Pulsed Doppler echocardiographic evaluation of the blood stream in children with morphological heart lesion

Echocardiography is well estabished as a valuable method for detecting specific lesions and is useful for obtaining information which is helpful in the management of many patients with congenital and acquired abnormalities of the heart and great vessels (1-9). However, conventional M-mode and two-dimensional echocardiographic techniques are not always diagnostic since some acquired and congenital cardiac disorders result in nonspecific echocardiographic findings (10-11). Range gated pulsed Doppler (RGPD) is a diagnostic approach supplementing M-mode echocardiography in identifying blood-flow patterns at well defined intracardiac sampling areas of interest. The sample areas may be selected at any depth from 2 to 15 centimeters along the ultrasonic beam in order to localize information from a specific zone in a known cardiac cavity or from a great vessel. By demonstrating that intracardiac flow is either laminar or non-laminar, conclusions can be made as to what structural abnormality exists. The purpose of this investigation was to determine the sensitivity and limitations of range gated pulsed Doppler echocardiography as a method to distinguish children with different forms of cardiac malformations. Precautions were taken to be as blind as possible to the diagnosis. The studies to be presented have in part been published previously (12-18). Their detailed review and interrelation form the basis of this wor

N-terminal-pro-B type natriuretic peptide as a useful tool to evaluate pulmonary hypertension and cardiac function in CDH infants

Objective: In congenital diaphragmatic hernia (CDH) the severity of pulmonary hypertension (PH) is considered, by several authors, determinant of clinical outcome. Plasmatic N-terminal-pro-B type natriuretic peptide (NT-proBNP) might be useful in diagnosis and management of PH in newborns, although its interest in CDH infants remains to be defined. Early NT-proBNP levels were assessed in CDH infants and correlated with cardiovascular echocardiographic parameters. Patients and Methods: 28 newborns, CDH and age-matched controls were enrolled in a prospective study. Clinical condition, NT-proBNP plasmatic levels, echo parameters of PH and biventricular function were assessed at 24 h after delivery as well as survival outcome. Results: Estimated mean pulmonary pressure and NT-proBNP were significantly higher in CDH than control infants. NT-proBNP significantly correlated with estimated pulmonary artery pressure, right ventricular Tei index, and tricuspid E/A ratio. Additionally, we found that CDH infants with NT-proBNP >11,500 pg/ml experienced a worse prognosis. Conclusions: We demonstrated that PH is associated with NT-proBNP elevation and diastolic impairment in CDH infants. Early elevations in NT-proBNP levels seem to alert for a subset of CDH infants with worse prognosis. Copyrigh

European study on maternal and fetal management of fetal supraventricular tachyarrhythmia

This European study on maternal and fetal management of fetal supraventricular tachyarrhythmia (FSVT) was designed to achieve the following goals: to estimate the efficacy of transplacental digoxin administered intravenously to the mother in sustained FSVT, with or without cardiac failure, and intermittent FSVT without cardiac failure; and to evaluate the natural history of intermittent FSVT without cardiac failure. Doppler fetal echocardiography was utilized for diagnosis and sequential evaluation of FSVT and for the assessment of fetal hemodynamics. To obstetricians and pediatric cardiologists involved in prenatal cardiology, we propose a rational treatment and management regimen for FSVT. Our hope is to obtain a controlled study on a large number of fetuses on an international scale and thus provide a uniform maternal and fetal therapeutic strategy for FSVT.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Protocole europeen pour la prise en charge des tachycardies foetales supraventriculaires

SCOPUS: ar.jinfo:eu-repo/semantics/publishe