B Puerto

University of Barcelona, Barcino, Catalonia, Spain

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Publications (172)465.77 Total impact

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    ABSTRACT: Objective: To explore corpus callosum (CC) developmental differences by ultrasound in late-onset small fetuses compared with adequate for gestational age (AGA) controls. Study Design: Ninety four small (estimated fetal weight <10th centile) and 71 AGA fetuses were included. Small fetuses were further subdivided into fetal growth restriction (IUGR, n = 64) and small for gestational age (SGA, n = 30) based on poor perinatal outcome factors, that is, birth weight <3rd centile and/or abnormal cerebroplacental ratio and/or uterine artery Doppler. The entire cohort was scanned to assess CC by transvaginal neurosonography obtaining axial, coronal and midsagittal images. CC length, thickness, total area and the areas after a subdivision in 7 portions were evaluated by semiautomatic software. Furthermore, the weekly average growth of the CC in each study group was calculated and compared. Results: Small fetuses showed significantly shorter (small fetuses: 0.49 vs. AGA: 0.52; p < 0.01) and smaller CC (1.83 vs. 2.03; p < 0.01) with smaller splenium (0.47 vs. 0.55; p < 0.01) compared to controls. The CC growth rate was also reduced when compared to controls. Changes were more prominent in small fetuses with abnormal cerebroplacental Doppler suggesting fetal growth restriction. Conclusions: Neurosonographic assessment of CC showed significantly altered callosal development, suggesting in-utero brain reorganization in small fetuses. This data support the potential value of CC assessment by US to monitor brain development in fetuses at risk. © 2015 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 02/2015; DOI:10.1159/000366160
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    ABSTRACT: This article is a systematic review of the literature to establish the detection rate and false positive rate of the combined test for the screening of trisomy 21 in twins.
    Prenatal Diagnosis 11/2014; 34(11). DOI:10.1002/pd.4431
  • Ultrasound in Obstetrics and Gynecology 09/2014; 44(S1):231-231. DOI:10.1002/uog.14153
  • Ultrasound in Obstetrics and Gynecology 09/2014; 44(S1):36-36. DOI:10.1002/uog.13560
  • Ultrasound in Obstetrics and Gynecology 09/2014; 44(S1):114-114. DOI:10.1002/uog.13844
  • Ultrasound in Obstetrics and Gynecology 09/2014; 44(S1):36-37. DOI:10.1002/uog.13561
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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 08/2014; 44(2). DOI:10.1002/uog.13373
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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 01/2014; 43(1). DOI:10.1002/uog.12527
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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; 34(2). DOI:10.1159/000350697
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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 05/2013; 41(5). DOI:10.1002/uog.12302
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    ABSTRACT: Abstract Objectives: To compare the performance of three different strategies for prenatal screening for Down's syndrome in twins (nuchal translucency, the combined test, the combined test+ ductus venosus pulsatility index). Methods: We included 277 twin pregnancies with two cases of trisomy 21 (both dichorionic). We performed a computer simulation of Down's syndrome NT screening, combined test screening and the combined test with the addition of ductus venosus pulsatility index (DVPI) screening using the commercialized software SsdwLab6. The strategies were compared using the area under the ROC (Receiver Operating Characteristic Curve) curve. Results: NT screening false positive rate (FPR) was 10.9% (95%CI8.3-13.5). The combined test FPR was 6.2% (95%CI4.1-8.2%) and the combined test plus DVPI was 6% (95%CI4-8). FPR was higher in advanced maternal age patients. Detection rate was 100% in all cases. The AUC (area under the curve) was 0.987 (95% CI0.972-0-994) in NT screening; 0.987 (95%CI0.978-0.997) in the combined test and 0.983 (95% CI 0.977-0.996) in the combined test+DVPI. Conclusions: Down's syndrome screening is feasible in twins with low FPR. Results are similar to ones achieved in singletons. The combined test appears to be the most effective. The addition of DVIP doesn't significantly improve the prenatal screening for trisomy 21.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 03/2013; DOI:10.3109/14767058.2013.784252
  • Robin Julve, Ana Muñoz, Bienvenido Puerto, Magdalena Sanz
    01/2013; 24(1):38–41. DOI:10.1016/j.diapre.2012.01.005
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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; 128(1). DOI:10.1016/j.ygyno.2012.10.008
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    ABSTRACT: The aim is to describe the performance of first-trimester combined risk assessment in twin pregnancies. Maternal serum free beta-human chorionic gonadotrophin and pregnancy-associated plasma protein A (PAPP-A) were determined at 8 to 12 weeks and fetal nuchal translucency (NT) was measured at 11 to 13+6 weeks. The individual risk was estimated for each fetus using the combined test in dichorionic twins. In monochorionic twins, the mean risk assessment of the two fetuses was used. An invasive diagnostic procedure was offered when the risk was ≥1 : 270 in either one of the fetuses. From February 2007 to June 2011, 447 twin pregnancies were enrolled in this study. There were 402 (89.9%) dichorionic and 45 (10.1%) monochorionic twins. In dichorionic twins, mean crown-rump length (CRL) was 63.9 mm; median NT multiples of the median (MoM) was 0.97; median Β-hCG was MoM 1.74; median PAPP-A was 1.72. In monochorionic twins, mean CRL was 61.9 mm; median NT MoM was 0. 98; median Β-hCG MoM was 1.44; and median PAPP-A was 1.51. Two pregnancies with Down syndrome were detected by first trimester screening, both in dichorionic twins. The false positive rate was 5.7% (95% confidence interval 4.1-7.3) and 4.4% (95% confidence interval 0.1-8.8%) in dichorionic and monochorionic twins, respectively. The combined test in twins appears to be a good method for Down syndrome screening with a high detection rate and an acceptable false-positive rate. © 2012 John Wiley & Sons, Ltd.
    Prenatal Diagnosis 10/2012; 32(10):927-32. DOI:10.1002/pd.3934
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    Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). DOI:10.1002/uog.11369
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    Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). DOI:10.1002/uog.11507
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    Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). DOI:10.1002/uog.11533
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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; 33(1). DOI:10.1159/000339681
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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.
    07/2012; 23(3):126–133. DOI:10.1016/j.diapre.2012.06.009
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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.
    07/2012; 23(3):93–101. DOI:10.1016/j.diapre.2012.06.008

Publication Stats

1k Citations
465.77 Total Impact Points

Institutions

  • 1990–2014
    • University of Barcelona
      • Department of Obstetrics and Gynecology, Pediatrics, Radiology and Anatomy
      Barcino, Catalonia, Spain
  • 2004–2013
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 2001–2013
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 1995–2013
    • Hospital Clínic de Barcelona
      • Servicio de Medicina Materno Fetal
      Barcino, Catalonia, Spain
  • 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