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14th World Congress on Ultrasound in Obstetrics and Gynecology

Poster abstracts

Differential diagnoses at that time were congenital heart block or

long QT syndrome. No precipitating factors such as recent viral
infection or drug history was noted. Autoimmune markers were
negative. Subsequent scans at 24 weeks gestation showed frequent
Premature atrial ectopic beats with ratio of 1 in every 1 normal atrial
contraction. Average FHR was 83 bpm. No evidence of heart failure
was noted. Paediatric cardiologist was consulted and diagnosis
of premature atrial contractions (PACs) was made. At 25 weeks
gestation, PACs appeared less frequent with a rhythm of 1 every
2 normal atrial contraction and average FHR of 102 bpm. At
26 weeks gestation, FHR 140 bpm with only occasional PACs (1
in 3 to 4 normal atrial contraction) was detected. There were no
cardiomegaly or hydropic changes all long. PACs was no longer
detected after 27 weeks gestation. Serial ultrasound scans at 28, 30
and 32 weeks gestation showed satisfactory fetal growth with no
cardiomegaly or hydropic changes. Fetal echocardiography showed
normal sinus rhythm with a rate of 130140 bpm. The present
case illustrated that fetal PACs could be misdiagnosed as sinus
bradycardia at early gestation and it could be resolved in-utero
without any intervention.

Methods: 73 consecutive fetuses with structural heart defects

detected at early prenatal screening (prior to 18 gestational weeks)
were included in our study. We selected those diagnosed with an
abnormality detected on the 3VT view. Color Doppler was added
in all cases. All patients received genetic counseling and pediatric
cardiology consultation.
Results: 19 fetuses had an abnormality detected on the 3VT view.
Gestational age ranged from 12 to 18 weeks (mean 15 + 2 weeks).
Lesions included abnormal aortic size in five fetuses with hypoplastic
left heart syndrome and one fetus with coarctation of the aorta; a
right aortic arch in one fetus; abnormal pulmonary artery size in
five fetuses with tetralogy of Fallot; abnormal vessel arrangement
in two fetuses with transposition of the great arteries; four vessels
in two fetuses with persistent left superior vena cava; double outlet
right ventricle in one fetus. Two fetuses had a dilated superior vena
cava and a narrow aorta, respectively, which were not confirmed
postnatally. Application of color Doppler aided in improving
diagnosis in cases involving stenotic valves and in determining
ductal flow. Twelve patients opted for pregnancy termination.
Conclusions: The 3VT view is efficient in early prenatal diagnosis
of cardiac defects, which involve the outflow tracts and the aortic
arch. It enables early visualization of critical heart defects and early
termination for those who desire it. The addition of color Doppler
further contributes to the diagnosis. We suggest that visualization
of the 3VT view and color Doppler application should be utilized in
early prenatal sonographic evaluation.

Quantitative assessment of right ventricular function using
tissue Doppler imaging in cases of twin to twin
transfusion syndrome
T. Akira1 , K. Harada2 , K. Yasuda1 , M. Murata1 , M. Ogawa2

Akita City Hospital, Japan, 2 Akita University, Japan

Objective: Although tissue Doppler imaging (TDI) has been

established for quantitative assessment of right ventricular (RV)
function and RV filling pressure, the technique has not been validated
for diagnosis of fetal cardiac failure. In this study, we assessed RV
function in fetuses with heart failure using TDI.
Methods: A total of 41 fetuses, 5 fetuses (3135 gestational age)
with heart failure (twin to twin transfusion syndrome: TTTS) and
36 gestational age-matched normal fetuses (N), were studied using
echocardiography combined with TDI. RV myocardial velocities
were determined during systole (Sa) and early (Ea) and late
diastole (Aa), and tricuspid inflow velocities were measured during
early (E) and late diastole (A). The ratio of E to Ea (E/Ea) was
utilized as an index of filling pressure. TDI-derived index of
combined systolic/diastolic myocardial performance (TDI-Tei index)
was measured.
Results: The mean Ea, Aa, and Sa did not differ between the
2 groups. The mean E/Ea and TDI-Tei index in the fetuses
with TTTS were significantly higher than those in normal fetuses
(E/Ea: 9.02 1.02 vs 6.20 0.97; p < 0.05, TDI-Tei: 0.77 0.04 vs
0.55 0.05; p < 0.05). The E/Ea and TDI-Tei index in all fetuses
with TTTS were greater than 2SD above the mean. One fetus
(TDI-Tei index = 0.94) died in early infancy because of severe heart
failure, while the remaining four fetuses with TTTS (TDI-Tei index
< 0.8) are alive.
Conclusions: Although TDI velocities were not sufficiently sensitive
to identify fetuses with TTTS vs. normal fetuses, TDI-Tei index and
E/Ea were useful and sensitive indicators of global RV dysfunction.

Utilization of the three vessels and trachea (3VT) view in
early prenatal diagnosis of cardiac defects
V. H. Eisenberg, R. Achiron, J. Hegesh, M. Berkenstadt,
Y. Zalel
Chaim Sheba Medical Center, Israel
Objectives: To describe our experience with prenatal diagnosis
of abnormalities in the 3VT view of the heart, diagnosed before
18 weeks gestation, utilizing high-resolution ultrasonography and
color Doppler techniques.


Cantrell syndrome case report
D. C. Prete1 , F. M. Sobinho2 , A. G. Capellari2 , L. Cosmo2 ,
M. Takeda2

State University of Londrina, Brazil, 2 Brazil

Thoraco-abdominal ectopia cordis or Cantrell-Heller-Ravitch

syndrome is a complete syndrome, characterized by two major
defects: ectopia cordis and an abdominal wall defect (most
commonly an omphalocele, but gastroschisis can also be present).
The other three defects of the pentalogy are disruption of all the
interposing structures: the distal sternum, anterior diaphragm and
diaphragmatic pericardium. Is a rare congenital syndrome, first
described by Cantrell in 1958, occurs sporadically, with variable
degrees of expression. We report case of 16-year-old women,
first pregnancy, admit to our hospital in 30 week of gestation,
ultrasound examination revealed polyhydroamnion, lower sternal
defect, ectopia cordis and omphalocele.

Prenatal detection of a right sided aortic arch by targeted
visualization of the three vessel view
P. Kreiselmaier, R. Axt-Fliedner, M. Krapp
University of Schleswig-Holstein, Germany
Introduction: Anomalies of the aortic arch may be associated with
congenital heart defects or may be an incidental finding in normal
infants. We are presenting a fetus with right aortic arch detected by
an abnormal three vessel view.
Case report: The patient was referred at 23 weeks of gestation
because of an abnormal three vessel view. The patient had a positive
history for ventricular septal defect. We confirmed an abnormal
three vessel view by visualization of an U-shaped configuration with
intermediate trachea. We found a right aortic arch with vascular
ring and an abberant left subclavian artery. Furthermore, the left
common carotid origined first from the aortic arch followed by the
right common carotid, right subclavian artery, and the abberant
left subclavian artery. 3-D echocardiography confirmed the presence
of a retroesophageal vessel, which is described in the literature as
diverticulum of Kommerrell. No additional cardiac or extracardiac

Ultrasound in Obstetrics & Gynecology 2004; 24: 269372