Fetal biometry and Doppler changes in transposition of great arteries compared to left-sided heart lesions J. Binder1,2 , S. Carta1 , B. Thilaganathan1 , A.T. Papageorghiou1 , A. Bhide1 , A. Khalil1 1 Fetal Medicine Unit, St George’s Hospital, London, United Kingdom; 2 Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Vienna, Austria
Objectives: Recent studies have reported an altered cerebral circulation in fetuses with congenital heart defects (CHD), suggestive of brain sparing. However, these changes have not been ascertained in the different types of CHD. The aim of this study was to investigate the changes in the fetal biometry and Doppler in transposition of great arteries (TGA) compared to left-sided heart lesions. Methods: This was a case–control study including singleton pregnancies with fetal TGA (n = 11) and left-sided heart lesions (n = 25), which included hypoplastic left heart syndrome, aortic stenosis, interrupted aortic arch and aortic coarctation. The control group (n = 729) consisted of pregnancies in which the fetuses had undergone detailed cardiac assessment in order to exclude CHD. Pregnancies complicated by extra-cardiac major structural abnormalities, chromosomal or genetic abnormalities were excluded. The umbilical artery (UA) pulsatility index (PI) and middle cerebral artery (MCA) PI were recorded after 20 weeks’ gestation. The head circumference (HC), abdominal circumference (AC) and estimated fetal weight (EFW) values were converted into z scores and centiles, and Doppler parameters into multiples of the median (MoM), adjusting for gestational age. Results: The UA PI was significantly higher (p < 0.001), while the MCA PI (p = 0.449) was not significantly different in the TGA group compared to the control group. The UA PI was significantly higher, while the MCA PI was significantly lower in the group with left-sided heart lesions (p < 0.001 for both). The EFW centile was significantly lower in both the TGA (median 4.96; IQR 0.07-50.04 vs 51.30; 28.58-70.13, p < 0.001) and left-sided heart lesions (median 28.37; IQR 0.13-40.09 vs 51.30; 28.58-70.13, p < 0.001) groups compared to the control group. Conclusions: Left-sided heart lesions, but not TGA, are associated with evidence of brain sparing. Both groups of CHD are associated with smaller fetal biometry and raised UA Doppler.
OP20.10 Prenatal diagnosis improve neonatal outcome only in severe coarcation of the aorta M. Slodki1,2 , N.S. Seligman3 , A. Augustyniak5 , M. Glowacka1 , K. Zych-Krekora2 , J. Moll4 , M. Respondek-Liberska6 1
Institute of Health Sciences, State School of Higher Professional Education, Plock, Poland; 2 Department of Prenatal Cardiology, Polish Mother Memorial Hospital Research Institute, Lodz, Poland; 3 Department of Obstetrics and Gynecology, University of Rochester Medical Centre, Rochester, NY, USA; 4 Department of Pediatric Cardiology, Polish Mother Memorial Hospital Research Institute, Lodz, Poland; 5 Department of Anesthesiology and Intensive Medical Therapy, Polish Mother Memorial Hospital Research Institute, Lodz, Poland; 6 Department of Fetal Malformations, Medical University Lodz, Lodz, Poland; Authors are members of International Prenatal Cardiology Collaboration Group
© The Authors 2016 © Ultrasound in Obstetrics & Gynecology 2016; 48 (Suppl. 1): 51–166.
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