OC96: Estimation of the myocardial performance index in fetuses at 11.0–13.6 weeks' gestation

Abstract

Objectives: To investigate the cardiac defects (CHD) found in association with an increased nuchal translucency (NT). Methods: Patients referred from January 1998 until February 2007 with an NT ≥ 95 th percentile at 11-14 weeks and where a cardiac defect was found were included. Chromosome analysis, fetal echocardiography and postnatal echocardiography were performed. After pregnancy termination a postmortem examination was performed when possible. Results: CHD were identified in 63 fetuses (major CHD in 50; 79%). The median NT was 4.8 (range, 2.6−13) mm. Group 1 included 36 fetuses (57%) with a normal karyotype. Median NT was 5.2 (range, 2.8−9) mm. Twenty-four (66.7%) had major CHD. CHD included VSD (10), HLHS (four), TGV (three), AVSD (three), PA + VSD/TOF (two), PS (two), uncertain cardiac diagnosis with hydrops (two), aortic arch abnormalities (two), PDA (two), DORV (one), ASD (one), tricuspid atresia (one), aortic incompetence (one), mitral valve abnormality (one) and persistent right umbilical vein (one). Group 2 included seven fetuses (11%) with a genetic disorder including: 18p deletion (two), 22q11 deletion (two), Coffin-Siris (one) and Holt-Oram (one). CHD found included HLHS, TGV, truncus arteriosus, VSD (two), ASD and DORV. Group 3 included 20 fetuses (32%) with abnormal numeric karyotype including 10 trisomy 21, six trisomy 18, two XO, one trisomy 13 and one trisomy 9. Median NT was 4.7 (range, 2.6−13) mm. Nineteen had major CHD. CHD found with trisomy 21 included AVSD (six), inlet VSD (two) and RV non-compaction (one). In fetuses with trisomy 18, VSD (two), polyvalvular disease (two), HLHS (one) and aortic arch abnormality (one) were found. Both fetuses with XO had HLHS. PA + VSD was found with trisomy 13 and truncus arteriosus in trisomy 9. Conclusions: Various CHD are associated with an increased NT. Conotruncal defects, branchial arch derivative defects, left and right obstructive lesions and shunts were seen. Anomalous pulmonary venous drainage and cor triatriatum were not seen; thus abnormal targeted growth is not the mechanism linking CHD and an increased NT. OC95Feasibility of the first level transabdominal screening for cardiac defects at the time of NT measurements using a new high-definition blood flow imaging mode Department of Obstetrics and Gynecology -DMCO San Paolo-Milan, ItalyObjectives: To test the efficacy of a new high-definition blood flow imaging mode (e-flow), not based on the transmission method of Doppler technology, for the visualization of four chambers and great-vessels sections in fetuses at 11 + 0-13 + 6 weeks of gestation (wg), during the measurement of NT performed by first-level operators in comparison with information obtained from B-Mode alone. Methods: Some 300 consecutive fetuses at 11-13 + 6 wg, referred for NT measurements, were examined by three first-level operators. Cardiac morphology was screened by B-mode and e-flow mode (Aloka Prosound SSD Alpha 10), with two main sections (four chambers and three-vessels view), according to standardized methodology. Qual...

The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

“…MPI has also been evaluated in first-trimester normal and complicated pregnancies [16,69,71,72,73,74,75,76,77,78,79], and compared with normal infants and children [11,54]. Reported Mod-MPI values for normal singleton fetuses range from 0.35 to 0.60 [9,11,54,55,62,67,68,79,80,81].…”