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New classifications of prenatally diagnosed congenital heart defects and their influence of neonatal survivability 产前诊断先天性心脏缺陷的新分类及其对新生儿存活率的影响
Pub Date : 2015-09-01 DOI: 10.12847/09151
M. Słodki, M. Respondek-Liberska
Abstract Attempts to adapt the classifications of pediatric congenital heart defects (CHD) to prenatal cardiology have been lasting for many years. The paediatric cardiology CHD classifications are mainly based on anatomic details and/or pulmonary blood flow and are not always useful in fetal medicine. Because of these reasons and also many more, adaptation attempts of congenital heart defects of children, from pediatric to prenatal cardiology have not brought desired effects.Clinical course in utero and at delivery can now be predicted, and as a consequence, fetal medicine specialists are being asked to consider the fetus as a patient and the transition to postnatal life is an important part of care. The new prenatal classifications of CHD shows new particular group of CHD, requiring emergent procedure after birth. Thanks to organizing special delivery room with special team of specialist we can much more improve the outcome, especially in severest CHD.
将儿童先天性心脏缺陷(CHD)的分类与产前心脏病学相适应的尝试已经持续了多年。儿科心脏病学的冠心病分类主要基于解剖细节和/或肺血流,在胎儿医学中并不总是有用的。由于这些以及更多的原因,从儿科到产前心脏病学,对儿童先天性心脏缺陷的适应尝试并没有带来预期的效果。现在可以预测子宫内和分娩时的临床过程,因此,胎儿医学专家被要求将胎儿视为患者,并将其过渡到产后生活是护理的重要组成部分。新的产前冠心病分类显示了新的特殊的冠心病群体,需要在出生后进行紧急手术。由于组织了专门的产房和专门的专家团队,我们可以更好地改善结果,特别是在最严重的冠心病。
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引用次数: 11
Prenatal invasive decompression therapy of an arachnoid cyst in a fetus with normal heart anatomy and no functional anomalies - a case report 心脏解剖正常无功能异常胎儿蛛网膜囊肿的产前有创减压治疗1例
Pub Date : 2015-09-01 DOI: 10.12847/09156
J. Malinowski, M. Słodki, K. Szaflik, Wanda Mikolajczyk-Wieczorek
Abstract We present a case of a female fetus with large posterior fossa cyst. After detailed diagnosis in referral center revealing normal heart anatomy and no functional abnormalities in cardiovascular system, a trial decompression of the fluid reservoir was suggested to the parents and successfully performed at the 30th week of pregnancy. Neurosurgical treatment was continued in the neonatal period. At the age of 7 months, the child presented normal physical development, and the cranial image of the CNS showed good recovery of the brain.
摘要我们报告一例女性胎儿与大后窝囊肿。经转诊中心详细诊断,发现心脏解剖正常,无心血管系统功能异常,建议父母进行储液池减压试验,并于妊娠第30周成功实施。新生儿期继续进行神经外科治疗。7个月时,患儿身体发育正常,中枢神经系统颅脑图像显示大脑恢复良好。
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引用次数: 1
State of art of MRI of fetal heart 胎儿心脏核磁共振成像技术进展
Pub Date : 2015-09-01 DOI: 10.12847/09152
L. Manganaro
Abstract Congenital heart defect (CHD) is one of the most common type of fetal malformations. Tissue-Doppler imaging, dynamic threedimensional (4D) echocardiography and fetal cardiac magnetic resonance imaging (MRI) are advanced modalities for the assessment of cardiac structure and function. MRI can study the cardiac morphology using T2-weighted half-Fourier single-shot turbo spin-echo sequence (HASTE) and steady-state free precession (True FISP) sequences. Also a dynamic study can be performed, through the acquisition of cine-MR sequences with real-time steady-state free precession (SSFP) oriented according to the standard projections used in fetal echocardiographic scanning. If the challenges relating to motion and cardiac gating can be overcome, MRI has the potential to provide high-resolution imaging of the fetal heart.
先天性心脏缺陷(CHD)是最常见的胎儿畸形之一。组织多普勒成像、动态三维超声心动图和胎儿心脏磁共振成像(MRI)是评估心脏结构和功能的先进方法。MRI可以利用t2加权半傅立叶单次涡轮自旋回波序列(HASTE)和稳态自由进动序列(True FISP)研究心脏形态。此外,根据胎儿超声心动图扫描中使用的标准投影,通过实时稳态自由进动(SSFP)获取电影磁共振序列,也可以进行动态研究。如果能够克服与运动和心脏门控相关的挑战,MRI有可能提供胎儿心脏的高分辨率成像。
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引用次数: 1
Routine third trimester fetal cardiac evaluation: time for consideration 常规妊娠晚期胎儿心脏评估:考虑时间
Pub Date : 2015-09-01 DOI: 10.12847/09154
I. Strzelecka, J. Płużańska, J. Węgrzynowski, T. Moszura, M. Słodki, M. Respondek-Liberska
Abstract Most heart defects form between 4 and 6 weeks after fertilization. The detection rate is still growing. Despite significant progress in prenatal diagnosis some cases still go undetected. We present two cases of similar defects: prenatally detected and undetected, both presenting with a normal four chamber view in mid-pregnancy. We compared the follow-up of both neonates along with sustained health and economic consequences. The dynamics of the development of heart defects during prenatal life suggests the legitimacy to perform additional, late echocardiography exams (35-38 weeks of gestation)
大多数心脏缺陷形成于受精后4 ~ 6周。检出率仍在增长。尽管产前诊断取得了重大进展,但仍有一些病例未被发现。我们提出了两例类似的缺陷:产前检测和未检测,在妊娠中期均呈现正常的四腔视图。我们比较了两名新生儿的随访情况以及持续的健康和经济后果。产前心脏缺陷的动态发展表明,进行额外的后期超声心动图检查(妊娠35-38周)是合理的。
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引用次数: 16
Recommendations for Fetal Echocardiography in Singleton Pregnancy in 2015 2015年单胎妊娠胎儿超声心动图建议
Pub Date : 2015-06-01 DOI: 10.12847/06155
M. Respondek-Liberska, M. Sklansky, D. Wood, M. Słodki, S. Weiner, B. Cuneo, J. Huhta, U. Gembruch, G. Rizzo, G. Sharland, R. Achiron, J. Pruetz
Abstract The first recommendations and guidelines for physicians training in fetal echocardiography (FE) were created in 1990 and later on up-dated by multiple medical associations and journals in Europe and the United States. This time advanced fetal cardiac ultrasound recommendations focused more on the organizational and logistical aspects of FE, to better define the fetal echo guidelines for practitioners in tertiary centers. Underlined is FE in 3rd trimester, with special attention to the direction of flow across the foramen ovale and ductus arteriosus. AHA classification of heart defects in prenatal cardiology into seven major groups (from 2014) is presented as well as the Polish classification into four groups (from 2012) related to the urgency of required time to postnatal treatment/intervention based on FE findings in the 3rd trimester of pregnancy. Current definition of fetal cardiologist in 2015 is also presented.
针对胎儿超声心动图(FE)医生培训的第一批建议和指南创建于1990年,后来由欧洲和美国的多个医学协会和期刊进行了更新。这一次先进的胎儿心脏超声建议更多地集中在组织和后勤方面的FE,以更好地定义胎儿超声指南的从业者在三级中心。下划线为妊娠晚期的FE,特别注意通过卵圆孔和动脉导管的血流方向。美国心脏协会(AHA)将产前心脏病学中的心脏缺陷分为七大类(自2014年起),波兰根据妊娠晚期FE发现的产后治疗/干预所需时间的紧迫性将心脏缺陷分为四大类(自2012年起)。并介绍了2015年胎儿心脏病专家的定义。
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引用次数: 13
Can Inflammatory Markers Diagnosed Upon Ultrasound Examination During Pregnancy Regress After Administration of Vaginal Treatment? – A Pilot Study 妊娠期间超声检查诊断出的炎症标志物在阴道治疗后会消退吗?-一项先导研究
Pub Date : 2015-06-01 DOI: 10.12847/06152
M. Szubert, M. Respondek-Liberska
Abstract Background: Inflammatory markers in prenatal ultrasound are a heterogeneous group of images that can evolve during pregnancy, due to regression or exacerbation of infection in pregnant women. Objective:The assessment if effective rebalancing of the bacterial flora of the vagina can lead to withdrawal of the symptoms of inflammation in ultrasound examination (US). Methods: A retrospective pilot study, among pregnant woman admitted to the Department of Prenatal Cardiology ICZMP in 2013-2014 in whom ultrasonographic signs of intrauterine infection were present. Electronic database were searched for key words ”infection, placentitis, tricuspid regurgitation, poly/oligohydramnion, IUGR, CRP, antibiotics, vaginal treatment”. The analysis included 238 patients, 30 received antibacterial vaginal treatment, from 27 patients a complete follow-up (control ultrasound after 10-14 days and data on labor) were obtained. Results: The average age of patients was 29 years. In 22% of patients tricuspid regurgitation was observed and it was the most commonly recognized marker of infection. Regression of infection signs were observed in 21 patients (77.8%) after 2 weeks of vaginal treatment. 2 patients presented with ultrasound image stabilization, in 3 patients worsening of tricuspid regurgitation or cardiac hypertrophy were detected. Polyhydramnios, the second most common parameter (18.51% of patients) resolved after treatment in all studied patients. The delivery took place an average at 39th week of gestation (SD +/- 1.93). Conclusions: Effective anti-inflammatory vaginal treatment improved ultrasound images in 21 out of 27 fetuses. These preliminary observations suggesting a beneficial role of the vaginal treatment on inflammatory markers in pregnancy ultrasound require further investigation.
背景:产前超声中的炎症标记物是一组异质性图像,可在妊娠期间演变,由于孕妇感染的消退或加剧。目的:评估阴道菌群的有效再平衡是否能导致超声检查(US)炎症症状的消退。方法:对2013-2014年在ICZMP产前心脏科就诊的存在宫内感染超声征象的孕妇进行回顾性初步研究。在电子数据库中检索关键词为“感染、胎盘炎、三尖瓣反流、羊水多/少、IUGR、CRP、抗生素、阴道治疗”。分析238例患者,其中30例接受阴道抗菌治疗,27例患者进行完整随访(10-14天后对照超声及分娩资料)。结果:患者平均年龄29岁。22%的患者观察到三尖瓣反流,这是最常见的感染标志。经阴道治疗2周后,21例(77.8%)感染症状消退。2例超声图像稳定,3例三尖瓣返流加重或心肌肥厚。羊水过多,第二大最常见的参数(18.51%的患者)在所有研究患者治疗后消失。分娩平均发生在妊娠第39周(SD +/- 1.93)。结论:有效的阴道消炎治疗改善了27例胎儿中的21例超声图像。这些初步观察表明阴道治疗对妊娠超声炎症标志物的有益作用需要进一步研究。
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引用次数: 0
Relative Certainty as Opposed to Uncertainty in the Diagnosis of Isomerism 同分异构体诊断中的相对确定性与不确定性
Pub Date : 2015-06-01 DOI: 10.12847/06151
Diane E Spicer, M. Respondek-Liberska, Robert H. Anderson
Abstract The situation in which the bodily organs are “jumbled up”, frequently described in terms of visceral heterotaxy, was first brought to prominence by Ivemark, who emphasised the situation in terms of anatomy and development of the spleen. Putschar and Mannion then indicated that “between the normal situs, which is asymmetrical, and the situs inversus, which is the asymmetrical mirror-image of normality, a symmetrical situs sometimes exists, and this is the essence of bodily isomerism”. In the setting of the congenitally malformed heart, however, the isomeric features are found uniformly only in the atrial appendages. To date, these such subtle features have largely been recognised at autopsy, but if specifically sought for, they should be identified by the echocardiographer, even when working in the prenatal setting. The positive diagnosis of cardiac isomerism, therefore, depends on the recognition of isomeric atrial appendages. There is no evidence of isomerism at ventricular or arterial level. The relationship of the great vessels as they traverse the diaphragm, nonetheless, has been shown to be helpful in pointing to the need for more specific examination of the atrial appendages. When analysed on this basis, there can only be left or right isomerism, although the isomeric features are not always found uniformly throughout the bodily organs. Should there be disharmony between the systems, the specific findings should be described for each system, thus removing any suggestion of ambiguity. The distinction between left and right isomerism is crucial for counselling, not only for immediate decisions regarding the progress of the pregnancy in question, but for future potential pregnancies. Distinguishing between pregnancies developing with right and left isomerism could also provide the key for determining the genes responsible for the production of laterality.
身体器官“混乱”的情况,经常用内脏异质来描述,首先由Ivemark提出,他强调了脾脏解剖和发育方面的情况。Putschar和Mannion随后指出,“在不对称的正常体位和不对称的反体位之间,有时存在对称的体位,这就是身体异构的本质”。然而,在先天性畸形心脏的情况下,异构体特征只在心房附件中发现。到目前为止,这些微妙的特征在很大程度上已经在尸检中被识别出来,但如果特别寻找,它们应该由超声心动图医师识别,即使在产前工作时也是如此。因此,心脏异构体的阳性诊断取决于对异构体心房附件的识别。没有证据表明在心室或动脉水平有异构体。尽管如此,大血管在横膈膜上的关系,已经被证明有助于指出需要对心房附件进行更具体的检查。在此基础上分析时,只能有左同分异构体或右同分异构体,尽管在整个身体器官中发现的同分异构体特征并不总是一致的。如果系统之间存在不和谐,则应描述每个系统的具体结果,从而消除任何含糊不清的暗示。区分左右同分异构体对咨询是至关重要的,不仅对有关怀孕进展的即时决定,而且对未来潜在的怀孕也是如此。区分右侧和左侧同分异构体发育的妊娠也可以为确定负责产生侧位的基因提供关键。
{"title":"Relative Certainty as Opposed to Uncertainty in the Diagnosis of Isomerism","authors":"Diane E Spicer, M. Respondek-Liberska, Robert H. Anderson","doi":"10.12847/06151","DOIUrl":"https://doi.org/10.12847/06151","url":null,"abstract":"Abstract The situation in which the bodily organs are “jumbled up”, frequently described in terms of visceral heterotaxy, was first brought to prominence by Ivemark, who emphasised the situation in terms of anatomy and development of the spleen. Putschar and Mannion then indicated that “between the normal situs, which is asymmetrical, and the situs inversus, which is the asymmetrical mirror-image of normality, a symmetrical situs sometimes exists, and this is the essence of bodily isomerism”. In the setting of the congenitally malformed heart, however, the isomeric features are found uniformly only in the atrial appendages. To date, these such subtle features have largely been recognised at autopsy, but if specifically sought for, they should be identified by the echocardiographer, even when working in the prenatal setting. The positive diagnosis of cardiac isomerism, therefore, depends on the recognition of isomeric atrial appendages. There is no evidence of isomerism at ventricular or arterial level. The relationship of the great vessels as they traverse the diaphragm, nonetheless, has been shown to be helpful in pointing to the need for more specific examination of the atrial appendages. When analysed on this basis, there can only be left or right isomerism, although the isomeric features are not always found uniformly throughout the bodily organs. Should there be disharmony between the systems, the specific findings should be described for each system, thus removing any suggestion of ambiguity. The distinction between left and right isomerism is crucial for counselling, not only for immediate decisions regarding the progress of the pregnancy in question, but for future potential pregnancies. Distinguishing between pregnancies developing with right and left isomerism could also provide the key for determining the genes responsible for the production of laterality.","PeriodicalId":415760,"journal":{"name":"Prenatal Cardiology","volume":"163 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125662828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Prenatal Sonographic Diagnosis of Pierre-Robin Sequence - A Case Report 产前超声诊断皮埃尔-罗宾序列1例报告
Pub Date : 2015-06-01 DOI: 10.12847/06154
R. Zieliński, S. Foryś, M. Respondek-Liberska
Abstract The rare anomalies diagnosed in prenatal ultrasonographic examination include Pierre-Robin sequence. The aim of the report was to demonstrate a well-documented case of Pierre-Robin sequence detected by ultrasonography at the 24th week of gestation, present the differentiation of Pierre-Robin sequence in the prenatal ultrasonography and to emphasize the importance of early sonographic diagnosis of the anomaly. The prenatal diagnosis of Pierre-Robin sequence in prenatal ultrasonographic assessment is of great importance as it permits planning further course of pregnancy as well as EXIT procedure and postnatal treatment.
摘要产前超声检查中诊断的罕见异常包括皮埃尔-罗宾序列。本文报告一例妊娠24周超声检查发现Pierre-Robin序列的病例,介绍了产前超声检查中Pierre-Robin序列的区别,并强调早期超声诊断异常的重要性。在产前超声检查中,皮埃尔-罗宾序列的产前诊断对于规划妊娠的进一步进程、退出程序和产后治疗具有重要意义。
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引用次数: 0
The Significance of Autopsy to Look for Extracardiac Anomalies, Despite Correct Prenatal Diagnosis of Hypoplastic Left Heart Syndrome in Two Siblings 尸检寻找心外异常的意义,尽管正确的产前诊断左心发育不全综合征的两个兄弟姐妹
Pub Date : 2015-06-01 DOI: 10.12847/06153
I. Gawron, M. Borówka, J. Kolcz, J. Skalski
Abstract Thanks to recent progress in foetal imaging, it is now possible to detect many anatomical defects at earlier gestational age. To illustrate the importance of prenatal diagnosis and the impact of extracardiac congenital anomalies we presented the cases of sibling with prenatal diagnosis of hypoplastic left heart syndrome (HLHS) and post-mortem diagnosis of adrenal hypoplasia. Prenatal diagnosis was made in one mother twice, in two subsequent pregnancies, respectively at 22 and 18 weeks gestational age. The mother-to-be was referred to specialist foetal echocardiography because of suspected image of the heart. After the diagnosis was made, future parents were thoroughly informed about prognosis and possible management and decided to continue pregnancy, and treat a newborn, despite the fact that the foetal defect was diagnosed subsequently. The two newborns underwent surgical treatment and no complications occurred during the surgery. The children died after Norwood operation among the symptoms of acute adrenal failure. In post-mortem examination of the younger, the severe adrenal hypoplasia was identified. Prenatal diagnosis enables to make informed, conscious decisions at appropriate gestational age. Detection of congenital heart defect should incline an ultrasonographer towards searching for extracardiac lesions, which might significantly influence prognosis and surgical outcomes.
由于胎儿成像的最新进展,现在可以在孕早期检测到许多解剖缺陷。为了说明产前诊断的重要性和心外先天性异常的影响,我们提出了兄弟姐妹产前诊断为左心发育不全综合征(HLHS)和尸检诊断为肾上腺发育不全的病例。一位母亲在随后的两次怀孕中分别在22周和18周进行了两次产前诊断。由于疑似心脏图像,这位准妈妈被转介到胎儿超声心动图专家那里。在诊断出来后,未来的父母被彻底告知预后和可能的治疗方法,并决定继续怀孕,并治疗新生儿,尽管胎儿缺陷随后被诊断出来。两例新生儿均接受手术治疗,手术过程中无并发症发生。这两名儿童在诺伍德手术后死于急性肾上腺衰竭。在年轻人的尸检中,发现了严重的肾上腺发育不全。产前诊断能够在适当的胎龄做出明智的、有意识的决定。先天性心脏缺陷的检测应使超声检查倾向于寻找心外病变,这可能会显著影响预后和手术结果。
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引用次数: 0
Prenatal Diagnosis of Holt-Oram Syndrome Holt-Oram综合征的产前诊断
Pub Date : 2015-03-01 DOI: 10.12847/03155
H. Moczulska, M. Respondek-Liberska
Abstract Holt-Oram syndrome is a rare genetic syndrome, characterized by upper limb anomalies and congenital heart defects. The overall prenatal detection rate is low. We report a case of fetus with Holt-Oram syndrome with the current review of the literature.
Holt-Oram综合征是一种罕见的遗传综合征,以上肢异常和先天性心脏缺陷为特征。总体产前检出率较低。我们报告一例胎儿与Holt-Oram综合征与目前的文献回顾。
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引用次数: 2
期刊
Prenatal Cardiology
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