1.
Profiling fetal cardiac function in twin–twin transfusion syndrome
Stirnemann, J. J.; Mougeot, M.; Proulx, F. ...
Ultrasound in obstetrics & gynecology,
January 2010, Letnik:
35, Številka:
1
Journal Article
Objectives
Cardiomyopathy in the recipient twin is a marker of severity in twin–twin transfusion syndrome (TTTS), making it a potentially valuable tool for staging the disease. This study aimed to ...
provide a quantitative description of cardiac function in the recipient twin.
Methods
Consecutive monochorionic pregnancies complicated with TTTS and treated by percutaneous laser coagulation underwent fetal echocardiography before surgery. An unsupervised classification analysis was conducted to identify groups of twins with similar cardiac profiles. The predictive value of the recipient twin's preoperative cardiac function based on these profiles was assessed, using perinatal death of at least one twin as the main outcome. The cardiac function profiles that we identified were compared with the current Quintero staging.
Results
A total of 107 pregnancies were included, with six of these lost to follow‐up; 63/107 complete cases were available for multivariate description of the recipient's cardiac function. Three different preoperative cardiac profiles were identified with increasing right and left myocardial performance index, decreasing right and left shortening fraction, and increasing ductus venosus pulsatility index. Although the three groups represented progressive stages of the syndrome‐related cardiomyopathy, no correlation was found with pregnancy outcome. Of Quintero Stage 1 cases, 55% showed significant alterations of cardiac function in the recipient twin.
Conclusions
Progressive cardiomyopathy can be assessed quantitatively in the recipient twin and does not influence pregnancy outcome when fetoscopic laser coagulation is the first‐line treatment. Compared with the current staging, cardiac profiling allows discrimination of cases with significant myocardial dysfunction. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.
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3.
Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature
Jaeggi, E. T.; Hornberger, L. K.; Smallhorn, J. F. ...
Ultrasound in obstetrics & gynecology,
July 2005, Letnik:
26, Številka:
1
Journal Article
Objective
To review the pattern of presentation, management and outcome of fetal complete atrioventricular block (CAVB) associated with major structural congenital heart disease (CHD), when compared ...
to isolated CAVB.
Methods
Retrospective analysis of the medical records and echocardiograms of all CAVB cases, diagnosed prenatally at two tertiary care centers between the years 1990 and 2002.
Results
Of a total of 59 consecutive fetal cases of CAVB, 24 (41%) had underlying major CHD, mainly left isomerism (n = 18) and congenitally corrected transposition of the great arteries (cc‐TGA) (n = 3). When compared to isolated CAVB (n = 35), cases with CHD were detected earlier (21 ± 6 vs. 26 ± 6 weeks; P < 0.02) and—despite comparable heart rates—more often had fetal hydrops (38% vs. 9%; P < 0.02), while pregnancy continuation (66% vs. 94%; P < 0.02) or prenatal treatment (19% vs. 64%; P < 0.001) was less likely. Of 16 CHD cases with pregnancy continuation, β‐inotropic treatment of fetal bradycardia was attempted in three cases: all had left isomerism and died early postnatally. Livebirth and 1‐year survival rates of CAVB with CHD were 56% and 19%, respectively, when compared to isolated CAVB with 88% and 75%, respectively (P < 0.0001). The four neonatal survivors (one left isomerism, three cc‐TGA) had heart rates persistently > 60 bpm throughout gestation and 3/4 underwent a biventricular repair.
Conclusions
Fetal CAVB with CHD continues to be associated with a poor outcome, in particular in the presence of left isomerism and fetal heart rates < 60 bpm. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.
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4.
Prenatal diagnosis and prognosis of accelerated idioventricular rhythm
Fouron, J.‐C.; McNeal‐Davidson, A.; Abadir, S. ...
Ultrasound in obstetrics & gynecology,
November 2017, 2017-Nov, 2017-11-00, 20171101, Letnik:
50, Številka:
5
Journal Article
ABSTRACT
Objectives
As postnatal identification of accelerated idioventricular rhythm (AIVR) relies on specific electrocardiographic patterns, prenatal diagnosis of this condition is challenging and ...
its true incidence is unknown. The objectives of this study were to evaluate the performance of prenatal ultrasonography in identifying intrauterine cardiocirculatory events linked to specific electrocardiographic signs of postnatal AIVR, including left or right ventricular origin, and to assess the prenatal prognosis of this arrhythmia.
Methods
We reviewed Doppler tracings from the superior vena cava/ascending aorta (SVC/Ao), ductus venosus (DV), ductus arteriosus (DA) and aortic isthmus (AoI), as well as simultaneous M‐mode recordings of septal and left ventricular wall motions of fetuses diagnosed with AIVR from January 2004 to December 2014.
Results
Three cases of AIVR were identified among 27 912 fetuses. SVC/Ao Doppler flow recordings revealed atrioventricular dissociation (ventricular rates within 20% of atrial rates) in all three fetuses and episodes of isorhythmic atrioventricular dissociation in one, while M‐mode confirmed normal left ventricular shortening fraction in all cases. Fusion beats were observed on AoI tracing in one fetus, while simultaneous recordings of AoI and DA revealed signs of right bundle branch block in one case and left bundle branch block in the other two. On DV Doppler recordings, retrograde a‐waves in the presence of simultaneous atrial and ventricular contractions were observed in all three fetuses, leading to an increase in central venous pressure in all and hydrops fetalis in two cases without evidence of ventricular dysfunction.
Conclusions
Echocardiographic criteria required for postnatal diagnosis of AIVR can be documented in utero using specific ultrasonographic approaches. During fetal life, AIVR may not be a benign entity. Hydrops fetalis is frequently associated with AIVR because of increase in central venous pressure related to simultaneous atrioventricular contractions; thus, the ultrasonographic investigation protocol of fetuses with unexplained hydrops fetalis should aim at ruling out AIVR and include Doppler flow recordings in SVC/Ao, DV, AoI, DA and umbilical vein. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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5.
Early intertwin differences in myocardial performance during the twin-to-twin transfusion syndrome
Raboisson, M J; Fouron, J C; Lamoureux, J ...
Circulation,
2004-Nov-09, Letnik:
110, Številka:
19
Journal Article
In the twin-to-twin transfusion syndrome (TTTS), pressure rather than volume overload is increasingly considered as a key factor in the pathogenesis of the cardiomyopathy of the recipient twin. If ...
this is the case, cardiac dysfunction should be among the first signs observed with TTTS. The objective of this study was to determine whether intertwin differences in myocardial function are modified early in the course of TTTS and whether they can help to differentiate this condition from intrauterine growth restriction (IUGR).
Eight variables were analyzed on the first fetal echocardiography on 21 pairs of twins with TTTS and 11 with IUGR. No difference was found between the 2 groups for the cardiothoracic ratio, pulsatility indices in the umbilical and middle cerebral arteries, and peak velocity of the middle cerebral artery. Significant difference was found for ventricular septal thickness, but with no association with the conditions under study. With TTTS, left ventricular shortening fraction was consistently greater in the donor twins, and myocardial performance indices (MPIs) were elevated in the recipient twins. This increase in MPI was caused by a lengthening of the isovolumic periods compared with those of the donor twin: left ventricular and right ventricular isovolumic periods 0.105+/-0.047 and 0.097+/-0.026 seconds, respectively, for the recipient twins versus 0.0561+/-0.46 and 0.065+/-0.03 seconds, respectively, for the donor twins (P<0.001). These changes in the isovolumic periods were mainly due to significant prolongation of isovolumic relaxation times. A change in left ventricular MPI > or =0.09 combined with a change in right ventricular MPI > or =0.05 would identify a TTTS with a sensitivity of 75% and a false-positive rate of 9%.
The observed diastolic function impairment goes along with the pressure-overload pathogenic concept proposed in TTTS. Assessment of intertwin difference in MPI is a valuable tool for early differential diagnosis between TTTS and isolated IUGR.
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6.
Relevance of measuring diastolic time intervals in the ductus venosus during the early stages of twin–twin transfusion syndrome
Bensouda, B.; Fouron, J.‐C.; Raboisson, M.‐J. ...
Ultrasound in obstetrics & gynecology,
December 2007, Letnik:
30, Številka:
7
Journal Article
Objective
To determine if the discrete myocardial diastolic dysfunction documented previously in the recipient twin during the early stages of twin–twin transfusion syndrome (TTTS) has any ...
repercussion on flow velocities through the ductus venosus (DV) and to investigate if this could allow early differentiation between TTTS and selective intrauterine growth restriction (IUGR).
Methods
Two groups of monochorionic twin pregnancies with growth discordance between twins were reviewed retrospectively. Group I was composed of fetuses in Stages I and II of TTTS; laser or amnioreduction was not performed in any instance. Group II twin pairs each included one fetus with IUGR due to placental circulatory insufficiency. Intertwin differences (smaller minus larger fetus) were analyzed for myocardial performance index of the right ventricle (MPI‐RV) and for time variables in the DV.
Results
There were 38 pairs of monochorionic twins (24 TTTS and 14 IUGR) in this study. In the TTTS group, the donors had a significantly lower MPI‐RV (0.419 ± 0.18 vs. 0.596 ± 0.17, F(1, 19df) = 24.017, P < 0.001), a significantly longer total ventricular filling time (150.9 ± 25.6 ms vs. 124.0 ± 22.6 ms; F(1, 21df) = 19.631, P < 0.001) and a significantly longer early filling time (118.9 ± 22.9 ms vs. 92.6 ± 18.9 ms, F(1, 21df) = 28.419, P < 0.001) than had the recipient. None of these three differences was present in the IUGR group. Probability studies revealed that cut‐off values of 12.75 for intertwin differences in total filling time and 8.5 for intertwin differences in early filling time had sensitivities of 71% and 92%, respectively. The false‐positive rates were 23% and 15%, respectively, for the early diagnosis of TTTS.
Conclusion
In monochorionic twin pregnancies, shortening of the ventricular filling time in the recipient twin indicates diastolic myocardial dysfunction occurring early in the pathophysiology of TTTS. This early interwin difference in myocardial function is not found in pregnancies with IUGR in one twin due to placental circulatory insufficiency, allowing early differentiation between TTTS and selective IUGR. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.
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7.
Feasibility and reliability of Doppler flow recordings in the fetal aortic isthmus: a multicenter evaluation
Fouron, J.‐C.; Siles, A.; Montanari, L. ...
Ultrasound in obstetrics & gynecology,
June 2009, Letnik:
33, Številka:
6
Journal Article
Objectives
To evaluate the performance of three different centers with respect to their ability to identify the fetal aortic isthmus (AoI) adequately and place a Doppler sample volume in the AoI ...
correctly, and to address the reproducibility of the isthmic flow index (IFI) calculated from Doppler waveforms recorded in the three centers.
Methods
The three collaborating centers sent several ultrasonographic recordings taken at random over a 6‐week period to the Saint‐Justine Fetal Cardiology Unit (StJ‐FCU). A performance quotient ((number of total readings − number of unsatisfactory results)/number of total readings) was calculated for each center by each of three judges, who were experienced fetal cardiologists, to assess the ability of each center to identify the isthmus and to place the Doppler sample volume (DSV) adequately. Intraclass correlation coefficients (ICC) were computed to quantify the variability of IFI measurements ((systolic + diastolic)/systolic flow velocity integrals).
Results
Fifty‐five recordings were available for this study. Concerning isthmus identification, there was 100% agreement between the three judges from StJ‐FCU and the performance quotients of Centers A, B and C were: 0.90, 0.95 and 1.00, respectively. For DSV positioning, agreement between the judges varied; for Judge 1 vs. Judge 2, kappa = 0.836 (95% CI, 0.651–1.000); for Judge 1 vs. Judge 3, kappa = 0.773 (95% CI, 0.557–1.000); for Judge 2 vs. Judge 3, kappa = 0.941 (95% CI, 0.805–1.000). The performance quotients of the three centers for DSV positioning were consistently lower than were those for identification of the isthmus, being 0.85, 0.76 and 0.92, respectively. The ICC between the first and second measurements of the IFI by Rater 1 was 0.96 (95% CI, 0.93–0.98, P < 0.001) and that between Raters 1 and 2 was 0.97 (95% CI, 0.95–0.99, P < 0.001).
Conclusion
Adequate imaging of the fetal AoI can be achieved easily by a trained sonographer, while DSV positioning is challenging. The intra‐ and interrater variability of the IFI are low. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.
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8.
Blood pressures in newborns with twin-twin transfusion syndrome
Mercanti, I; Boivin, A; Wo, B ...
Journal of perinatology,
06/2011, Letnik:
31, Številka:
6
Journal Article
In addition to unbalanced flow through placental anastomoses, evidence suggests that transfer of circulating vasoactive elements from the donor to the recipient contribute to the pathological process ...
of twin-twin transfusion syndrome (TTTS). The objective of this study was to test the hypothesis that TTTS recipients have higher blood pressure (BP) at birth than donors.
Chart review of all TTTS infants born from 1996 to 2007 with both twins alive 24 h (51 pairs; average gestational age 30±3 weeks).
Both systolic and diastolic neonatal BPs were significantly higher in recipients. When expressed relative to predicted BP for birth weight (BW), BP were lower than expected in donors and higher in recipients.
Data indicate that TTTS recipients have BP significantly higher than donors and than BP expected for BW. The long-term impact of these early hemodynamic perturbations remains to be determined.
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9.
Fetal cardiac performance in uncomplicated and well‐controlled maternal type I diabetes
Jaeggi, E. T.; Fouron, J.‐C.; Proulx, F.
Ultrasound in obstetrics & gynecology,
April 2001, Letnik:
17, Številka:
4
Journal Article
Objective
To study the impact of well‐controlled, uncomplicated maternal diabetes on fetal cardiac development and performance.
Methods
The following variables were studied in 45 fetuses of type I ...
diabetic women by means of mid‐ and late‐trimester echocardiography: interventricular septal thickness; aortic and pulmonary valve diameters; peak and time‐to‐peak flow velocity of the great arteries; the ratio between peak velocities during early (E) and late (A) ventricular filling at the level of the atrioventricular valves; ventricular fractional shortenings; and output. The findings were compared to age‐matched control groups of normal fetuses.
Results
A significant augmentation of interventricular septal thickness was demonstrated for mid‐trimester fetuses of diabetic women, which progressed further towards the end of pregnancy. However, the indices of diastolic and systolic function remained comparable between the gestational age‐matched groups.
Conclusion
Progressive myocardial thickening occurs commonly in mid‐ and late‐trimester fetuses of uncomplicated and well‐controlled diabetic pregnancies. The observed degree of hypertrophy is generally mild and does not affect age‐related changes in fetal cardiac function. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
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10.
Structural, functional and metabolic remodeling of rat left ventricular myocytes in normal and in sodium-supplemented pregnancy
BASSIEN-CAPSA, V; FOURON, J.-C; COMTE, B ...
Cardiovascular research,
02/2006, Letnik:
69, Številka:
2
Journal Article
Pregnancy is an important physiological condition associated with hemodynamic and endocrine changes that affect the heart. Nevertheless, very little is known about cardiomyocyte remodeling in this ...
condition. Here, we studied the morphological, functional and metabolic remodeling of rat left ventricular myocytes that occurs in late stages of normal pregnancy (P) and in experimental preeclampsia induced by elevated (0.9%) sodium intake (P0.9).
We applied confocal microscopy to examine the morphology and the contractility of single cells, while the patch clamp technique was used to assay ionic currents.
Our results revealed a significant increase in the volume of single left ventricular cardiac myocytes in P, mainly resulting from cell elongation. In P0.9, further increase in the cell length led to a significant rise in the length/width ratio. Cell contractility was significantly decreased in glucose-based solutions in response to stimulation at 0.5 Hz and 6 Hz in P as well as in P0.9. The density of L-type calcium current (I(Ca)L) was not significantly altered in P or in P0.9. Metabolic substrates lactate and pyruvate, increased in the blood of P and P0.9 rats, enhanced contractility in P, without affecting I(Ca)L. The same effect, present but blunted in P0.9, was associated with a significant increase in I(Ca)L.
Our results demonstrate that processes of adaptive remodeling take place in normal pregnancy, while maladaptive components are identified in experimental preeclampsia; they also reveal an adaptation in the use of energy substrates in pregnancy and its impairment by sodium supplementation.
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