Fetal interventions for congenital heart disease

Freud, Lindsay R.; Tworetzky, Wayne

doi:10.1097/mop.0000000000000331

Cited by 41 publications

(41 citation statements)

References 47 publications

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“…Z scores may also be useful in forecasting the natural history of valve stenosis and in designing clinical trials on the value of in utero valvuloplasty, where patients can be stratified according to z scores. 5,10,33,34 A separate issue is whether measurement of the outflow tracts should constitute part of routine screening for prenatal diagnosis of outflow tract abnormalities. Published guidelines on fetal echocardiography 1,2,35 by several professional bodies recommend assessment of relative size of outflow tracts, but such assessment does not stipulate actual measurement.…”

Section: Potential Rhythm Disturbance 90mentioning

confidence: 99%

Reference Ranges for the Size of the Fetal Cardiac Outflow Tracts From 13 to 36 Weeks Gestation

Vigneswaran

Akolekar

Syngelaki

et al. 2018

Circ: Cardiovascular Imaging

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Background: Assessment of the outflow tract views is an integral part of routine fetal cardiac scanning. For some congenital heart defects, notably coarctation of the aorta, pulmonary valve stenosis, and aortic valve stenosis, the size of vessels is important both for diagnosis and prognosis. Existing reference ranges of fetal outflow tracts are derived from a small number of cases. Methods and Results: The study population comprised 7945 fetuses at 13 to 36 weeks’ gestation with no detectable abnormalities from pregnancies resulting in normal live births. Prospective measurements were taken of (1) the aortic and pulmonary valves in diastole at the largest diameter with the valve closed, (2) the distal transverse aortic arch on the 3 vessel and trachea view beyond the trachea at the distal point at its widest systolic diameter, and (3) the arterial duct on the 3 vessel and trachea view at its widest systolic diameter. Regression analysis, with polynomial terms to assess for linear and nonlinear contributors, was used to establish the relationship between each measurement and gestational age. The measurement for each cardiac diameter was expressed as a z score (difference between observed and expected value divided by the fitted SD corrected for gestational age) and percentile. Analysis included calculation of gestation-specific SDs. Regression equations are provided for the cardiac outflow tracts and for the distal transverse aortic arch:arterial duct ratio. Conclusions: The study established reference ranges for fetal outflow tract measurements at 13 to 36 weeks’ gestation that are useful in clinical practice.

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Section: Potential Rhythm Disturbance 90mentioning

confidence: 99%

Reference Ranges for the Size of the Fetal Cardiac Outflow Tracts From 13 to 36 Weeks Gestation

Vigneswaran

Akolekar

Syngelaki

et al. 2018

Circ: Cardiovascular Imaging

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“…In utero balloon dilation of the semilunar valves early in the second trimester has been performed with the aim of increasing the chances of achieving a postnatal biventricular circulation, thus avoiding the need for single ventricle palliation in selected cases . The new motion compensated cine CMR sequences have the potential to measure ventricular volume and therefore track longitudinal ventricular growth in this setting .…”

Section: Future Directionsmentioning

confidence: 99%

Current and future role of fetal cardiovascular MRI in the setting of fetal cardiac interventions

Marini

Sun

et al. 2019

Prenatal Diagnosis

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Over recent years, technical developments resulting in the feasibility of fetal cardiovascular magnetic resonance (CMR) have provided a new diagnostic tool for studying the human fetal heart and circulation. During the same period, we have witnessed the arrival of several minimally invasive fetal cardiac interventions (FCI) as a possible form of treatment in selected congenital heart diseases (CHDs). The role of fetal CMR in the planning and monitoring of FCI is not yet clear. Indeed, high-quality fetal CMR is not available or routinely offered at most centers caring for patients with prenatally detected CHD. However, in theory, fetal CMR could have much to offer in the setting of FCI by providing complementary anatomic and physiologic information relating to the specific intervention under consideration. Similarly, fetal CMR may be useful as an alternative imaging modality when ultrasound is hampered by technical limitations, for example, in the setting of oligohydramnios and in late gestation. In this review, we summarize current experience of the use of fetal CMR in the diagnosis and monitoring of fetuses with cardiopathies in the setting of a range of invasive in utero cardiac and vascular interventions and medical treatments and speculate about future directions for this versatile imaging medium.

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“…Some forms of CHD require surgery in the first weeks or months after birth. Since earlier postnatal interventions reduce myocardial damage and reduce mortality (Gardiner, 2009), earlier fetal interventions are being sought (Freud and Tworetzky, 2016;Marantz and Grinenco, 2015;McLaughlin et al, 2016;Tulzer and Arzt, 2013). Stem-cell based therapies and engineered cell sheets may offer a new line of treatment, in conjunction with standard surgical approaches.…”

Section: Introductionmentioning

confidence: 99%

Deriving Cardiomyocytes from Human Amniocytes

Sunderland

Demarest

et al. 2018

Preprint

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STATEMENTAmniocytes are a possible source of patient-specific cardiomyocytes for newborns with congenital heart disease. Genome-wide DNA methylation patterns and transcriptional repressors preclude direct differentiation, but pluripotent reprogramming provides cardiomyocytes for dissecting genetic pathways contributing to this disease. ABSTRACTMany forms of congenital heart disease (CHD) have high morbidity-mortality rates and require challenging surgeries. Human amniocytes have important stem cell characteristics and could potentially provide patient-specific tissue for repairs of some types of CHDs. We report that amniocytes express features of poised cardiomyocytes. However, a variety of direct reprogramming approaches failed to convert their fetal and transcriptionally repressed state into bona fide cardiomyocytes. Induced-pluripotent stem cell (iPSC) reprogramming removes repression and converts amniocytes to a baseline pluripotent state. Based on molecular and electrophysiological signatures, iPSC reprogrammed amniocytes can be induced to differentiate into functionally immature, predominantly ventricular cardiomyocytes and a heterogeneous mixture of vascular and unspecified epithelial cells. Developmental time course analyses and pattern clustering of amniocyte-derived cardiomyocytes identifies numerous temporal coregulators of cardiac induction and maturation as well as distinct sarcomeric and ion channel gene signatures. Normal fetal cardiomyocytes are derived by overcoming complex forms of transcriptional repression that suppress direct transdifferentiation of human amniocytes. These results suggest the possibility of using amniocytes as a source of patient-specific ventricular cardiomyocytes for cell therapies.

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Fetal interventions for congenital heart disease

Abstract: FCI is an evolving form of treatment for congenital heart disease that holds promise for select patients. Critical evaluation of both short and long-term outcomes is warranted.

Cited by 41 publications

References 47 publications

Reference Ranges for the Size of the Fetal Cardiac Outflow Tracts From 13 to 36 Weeks Gestation

Reference Ranges for the Size of the Fetal Cardiac Outflow Tracts From 13 to 36 Weeks Gestation

Current and future role of fetal cardiovascular MRI in the setting of fetal cardiac interventions

Deriving Cardiomyocytes from Human Amniocytes

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