B Puerto

University of Barcelona, Barcino, Catalonia, Spain

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Publications (169)496.31 Total impact

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    ABSTRACT: Objectives The aim of our study was to evaluate the association of CHD on head biometry and cerebrovascular blood flow dynamics at the time of diagnosis in the second trimester of pregnancy.Material and Methods95 consecutive fetuses diagnosed with CHD. At the time of diagnosis of CHD, we assessed fetal biometry and brain perfusion by middle cerebral artery pulsatility index (MCA-PI), cerebroplacental ratio (CPR) and Fractional Moving Blood Volume (FMBV). The results were compared with 95 normal fetuses matched for gestational age (GA).ResultsMedian gestational age at diagnosis was 22.3 weeks (range 20 – 23.5 weeks). Fetuses with CHD showed significantly lower MCA-PI and CPR Z-scores (−0.23 vs 0.34 and −0.37 vs 0.30; p < 0.001, respectively) and higher FMBV Z-scores (2.35 vs 0.15; p < 0.001). FMBV >95th centile was observed in 81.1% of cases as compared with 10.5% in controls (p < 0.001). Moreover, cases showed significantly smaller biparietal diameter (BPD) and head circumference (HC) Z-scores (−1.61 vs −0.43 and −0.89 vs 0.09; p < 0.001, respectively) and a higher proportion of BPD and HC measurements below the 5th percentile compared with controls (51.6% vs 13.7% and 26.3% vs 4.2%; p < 0.001, respectively).These findings were more pronounced in those CHD with compromised oxygenated blood delivery to the brain, such as left outflow tract obstruction and transposition of the great arteries.ConclusionsA high proportion of fetuses with CHD have smaller head and increased brain perfusion already in the second trimester, suggesting an early onset of the mechanisms leading to poorer neurodevelopment later in life.
    Ultrasound in Obstetrics and Gynecology 03/2014; · 3.56 Impact Factor
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    ABSTRACT: Objective: Congenital high airway obstruction syndrome (CHAOS) normally has a dire prognosis due to laryngeal atresia and association with other anomalies. However, rare cases with an isolated tracheal membrane have been described. We assessed systematically the larynx and vocal cords in fetuses with CHAOS, with the goal of identifying such cases and attempting fetoscopic deobstruction. Methods: Between 2008 and 2012, 7 cases of CHAOS were referred to our institution. The ultrasonographic aspect of the larynx and trachea was assessed. We report the ultrasound findings, necropsy findings of 6 cases and perinatal outcome in 1 case undergoing therapy. Results: In 6 cases, laryngeal atresia was presumed by ultrasound and confirmed by necropsy after termination of pregnancy. In 1 case, normal appearance of the vocal cords led to suspicion of a possible isolated tracheal web completely occluding the trachea. Fetoscopy confirmed the finding, thus the membrane was perforated. Lung size normalized and hydrops resolved. A normal fetus was delivered at term, requiring no respiratory support. At 9 months of age, the infant showed a normal laryngoscopy and was developing well. Conclusions: Systematic ultrasound assessment of the vocal cords can be performed in fetuses with CHAOS. We report the first case of long-term intact survival after fetoscopic airway deobstruction.
    Fetal Diagnosis and Therapy 07/2013; · 1.90 Impact Factor
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    ABSTRACT: OBJECTIVES: To evaluate in a cohort of 248 fetuses seen at a tertiary referral center, the frequency of isolated ventricular septal defects (VSD) among all congenital heart defects (CHD), the association with chromosomal and post-natal anomalies, and the rate of spontaneous closure. PATIENTS AND METHODS: A 6-year study on 10800 patients referred for a cardiac scan, with 995 confirmed congenital heart diseases (CHD). The prevalence and characteristics of VSDs were analyzed, including follow-up until one year of age. A multivariate binary logistic regression was performed to test the independent contribution of the VSD/Aorta ratio (<0.5 and ≥0.5) and location of VSD (perimembranous and muscular) in the prediction of spontaneous closure before one year of life. RESULTS: 248 (24.9% of all CHD) VSDs were diagnosed, 216 (87.1%) muscular and 32 (12.9%) perimembranous. Median GA at diagnosis was 30.4 (range 17-41) weeks and mean size 2.6 (SD, 0.77) mm. Serious chromosomal anomalies were found in 1 (3.1%) perimembranous VSD compared to none of 216 muscular defect (p=0.12). Post-natal malformations were diagnosed in 8 cases (3.8%). Spontaneous closure occurred in 13 fetuses (5.32%) and 151 infants (76.3%), and it was predicted by VSD/Aorta ratio (OR 0.445; 95% CI 0.216-0.914, p<0.03) and location (OR 0.385, 95% CI 0.160-0.926, p<0.0.03). CONCLUSIONS: In a fetal cardiology unit, isolated muscular VSD is today the most prevalent CHD. Contrary to post-natal series muscular VSD were the most common. Perimembranous VSD was associated with a higher risk of chromosomal anomalies. Muscular VSD had similar risks to normal pregnancies. Spontaneous closure was frequent and occurred in most cases postnatally.
    Ultrasound in Obstetrics and Gynecology 06/2013; · 3.56 Impact Factor
  • Robin Julve, Ana Muñoz, Bienvenido Puerto, Magdalena Sanz
    Diagnóstico Prenatal. 01/2013; 24(1):38–41.
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    ABSTRACT: OBJECTIVE: The objective of this prospective study was to determine the feasibility, safety and performance of a new method for sentinel lymph node (SLN) detection in endometrial cancer (EC) using transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR). METHODS: From 2006 to 2011, 74 patients with high-risk EC were included in the study. Twenty-four hours before surgery 148MBq of 99mTc-nanocolloid (8mL) were injected into two spots in the anterior and posterior myometrium using an ultrasound-guided transvaginal puncture. SLN were localized preoperatively by lymphoscintigraphy and intraoperatively with gamma probe. After SLN biopsy the patients underwent a complete laparoscopic pelvic and paraaortic lymphadenectomy. RESULTS: The TUMIR method was successfully achieved in 67/74 patients (90.5%). SLN were identified in 55 women (74.3%). No adverse effects were observed. Pelvic drainage was observed in 87.2% of women and paraaortic SLN were identified in 45.4%, with 12.8% of the patients draining only in this area. The mean number of SLN retrieved was 2.8 per patient (range 1 to 9). Metastatic disease was found in 13 (23.6%) patients. Metastatic involvement of the paraaortic lymph nodes was observed in 4 (30.7%) cases. All were identified by TUMIR. The sensitivity and negative predictive value of SLN detected by TUMIR to detect metastasis were 92.3% (95% CI 22.9-100) and 97.7% (95% CI 82.0-100), respectively. CONCLUSIONS: TUMIR is a safe, feasible method to detect SLN in patients with EC, having a good detection rate and providing representative information of the lymphatic drainage of EC.
    Gynecologic Oncology 10/2012; · 3.93 Impact Factor
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    ABSTRACT: OBJECTIVE: Our aim was to construct reference ranges for Cisterna Magna (CM) width at 11-13 weeks in healthy fetuses and determine whether open spina bifida and posterior fossa anomalies could be diagnosed in first trimester fetuses. METHODS: This was a retrospective study. CM width reference ranges were constructed based on the measurements obtained from 80 healthy fetuses with normal postnatal outcome undergoing routine first trimester ultrasound at 11-13 weeks, with the use of Lambda-Mu-Sigma (LMS) method. CM was measured in the fetal mid-sagittal view, routinely used for nuchal translucency assessment. In addition, in 11 fetuses with open spina bifida or posterior fossa anomalies, mostly diagnosed later in pregnancy, first trimester images were retrospectively reviewed and CM measurements were compared against reference ranges. RESULTS: CM width was noted to increase with gestation in normal fetuses. Eleven fetuses with posterior fossa anomalies were reviewed: open spina bifida (n = 5), megacistena magna (n = 3), Blake's pouch cyst (n = 2) and posterior fossa arachnoid cyst (n = 1). All the fetuses with open spina bifida had a CM width below the 5th centile. In the two fetuses with Blake's pouch cyst and in two with megacistena magna, CM width was above the 95th centile. In one of the fetuses with a megacisterna magna and the one with an arachnoid cyst, CM width was normal. CONCLUSION: We have constructed reference ranges for CM width at 11-13 weeks using mid-sagittal view. It appears that first trimester CM width can be used as a marker for the early detection of open spina bifida. However, our findings need to be confirmed in prospective large series. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
    Ultrasound in Obstetrics and Gynecology 09/2012; · 3.56 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). · 3.56 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). · 3.56 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). · 3.56 Impact Factor
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    ABSTRACT: This is the first report of fetoscopy to successfully treat a case of bilobar bronchial atresia presenting in the form of a massive right lung tumor causing severe thoracic compression with mediastinal shift, pulmonary hypoplasia and eventually fetal hydrops. The presence of an echolucent tubular structure in the pulmonary hilum was identified as the intrapulmonary continuation of the interrupted main bronchus, and led to the diagnosis of main bronchial atresia. After extensive discussion and counseling, a fetoscopic operation was designed and indicated. The procedure consisted of a fetal tracheoscopy and access to the right main bronchus, which was perforated with a diode laser until a communication with the dead end of the intrapulmonary main bronchus was achieved. After the operation a significant reduction in size was observed, hydrops and mediastinal shift disappeared and O/E LHR increased to 85%. The fetus was born at term and lobectomy of two dysplastic pulmonary lobes was performed. The infant is developing well at 14 months of age. This report demonstrates that fetoscopic airway decompression can achieve fetal survival in the rare event of main bronchus atresia.
    Fetal Diagnosis and Therapy 07/2012; · 1.90 Impact Factor
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    ABSTRACT: Monochorionic twin pregnancy (MC) occurs in one in 250 pregnancies and represents a significant proportion of perinatal morbidity and mortality in twin pregnancies, and in general. The optimal management of MC is based on two fundamental aspects: early classification of chorionicity and close monitoring. The differential diagnosis of the complications of MC is still a challenge to the fetal medicine specialist. This is due to the frequent overlap of clinical signs and the complex relationships between the potential complications. However, the differential diagnosis and subsequent decisions are based on relatively simple rules. While some cases can be really complicated, clinical experience shows that in most cases proper classification and management can be achieved through the consistent use of simple concepts. This review provides an overview that allows a comprehensive understanding of MC twin pregnancies, the typical complications and the key concepts that allow an appropriate differential diagnosis and specific management.
    Diagnóstico Prenatal. 01/2012; 23(3):93–101.
  • Robin Julve, Ana Muñoz, Bienvenido Puerto, Magdalena Sanz
    Diagnóstico Prenatal. 01/2012; 23(2):83–85.
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    ABSTRACT: Congenital diaphragmatic hernia (CDH) is a severe congenital birth defect, which is commonly associated with genetic abnormalities and malformations in other systems. Once the diagnosis is made, there should be a thorough evaluation to confirm that the malformation is isolated, as well as an assessment of prognostic factors, essentially lung size and liver herniation. With these parameters an individualized and relatively accurate prognosis can be offered to parents. Management options include termination of pregnancy, conservative prenatal management and post-natal treatment, or fetal therapy. Fetal therapy consists of fetal endoscopic tracheal occlusion (FETO) and is offered in a small number of centers worldwide. Available evidence suggests that prenatal treatment might increase the chances of survival by 35-40% compared with baseline survival. Several randomized trials are now underway to assess the impact of therapy on very severe and moderate cases of CDH.
    Diagnóstico Prenatal. 01/2012; 23(3):126–133.
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    ABSTRACT: Objective To evaluate the perinatal outcome in the 500 consecutive cases of severe twin-twin transfusion syndrome (TTTS) treated in a single centre with fetoscopic laser coagulation.Material and methodsA prospective study including 500 cases of severe TTS treated with laser therapy as a first option. Main outcome measures were survival, perinatal outcome, obstetrical complications and rate of neurological damage at 6-12 months of life.ResultsMean gestational age at therapy was 19.4 weeks (range 15.0-31.4). The placenta was anterior in 48% (n = 240) of the cases. The rate of conversion to cord occlusion was 1.2% (6/500). Overall neonatal survival was 74.8% (748/1,000), with at least one survivor in 91.6% (458/500). Mean duration of surgery was 29.4 min (range 9-64). There were no cases of intra- or post-operative abruptio placenta or chorioamnionitis. TTTS persisted in 2 cases (0.4%) and TAPS occurred in 8 (1.6%). Premature rupture of membranes (PROM) at < 32 weeks occurred in 32 cases (6.4%). Mean gestational age at delivery was 33.6 weeks (26.4-38.5), with 92% beyond 28 weeks. Mean birth-weight was 1,920 g (range 680-3,660) in recipients and 1,615 g (range 440-2,530) in donors. Severe neurological damage was observed in 6.4%.Conclusions In this large consecutive series of TTTS treated by fetoscopy in the same centre, results lie in the high range of those previously reported. Fetoscopic laser coagulation of the placental anastomosis is a safe therapy and offers consistent results in centres with experience.
    Diagnóstico Prenatal. 01/2012; 23(3):102–108.
  • The Ultrasound Review of Obstetrics & Gynecology 12/2011; 4(3).
  • Ultrasound in Obstetrics and Gynecology 10/2011; 38(S1). · 3.56 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 10/2011; 38(S1). · 3.56 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 10/2011; 38(S1). · 3.56 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 10/2011; 38(S1). · 3.56 Impact Factor
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    ABSTRACT: To compare the outcomes of a consecutive case series of monochorionic (MC) monoamniotic (MA) discordant twins treated with umbilical cord occlusion and transection, with those of a cohort of MC diamniotic (DA) twins treated with conventional cord occlusion. This study included 17 MCMA twins (12 true MA and five iatrogenic) treated with cord occlusion and transection and a control group of 72 MCDA discordant twins treated during the same period with cord occlusion in a single center. Duration of surgery, rates of preterm delivery (PTD) or preterm premature rupture of membranes (PPROM) < 32 weeks and intrauterine fetal demise (IUFD), perinatal outcome and neonatal survival were prospectively recorded in both groups. Median durations of surgery were 28.5 (range, 14.0-74.0) min and 24.0 (3.0-60.0) min in the cord transection and control groups, respectively (P = 0.24). There were no significant differences between cord transection and control groups in the rates of PPROM (35.3% vs. 20.8%, P = 0.22), PTD (41.2% vs. 28.2%, P = 0.29), IUFD (0% vs. 2.8%, P = 1.0) and neonatal survival (76.5% vs. 80.6%, P = 1.0). Gestational age at delivery (median 35.0 (24.5-39.0) vs. 37.1 (26.2-41.0) weeks, P = 0.21) and fetal birth weight (2215 (800-3200) g vs. 2605 (588-3830) g, P = 0.51) were similar between study groups. Cord occlusion and transection in MCMA discordant twins resulted in similar perinatal outcomes to those of MCDA discordant twins treated with cord occlusion.
    Ultrasound in Obstetrics and Gynecology 06/2011; 37(6):684-8. · 3.56 Impact Factor

Publication Stats

1k Citations
496.31 Total Impact Points


  • 1990–2014
    • University of Barcelona
      • • Department of Obstetrics and Gynecology, Pediatrics, Radiology and Anatomy
      • • Departament de Medicina
      Barcino, Catalonia, Spain
  • 2013
    • Hospital Sant Joan de Déu
      Barcino, Catalonia, Spain
  • 1991–2013
    • Hospital Clínic de Barcelona
      • • Servicio de Medicina Materno Fetal
      • • Servicio de Bioquímica y Genética Molecular
      • • Servicio de Enfermedades Autoinmunes y Sistémicas
      Barcino, Catalonia, Spain
  • 2011–2012
    • Centro de Investigación Biomédica en Red de Enfermedades Raras
      Valenza, Valencia, Spain
  • 2005–2007
    • Southern Medical Clinic
      San Fernando, City of San Fernando, Trinidad and Tobago
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 2006
    • Hospital Universitario 12 de Octubre
      • Department of Obstetrics and Gynecology
      Madrid, Madrid, Spain
  • 2001–2003
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain