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הצגת עבודות, יום ד', 17.2.2010 - תכנית ותקצירים

הכנס הדו שנתי

של החברה הישראלית לאולטרה-סאונד במיילדות וגינקולוגיה

כפר המכביה, 17-18 בפברואר 2010

 

הצגת עבודות יום ד', 17.2.2010

15:00 – 13:30

יושבי ראש: ד"ר יוסי פרדו, ד"ר רפי בולדס, פרופ' בני כספי

 

יש ללחוץ על הלינק כדי לצפות בתקציר

התקצירים מופיעים בהמשך דף זה ולא יודפסו בתכנית שתחולק הכנס

תכנית:

1

 

13:30-13:37

קביעת מדדי הביומטריה העוברית באוכלוסיית הנשים בצפון ישראל לצורך אבחון מיקרוצפליה

אתי דניאל-שפיגל, אהוד וינר, אילן ירום, אליעזר שלו.

מרכז רפואי העמק, עפולה

2

 

 

13:37-13:44

הערכת משקל סונוגרפית: המימדהשלישי-מחקר פרלימינארי

ניר חייא2, אודי ארגז,1 ישראל גולדשטיין1, יעל גולדברג,2 זאבויינר1

1. הקריה הרפואית לבריאות האדם-רמב"ם, מחלקת נשיםויולדות. 2. בית חולים כרמל, מחלקת נשים ויולדות

3

 

 

 

 

13:44-13:51

Perinatal and neonatal outcome of monochorionic (MC) twins with selective IUGR (sIUGR) hospitalized under strict surveillance

Boaz Weisz, Liat Hogen, Liat. Gindes, Alon Shrim, Michal Simchen, Eyal Schiff and Shlomo Lipitz

Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer

4

 

 

13:51-13:58

Color and power Doppler imaging in diagnosis of pelvic gastrointestinal stromal tumor (GIST)

Leibovitz Z.,Degani S., ShapiroI., Ohel G.

Bnai-Zion Medical Center; Technion-Israel Institute of Technology, Haifa.

5

 

 

 

13:58-14:05

The prenatal diagnosis ofisolated varix of the fetal intra-abdominalumbilical vein (VFIUV): Iatrogenic prematurity is not obligatory

M. Bas-Landau, R.Rabinowitz, O.Shen, E. Mazaki, A. Samueloff, M.S. Schimmel, S.Grisaru-Granovsky

בית חולים שערי צדק , ירושלים

6

 

 

 

 

 

14:05-14:12

Long-term follow-up of children with ovarian cysts diagnosed prenatally

Ido Ben-Ami¹, Adi Kogan¹, Noga Fuchs¹, Noam Smorgick¹, Sonia Mendelovic2, Arie Herman¹ and Ron Maymon¹

1Departments of Obstetrics and Gynecology and 2Pathology, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv

7

 

 

 

 

14:12-14:19

Added value of the gray scale Whirlpool Sign in diagnosis of adnexal torsion

Dan V. Valsky, Efrat Esh-Broder, Sarah M. Cohen, Michal Lipschuetz, Simcha Yagel.

Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Mt. Scopus Jerusalem.

8

 

 

 

 

 

 

 

 

14:19-14:26

Pilot study comparing ex-vivo HREM imaging and in-vivo 4DHRTV ultrasound of the first trimester fetal heart

Liat Gindes1, Hikoro Matsui2, Reuven Achiron1, Marcin Wiechec2,Timothy Mohun3, Siew Yen Ho4, Helena Gardiner2.

1. Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Aviv University, Israel.2. Department of Reproductive and Developmental Biology, Faculty of Medicine at Queen Charlotte’s and Chelsea Hospital, Imperial College, London.3. Division of Developmental Biology, National Institute of Medical Research, London.4. Cardiac Morphology Unit, National Heart and Lung Institute at Royal Brompton Hospital, London.

9

 

 

14:26-14:33

Evaluation of normal fetal atrio-ventricular septal diameter from 11 gestational weeks to 34 weeks

Jimmy Jadaon, Magie Mukary, Sami Haddad, Moshe Ben-Ami

Baruch Padeh medical center, Poria

10

 

 

 

 

14:33-14:40

Direct 4D-MPI in fetuses with evolving cardiac compromise

1Baruch Messing, 2David Mallatiner, 1Dan V Valsky, 1Michal Lipschuetz, 1Daniel Rosenak, 1Sarah M Cohen, 1Simcha Yagel

1Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Mt. Scopus, Jerusalem, Israel

2Poria State Hospital, Tiberias.

11

 

 

 

14:40-14:47

Fetal contraction fraction (FCF) to evaluate cardiac contractility

Baruch Messing, Michal Lipschuetz, Dan V Valsky, Sarah M Cohen, Simcha Yagel

Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Mt. Scopus, Jerusalem.

12

 

 

 

14:47-14:54

Prenatal Diagnosis of Right Aortic Arch as an Isolated Finding: Natural History and Prognosis

Razon Yaron, Berant Michael, Fogelman Rami, Birk Einat

Heart institute, Schneider Children Medical Center of Israel (SCMCI), Petah-Tikva

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv.

 

 התקצירים

1

13:30-13:37

 

קביעת מדדי הביומטריה העוברית באוכלוסיית הנשים בצפון ישראל לצורך אבחון מיקרוצפליה

אתי דניאל-שפיגל, אהוד וינר, אילן ירום, אליעזר שלו

מרכז רפואי העמק, עפולה.

 

מיקרוצפליה מוגדרת כהיקף ראש קטן מ- 2 או 3 סטיות תקן מתחת לממוצע. שימוש במדד היחיד של היקף ראש הקטן מ-3 סטיות תקן מתחת לממוצע לצורך הגדרה של מיקרוצפליה משמעו ששכיחות המצב באוכלוסיה הכוללת הינו כ- 0.1%. שכיחות זו גבוהה בהרבה מההערכה על פי תצפיות.

היכולת שלנו לפענח את מדידות הראש לצורך הערכת התסמונת אינה חד משמעית. הקושי נובע בין היתר מהרבגוניות של המצב והשונות במועד ההופעה הקלינית כמו גם משימוש בעקומות נורמל שונות. נהוג להשתמש בטבלאות נורמה המקובלות בספרות כפי שנמדדו על האוכלוסייה הלבנה בארה"ב. בעבודות שונות נמצא כי קיימים הבדלים משמעותיים במדדים הביומטריים של העובר בקבוצות אתניות שונות.

מטרת עבודה זו היא לאסוף את הנתונים הקיימים ביחידת העל-קול, מחלקת נשים ויולדות, בית חולים העמק, לצורך יצירת נומוגרמות של מדדי הראש השונים של העוברים באוכלוסיית הנשים החיות בצפון מדינת ישראל.

במסגרת המחקר בוצע איסוף רטרוספקטיבי של נתוני בדיקות העל-קול שבוצעו בין השנים 1998-2009 ביחידת העל-קול , מחלקת נשים ויולדות, בי"ח העמק. נתוני הבדיקות כללו: גיל הריון, מדדי היקף הראש, המרחק הבין רקתי, היקף הבטן ואורך הירך. מתוך כלל הבדיקות שבוצעו במכון בודדו הבדיקות של עוברים שאובחנו כתקינים.

עקומות גדילה שורטטו בהתבסס על נתונים שנלקחו מלמעלה מ-10000 עובריםבריאים,בהריונות יחיד בין השבועות 12 ל-42ובעזרת שימוש בריגרסית קוונטילים.

בשיטה זו נבנו עקומות גדילה המתאימות לקהילת הנשים בצפון ישראל . שימוש בנתונים אלו לצורך קביעת נורמת הגדילה של העוברים וזיהוי החריגים הינו כנראה מדויק יותר בהשוואה לשימוש בעקומות שמקורן ביבשות אחרות.

 

בחזרה לתכנית

2

13:37-13:44

 

הערכת משקל סונוגרפית: המימדהשלישי-מחקר פרלימינארי

ניר חייא2, אודי ארגז1, ישראל גולדשטיין1, יעל גולדברג2, זאבויינר1

1. הקריה הרפואית לבריאות האדם-רמב"ם, מחלקת נשיםויולדות.2. בית חולים כרמל, מחלקת נשים ויולדות.

 

מרבית הנוסחאות הקימות להערכת משקל העובר תוארו לפנילמעלה משני עשורים, מאז ועד היום חלה התקדמות משמעותית בטכנולוגיית ההדמיה העלשמעית המשמשת להערכת עוברים. הסטייה המקובלת בהערכת משקל לעוברים במועד הינהכ-10-15%, להערכת המשקל המבוצעת באמצעות הדמיה על שמעית משמעות רבה בקבלת החלטותרפואיות במהלך ההיריון. במקרים רבים, החלטות כגון: תכיפות המעקב, סיום ההיריוןואופן היילוד מושפעות באופן ישיר מנתוני הערכת המשקל.

גוף העובר הינו מסה בעלת נפח ברם הנוסחאות הקיימותלחישוב הערכת המשקל מתייחסות למדידות המבוצעת בשני מישורים בלבד.

השערת העבודה ומטרותיה: השערת העבודה היא כיניתן לגבש נוסחה להערכת משקל עוברים אשר תתבסס על נתוני נפח הראש והבטן ובכך להקטיןאת מידת הסטייה בין משקל העובר המוערך לזה בפועל. למעשה, אנו מעוניינים לנצל אתהטכנולוגיה המתקדמת של האולטראסאונד התלת מימדי.

שיטות:המשתתפות במחקר הינן נשים בשליש השלישילהריונן אשר מגיעות ליחידת ההדמיה העל שמעית במחלקתנו לצורך ביצוע הערכה סונוגרפית. בשלב הראשון של המחקר בוצעו מדידות עוברים ובנוסף נאסף מידע על גיל ההיריון, מיןהעובר, מהלך ההיריון, סיבוכים בהריון,מצבה הבריאותי של היולדת, עברה המיילדותיותוצאות הלידה.המדידות כללו BPD, AC,FL וכן מדדי נפח הראש והבטן תוך שימוש בתכנתה-"VOCAL". החתכים הראשוניים מהם בוצעה בדיקת ה – VOCAL היו החתכים הקלסיים של היקף ראשובטן.

תוצאות:סה"כ נאספו נתונים מבדיקת 57 נשים כאשרהגיל הממוצע הינו 32 שנים (טווח הגילאים הינו 23-45 שנים), שבוע ההיריון הממוצעהינו 35 שבועות (28-40 שבועות). נמצא מתאם גבוה בין מדדי נפח הבטן ומדדי AC (r=0.87). נמצאמתאם גבוה בין מדדי נפח הראש ומדדי HC (r=0.822). נמצא מתאם גבוה בין מדדינפח הראש ו-BPD (r=0.797  ). בנוסף, יוצגו עקומות ראשוניות של מדדי נפח בטן ונפח ראש עובר לאורךהשליש השלישי להריון.

סיכום:מתוצאות המחקר עולה כי קיים קשר מובהקבין מדדי נפח הראש והבטן לבין מדדי AC,BPD,HC, וכן  .EFWתוצאות ראשוניות אלה מהוות בסיס לשימוש במדידותנפח להשם הערכה טובה יותר של מדדי ומשקלהעובר

בחזרה לתכנית

3

13:44-13:51

 

Perinatal and neonatal outcome of monochorionic (MC) twins with selective IUGR (sIUGR) hospitalized under strict surveillance

Boaz Weisz, Liat Hogen, Liat. Gindes, Alon Shrim, Michal Simchen, Eyal Schiff and Shlomo Lipitz

Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer

 

Introduction: Selective IUGR of MC twins is associated with perinatal morbidity and mortality. We aimed to evaluate the prenatal and neonatal short term outcome of MC twins with sIUGR who were hospitalized under strict surveillance in a tertiary center.

Study design: This was a retrospective study, involving 3 groups of MCT. Group I-uncomplicated MC twin pregnancies (n=90). Group II- sIUGR with normal flow (n=21) and group III- sIUGR and abnormal u/a flow (n=19). The latter were hospitalized in HRP ward under strict surveillance. Perinatal and neonatal outcome were compared between the three groups.

Results: None of the fetuses in the sIUGR pregnancies died in utero. Both sIUGR with normal flow and sIUGR with abnormal flow had longer pre-delivery hospitalization, were delivered earlier and had longer neonatal hospitalization. Neonatal outcome of cases complicated with sIUGR and normal flow was similar to controls. Neonates born to pregnancies complicated with sIUGR and abnormal flow had significantly more CNS findings (p=0.003), RDS (p<0.001), NEC (p=0.03), sepsis (p<0.001) and neonatal death (p=0.03).

Conclusion: Selective IUGR cases with normal flow have similar outcome as compared to non complicated MC pregnancies. When hospitalized under strict surveillance, MC twins with sIUGR and abnormal flow have reasonable outcome with significantly more neonatal complications compared to the control group.

 

בחזרה לתכנית

4

13:51-13:58

 

Color and power Doppler imaging in diagnosis of pelvic gastrointestinal stromal tumor (GIST)

Leibovitz Z.,Degani S., Shapiro I., Ohel G.

Bnai-Zion Medical Center; Technion-Israel Institute of Technology, Haifa, Israel.

 

Objective: Description of the pelvic GIST diagnosis based on the demonstration of the tumor vascular connection to the small bowel.

Methods: GIST is a known pelvic mass imitating ovarian malignancy. Three cases of GIST sonographic diagnosis are presented and discussed.

Results: The tumors appeared as mobile, oval, well defined pelvic masses. Sonographically, they were described as complex pelvic tumors. Their cystic components had irregular internal borders. No free pelvic fluid was noticed in two cases. In last case (which was initially misdiagnosed as OHSS in early gestation) a massive hemoperitoneum was observed, secondary to bleeding from the superficial tumor vessels.Peritoneal surface of the pelvis and pelvic organs was unremarkable. The tumors showed abundant disorganized vascularity in their solid tissue. On the color and power Doppler scan a distinctive vascular connection was demonstrated between the tumor and the serosal surface of small bowel in both cases. Histological examination confirmed GIST diagnosis of the tumors.

Conclusions: Systematic color and power Doppler scanning of the pelvic masses oriented to their vascular connections helps to differentiate between GIST and gynecological tumors.

בחזרה לתכנית

5

13:58-14:05

 

The prenatal diagnosis ofisolated varix of the fetal intra-abdominalumbilical vein (VFIUV): Iatrogenic prematurity is not obligatory

M. Bas-Landau, R.Rabinowitz, O.Shen, E. Mazaki, A. Samueloff, M.S. Schimmel, S.Grisaru-Granovsky

 

Background: VFIUV was initially reported in relationship withpostmortem of stillborns . As the natural history and management of isolated VFIUV were uncertain, mode of surveillance followed by induction of delivery at 34 weeks were suggested in an attemptto minimize the “stillborn risk”.

Aim: To evaluate our experience with isolated VFIUV in a tertiary center and correlate our strategy with outcome.

Methods: Retrospective analysis of all cases of isolated VFIUV between the years 2004-2009. Following incidental finding of the above mentioned lesion, anomaly scan ,at any gestational age, was performed together with measurement of the diameter of the lesion and doppler studies for turbulent flow. VFIUV diagnosis (outer -inner edge, : focal dilatation >9mm or at least 50% larger than the intrahepatic UV, using GA specific criteria ).

Isolated VFIUV was defined as normal fetal anatomy , karyotype and neonatal checkup. Time of delivery was dependent on the physician that was following the pregnancy, starting on the 35 th weeks of gestation.

We reviewed ultrasound, maternal and newborn medical records, confirmation by telephone interviews.

Descriptive statistics :mean± SD, range, chi-square , Pearson index

Results: 24 women with fetuses with isolated VFIUV (excluded one lost for follow up). Demographics: maternal age 33 ± 7.1 years; Jewish 22 (96%); mean gravidity 4.9±2.7; GA initial diagnosis 30.5± 4.4 weeks (20-39); diagnosed < 32 weeks 13 (56.5%); singletons 20(87%). VFIUV diameter 13 mm ± 2.9 (9-20), turbulent flow 7 (30.4%). All fetuses were live-born, with a normal follow up 2 – 60 months. GA at birth 37±2.5 weeks (33-41); birth weight 2866±687.6 grams; males 14 (60.9%). Overall induction 65.2%.Preterm (35-37+0 weeks) induction due to VFIUV alone performed in 4 (17.4%) ; other cause for preterm delivery (3 twins, 1 PPROM,1 abruption) 5 (21.7%) ; allowed to continue until spontaneous labor 14 (60.9%). Overall cesarean 28.6% (4/23). Overall NICU admission 5(21.7%). Timing and mode of delivery were unrelated to the GA diagnosis, size and type of flow of VFIUV (p=0.101, p=0.727, p=0.671 respectively) ®=0.4. Those induced preterm significantly contributed to the higher rate of cesarean and NICU admission p=0.015 and p= 0.029, respectively.

Conclusion: VFIUV is a sonographic diagnosis with an apparent benign course. Our excellent perinatal outcome, unrelated to the structural and flow characteristics of the finding, warrants against early induction and costly preterm births.

 

בחזרה לתכנית

6

14:05-14:12

 

Long-term follow-up of children with ovarian cysts diagnosed prenatally

Ido Ben-Ami¹, Adi Kogan¹, Noga Fuchs¹, Noam Smorgick¹, Sonia Mendelovic2, Arie Herman¹ and Ron Maymon¹

Departments of Obstetrics and Gynecology1 and Pathology2, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv

 

Objective To assess long-term outcomes of children who had ovarian cysts diagnosed prenatally.

Methods We retrospectively reviewed prenatal records and ultrasonograms of fetuses who were diagnosed with ovarian cysts in our ultrasound unit between January, 1997 and December, 2008. During January -April, 2009, those children were invited to our institute for transabdominal pelvic sonographic re-examination. Demonstration of the uterus and adnexa was required.

Results Twenty-one children were diagnosed prenatally with either simple (n = 11) or complex (n = 12) ovarian cysts and treated by either conservative management (n = 13) or surgical intervention (n = 10) postnatally.

The ipsilateral ovary was not detected in 8 of the 11 children in whom a complex cyst had been detected on the first postnatal scan. A significantly higher rate of ovarian loss was diagnosed when the sonographic appearance of the ovarian cyst was simple on the antenatal scan and complex on the postnatal scan (6 out of 7) compared to when the ovarian cyst was simple on both scans (1 out of 4, P = 0.04).

ConclusionPrenatal detection of complex ovarian cyst should indicate close monitoring in order to alert to the need for early intervention for preventing impending ovarian loss. Children in whom an ovarian cyst was diagnosed prenatally should have long-term pelvic ultrasound follow-up.

 

בחזרה לתכנית

7

14:12-14:19

 

Added value of the gray scale Whirlpool Sign in diagnosis of adnexal torsion

Dan V. Valsky, Efrat Esh-Broder, Sarah M. Cohen, Michal Lipschuetz, Simcha Yagel

Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Mt. Scopus Jerusalem.

 

Background: Adnexal torsion is a common gynecologic emergency affecting females of all ages. Expedient diagnosis and treatment are important, particularly in young fertile patients to preserve ovarian viability. Classical parameters for the clinical and sonographic diagnosis of adnexal torsion have very high false-positive rates, approaching 50%. The sonographic whirlpool sign (WS) has been shown to be effective to visualize the torsed part in prenatal diagnosis of malrotation of the midgut with volvulus, as well as scrotal and ovarian torsion. We aimed to evaluate the yield of WS in diagnosis of torsion, as compared to a protocol based on “classic” sonographic signs of torsion alone.

Patients and Methods: Retrospective chart review. Files of all patients who underwent laparoscopy for suspected torsion at our center between January 2006-May 2009 were extracted and reviewed. Ultrasound reports were retrieved from our computerized database. Patients were assigned to study group if whirlpool sign was investigated during pre-procedural evaluation or to comparison group if only the standard protocol was applied.

Results: 80 women were referred for laparoscopy for suspected adnexal torsion during the study period. In 22/80 ultrasound investigation included the WS (study group) while 58 were examined by standard protocol (comparison group). 20/22 women in the study group had positive WS on ultrasound; 18/20 (90%) had confirmed torsion on laparoscopy. 32/58 (55.2%) women in the comparison group had confirmed torsion on laparoscopy. Rate of true positive diagnosis differed significantly (90% vs 55.2%, p<0.05).

Conclusion: The addition of sonographic WS to the preoperative sonographic evaluation of patients with suspected torsion appears to improve the rate of true positive diagnoses as confirmed by laparoscopy.

 

בחזרה לתכנית

8

14:19-14:26

 

Pilot study comparing ex-vivo HREM imaging and in-vivo 4DHRTV ultrasound of the first trimester fetal heart

Liat Gindes1, Hikoro Matsui2, Reuven Achiron1, Marcin Wiechec2,Timothy Mohun3, Siew Yen Ho4, Helena Gardiner2.

1. Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Aviv University, Israel.2. Department of Reproductive and Developmental Biology, Faculty of Medicine at Queen Charlotte’s and Chelsea Hospital, Imperial College, London.3. Division of Developmental Biology, National Institute of Medical Research, London.4. Cardiac Morphology Unit, National Heart and Lung Institute at Royal Brompton Hospital, London.

 

Purpose: To compare 3D High Resolution Episcopic Microscopy (HREM) with in-vivo 4D High Resolution Trans Vaginal ultrasound (4DHRTV) in the ability to discern morphological features of the normal human fetal heart at the first trimester.

Methods: Prospective collaborative pilot study on fetal hearts between 9 to 14 weeks.

HREM uses 21 ex-vivo fetal hearts (9w0d-13w6d) and make a virtual 3D volume dataset by automatic section into thousands of precisely aligned slices and produces serial 2D digital images. This allows “anatomical dissection” in any plane through the fetal heart. 4DHRTV ultrasound uses 30 in vivo fetal heart (10w2d-14w0d) obtained using high resolution transvaginal ultrasound. A feasibility comparison between various fetal heart structures was performed using classical (standard) axial planes and surface planes.

Results: HREM shows four characteristic features in the first compared to second trimester: prominent atrial appendages, spiral ventricular arrangement, prominent coronary arteries and thickened arterial walls.4DHRTV also shows the first two in 47% and 53% of the cases respectively, but ultrasound resolution does not yet permit quantification of wall thickness and demonstration of coronary arteries at this resolution of 3-5 mm diameter of the heart.

Conclusions: First trimester 4DHRTV shows similar morphological features to HREM.HREM provides a gold standard of imaging, against which developments in ultrasound resolution can be compared.

בחזרה לתכנית

9

14:26-14:33

 

Evaluation of normal fetal atrio-ventricular septal diameter from 11 gestational weeks to 34 weeks

Jimmy Jadaon, Magie Mukary, Sami Haddad, Moshe Ben-Ami

Baruch Padeh medical center, Poria

 

Introduction: Atrio-ventricular septum (AVS) refers to the area between the insertion of mitral valve and tricuspid valve leaflets to ventricular septum. In normal fetuses the tricuspid valve has an apical displacement relative to the mitral valve. This area is of great importance because of its involvement in 2 congenital heart defects: Ebstein's anomaly and atrio-ventricular septal defect. Since AVS is evaluated subjectively during fetal anatomic survey, our aim is to determine a nomogram of the AVS diameter between 11 and 34 weeks.

Materials and methods: Measurement of AVS and inter-ventricular septum (IVS) diameters were performed by fetal echocardiography in a 4-chamber view from 11 to 34 gestational weeks in otherwise normal pregnancies. In addition, fetal biometry was evaluated. Linear regression analysis was used to evaluate the correlation between parameters and statistical significance was considered when p<0.05.

Results: Two hundred ninety six examinations of normal fetuses were included. Linear regression analysis revealed a positive correlation between AVS length and gestational age (r2=0.96, P<0.001) (Fig. 1). With each increase of 1 week in gestational age, there was an increase of 0.165 mm in AVS diameter (β=0.165, P<0.001). AVS diameter was also proportional to IVS diameter with increasing gestational age (r2=0.882, β=0.94, P<0.001). Positive linear correlation was obtained between AVS diameter and fetal biometry (p<0.001).

Conclusion: We provide a nomogram for AVS diameter which can be used as a reference when either Ebstein anomaly or AV septal defects are suspected.

 

בחזרה לתכנית

10

14:33-14:40

 

Direct 4D-MPI in fetuses with evolving cardiac compromise

1Baruch Messing, 2David Mallatiner, 1Dan V Valsky, 1Michal Lipschuetz, 1Daniel Rosenak, 1Sarah M Cohen, 1Simcha Yagel

1Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Mt. Scopus, Jerusalem.2Poria State Hospital, Tiberias.

 

Background: Modified myocardial performance index (Mod-MPI) is an accepted method of cardiac performance evaluation in children, adults and fetuses based on Doppler flow evidence of opening and closing of the AV and semilunar valves. We demonstrated 4D-MPI, based on analysis of STIC-acquired volume sets for direct visualization of opening and closing of the valves and assessment of the isovolumetric and ejection periods. We applied 4D-MPI to the evaluation of pathological cases with suspected or developing cardiac compromise and compared these results with Mod-MPI and normal 4D-MPI nomograms.

Methods: Gravidae referred for evaluation of fetal pathologies with suspicion of cardiac compromise were examined with 2DUS parameters as indicated, including Mod-MPI. 4D-MPI was obtained in post-processing from saved STIC volumes. In multiplanar mode in post-processing, isovolumetric and ejection periods were measured according to valve status. 4D-MPI results were compared to conventional Mod-MPI.

Results: 30 healthy fetuses were examined to establish normal range of values for 4D-MPI at 24-32 weeks. MPI measured in both methods remained relatively stable during pregnancy. In 13 cases of evolving cardiac compromise (agenesis of ductus venosus with extra-hepatic connection-4, cardiomyopathy-2, SVT-2, diaphragmatic hernia-1, fetal anemia [before treatment]-2, pulmonary-venous shunt-1, CMV infection-1), conventional Mod-MPI and 4D-MPI showed similar results.The difference between them did not exceed ± 0.05 (clinically insignificant).

Conclusions: 4D-MPI is useful for direct evaluation of fetuses with suspected cardiac compromise, and provided results comparable to those obtained with conventional Mod-MPI. 4D-MPI may form part of the 3D/4DUS exam performed on these fetuses.

 

בחזרה לתכנית

11

14:40-14:47

 

Fetal contraction fraction (FCF) to evaluate cardiac contractility

Baruch Messing, Michal Lipschuetz, Dan V Valsky, Sarah M Cohen, Simcha Yagel

Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Mt. Scopus, Jerusalem.

 

Background: Cardiac contractility is an important part of overall cardiac performance. The accepted method for contraction evaluation is the shortening fraction (SF) obtained in M-mode. Myocardial contraction measurement has also been attempted in 2DUS. We recently presented a 3D/4DUS contraction fraction for myocardial contractility measurement, and showed that the fetal myocardium decreases in volume during systole, while pediatric myocardium does not.

We aimed to examine fetal myocardial contraction fraction (FCF) in fetuses with suspected cardiac compromise, and to examine whether this measure can serve for evaluation of inotropic myocardial performance.

Methods: 70 normal fetuses were examined to establish a normal range of values. Subjects were patients referred for evaluation of pathologies raising suspicion of cardiac compromise. Following echocardiography performed according to our standard protocol, end-systolic and end-diastolic myocardial volumes (M-EDV, M-ESV) were measured in right and left ventricles. Fetal contraction fraction (FCF) was calculated as (M-EDV—M-ESV)/M-EDV for each ventricle. Ejection fraction (EF) and stroke volume were also calculated and compared to FCF.

Results: Right and left ventricle FCF ranged from 10-40% throughout gestation in normal fetuses; mean right ventricle FCF was 22%, mean left ventricle FCF was 28%. EF was 50-66% throughout gestation. In a fetus with cardiomyopathy low FCF (<5th percentile) reinforced the diagnosis, while in a case of stenotic outflow tracts the increased FCF (>75th percentile) suggested a compensatory process. A case of Ebstein’s anomaly exemplified both processes: decreased FCF in the pathological right ventricle with increased FCF in the normal left ventricle. In a case of cardiomegaly secondary to dilated ductus venosus, the FCF remained normal. This finding reinforced our assessment that the observed cardiomegaly did not result from intrinsic myocardial pathology but from extracardiac cause.

Conclusions: We propose Fetal Contraction Fraction (FCF) as a measure of inotropic myocardial performance in the overall evaluation of fetal cardiac compromise.

 

בחזרה לתכנית

12

14:47-14:54

 

Prenatal Diagnosis of Right Aortic Arch as an Isolated Finding: Natural History and Prognosis

Razon Yaron, Berant Michael, Fogelman Rami, Birk Einat

Heart institute, Schneider Children Medical Center of Israel (SCMCI), Petah-Tikva

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv

 

Background: Right aortic arch is usually associated with the presence of a significant congenital heart disease. The prognosis is almost always determined by the severity of the cardiac lesion. The significance of a right aortic arch with normal heart in the fetus is not known, and depends on its effect on the trachea.

Objective: To describe the natural history and prognosis of isolated right aortic arch in the fetus.

Methods: Fetal echocardiography database at the heart institute at SCMCI was reviewed for all fetuses that had a diagnosis of right aortic arch with normal intracardiac anatomy between 1999 - 2008. Demographic and echocardiographic details were retrieved and reviewed.

Results: Out of 13450 fetal echocardiograms, 32 fetuses had a diagnosis of right aortic arch or double aortic arch with normal intracardiac anatomy. Gestational age at prenatal diagnosis was 19-34 weeks (mean=23). Prenatal diagnosis was correct in 23 out of 28 newborns examined after birth. Four newborns with double aortic arch were misdiagnosed as having a right aortic arch and one vise versa. Five infants (18%) were symptomatic (stridor) during infancy, four with double aortic arch. All underwent successful surgical repair

Conclusions: A right aortic arch can be accurately diagnosed in the fetus but the presence of a double aortic arch may be missed. A fetus with a right aortic arch should be evaluated after birth in order to rule out the presence of a tight vascular ring, which may require surgical repair with the appearance of symptoms

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