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ABSTRACT: To describe the methodology for correct visualization of the anterior fontanelle using three-dimensional ultrasound, to report its normal development during gestation, and to compare this with abnormal development.
This was a cross-sectional prospective evaluation of development of the anterior fontanelle in a series of 78 normal fetuses and 47 fetuses with congenital anomalies between 12 and 38 weeks of gestation. The anterior fontanelle was visualized in a mid-sagittal view of the fetal head, preferably with a pocket of fluid between the fetal head and the uterine wall, to ensure an optimal acoustic window. Visualization using volume contrast imaging mode in the coronal plane (VCI-C) was preferred to static acquisition of three-dimensional (3D) volumes, as the former allows real-time evaluation of the 3D image. Anteroposterior and laterolateral diameters, perimeter and area of the fontanelle were measured offline, with the diameters normalized for biparietal diameter and the perimeter and area normalized for head circumference. The variables were then regressed against gestational age.
The best fitting regression model to describe the relationships between the fontanelle anteroposterior diameter and area and gestational age was a quadratic one, whereas a simple linear model fitted all remaining variables. All variables showed a positive or biphasic correlation with advancing gestational age, but a negative one after normalization for biparietal diameter or head circumference. Twenty of the 47 fetuses with abnormalities had abnormal (18 enlarged and two reduced) fontanelle dimensions, particularly those with chromosomal or non-chromosomal syndromes, primary or secondary cardiac overload, primary skeletal dysplasias or central nervous system malformations. Hydrops was not associated with abnormal fontanelle dimensions.
We have described the methodology to obtain correct visualization of the fetal anterior fontanelle. The actual size of the fontanelle increases during gestation, while its size in relation to the volume of the fetal head diminishes, possibly due to the rapid development of the brain hemispheres and the consequent outward growth of the calvarial bones. The fact that enlarged fontanelle dimensions may be associated with certain fetal abnormalities may be employed advantageously in the differential diagnosis of some syndromic conditions in utero.
Ultrasound in Obstetrics and Gynecology 08/2008; 32(6):755-61. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 08/2008; 32(2):237-8. · 3.01 Impact Factor
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ABSTRACT: Coronary arterial abnormalities can be one of the few negative prognostic indicators in transposition of the great arteries (TGA), and their occurrence is related to the type of spatial relationship of the great arteries. The main objective of this study was to assess whether the use of the reconstructed en-face view with color Doppler imaging of the four cardiac valves can demonstrate the different types of spatial relationship of the arterial trunks in fetuses with TGA, in order to derive the risk of coronary abnormalities. A secondary end-point was the evaluation of the type of coronary arterial branching pattern.
Twenty-three fetuses with a confirmed diagnosis of TGA underwent four-dimensional (4D) echocardiography at 19-33 gestational weeks. The en-face view of the four cardiac valves and color Doppler with high persistence were employed to assess the spatial relationships of the great arteries. In all cases, confirmation of the vessels' arrangement and coronary arterial distribution was obtained at neonatal echocardiography and/or surgery.
The spatial relationships of the great vessels was identified correctly in 20/23 (87%) cases. The aorta was found to be located anterior to and to the right of the pulmonary trunk in 13/23 (56.5%) cases and just anterior to the pulmonary artery in 6/23 (26.1%) cases; in the remaining four (17.4%) cases, the two vessels were side by side. With respect to the association between the spatial relationship of the great arteries and the occurrence of an unusual pattern of coronary arterial branching, five of the TGA fetuses had abnormal coronary arterial distribution.
Using 4D echocardiography with color Doppler, it is possible to define the spatial relationships of the great arteries in fetuses with TGA with a high degree of accuracy. This information can be used during counseling to predict the likelihood of abnormal coronary arterial distribution.
Ultrasound in Obstetrics and Gynecology 04/2008; 31(3):271-6. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 09/2007; 30(4):415 - 416. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 08/2006; 28(4):438 - 439. · 3.01 Impact Factor
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ABSTRACT: Spatio-temporal image correlation associated with the tomographic ultrasound imaging mode (TUI-STIC) is a new modality that allows a complete sequential analysis of cardiac structures to be displayed on a single panel by showing all echocardiographic transverse views at the same time. The aims of this study were to identify the best settings for displaying the classic echocardiographic views at different gestational ages and to investigate the role of TUI-STIC in the sequential segmental analysis of complex congenital heart disease (CHD).
Four-dimensional volumes from 103 cases of confirmed fetal CHD diagnosed and managed at our referral center were evaluated using TUI-STIC. To select the best interslice distance for adequate display of the central cardiovascular connections, each volume was opened and the TUI mode activated, having as a reference the apical four-chamber view. The number of slices was set at nine. The volume was then scrolled until the most significant echocardiographic views were displayed on the screen windows. Then, if too many windows showed intermediate non-diagnostic views, the slice distance was adjusted finely until all key echocardiographic views showed up in the various windows. The interslice distance was regressed against gestational age and the best-fitting curve was identified.
A sequential segmental analysis could be shown with TUI-STIC in all cases. A linear regression equation best fitted the correlation between interslice distance and advancing gestational age (r(2) = 0.9042), with the mean interslice distance being 2.7 (SD, 0.3) mm at 19-23 gestational weeks, and 4.0 (SD, 0.4) mm at 30-33 weeks. These settings allowed a complete sequential analysis in all cases.
TUI-STIC allows a complete sequential analysis of CHD in the fetus. The most suitable interslice distances for all gestational ages could be identified. These data may be used while adopting this imaging modality in the four-dimensional evaluation of fetal CHD.
Ultrasound in Obstetrics and Gynecology 06/2006; 27(5):555-61. · 3.01 Impact Factor
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ABSTRACT: Right superior vena cava (RSVC) draining into the left atrium, causing hypoxemia, represents a very rare congenital malformation which has not previously been described in the fetus. We describe a case in which fetal echocardiography at 22 weeks' gestation revealed an enlarged superior vena cava connecting abnormally with a mildly enlarged left atrium. Neonatal transthoracic echocardiography confirmed the diagnosis and showed an abnormal connection of the right pulmonary veins to the RSVC. Right-to-left shunt due to anomalous drainage of the RSVC into the left atrium associated with an atrial septal defect and anomalous pulmonary venous return were diagnosed on echocardiography and confirmed by angiography. The newborn was hemodynamically stable at birth and at the 1-year follow-up.
Ultrasound in Obstetrics and Gynecology 05/2006; 27(4):445-8. · 3.01 Impact Factor
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ABSTRACT: To describe the anatomy, associated anomalies and outcome of 30 cases of congenitally corrected transposition of the great arteries (ccTGA) detected prenatally.
This was a retrospective observational study of the 30 cases of ccTGA confirmed at autopsy or postnatal echocardiography seen at one of three referral centers from 1994 to 2003. The following data were considered: gestational age at diagnosis, cardiac anatomy, associated cardiac and extracardiac anomalies and fetoneonatal outcome. All fetuses underwent fetal echocardiography and a detailed anomaly scan, with follow-up scans at 3-4-week intervals until delivery. The diagnosis was confirmed at autopsy or after delivery. Follow-up data were retrieved from the clinical files of the patients.
The mean gestational age at diagnosis was 25.5 weeks. Intracardiac defects associated with the ccTGA included a ventricular septal defect in 21 cases, pulmonary outflow obstruction in 12 cases, an abnormal tricuspid valve in 10 cases, ventricular hypoplasia in five cases and dextro/mesocardia in five cases. The karyotype was normal in all 24 newborns, and unknown in the cases which resulted in termination of pregnancy (n = 5) or intrauterine death (n = 1). There were associated extracardiac anomalies in four cases only. Three of the four cases of atrioventricular block (AV block) developed in the third trimester, while the fourth appeared after birth. There were nine deaths (five terminations, two perinatal deaths and two infant deaths). The remaining 21 (70%) newborns were alive at a median follow-up time of 32 months, 11 of them after various surgical procedures.
Our data suggest that in fetuses with ccTGA the risk of chromosomal and extracardiac anomalies is low, in accordance with postnatal data. The spectrum of associated cardiac lesions is consistent with that reported in the pediatric literature. These data may be of use during prenatal counseling since no figures regarding survival and/or outcome of ccTGA in the fetus have been reported so far.
Ultrasound in Obstetrics and Gynecology 04/2006; 27(3):281-5. · 3.01 Impact Factor
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ABSTRACT: Cavernous lymphangiomas are characterized by penetration through the subcutaneous areas between the muscular septa and represent rare variants of the more common superficial lymphangioma. Although frequently described in the fetus when involving the posterior aspect of the neck (i.e. cystic hygroma), involvement of the craniofacial region is rare. We describe the prenatal findings in a case of cavernous lymphangioma of the fetal face and neck, which extended caudally to envelop the larynx and the trachea. The anomaly was assessed by two- and three-dimensional (3D) ultrasound. The latter approach was used thoroughly both during counseling with the couple and during consultation with the pediatric surgeon. This case report confirms the usefulness of the 3D approach in the management of rare fetal anomalies. In particular, the possibility of navigating the volume facilitated consultation with the pediatric surgeon and counseling of the parents.
Ultrasound in Obstetrics and Gynecology 10/2005; 26(3):300-2. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 09/2005; 26(4):346 - 346. · 3.01 Impact Factor
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Heart (British Cardiac Society) 12/2004; 90(11):1348-9. · 4.22 Impact Factor
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ABSTRACT: To define the role of tissue harmonic imaging (THI) in fetal echocardiography.
Three trials were conducted in a tertiary referral center: Study A was a prospective randomized trial including 50 women referred for fetal echocardiography. Those allocated to Arm 1 underwent conventional fundamental frequency ultrasound (FFU) and those allocated to Arm 2 underwent THI. Study B was conducted in 21 patients who were obese or overweight with significant weight gain in pregnancy. In these patients, both THI and FFU echocardiography were performed and compared. In Study C, THI was employed as a second-line rescue technique in cases of inadequate or incomplete examination by FFU. A subjective scoring system was used by a reviewer who had not performed the examinations to assess the comprehensiveness of the examination and the image resolution. The reviewer was blinded to the image modality.
In Study A, no difference was found in the diagnostic accuracy between THI and FFU echocardiography but the resolution was significantly poorer in the THI arm. In studies B and C, THI performed significantly better than FFU (P < 0.001).
THI echocardiography seems to be the best technique to employ in obese women and in those in whom FFU fails to provide diagnostic information. However, due its poorer resolution in women of average weight, FFU echocardiography should remain the technique of choice.
Ultrasound in Obstetrics and Gynecology 03/2004; 23(2):159-64. · 3.01 Impact Factor
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ABSTRACT: To assess the accuracy of prenatal diagnosis, the incidence of extracardiac and chromosomal anomalies, and the perinatal outcome in a population of fetuses with common arterial trunk (CAT).
Observational study of 23 fetuses from three referral centres with a confirmed diagnosis of CAT. All underwent fetal echocardiography, detailed anatomical scanning, and karyotyping. In 19 cases, FISH analysis was done to detect 22q11 microdeletion. The following variables were evaluated: gestational age at diagnosis, anatomical variants of the CAT, presence of extracardiac and chromosomal anomalies, pregnancy, and fetal-neonatal outcome. Necropsy reports and postnatal files were available for confirmation of the prenatal diagnosis in all cases.
The prenatal diagnosis proved correct in 23 of 24 cases, the last being pulmonary atresia with ventricular septal defect (PAVSD). A second cardiovascular anomaly was present in eight cases (34.8%); extracardiac anomalies were found in 10 (43.4%). FISH analysis showed 22q11 microdeletion in six of 19 cases (31.6%). Outcomes were as follows: eight terminations of pregnancy (34.8%), two intrauterine deaths (8.7%), five postnatal deaths (before or after surgery) (21.7%); the remaining eight neonates (34.8%) are alive and thriving after surgery (six) or awaiting surgery (two).
CAT can be reliably diagnosed and characterised in prenatal life, although differentiation from PAVSD may be challenging. The association with chromosomal anomalies is consistent (8.7%), but there is a higher risk of 22q11 microdeletion (31.6%), in agreement with postnatal studies. The relatively poor survival rate (34.8%) reflects the high rate of terminations and the unfavourable cardiac anatomy in some cases.
Heart (British Cardiac Society) 01/2004; 89(12):1437-41. · 4.22 Impact Factor
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Ultrasound in Obstetrics and Gynecology 08/2003; 22(S1):68 - 68. · 3.01 Impact Factor
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ABSTRACT: To assess the feasibility of ultrasound identification of aortic valve anatomy in the fetus, with particular emphasis on the detection of bicuspid aortic valve.
This study was a prospective analysis of 21 fetuses with prenatally diagnosed congenital left heart obstructive lesions and 45 normal fetuses undergoing routine ultrasound evaluated at a tertiary referral center. These fetuses underwent detailed echocardiography, including the study of the aortic valve on a targeted short-axis view of the right ventricle. Necropsies or postnatal echocardiograms were available for confirmation of the diagnosis in all cases.
Aortic cusps and commissures were satisfactorily visualized in 38/45 (84%) normal fetuses and in 18/21 (86%) fetuses with congenital heart disease. The aortic valve was correctly defined as bicuspid in one normal fetus and in six fetuses with congenital heart disease. In two fetuses with a positive family history, the bicuspid aortic valve was isolated. There was one incorrect diagnosis (a unicuspid unicommissural valve diagnosed prenatally as a bicuspid aortic valve in a fetus with severe aortic stenosis) and one false-positive diagnosis in a fetus diagnosed with a coarctation and a bicuspid aortic valve late in the third trimester of pregnancy and in which both anomalies were not confirmed at neonatal echocardiography.
This study demonstrated that aortic valve anatomy can be satisfactorily assessed in fetuses with and without left heart obstructive lesions. We believe that a detailed search for a bicuspid aortic valve should be attempted in all patients referred for a positive family history of congenital heart disease, in general, and of left ventricle outflow tract obstruction or bicuspid aortic valve, in particular. In fact, the presence of an asymptomatic bicuspid aortic valve has been demonstrated to represent an important factor predisposing to the development of bacterial endocarditis and dissecting aortic aneurysm late in adult life. Therefore, an early detection of such an anomaly may contribute to ensure a longer symptom-free lifespan of individuals with the most common cardiac anomaly at birth.
Ultrasound in Obstetrics and Gynecology 08/2002; 20(1):30-4. · 3.01 Impact Factor
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ABSTRACT: To assess the effect of estriol treatment per vaginam before Burch culposuspension in postmenopausal women with stress urinary incontinence (IUS).
Design: prospective randomised study. Setting: Department of Gynaecology, Obstetrics and Physiopathology of Human Reproduction-Medical School-University of Naples Federico II . Patients: twenty women in postmenopause at least from five years with a urogenital symptomatology due to IUS. Interventions: women were randomised into one of two groups (treated or control) and they were submitted to an evaluation of vulva and vagina trophism. All the women were submitted to a urodynamic examination and to a transvaginal ultrasonography with evaluation of pubis-bladder neck distance, bladder and proximal urethra position, before treatment, one week before the operation and after six months from the same operation. Evaluations: subjective symptomatology and urodynamic parameters between treated and control groups before and after operation.
After 12 weeks of treatment, a significant improvement of subjective symptomatology and a not significant improvement of all the urodynamic parameters in the treated group in comparison with the control group have been demonstrated, while any anatomic alteration compared with the basal hasn t been observed. After six months from the operation in all the women a significant reduction of subjective quantity of urine lost after a strain has been demonstrated and significant variations of urodynamic parameters without significant differences between treated group and control group were also observed.
The estriol treatment per vaginam is not so effective on the result of Burch culposuspension in postmenopausal women with IUS.
Minerva ginecologica 05/2001; 53(2):141-5.
