HYPOPLASTIC LEFT HEART SYNDROME Diagnostic clues and prenatal therapy
|
|
- Piers Ross
- 5 years ago
- Views:
Transcription
1 HYPOPLASTIC LEFT HEART SYNDROME Diagnostic clues and prenatal therapy Teresa Alvarez Pediatric Cardiology Gregorio Marañón Hospital
2 Hypoplastic Left Heart Syndrome Hypoplastic left heart syndrome (HLHS) is a spectrum of cardiac malformations with the common denominator of underdeveloped left structures, including the mitral valve, left ventricle and aorta and as a consequence the left ventricle is unable to maintain cardiac output. Incidence 1/ live newborns 2nd most frequent congenital cardiopathy appearing in 1st week of life Mortal Three/four therapeutic options: - Compassionate treatment - Norwood procedure - Heart transplant - Hybrid procedure?
3 Hypoplastic Left Heart Syndrome This is the cardiopathy which has changed most in diagnosis, management and results CONTROVERSY
4 Prenatal diagnosis of HLHS Prenatal diagnosis 2011 In fetal cardiology it is an easy diagnosis, relatively common and with poor therapeutic options
5 Repercussion of prenatal diagnosis on prevalence of congenital cardiopathies Pediatric cardiology 2006;27: The impact of fetal echocardiography on the prevalence of liveborn congenital heart disease. I. Germanakis
6 Repercussion of prenatal diagnosis on prevalence of congenital cardiopathies Changing spectrum and outcome of 705 fetal congenital heart disease cases: 12 years experience in a trird-level center. M. Russo, D. Paladini. J Cardiovasc Med 2008: cardiopathies Increase in isolated cardiopathies Decrease in more severe cardiopathies (HLHS) Improvement in survival Decrease in terminations ( lesser severe cases, more isolated cardiopathies)
7 Repercussion of prenatal diagnosis on prevalence of congenital cardiopathies Gregorio Marañon Hospital experience Number of consultations New cardiopathy diagnosis - Fetal cardiology clinic 4 days per week - The number of HLHS prenatal diagnosis is constant, with an increase in early diagnosis in patients from our area Patients with a relatively simple echographic diagnosis not derived to tertiary center
8 Ideal objectives of prenatal counselling Provide an exact diagnosis of the malformation Provide a clear and realistic scheme of prognosis Explain possible management and treatment options Help parents find best management option Counselling following a diagnosis of congenital heart disease. L. Allan. Prenatal Diagnosis 2004;24:
9 Diagnostic peculiarities of prognostic importance 1. Mitral stenosis- aortic atresia 2. Foramen ovale restriction 3. Minute ascending aorta 4. Tricuspid regurgitation 5. Ventricular dysfunction 6. Associated malformations Difference in mortality for standard patients and patients with risk factors
10 Diagnostic peculiarities of prognostic importance 1. Mitral stenosis- aortic atresia
11 Diagnostic peculiarities of prognostic importance 2. Foramen ovale restriction - Small LA - Accelerated flow in FO - Pathological doppler in pulmonary veins - Absence of decompression veins Poor prognosis factor Hypoplastic left heart syndrome with intact or highly restrictive atrial septum. A.P. Vlabos, J.E. Lock. Circulation 2004; 109:
12 Diagnostic peculiarities of prognostic importance 2. Foramen ovale restriction
13 Diagnostic peculiarities of prognostic importance 2. Foramen ovale restriction 21 pts weeks Success 19 pts Global survival 52%. 2 in utero deaths 12 required urgent postnatal intervention, 42% survival 7 Programmed stage 1, 86% survival
14 Diagnostic peculiarities of prognostic importance 2. Foramen ovale restriction Vasoreactive Response to Maternal Hyperoxygenation (MH) in the Fetus with Hypoplastic Left Heart Syndrome (HLHS) Anita Szwast, Jack Rychik The Fetal Heart Program at the Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Circ Cardiovasc Imaging March 3(2):
15 Diagnostic peculiarities of prognostic importance 3. Diminutive ascending aorta
16 Diagnostic peculiarities of prognostic importance 4. Tricuspid regurgitation and ventricular dysfunction
17 Diagnostic peculiarities of prognostic importance 1. MItral stenosis- aortic atresia 2. Foramen ovale restriction 3. Diminutive ascending aorta 4. Tricuspid regurgitation 5. Ventricular dysfunction 6. Associated malformations Not all HLHS are the same Difference in mortality for standard patients and patients with risk factors
18 Diagnostic peculiarities of prognostic importance ANATOMICAL VARIATIONS CONDITIONING PROGNOSIS Perinatal and early surgical outcome for the fetus with hypoplastic left heart syndrome: a 5-year single institutional experience. J. Rychik, A. Szwast. Ultrasound Obstet Gynecol Oct;36(4):465-7 High risk: extracardiac malformations chromosmopathies premature <34 wks Restrictive or integral IA septum TR or severe ventricular dysfunction Standard risk: absence of risk factors
19 Diagnostic peculiarities of prognostic importance ANATOMICAL VARIATIONS CONDITIONING PROGNOSIS Perinatal and early surgical outcome for the fetus with hypoplastic left heart syndrome: a 5-year single institutional experience. J. Rychik, A. Szwast. Ultrasound Obstet Gynecol Oct;36(4): HLHS early diagnosis Genetic anomalies 162 (67.5%)standard risk and 78 (32.5%) high risk When faced with a HLHS prenatal diagnosis it is important to perform a 38 (15.8%) Extracardiac chose termination malformations no neonatal surgery complete evaluation for an accurate diagnosis. One third of cases include risk factors limiting 185 newborns Premature survival (77.1%) but <34 two wks thirds Norwood. have procedure exellent survival Additional cardiac findings as integral AS Tricuspid regurgition or severe ventricular dysfunction 155 survivors/30 deaths (survival 83.8%) Standard risk: survival 92.8% High risk: survival 56%
20 Changes in parental decisions dependent on results Experience with Norwood procedure Centers with most experience report survival rates of 90% con el primer tiempo A survival rate of 80% is common Improving with experience Depending on risk factors Gregorio Marañon Hospital results MORTALIty NORWOOD MORTALIty 45% 19% Hypoplastic left heart syndrome: evolution of different therapeutic options. An Pediatr (Barc) 2008;68(Supl 2):1-378 / pág. 136 SANO
21 Changes in parental decisions dependent on results Experience with Norwood procedure Centers with most experience report survival rates of 90% con el primer tiempo A survival rate of 80% is common Improving with experience Depending on risk factors Low volume < 15 cases/year
22 Changes in parental decisions dependent on results Hypoplastic left heart syndrome: outcome of different therapeutic options. An Pediatr (Barc) 2008;68(Supl 2):1-378 / pág. 136
23 Changes in parental decisions dependent on results As treatment results improve over time the rate of terminations decreases. Fetal cardiology. G. Sharland. Semin Neonatol 2001:6:3-15
24 Changes in parental decisions dependent on results
25 Changes in parental decisions dependent on results Pregnancy termination: Varies among countries and centers in the same country prenatalscreeninganddiagnosis/ prenataldetectionrates Social and religious factors Legal limits Gestational age at diagnosis Associated malformations Chromosomopathies Treatment results
26 Neurological Prognosis and Quality of Life Norwood Procedure Results Long Term No patients over 20 years of age Analyzed results on older patients evaluate techniques that are now out of date Survival After Reconstructive Surgery for Hypoplastic Left Heart Syndrome : A 15-Year Experience From a Single Institution. William T. Mahle, Thomas L. Spray, Gil Wernovsky,. Circulation 2000;102;III-136-III-14 SURVIVAL AT 5 YEARS 50-75%
27 Neurological Prognosis and Quality of Life 88 patients with HLHS born checked at 1 year Exclusion criteria: major malformations o cromosomopathy Bayley scale of infant development II: PDI:desarrollo motor grosero y fino y MDI memory, problem resolution, numerical concepts, vocalization, language and social abilities. Average scale100 (70<2DS) Neuromuscular examination Genetic clinic Abnormal neuromuscular examination 64% Score MDI medio 90 (rango ) con 11% <70 Score PDI medio 73 (rango ) y 48% <70 Score motor se afecta mas que el intelectual RISK OF LOW PDI SCORE: SUSPICION OF GENETIC Syndrome PREMATURE RISK OF LOW MDI SCORE: SUSPICION OF GENETIC SYNDROME PREMATURE ETI PRIOR TO SURGERY Pediatrics 2008:121:
28 Neurological Prognosis and Quality of Life 40 Cardiopathies and 19 control patients Compara C. Complejas frente a CIV Estudio por RMN y Escala de desarrollo de Baley Las cardiopatias mas severas (SVIH) tiene un menor volumen frontal posiblemente por un insulto prenatal y puede ser la causa de la alta incidencia de microcefalia J Thorac cardiovasc Surg 2009;137:146-53
29 Neurological Prognosis and Quality of Life
30 Possibility of AVOIDING HLHS Fundament Flow theory: LSimple anatomical lesion appearing in morphogenesie semilunar valve stenosis Alterations in flow/pressure patterns Postnatal complex malformation Ventricular hypoplasia An early intervention in the 3rd trimester can alter outcome and avoid secondary damage and therefore improve postnatal prognosis Intervention for severe aortic stenosis in the fetus: Altering the progression of left sided heart disease. J. C. Levine, W. Tworetzky. Progress in Pediatric Cardiology 2006:22;71-78
31 Possibility of AVOIDING HLHS It is difficult to select patients who will benefit from prenatal therapy 43 fetus with critical AS with normal left ventricle <30 wks 23 live newborns 17 HLHS 6 biventricular circulation Circulation 2006;113:
32 Possibility of AVOIDING HLHS 87 procedures Success 72 cases Failure 15 cases (17%) 8 deaths related to procedure 1 TOG 61 NB 3 not born 12 Nb 33 HLHS 28 biventricular 37% 11 HLHS 1 biventricular Fetal mortality <10% Children s Hospital Boston. Updates in pediatric cardiology march/2011
33 Conclusions This is a common cardiopathy in fetal cardiology The suspicion diagnosis is simple but performing an accurate diagnosis with an individualized prognosis requires a specialized study
34 Conclusions Survival rates for this pathology have changed radically over the last ten years Initial mortality rates in most centers with experience is lower than 30%
35 Conclusiones Long term prognosis is uncertain These patients are at risk of alterations in neurodevelopment Most survivors lead a normal life with an average developmental rate
36 Conclusiones Procedure results and long term evolution are decisive in prenatal counselling When the pathology is severe and therapeutic options are poor parents demand the professional s personal opinion
37 Conclusions Why is HLHS different to other congenital cardiopathies? Requires complex neonatal correction Patients at risk of neurological development alterations Other cardiopathies with similar mid term prognosis exist Other pathologies with similar surgical risks exist MALA PERCEPCION POR PARTE DE LOS PROFESIONALES Survey Doctors (neonatologists, cardiologistsand surgeons), Centers (low, medium and high volume) Analysis of the perception of surgery results by different professionals and the repercussion on information
38 Conclusions Residents and nurses Centers with volume: high, medium and low Questionaire: demographics, personal opinion on results of treatment of HLHS, attitude to a hypothetical case of HLHS In the case of a prenatal HLHS diagnosisl 43% of residents and 50% of nurses would opt for termination Factors associated with the decision to terminate pregnancy: having other children, having more professional experience and working in a low volume center. The perception of survival and quality of life is fundamental when deciding whether to continue pregnancy or deciding on surgical treatment and is related to the volume and results of the center. In the case of post natal diagnosis 48% of residents and 68% of nurses would seriously consider compassive treatment Factors associated with the decision for compassive treatment: being an intensive care nurse, more years of experiencea The belief that survival at 5 years was < 50% and quality of life at 5 years being worse was more common among intensive care nurses and from lower volume centers
39 Thank you!!
Hypoplastic left heart syndrome (HLHS) can be easily
Improved Surgical Outcome After Fetal Diagnosis of Hypoplastic Left Heart Syndrome Wayne Tworetzky, MD; Doff B. McElhinney, MD; V. Mohan Reddy, MD; Michael M. Brook, MD; Frank L. Hanley, MD; Norman H.
More informationAccuracy of the Fetal Echocardiogram in Double-outlet Right Ventricle
Blackwell Publishing IncMalden, USACHDCongenital Heart Disease 2006 The Authors; Journal compilation 2006 Blackwell Publishing, Inc.? 200723237Original ArticleFetal Echocardiogram in Double-outlet Right
More informationMethods PEDIATRIC CARDIOLOGY
1805 PEDIATRIC CARDIOLOGY Trends and Outcomes After Prenatal Diagnosis of Congenital Cardiac Malformations by Fetal Echocardiography in a Well Defined Birth Population, Atlanta, Georgia, 1990 1994 EDUARDO
More informationAtrial Septostomy in HLHS and ECMO: Indications, Technique and Outcome
Atrial Septostomy in HLHS and ECMO: Indications, Technique and Outcome Dr Damien Kenny, MB, MD Assistant Professor of Pediatrics Director of the Cardiac Catheterization Hybrid Suite Co-Director of the
More informationFoetal Cardiology: How to predict perinatal problems. Prof. I.Witters Prof.M.Gewillig UZ Leuven
Foetal Cardiology: How to predict perinatal problems Prof. I.Witters Prof.M.Gewillig UZ Leuven Cardiopathies Incidence : 8-12 / 1000 births ( 1% ) Most frequent - Ventricle Septum Defect 20% - Atrium Septum
More informationThe Fetal Cardiology Program
The Fetal Cardiology Program at Texas Children s Fetal Center About the program Since the 1980s, Texas Children s Fetal Cardiology Program has provided comprehensive fetal cardiac care to expecting families
More informationSummary. HVRA s Cardio Vascular Genetic Detailed L2 Obstetrical Ultrasound. CPT 76811, 76825, _ 90% CHD detection. _ 90% DS detection.
What is the role of fetal echocardiography (2D 76825, cardiovascular color flow mapping 93325) as performed in conjunction with detailed fetal anatomy scan (CPT 76811) now that AIUM requires limited outflow
More informationCardiac Intervention in Fetus. Gyeong-hee Yoo, M.D. Department of Pediatrics Soonchunhyang University Cheonan Hospital
10 1111 Cardiac Intervention in Fetus Gyeong-hee Yoo, M.D. Department of Pediatrics Soonchunhyang University Cheonan Hospital Fetal echocardiography Serial f/u intrauterine course of disease Cardiac anomaly
More informationSystematic approach to Fetal Echocardiography. Objectives. Introduction 11/2/2015
Systematic approach to Fetal Echocardiography. Pediatric Echocardiography Conference, JCMCH November 7, 2015 Rajani Anand Objectives Fetal cardiology pre-test Introduction Embryology and Physiology of
More informationHypoplastic Left Heart Syndrome: Echocardiographic Assessment
Hypoplastic Left Heart Syndrome: Echocardiographic Assessment Craig E Fleishman, MD, FACC, FASE Director, Non-invasive Cardiac Imaging The Hear Center at Arnold Palmer Hospital for Children, Orlando SCAI
More informationMajor Forms of Congenital Heart Disease: Consultant Pediatric and Fetal Cardiology King Abdulaziz Cardiac Center, National Guard Hospital Riyadh
Major Forms of Congenital Heart Disease: Impact of Prenatal Detection and Diagnosis Dr Merna Atiyah Consultant Pediatric and Fetal Cardiology King Abdulaziz Cardiac Center, National Guard Hospital Riyadh
More informationEpidemiology of congenital heart diseases
Epidemiology of congenital heart diseases Damien Bonnet Unité médico-chirurgicale de Cardiologie Congénitale et Pédiatrique Hôpital Universitaire Necker Enfants malades APHP, Université Paris Descartes,
More informationEarly fetal echocardiography: congenital heart disease detection and diagnostic accuracy in the hands of an experienced fetal cardiology program
DOI: 10.1002/pd.4372 ORIGINAL ARTICLE Early fetal echocardiography: congenital heart disease detection and diagnostic accuracy in the hands of an experienced fetal cardiology program Jodi I. Pike, Anita
More informationISUOG Basic Training. Obtaining & Interpreting Heart Views Correctly Alfred Abuhamad, USA. Basic training. Editable text here
ISUOG Basic Training Obtaining & Interpreting Heart Views Correctly Alfred Abuhamad, USA Learning Objectives 6, 7 & 8 At the end of the lecture you will be able to: describe how to assess cardiac situs
More informationHeart and Lungs. LUNG Coronal section demonstrates relationship of pulmonary parenchyma to heart and chest wall.
Heart and Lungs Normal Sonographic Anatomy THORAX Axial and coronal sections demonstrate integrity of thorax, fetal breathing movements, and overall size and shape. LUNG Coronal section demonstrates relationship
More informationHow Does Imaging Inform Fetal Cardiovascular Treatment?
How Does Imaging Inform Fetal Cardiovascular Treatment? Edgar Jaeggi, MD Head, Fetal Cardiac Program Labatt Family Heart Center Department of Pediatrics The Hospital for Sick Children University of Toronto
More informationDiagnosis of fetal cardiac abnormalities
Archives of Disease in Childhood, 1989, 64, 964-968 Personal practice Diagnosis of fetal cardiac abnormalities L D ALLAN Guy's Hospital, London The feasibility of cross sectional imaging of the structure
More informationFetal Ductus Arteriosus: The Good, Bad, and the Ugly. Tet Abs Valve syndrome With PDA. Fetal Ductus Arteriosus. James C. Huhta, M.D.
Fetal Ductus Arteriosus: The Good, Bad, and the Ugly Tet Abs Valve syndrome With PDA James C. Huhta, M.D. Perinatal Cardiology Tampa, Florida 7 th Annual Fetal Echocardiography Course Friday, November
More informationDeok Young Choi, Gil Hospital, Gachon University NEONATES WITH EBSTEIN S ANOMALY: PROBLEMS AND SOLUTION
Deok Young Choi, Gil Hospital, Gachon University NEONATES WITH EBSTEIN S ANOMALY: PROBLEMS AND SOLUTION Carpentier classification Chauvaud S, Carpentier A. Multimedia Manual of Cardiothoracic Surgery 2007
More informationDiagnosis of Congenital Cardiac Defects Between 11 and 14 Weeks Gestation in High-Risk Patients
Article Diagnosis of Congenital Cardiac Defects Between 11 and 14 Weeks Gestation in High-Risk Patients Zeev Weiner, MD, Abraham Lorber, MD, Eliezer Shalev, MD Objective. To examine the feasibility of
More informationIntroduction to Fetal Medicine. Lloyd R. Feit M.D. Associate Professor of Pediatrics Warren Alpert Medical School Brown University
Associate Professor of Pediatrics Warren Alpert Medical School Brown University Fetal Cardiology Important in evaluation of high risk pregnancies. Information obtainable in > 95% of patients attempted.
More informationFetal aortic valvuloplasty procedures: experience from Hospital Italiano de Buenos Aires
International Fetal Medicine and Surgery Society Sedona, Arizona May 13-18, 2011 Fetal aortic valvuloplasty procedures: experience from Hospital Italiano de Buenos Aires Otaño L 1, Aiello H 1, Peña G 2,,
More informationScreening for Critical Congenital Heart Disease
Screening for Critical Congenital Heart Disease Caroline K. Lee, MD Pediatric Cardiology Disclosures I have no relevant financial relationships or conflicts of interest 1 Most Common Birth Defect Most
More informationSWISS SOCIETY OF NEONATOLOGY. Prenatal closure of the ductus arteriosus
SWISS SOCIETY OF NEONATOLOGY Prenatal closure of the ductus arteriosus March 2007 Leone A, Fasnacht M, Beinder E, Arlettaz R, Neonatal Intensive Care Unit (LA, AR), University Hospital Zurich, Cardiology
More informationCoarctation of the aorta: difficulties in prenatal
7 Department of Fetal Cardiology, Guy's Hospital, London G K Sharland K-Y Chan L D Allan Correspondence to: Dr G Sharland, Department of Paediatric Cardiology, 1 lth Floor, Guy's Tower, Guy's Hospital,
More informationDeborah Kozik, DO Assistant Professor Division of Cardiothoracic Surgery s present: Early Repair Era
Deborah Kozik, DO Assistant Professor Division of Cardiothoracic Surgery 1954 1960: Experimental Era 1960 s 1980 s: Palliation Era 1980 s present: Early Repair Era 2010 2030 s: Fetal Interventions Hybrid
More informationVasoreactive Response to Maternal Hyperoxygenation in the Fetus With Hypoplastic Left Heart Syndrome
Vasoreactive Response to Maternal Hyperoxygenation in the Fetus With Hypoplastic Left Heart Syndrome Anita Szwast, MD; Zhiyun Tian, MD; Margaret McCann, RDMS; Denise Donaghue, RN, MSN; Jack Rychik, MD
More informationCongenital Heart Disease. Fetal Aortic Valve Stenosis and the Evolution of Hypoplastic Left Heart Syndrome Patient Selection for Fetal Intervention
Congenital Heart Disease Fetal Aortic Valve Stenosis and the Evolution of Hypoplastic Left Heart Syndrome Patient Selection for Fetal Intervention Kaarin Mäkikallio, MD, PhD; Doff B. McElhinney, MD; Jami
More informationFirst Trimester Fetal Echocardiography: Insight Into the Fetal Circulation
First Trimester Fetal Echocardiography: Insight Into the Fetal Circulation Lisa K. Hornberger, MD Fetal & Neonatal Cardiology Program Department of Pediatrics, Division of Cardiology Department of Obstetrics
More informationFetal Echocardiography and the Routine Obstetric Sonogram
JDMS 23:143 149 May/June 2007 143 Fetal Echocardiography and the Routine Obstetric Sonogram SHELLY ZIMBELMAN, RT(R)(CT), RDMS, RDCS ASAD SHEIKH, MD, RDCS Congenital heart disease (CHD) is the most common
More informationIdentification of congenital cardiac malformations by echocardiography in midtrimester fetus*
Br Heart J 1981; 46: 358-62 Identification of congenital cardiac malformations by echocardiography in midtrimester fetus* LINDSEY D ALLAN, MICHAEL TYNAN, STUART CAMPBELL, ROBERT H ANDERSON From Guy's Hospital;
More informationPRACTICAL GUIDE TO FETAL ECHOCARDIOGRAPHY IC Huggon and LD Allan
PRACTICAL GUIDE TO FETAL ECHOCARDIOGRAPHY IC Huggon and LD Allan Fetal Cardiology Unit, Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK IMPORTANCE OF PRENATAL
More informationIntroduction. Study Design. Background. Operative Procedure-I
Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Ann Thorac Surg 2009;87:178 86 86 Addressor: R1 胡祐寧 2009/3/4 AM7:30 SICU 討論室 Introduction Hypoplastic
More informationHighly restrictive or intact atrial septum (RAS) in the
Predictive Value of Fetal Pulmonary Venous Flow Patterns in Identifying the Need for Atrial Septoplasty in the Newborn With Hypoplastic Left Ventricle Erik Michelfelder, MD; Carlen Gomez, MD; William Border,
More informationHeart and Soul Evaluation of the Fetal Heart
Heart and Soul Evaluation of the Fetal Heart Ivana M. Vettraino, M.D., M.B.A. Clinical Associate Professor, Michigan State University College of Human Medicine Objectives Review the embryology of the formation
More informationCongenital Heart Defects
Normal Heart Congenital Heart Defects 1. Patent Ductus Arteriosus The ductus arteriosus connects the main pulmonary artery to the aorta. In utero, it allows the blood leaving the right ventricle to bypass
More informationFetal Rhythm and Blues
Fetal Rhythm and Blues John Cotton, MD Professor of Pediatrics Division of Pediatric Cardiology Director, Fetal Cardiology Program UNC Chapel Hill, School of Medicine Objectives To review methods used
More informationULTRASOUND OF THE FETAL HEART
ULTRASOUND OF THE FETAL HEART Cameron A. Manbeian, MD Disclosure Statement Today s faculty: Cameron Manbeian, MD does not have any relevant financial relationships with commercial interests or affiliations
More informationCongenital Heart Disease
Screening Programmes Fetal Anomaly Congenital Heart Disease Information for health professionals Publication date: April 2012 Review date: April 2013 Version 2 67 Congenital Heart Disease Information for
More informationAlthough the surgical management of hypoplastic left
Hypoplastic Left Heart Syndrome With Intact or Highly Restrictive Atrial Septum Outcome After Neonatal Transcatheter Atrial Septostomy Antonios P. Vlahos, MD; James E. Lock, MD; Doff B. McElhinney, MD;
More informationMitral valve dysplasia syndrome: A unique form of left-sided heart disease
Mitral valve dysplasia syndrome: A unique form of left-sided heart disease Lindsay S. Rogers, MD, a Amy L. Peterson, MD, a J. William Gaynor, MD, b Jonathan J. Rome, MD, a Paul M. Weinberg, MD, a and Jack
More informationFailing right ventricle
Failing right ventricle U. Herberg 1, U. Gembruch 2 1 Pediatric Cardiology, 2 Prenatal Diagnostics and Fetal Therapy, University of Bonn, Germany Prenatal Physiology Right ventricle dominant ventricle
More informationAnatomy & Physiology
1 Anatomy & Physiology Heart is divided into four chambers, two atrias & two ventricles. Atrioventricular valves (tricuspid & mitral) separate the atria from ventricles. they open & close to control flow
More informationSeptember 28-30, 2018
September 28-30, 2018 Course Director Optimizing Detection of Congenital Heart Disease: Important Anatomic Cardiac Regions The Top 5 Critical Anatomic Regions in Fetal Cardiac Imaging Alfred Abuhamad,
More informationFetal Tetralogy of Fallot
36 Fetal Tetralogy of Fallot E.D. Bespalova, R.M. Gasanova, O.A.Pitirimova National Scientific and Practical Center of Cardiovascular Surgery, Moscow Elena D. Bespalova, MD Professor, Director Rena M,
More informationPrenatal Predictors of Postnatal Outcome in Pulmonary Atresia with Intact Ventricular Septum: A Multicenter Study
Fetal Heart Society Concept Research Proposal Date: 10/20/15 Main Study Prenatal Predictors of Postnatal Outcome in Pulmonary Atresia with Intact Ventricular Septum: A Multicenter Study Shaji C. Menon,
More information3/14/2011 MANAGEMENT OF NEWBORNS CARDIAC INTENSIVE CARE CONFERENCE FOR HEALTH PROFESSIONALS IRVINE, CA. MARCH 7, 2011 WITH HEART DEFECTS
CONFERENCE FOR HEALTH PROFESSIONALS IRVINE, CA. MARCH 7, 2011 MANAGEMENT OF NEWBORNS WITH HEART DEFECTS A NTHONY C. CHANG, MD, MBA, MPH M E D I C AL D I RE C T OR, HEART I N S T I T U T E C H I LDRE N
More informationPIAF study: Placental insufficiency and aortic isthmus flow Jean-Claude Fouron, MD
Dear colleagues, I would like to thank you very sincerely for agreeing to participate in our multicentre study on the clinical significance of recording fetal aortic isthmus flow during placental circulatory
More informationBasic Fetal Cardiac Evaluation
Basic Fetal Cardiac Evaluation Mert Ozan Bahtiyar, MD Director, Fetal Care Center Division of Maternal Fetal Medicine Department of Obstetrics, Gynecology and Reproductive Sciences S L I D E 1 Background
More informationPrenatal Imaging of Congenital Fetal Anomalies: A Case Series.
DOI: 10.21276/aimdr.2017.3.2.RD6 Case Report ISSN (O):2395-2822; ISSN (P):2395-2814 Prenatal Imaging of Congenital Fetal Anomalies: A Case Series. Reddy Ravikanth 1, Partha Sarathi Sarkar 2, Anil Kumar
More informationAn Analysis of Results for the Norwood. Operation at Evelina London Children s Hospital (ELCH)
An Analysis of Results for the Norwood Operation at Evelina London Children s Hospital (ELCH) 2012-2015 1 Introduction This report addresses the concerns raised by the 2012-2015 National Congenital Heart
More informationDisclosures. Outline. Learning Objectives. Introduction. Introduction. Sonographic Screening Examination of the Fetal Heart
Sonographic Screening Examination of the Fetal Heart Lami Yeo, MD Director of Fetal Cardiology Perinatology Research Branch of NICHD / NIH / DHHS Bethesda, MD and Detroit, Michigan, USA Professor, Division
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of percutaneous fetal balloon valvuloplasty for aortic stenosis 322 Introduction
More informationHemodynamic assessment after palliative surgery
THERAPY AND PREVENTION CONGENITAL HEART DISEASE Hemodynamic assessment after palliative surgery for hypoplastic left heart syndrome PETER LANG, M.D., AND WILLIAM I. NORWOOD, M.D., PH.D. ABSTRACT Ten patients
More informationRegional Prenatal Congenital Heart Disease Detection and Practices Jenny Ecord, APRN Ward Family Heart Center Wichita
Regional Prenatal Congenital Heart Disease Detection and Practices Jenny Ecord, APRN Ward Family Heart Center Wichita The Children's Mercy Hospital, 2014. 05/14 Objectives Review current local and regional
More informationFetal Echocardiography
Marie M. Gleason, M.D. Clinical Professor of Pediatrics The Perelman School of Medicine of the University of Pennsylvania Director of Outpatient and Community Cardiology and Cardiac Outreach Associate
More informationD iagnosis of congenital heart defects by fetal echocardiography
1070 CONGENITAL HEART DISEASE Timing of presentation and postnatal outcome of infants suspected of having coarctation of the aorta during fetal life C E G Head, V C Jowett, G K Sharland, J M Simpson...
More informationComparison of echocardiographic findings in fetuses at less than 15 weeks gestation with later cardiac evaluation
Ultrasound Obstet Gynecol 2013; 42: 679 686 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.12517 Comparison of echocardiographic findings in fetuses at less than 15
More informationLeitlinien. Hypoplastisches Linksherzsyndrom. Hypoplastic left heart syndrome (HLHS)
1.Title Hypoplastic left heart syndrome (HLHS) N.A. Haas, Bad Oeynhausen Ch. Jux, Giessen J. Photiadis, Berlin H.-H. Kramer, Kiel Typical forms: Mitral atresia/aortic atresia (MA/AoA) Mitral stenosis/aortic
More informationOutflow Tracts Anomalies
Diagnosis of Outflow Tract Anomalies in the Fetus General Framing D.Paladini Fetal Medicine & Surgery Unit Gasllini Children s Hospital - Genoa dariopaladini@ospedale-gaslini.ge.it Outflow Tracts Anomalies
More informationSingle Ventricle with Mitral and Aortic Atresia
1 Bahrain Medical Bulletin, Vol. 26, No. 2, June 2004 Single Ventricle with Mitral and Aortic Atresia Vijaya V Mysorekar, MBBS, MD* Chitralekha P Dandekar, MBBS, MD** Saraswati G Rao, MBBS, MD*** We report
More informationWhat is the Definition of Small Systemic Ventricle. Hong Ryang Kil, MD Department of Pediatrics, College of Medicine, Chungnam National University
What is the Definition of Small Systemic Ventricle Hong Ryang Kil, MD Department of Pediatrics, College of Medicine, Chungnam National University Contents Introduction Aortic valve stenosis Aortic coarctation
More informationS. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences
S. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences No financial disclosures Aorta Congenital aortic stenosis/insufficiency
More informationFetal Cardiac Anomaly
89 Symposium: OB/GY US (Room B) 12 : 10 1 2 : 30 Fetal Cardiac Anomaly 1. One third of all congenital anomalies 2. 6 10/1,000 live births 3. Related with more than 50% of childhood deaths and 20-30% of
More informationCongenital Heart Diseases in the Newborn: from the Pediatrician s Request to the Cardiologist s Evaluation
Congenital Heart Diseases in the Newborn: from the Pediatrician s Request to the Cardiologist s Evaluation Ivan Romero Rivera, Maria Alayde Mendonça da Silva, José Maria Gonçalves Fernandes, Ana Claire
More informationEvaluation of Fetal Pulmonary Veins During Early Gestation by Pulsed Doppler Ultrasound: A Feasibility Study
J. Fetal Med. (March 2015) 2:27 32 DOI 10.1007/s40556-015-0038-y ORIGINAL ARTICLE Evaluation of Fetal Pulmonary Veins During Early Gestation by Pulsed Doppler Ultrasound: A Feasibility Study Aldo L. Schenone
More informationIntroduction. Pediatric Cardiology. General Appearance. Tools of Assessment. Auscultation. Vital Signs
Introduction Pediatric Cardiology An introduction to the pediatric patient with heart disease: M-III Lecture Douglas R. Allen, M.D. Assistant Professor and Director of Community Pediatric Cardiology at
More informationANTENATAL ECHOCARDIOGRAPHIC DIAGNOSIS OF AN AORTOPULMONARY WINDOW COMBINED WITH PULMONARY STENOSIS IN NEONATE. A CASE REPORT
Case report ANTENATAL ECHOCARDIOGRAPHIC DIAGNOSIS OF AN AORTOPULMONARY WINDOW COMBINED WITH PULMONARY STENOSIS IN NEONATE. A CASE REPORT Author: Katarzyna Więckowska 1, Jerzy Węgrzynowski 2, Katarzyna
More informationISOLATED ANOMALOUS DEVELOPMENT OF MYOCARDIUM DURING FETAL LIFE: EXPERIENCE OF OUR CENTRE
Azienda Ospedaliera Universitaria Integrata Verona ISOLATED ANOMALOUS DEVELOPMENT OF MYOCARDIUM DURING FETAL LIFE: EXPERIENCE OF OUR CENTRE C.Sandrini *, L.Rossetti *, M.Rebonato *, M.A.Prioli *, F.Bettinazzi,
More informationDoppler Echocardiography in the Diagnosis and Management of Persistent Fetal Arrhythmias
1386 JACC Vol 7. No 6 June 19X6 I3Xh-91 Doppler Echocardiography in the Diagnosis and Management of Persistent Fetal Arrhythmias JANETTE F. STRASBURGER, MD, JAMES C. HUHTA, MD, FACC, ROBERT J. CARPENTER,
More informationTreatment of congenital aortic valve disease: Neonatal surgical management. Pascal Vouhé - Sick Children Hospital, Paris
Treatment of congenital aortic valve disease: Neonatal surgical management Pascal Vouhé - Sick Children Hospital, Paris Challenges. valvar lesions. associated lesions. status of left ventricle Valvar lesions.
More informationClinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!!
Clinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!! Abha'Khandelwal,'MD,'MS' 'Stanford'University'School'of'Medicine'
More information2019 Fetal Echocardiography:
AVAILABLE NOW ON-DEMAND, USB, OR DVD A CME Teaching Activity 2019 Fetal Echocardiography: Normal and Abnormal Hearts Designated for SA-CME 17.0 AMA PRA Category 1 Credit(s) TM Release Date: February 1,
More informationRelationship Between Isolated Mild Tricuspid Valve Regurgitation in Second-Trimester Fetuses and Postnatal Congenital Cardiac Disorders
ORIGINAL RESEARCH Relationship Between Isolated Mild Tricuspid Valve Regurgitation in Second-Trimester Fetuses and Postnatal Congenital Cardiac Disorders Jizi Zhou, MD, PhD, Yun Zhang, MD, Yonghao Gui,
More informationCardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions
Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS iib6@columbia.edu Pediatric Cardiology Learning Objectives To discuss the hemodynamic significance of
More informationCardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS Pediatric Cardiology
Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS iib6@columbia.edu Pediatric Cardiology Learning Objectives To discuss the hemodynamic significance of
More informationEarly fetal echocardiography: Experience of a tertiary diagnostic service
Australian and New Zealand Journal of Obstetrics and Gynaecology 2015; 55: 552 558 DOI: 10.1111/ajo.12379 Original Article Early fetal echocardiography: Experience of a tertiary diagnostic service Ritu
More informationBeyond Hypoplastic Left Heart Syndrome: The Spectrum of Congenital Heart Disease Associated with Left Ventricular Hypoplasia
Curr Pediatr Rep (2013) 1:102 108 DOI 10.1007/s40124-013-0016-6 CARDIOLOGY (WW LAI, SECTION EDITOR) Beyond Hypoplastic Left Heart Syndrome: The Spectrum of Congenital Heart Disease Associated with Left
More informationAbnormalThree-VesselView on Sonography: A Clue to the Diagnosis of Congenital Heart Disease in the Fetus
rt Pictorial Essay bnormalthree-vesselview on Sonography: Clue to the Diagnosis of Congenital Heart Disease in the Fetus screening tool for major congenital heart diseases [I. 2J. However, anomalies of
More informationDespite improved operative survival for infants born with
Congenital Heart Disease Creation of an Atrial Septal Defect In Utero for Fetuses With Hypoplastic Left Heart Syndrome and Intact or Highly Restrictive Atrial Septum Audrey C. Marshall, MD; Mary E. van
More informationTransposition of the great arteries in the fetus: assessment of the spatial relationships of the arterial trunks by four-dimensional echocardiography
Ultrasound Obstet Gynecol 2008; 31: 271 276 Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.5276 Transposition of the great arteries in the fetus: assessment of the
More informationUnexpected resolution of first trimester fetal valve stenosis: consequence
Unexpected resolution of first trimester fetal valve stenosis: consequence of developmental remodeling? Gardiner, Helena M. The Fetal Center, Children s Memorial Hermann Hospital, McGovern Medical School,
More informationCYANOTIC CONGENITAL HEART DISEASES. PRESENTER: DR. Myra M. Koech Pediatric cardiologist MTRH/MU
CYANOTIC CONGENITAL HEART DISEASES PRESENTER: DR. Myra M. Koech Pediatric cardiologist MTRH/MU DEFINITION Congenital heart diseases are defined as structural and functional problems of the heart that are
More informationRegional Prenatal Congenital Heart Disease Detection and Practices Lori Erickson MSN, RN, CPNP-PC Ward Family Heart Center
Regional Prenatal Congenital Heart Disease Detection and Practices Lori Erickson MSN, RN, CPNP-PC Ward Family Heart Center The Children's Mercy Hospital, 2014. 05/14 Objectives Evaluate our regional prenatal
More informationAuthors: Maciej Słodki 1, Maria Respondek-Liberska 1.2 INTRODUCTION
Original report HYPOPLASTIC LEFT HEART SYNDROME AT THE TERTIARY FETAL CARDIAC CENTER: AS PLANNED, URGENT OR SEVEREST CONGENITAL HEART DISEASE? PRENATAL CLASSIFICATION FOR OBSTETRICIANS AND NEONATOLOGISTS
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of percutaneous fetal balloon valvuloplasty for pulmonary atresia with intact
More informationLONG TERM OUTCOMES OF PALLIATIVE CONGENITAL HEART DISEASE
LONG TERM OUTCOMES OF PALLIATIVE CONGENITAL HEART DISEASE S Bruce Greenberg, MD, FACR, FNASCI Professor of Radiology and Pediatrics Arkansas Children's Hospital University of Arkansas for Medical Sciences
More informationCongenital heart disease in twin-to-twin transfusion syndrome treated with fetoscopic laser surgery
Chapter 10 Congenital heart disease in twin-to-twin transfusion syndrome treated with fetoscopic laser surgery Enrico Lopriore MD Regina Bökenkamp MD Marry Rijlaarsdam MD Marieke Sueters MD Frank PHA Vandenbussche
More informationSevere left heart obstruction with retrograde arch flow influences fetal cerebral and placental blood flow
Ultrasound Obstet Gynecol 13; : 9 99 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 1.1/uog.18 Severe left heart obstruction with retrograde arch influences fetal cerebral and
More informationCongenital heart defects are frequent and serious. Racial and Temporal Variations in the Prevalence of Heart Defects
Racial and Temporal Variations in the Prevalence of Heart Defects Lorenzo D. Botto, MD; Adolfo Correa, MD, PhD; and J. David Erickson, DDS, PhD ABSTRACT. Background. Documenting the prevalence and trends
More information2018 Fetal Echocardiography:
AVAILABLE NOW ON-DEMAND, USB, OR DVD A CME Teaching Activity 2018 Fetal Echocardiography: Designated for SA-CME 16.5 AMA PRA Category 1 Credit(s) TM Release Date: February 1, 2018 Educational Symposia
More informationResearch article. Primary detection of congenital heart diseases in the Kyrgyz Republic
Research article Primary detection of congenital heart diseases in the Kyrgyz Republic Irina A. Akhmedova, Gulzada A. Imanalieva, Damir A.Abibillaev, Taalaibek Z. Kudaiberdiev Scientific Research Institute
More informationHybrid Stage I Palliation / Bilateral PAB
Hybrid Stage I Palliation / Bilateral PAB Jeong-Jun Park Dept. of Thoracic & Cardiovascular Surgery Asan Medical Center, University of Ulsan CASE 1 week old neonate with HLHS GA 38 weeks Birth weight 3.0Kg
More informationOpinion. Isolated major congenital heart disease
Ultrasound Obstet Gynecol 2001; 17: 370 379 Opinion Blackwell Science, Ltd Isolated major congenital heart disease The principal theme of this issue of the Journal is the prenatal detection of fetal cardiac
More informationOutcomes of Infants with Prenatally Diagnosed Congenital Heart Disease Delivered in a Tertiary-care Pediatric Cardiac Facility METHODS
R E S E A R C H P A P E R Outcomes of Infants with Prenatally Diagnosed Congenital Heart Disease Delivered in a Tertiary-care Pediatric Cardiac Facility TRUPTI DEEPAK CHANGLANI, ANNU JOSE, ABISH SUDHAKAR,
More informationCardiac MRI in ACHD What We. ACHD Patients
Cardiac MRI in ACHD What We Have Learned to Apply to ACHD Patients Faris Al Mousily, MBChB, FAAC, FACC Consultant, Pediatric Cardiology, KFSH&RC/Jeddah Adjunct Faculty, Division of Pediatric Cardiology
More informationEchocardiographic and anatomical correlations in fetal
Br Heart J 1984; 52: 542-8 Echocardiographic and anatomical correlations in fetal congenital heart disease LINDSEY D ALLAN, DIANE C CRAWFORD, ROBERT H ANDERSON,* MICHAEL J TYNAN From Guy's Hospital, London;
More informationFUNCTIONALLY SINGLE VENTRICLE
MORPHOLOGICAL DETERMINANTS VI TRAN EuroEcho, Budapest, 7 th December 2011 DECLARATION OF CONFLICT OF INTEREST: I have nothing to declare What is the functionally single ventricle? The heart that is incapable
More informationEchocardiographic and anatomical correlates in the fetus*
Br Heart J 1980; : 51 Echocardiographic and anatomical correlates in the fetus* LINDSEY D ALLAN, MICHAEL J TYNAN, STUART CAMPBELL, JAMES L WILKINSON, ROBERT H ANDERSON From King's College Hospital, and
More informationNew Techniques in Fetal Cardiac MRI
New Techniques in Fetal Cardiac MRI Chris Macgowan Senior Scientist Translational Medicine, Hospital for Sick Children Associate Professor Medical Biophysics, University of Toronto Fetal Cardiovascular
More information