5 research outputs found
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Impact of maternal bariatric surgery on offspring perinatal cardiac function: A prospective study
Objective
To assess perinatal cardiac function in offspring of women with previous bariatric surgery and examine its association with maternal glucose control.
Design
Prospective study.
Setting
Maternity unit, UK.
Population
Fifty-four fetuses/neonates; 29 of post-bariatric surgery women and 25 of women without surgery.
Methods
Prospective, longitudinal observational study of pregnant women with and without previous bariatric surgery, matched for early pregnancy body mass index. Cardiac function of all offspring was assessed by two-dimensional conventional, spectral tissue Doppler and speckle-tracking echocardiography at 35–37 weeks of gestation and at 5–7 weeks of age. Maternal glycated haemoglobin (HbA1c) was measured at 27–30 weeks of gestation. Maternal demographics and fetal/infant cardiac function indices were compared between the groups. Correlation coefficient (r) is reported.
Main outcome measures
Fetal/infant cardiac function indices.
Results
Compared with no-bariatric neonates, offspring of post-bariatric women were smaller at birth (birthweight centiles: 64.96 ± 36.41 versus 40.17 ± 27.99; p = 0.007). There were no significant differences in fetal/infant cardiac function indices and perinatal cardiac changes, between groups. There was a positive correlation between maternal HbA1c and fetal left ventricular (LV) longitudinal strain (r = 0.33) and LV longitudinal strain rate (r = 0.29), suggesting an inverse relation between HbA1c and fetal LV systolic function, but this was mainly seen in offspring of women with no previous bariatric surgery (r = 0.56 and r = 0.50, respectively).
Conclusions
Maternal bariatric surgery does not appear to inadvertently affect the offspring cardiac performance. We found an inverse correlation between maternal HbA1c levels and fetal LV systolic function but this was mainly seen in the no-bariatric pregnancies
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In-hospital interstage improves interstage survival after the Norwood stage 1 operation.
OBJECTIVES: The interstage mortality rate after a Norwood stage 1 operation remains 12-20% in current series. In-hospital interstage facilitates escalation of care, possibly improving outcome. METHODS: A retrospective study was designed for hypoplastic left heart syndrome (HLHS) and HLHS variants, offering an in-hospital stay after the Norwood operation until the completion of stage 2. Daily and weekly examinations were conducted systematically, including two-dimensional and speckle-tracking echocardiography. Primary end points included aggregate survival until the completion of stage 2 and interstage freedom from escalation of care. Moreover, we calculated the sensitivity and specificity of speckle-tracking echocardiographic myocardial deformation in predicting death/transplant after the Norwood procedure. RESULTS: Between 2015 and 2019, 33 neonates with HLHS (24) or HLHS variants (9) underwent Norwood stage 1 (31) or hybrid palliation followed by a comprehensive stage 2 operation (2). Stage 1 Norwood-Sano was preferred in 18 (54.5%) neonates; the classic Norwood with Blalock-Taussig shunt was performed in 13 (39.4%) neonates. The Norwood stage 1 30-day mortality rate was 6.2%. The in-hospital interstage strategy was implemented after Norwood stage 1 with a 3.4% interstage mortality rate. The aggregate Norwood stage 1 and interstage Kaplan-Meier survival rate was 90.6 ± 5.2%. Escalation of care was necessary for 5 (17.2%) patients at 2.5 ± 1.2 months during the interstage for compromising atrial arrhythmias (2), Sano-shunt stenosis (1) and pneumonia requiring a high-frequency oscillator (2); there were no deaths. A bidirectional Glenn (25) or a comprehensive-Norwood stage 2 (2) was completed in 27 patients at 4.7 ± 1.2 months with a 92.6% survival rate. The overall Kaplan-Meier survival rate is 80.9 ± 7.0% at 4.3 years (mean 25.3 ± 15.7 months). An 8.7% Δ longitudinal strain 30 days after Norwood stage 1 had 100% sensitivity and 81% specificity for death/transplant. CONCLUSIONS: In-hospital interstage facilitates escalation of care, which seems efficacious in reducing interstage Norwood deaths. A significant reduction of longitudinal strain after Norwood stage 1 is a strong predictor of poor outcome
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Antenatal diagnosis of Double Aortic arch: Associated chromosomal and extra cardiac abnormalities, differential growth of arches during gestation and post-natal outcome.
Objectives In the postnatal sequential segmental diagnosis of cardiac abnormalities, it has historically been recognised that atrial situs usually follows that of the abdominal situs. Recognition of abdominal right isomerism (RI) or left isomerism (LI) is often associated with complex congenital heart disease (CHD). However, whilst ‘less complex or minor CHD’ and ‘normal hearts’ have been reported with LI, the same has not been previously reported in the setting of abdominal RI. We had identified a number of such cases in our fetal practice and therefore sought to clarify their features. Methods Patients were identified from the electronic databases in our tertiary fetal cardiac service comprising three fetal cardiology units. Prenatal echo reports and postnatal reports were reviewed. Results Six cases of abdominal RI without complex CHD were identified. Gestational age at diagnosis ranged from 18+0 to 23+1 weeks gestation. Four cases were livebirths; one pregnancy was terminated and one lost to follow up. The stomach was right sided with levocardia and apex to the left in 5 cases and the stomach left sided with dextrocardia and apex to the right in 1 case. The position of the aorta and inferior vena caca (IVC) is summarised in table 1: Table 1: Ultrasound findings of six fetuses with abdominal features of RI Key: R=right, L=left; IVC = inferior vena cava All cases had biventricular atrio-ventricular connections. There was right hand topology in the cases with laevocardia and apex to the left and left hand topology in the case with dextrocardia and apex to the right. Ventriculo-arterial connections were concordant in all cases. In four cases, no cardiac abnormalities were seen. In two cases, abnormalities of systemic venous return were identified: One fetus had a left superior vena cava (SVC) and IVC draining to a dilated coronary sinus; a second fetus had anomalous drainage of the IVC to the left sided atrium, a left SVC draining to the coronary sinus and abnormal drainage of hepatic veins. The presence of a coronary sinus in these 2 cases indicated discordance between abdominal and thoracic situs. One case developed bowel obstruction postnatally secondary to malrotation. Conclusions Abdominal RI can occur with normal intracardiac anatomy. This may be explained in some cases by discordance between abdominal and thoracic situs. Detailed sequential segmental analysis of the fetus is important to identify such cases as these fetuses are at risk of the postnatal complications of isomerism such as gut malrotation, splenic abnormalities and primary ciliary dyskinesia
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Single left superior vena cava antenatal diagnosis, associations and outcomes
Objectives
To describe the associated cardiac and extracardiac findings and estimate the prevalence of single left superior vena cava (LSVC) among fetuses referred for fetal echocardiography.
Methods
This is a retrospective case series study of fetuses diagnosed with situs solitus and single LSVC at the Brompton Centre for Fetal Cardiology, from October 2006 to December 2020. Prenatal and postnatal outcome data were collected. Prenatal diagnosis was based on abnormal vessel alignment at the 3-vessel view (3VV) and/or 3-vessel and trachea view (3VT), showing a vessel to the left of the pulmonary artery, the LSVC, and absence of the usual vessel to the right of the ascending aorta, the right superior vena cava (RSVC), and further visualisation of the LSVC draining to the coronary sinus.
Results
Amongst 19,968 fetal echocardiograms, 34 cases were identified (prevalence 0.17%). There were 32 livebirths, 1 lost to follow up and one fetal demise. Single LSVC was isolated in most cases. No major CHD was identified. One fetus showed mild isthmus hypoplasia, with no aortic coarctation postnatally. Two fetuses had umbilical vessel abnormalities. Genetic abnormality was found in one case.
Conclusions
Antenatal diagnosis of single LSVC in situs solitus is usually a benign isolated finding. Nevertheless, investigation of other cardiac, extracardiac and genetic disorders should be considered
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Double aortic arch: implications of antenatal diagnosis, differential growth of arches during pregnancy, associated abnormalities and postnatal outcome
Objectives
This study aimed to evaluate the prenatal characteristics of double aortic arch (DAA), assess the relative size of the arches and their growth during pregnancy, describe associated cardiac, extracardiac and chromosomal/genetic abnormalities and review postnatal presentation and clinical outcome.
Methods
All fetuses with a confirmed diagnosis of DAA seen in five specialized referral centers between November 2012 and November 2019 were retrospectively identified from the hospitals’ fetal databases. Fetal echocardiographic findings, intracardiac and extracardiac abnormalities, genetic defects, computed tomography (CT) findings and postnatal clinical presentation and outcome were evaluated.
Results
A total of 79 fetal cases of DAA were included. Of the whole cohort, 48.6% had an atretic left aortic arch (LAA) postnatally, with 5.1% being atretic at 1st fetal scan and diagnosed antenatally as right aortic arch (RAA). Among those who had CT scan, the LAA was atretic in 55.7%. DAA was an isolated abnormality in 91.1% of the cases, 8.9% had intracardiac (ICA) and 2.5% had extracardiac abnormalities (ECA). Among those tested, 11.5% had genetic abnormalities and specifically 22q11 microdeletion was identified in 3.8% of the patients. At a median follow up of 993.5 days, 42.5% of the patients had developed symptoms of tracheo-esophageal compression (5.5% during the first month of life) and 56.2% underwent intervention. Statistical analysis using Chi-square test showed no statistically significant correlation between patency of both aortic arches or not and need for intervention (P-value 0.134), development of vascular ring symptoms (P-value 0.350) or evidence of airway compression on CT (P-value 0.193)
Conclusions
Most DAA cases can be easily diagnosed in mid-gestation as both arches are patent with a dominant RAA. However, posnatally the LAA has become atretic in approximately half of the cases, supporting the theory of differential growth during pregnancy. DAA is usually an isolated abnormality; however, a thorough assessment is required, to exclude ICA and ECA and to discuss invasive prenatal genetic testing. Postnatally, early clinical assessment is needed, and CT scan should be considered, irrespective of the presence of symptoms or not