Prenatal diagnosis of isolated atrioventricular discordance using fetal echocardiography

A 28-year-old female was referred to our institute at 25 weeks of gestation due to fetal bradycardia. Fetal echocardiography showed the stomach bubble was on the left side with the heart axis pointing to the left. The right sided inferior vena cava connected to the right atrium (RA), and both pulmonary veins connected to the left atrium (LA)peer-reviewe

Antenatal antiarrhythmic treatment for fetal tachyarrhythmias: a study protocol for a prospective multicentre trial

Introduction Several retrospective or single-centrestudies demonstrated the efficacy of transplacentaltreatment of fetal tachyarrhythmias. Our retrospectivenationwide survey showed that the fetal therapy willbe successful at an overall rate of 90%. For fetuseswith hydrops, the treatment success rate will be 80%.However, standard protocol has not been established.The objective of this study is to evaluate the efficacy andsafety of the protocol-defined transplacental treatment offetal tachyarrhythmias. Participant recruitment began inOctober 2010.Methods and analysis The current study is a multicentre,single-arm interventional study. A total of 50 fetuseswill be enrolled from 15 Japanese institutions. Theprotocol-defined transplacental treatment is performed forsingletons with sustained fetal tachyarrhythmia ≥180 bpm,with a diagnosis of supraventricular tachycardia or atrialflutter. Digoxin, sotalol, flecainide or a combination is usedfor transplacental treatment. The primary endpoint isdisappearance of fetal tachyarrhythmias. The secondaryendpoints are fetal death related to tachyarrhythmia,proportion of preterm birth, rate of caesarean sectionattributable to fetal arrhythmia, improvement in fetalhydrops, neonatal arrhythmia, neonatal central nervoussystem disorders and neonatal survival. Maternal, fetal andneonatal adverse events are evaluated at 1 month afterbirth. Growth and development are also evaluated at 18and 36 months of corrected age.Ethics and dissemination The Institutional Review Boardof the National Cerebral and Cardiovascular Center ofJapan has approved this study. Our findings will be widelydisseminated through conference presentations and peerreviewedpublications

〈Original〉Second-trimester fetal heart screening using the spatiotemporal image correlation method

[Abstract]Background: The spatiotemporal image correlation (STIC) method, an echocardiographic approach to collecting data for offline analysis, can be used to perform fetal heart screenings. However, the utility of this technique for this indication is unknown. Method: We screened and analyzed the STIC data for all normal pregnancies (n = 405) at 2 obstetrics clinics in Osaka from January 2017 through June 2018. An obstetrician and a laboratory technician collected the STIC data from a four-chamber view image. A pediatric cardiologist analyzed the data offline. The images analyzed included the four-chamber view, pulmonary veins, right and left outflow view, threevessel view, and three-vessel trachea view. We classified findings of each image as normal, abnormal, or unconfirmed, and evaluated the final diagnoses. Results: There were 324 normal cases (80.0%), 25 abnormal cases (6.2%), and 56 unconfirmed cases (13.8%). Eleven patients had congenital heart disease (CHD) after birth; of these, 9 had severe CHD requiring hospitalization. The sensitivity and specificity of the STIC method for detecting CHD was 100% and 95.9%, respectively. Conclusion: The STIC method was useful for performing fetal CHD screenings. However, many images could not be analyzed

〈Original〉Left and right cardiac performance in children with small heart syndrome – Analysis with cardiac MRI –

[Abstract]Background: It has been reported that children who have orthostatic dysregulation (OD)symptoms are more likely to have a small heart. A low cardiac output of the left ventricle (LV) is thought to be the cause of the symptoms. Because the right ventricle (RV) has not been evaluated in past reports, we examined the cardiac activity of both ventricles by cardiac MRI (CMR) Method: We performed CMR in 23 children with small heart syndrome. Next, we divided the subjects into two groups based on the severity of the symptoms of OD The subjects were divided into two groups according to the severity of the OD symptoms (severe group [S-group] and mild group [M-group]) according to the guidelines, and the CMR cardiac parameters were compared. Results: Both ventricular volumes were smaller than normal, but the ejection fractions were within normal range. In the comparison of the severity of the OD symptoms,the LV end-diastolic volume, cardiac index, RV stroke volume, and ejection fraction were significantly smaller in the S group. In a simple logistic regression analysis using the severity of the OD symptoms, the LV end-diastolic volume, cardiac index, and RV ejection fraction were statistically significant variables. Conclusions: We could evaluate the RV performance in small heart syndrome using CMR. We found that the RV ejection fraction might contribute to the severity of the OD symptoms