Left Heart Obstructive Lesions and Left Ventricular Growth in the Midtrimester Fetus

Hornberger, Lisa K.; Sanders, Stephen P.; Rein, Azaria J.J.T.; Spevak, Philip J.; Parness, Ira A.; Colan, Steven D.

doi:10.1161/01.cir.92.6.1531

Cited by 229 publications

(141 citation statements)

References 28 publications

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“…Furthermore, obstructive lesions can develop or progress as pregnancy advances and may not be recognisable around 20 weeks of gestation. 32,33 We believe that another factor that adds to the persistent low detection rates is the fact that training programmes do not sufficiently teach how to diagnose those anomalies in fourchamber and sagittal views. The difficulty in the diagnosis of anomalies of the aortic arch has been widely acknowledged, 34 yet this study showed a significant increase in the detection rate of coarctation of the aorta.…”

Section: Discussionmentioning

confidence: 99%

Prenatal detection of congenital heart disease—results of a national screening programme

Velzen

Clur

Rijlaarsdam

et al. 2015

BJOG

209

232

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Objective Congenital heart disease (CHD) is the most common congenital malformation and causes major morbidity and mortality. Prenatal detection improves the neonatal condition before surgery, resulting in less morbidity and mortality. In the Netherlands a national prenatal screening programme was introduced in 2007. This study evaluates the effects of this screening programme. Design Geographical cohort study. Setting Large referral region of three tertiary care centres. Population Fetuses and infants diagnosed with severe CHD born between 1 January 2002 and 1 January 2012. Methods Cases were divided into two groups: before and after the introduction of screening. Main outcome measures Detection rates were calculated. Results The prenatal detection rate (n = 1912) increased with 23.9% (95% confidence interval [95% CI] 19.5–28.3) from 35.8 to 59.7% after the introduction of screening and of isolated CHD with 21.4% (95% CI 16.0–26.8) from 22.8 to 44.2%. The highest detection rates were found in the hypoplastic left heart syndrome, other univentricular defects and complex defects with atrial isomerism (>93%). Since the introduction of screening, the ‘late’ referrals (after 24 weeks of gestation) decreased by 24.3% (95% CI 19.3–29.3). Conclusions This is the largest cohort study to investigate the prenatal detection rate of severe CHD in an unselected population. A nationally organised screening has resulted in a remarkably high detection rate of CHD (59.7%) compared with earlier literature.

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Section: Discussionmentioning

confidence: 99%

Prenatal detection of congenital heart disease—results of a national screening programme

Velzen

Clur

Rijlaarsdam

et al. 2015

BJOG

209

232

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“…In at least some cases, the fetus is identified as having aortic stenosis at midgestation, which then evolves into HLHS during the second half of pregnancy (28). Flow abnormalities have been implicated in CVM.…”

Section: Discussionmentioning

confidence: 99%

Microcephaly is associated with early adverse neurologic outcomes in hypoplastic left heart syndrome

et al. 2013

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Background: Hypoplastic left heart syndrome (HLHS) is associated with significant mortality and morbidity. Fetal head growth abnormalities have been identified in a subset of HLHS fetuses, but it is unclear whether specific patterns of maladaptive growth affect clinical outcomes. We hypothesized that poor fetal head growth is associated with an increased frequency of adverse clinical outcomes. Methods: We retrospectively examined a cohort of HLHS patients from midgestation to 1 y of age. Fetal and birth anthropometric measurements were analyzed using the Olsen standard, and clinical outcomes were obtained. results: A total of 104 HLHS patients were identified over a 12-y period; fetal data were available in 38 cases. HLHS neonates demonstrated a high incidence of microcephaly (12%), small head size (27%), and poor head growth (32%). Allcause mortality was 31% at 30 d and 43% at 1 y. Neurologic outcomes were observed in 12% of patients and were significantly increased with microcephaly (43 vs. 4%; P = 0.02). The average length of hospital stay following stage I palliation was 33.4 ± 33 d, correcting for early death. conclusion: In term nonsyndromic HLHS, fetal and neonatal microcephaly are associated with early adverse neurologic outcomes but not mortality.

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“…Left and right ventricular end-systolic and end-diastolic diameters and wall thickness were measured from M-mode tracings or 2-dimensional images as previously described. 6,7 Measurements obtained in the fetal CM cases were compared with values obtained in 55 normal pregnancies. Left and right ventricular systolic function was evaluated by calculating the shortening fraction (SF).…”

Section: Methodsmentioning

confidence: 99%

Fetal Cardiomyopathies

et al. 2002

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Background-Although the prenatal diagnosis of most fetal structural heart defects and dysrhythmias has been described, there is a paucity of information about cardiomyopathies (CMs) in prenatal life. Methods and Results--To determine the pathogenic mechanisms, hemodynamic findings, and outcome of fetal CM, we reviewed the fetal echocardiograms and perinatal histories of 55 affected fetuses. Dilated CM was diagnosed in 22 cases, including 2 with congenital infections, 5 familial cases, 6 with endocardial fibroelastosis related to maternal anti-Ro/La antibodies, and 9 idiopathic cases. Thirty-three had hypertrophic CM, 7 associated with maternal diabetes, 2 with Noonan's syndrome, 2 with ␣-thalassemia, 18 with twin-twin transfusion syndrome, 1 with familial hypertrophy, and 3 with idiopathic hypertrophy. Systolic dysfunction was present in all cases of dilated CM and 15 cases of hypertrophic CM. Diastolic dysfunction was present in 19 of 30 fetuses with assessment of diastolic function parameters. Significant mitral or tricuspid valve regurgitation was seen in 32 cases. Eight fetuses were hydropic and 23 had signs of early hydrops. Seven pregnancies were terminated. Of 46 continued pregnancies with follow-up, 29 (63%) died perinatally. The presence of systolic dysfunction, diastolic dysfunction, and significant atrioventricular valve regurgitation were identified as risk factors for mortality. By multiple logistic regression, diastolic dysfunction was associated with an 8-fold increased risk relative to the other parameters. Conclusions-Fetal CM has a broad spectrum of intrinsic and extrinsic causes. A poor outcome is observed in many affected fetuses. Diastolic dysfunction in fetal CM is associated with the highest risk of mortality. (Circulation. 2002; 106:585-591.)

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Left Heart Obstructive Lesions and Left Ventricular Growth in the Midtrimester Fetus

Abstract: The potential for the in utero development or progression in severity of left heart obstruction and hypoplasia in left heart obstructive lesions necessitates serial prenatal study in affected fetuses carried to term.

Cited by 229 publications

References 28 publications

Prenatal detection of congenital heart disease—results of a national screening programme

Prenatal detection of congenital heart disease—results of a national screening programme

Microcephaly is associated with early adverse neurologic outcomes in hypoplastic left heart syndrome

Fetal Cardiomyopathies

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