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Ultrasound Core Laboratories (UCL) are used in multicenter trials to assess imaging biomarkers to define robust phenotypes, to reduce imaging variability and to allow blinded independent review with the purpose of optimizing endpoint measurement precision. The Household Air Pollution Intervention Network, a multicountry randomized controlled trial (Guatemala, Peru, India and Rwanda), evaluates the effects of reducing household air pollution on health outcomes. Field studies using portable ultrasound evaluate fetal, lung and vascular imaging endpoints. The objective of this report is to describe administrative methods and training of a centralized clinical research UCL. A comprehensive administrative protocol and training curriculum included standard operating procedures, didactics, practical scanning and written/practical assessments of general ultrasound principles and specific imaging protocols. After initial online training, 18 sonographers (three or four per country and five from the UCL) participated in a 2 wk on-site training program. Written and practical testing evaluated ultrasound topic knowledge and scanning skills, and surveys evaluated the overall course. The UCL developed comprehensive standard operating procedures for image acquisition with a portable ultrasound system, digital image upload to cloud-based storage, off-line analysis and quality control. Pre- and post-training tests showed significant improvements (fetal ultrasound: 71% ± 13% vs. 93% ± 7%, p < 0.0001; vascular lung ultrasound: 60% ± 8% vs. 84% ± 10%, p < 0.0001). Qualitative and quantitative feedback showed high satisfaction with training (mean, 4.9 ± 0.1; scale: 1 = worst, 5 = best). The UCL oversees all stages: training, standardization, performance monitoring, image quality control and consistency of measurements. Sonographers who failed to meet minimum allowable performance were identified for retraining. In conclusion, a UCL was established to ensure accurate and reproducible ultrasound measurements in clinical research. Standardized operating procedures and training are aimed at reducing variability and enhancing measurement precision from study sites, representing a model for use of portable digital ultrasound for multicenter field studies. [ABSTRACT FROM AUTHOR]

In vivo micro-imaging of mice is useful in studying the genetic basis of cardiac development in mutant embryos. We examined Phox2b-/- mutant mice, which lack autonomic innervation to the heart and die in utero, and investigated whether this lack of innervation causes cardiac dysfunction during embryogenesis. A VisualSonics Vevo 2100 ultrahigh-frequency linear array ultrasound machine with 30- and 40-MHz probes was used to analyze embryo size, gross characteristics, ventricular contractility and rhythm. Phox2b-/- mutant embryos underwent cessation of heartbeat and death at a greater rate than wild-type controls. We did not observe a hydrops phenotype or congenital heart defects in Phox2b-/- mutants. Analysis of heart rhythm revealed no significant correlation with genotype. Absent these signs of a progressive pathology, we suggest that Phox2b-/- mutant embryos likely die of sudden death secondary to acute arrhythmia. These data provide insight into the role of cardiac autonomic innervation during development. [ABSTRACT FROM AUTHOR]

Hypoplastic left heart syndrome (HLHS) is a rare, but exceptionally serious, congenital heart defect. We aimed to explore the best-fitted Z-score models for individual chamber dimension and to draw a comparison between fetuses with HLHS and the normal Chinese cohort. We made measurements of 1674 healthy fetuses and 79 fetuses with HLHS, undertaking echocardiography. Normal fetal cardiovascular Z-score formulae were established by curve-fitting with 5 algorithmic functions and weighted regression of absolute residuals. Classic linear models were fitted for left ventricular diameter against gestational age, and log-transformed linear-power models-were statistically better for left ventricular length, diameter of left atrium and ascending aorta. Fetuses with HLHS manifested significantly lower Z-score means (≤3.5) for these 4 parameters and the vast majority (∼90%) lay beyond -2. Overall, cardiovascular Z-score equations were reliably constructed in a larger Chinese cohort, and their application should benefit evaluation and diagnosis of HLHS. [ABSTRACT FROM AUTHOR]

Clutter in echocardiography hinders the visualization of the heart and reduces the diagnostic value of the images. The detailed mechanisms that generate clutter are, however, not well understood. We present five different hypotheses for generation of clutter based on reverberation artifact with a focus on apical four-chamber view echocardiograms. We demonstrate the plausibility of our hypotheses by in vitro experiments and by comparing the results with in vivo recordings from four volunteers. The results show that clutter in echocardiography can be originated both at structures that lie in the ultrasound beam path and at those that are outside the imaging plane. We show that reverberations from echogenic structures outside the imaging plane can make clutter over the image if the ultrasound beam gets deflected out of its intended path by specular reflection at the ribs. Different clutter types in the in vivo examples show that the appearance of clutter varies, depending on the tissue from which it originates. The results of this work can be applied to improve clutter reduction techniques or to design ultrasound transducers that give higher quality cardiac images. The results can also help cardiologists have a better understanding of clutter in echocardiograms and acquire better images based on the type and the source of the clutter. [ABSTRACT FROM AUTHOR]

Machine learning for ultrasound image analysis and interpretation can be helpful in automated image classification in large-scale retrospective analyses to objectively derive new indicators of abnormal fetal development that are embedded in ultrasound images. Current approaches to automatic classification are limited to the use of either image patches (cropped images) or the global (whole) image. As many fetal organs have similar visual features, cropped images can misclassify certain structures such as the kidneys and abdomen. Also, the whole image does not encode sufficient local information about structures to identify different structures in different locations. Here we propose a method to automatically classify 14 different fetal structures in 2-D fetal ultrasound images by fusing information from both cropped regions of fetal structures and the whole image. Our method trains two feature extractors by fine-tuning pre-trained convolutional neural networks with the whole ultrasound fetal images and the discriminant regions of the fetal structures found in the whole image. The novelty of our method is in integrating the classification decisions made from the global and local features without relying on priors. In addition, our method can use the classification outcome to localize the fetal structures in the image. Our experiments on a data set of 4074 2-D ultrasound images (training: 3109, test: 965) achieved a mean accuracy of 97.05%, mean precision of 76.47% and mean recall of 75.41%. The Cohen κ of 0.72 revealed the highest agreement between the ground truth and the proposed method. The superiority of the proposed method over the other non-fusion-based methods is statistically significant (p < 0.05). We found that our method is capable of predicting images without ultrasound scanner overlays with a mean accuracy of 92%. The proposed method can be leveraged to retrospectively classify any ultrasound images in clinical research. [ABSTRACT FROM AUTHOR]

The aim of our prospective pilot study with exploratory analysis was to compare longitudinal and apical foetal speckle tracking echocardiography (STE) using tissue motion annular displacement (TMAD) and segmental longitudinal strain (SLS). We compared two different STE quantification tools in a longitudinal and apical four-chamber view in 57 normal foetuses between 20 and 40 wk of gestation. Myocardial mechanical dyssynchrony and strain were assessed using offline quantification software (QLab Version 10.3, Philips Medical Systems, Andover, MA, USA). We compared the dyssynchrony measurements with TMAD and SLS in longitudinal and apical four-chamber views. Furthermore, we examined the segmental strain values of both ventricles with SLS and compared the differences between longitudinal and apical measurements. Dyssynchrony measurements with TMAD and SLS and strain measurements with SLS were feasible in all cases. In the apical view, the dyssynchrony measurements with TMAD were systematically greater than those achieved with SLS (p < 0.001). For the longitudinal view, no differences were observed between tools (p = 0.153). The application of SLS provided similar results for dyssynchrony in both views (intra-class correlation coefficient [ICC] = 0.281, p = 0.623), but the strain measurements in the left and right ventricles differed significantly between views (ICC = -0.082, p = 0.011, and ICC = -0.061, p = 0.024, respectively). For TMAD, we found large differences in the dyssynchrony values between longitudinal and apical assessment (ICC = -0.060, p = 0.03). Furthermore, TMAD exhibited reduced accuracy in the system's automatic tracking algorithm, limiting the data quality. The dyssynchrony assessment is affected less by the foetal position in SLS than in TMAD. The strain readings in SLS varied depending on the view in which they were assessed. The application of TMAD cannot be recommended for foetal STE. [ABSTRACT FROM AUTHOR]

We searched for the possibilities and limitations of fetal heart valves assessment when screening for fetal anomalies at 11-14 weeks, 19-23 weeks and third trimester. This is a prospective study performed in our clinic of Obstetrics and Gynecology of Craiova between January 2020 and December 2021. In addition to the existing protocols of fetal heart assessment, we enclosed a supplementary protocol for the evaluation of the fetal heart valves- specific for every gestational age. We analyzed the extent to which it was achieved during our study, if it prolonged the examination time and whether it was helpful in detecting fetal heart valvular pathology During our study we observed the utility for the fetal heart valves assessment especially in the second and third trimester of pregnancy. We did not notice a significant extension of time for the examination of the fetal heart. The fetal heart valves assessment, although it is far away from offering the details of a postnatal heart evaluation can be integrated in the assessment of the fetal heart and can bring benefits in the prenatal diagnosis of such pathology. [ABSTRACT FROM AUTHOR]

We measured acoustic output, expressed as the thermal index (TI) and mechanical index (MI), during fetal echocardiography at the time of the first trimester scan. TI and MI were retrieved from the saved displays during gray-mode, high-definition color flow Doppler and pulsed-wave Doppler (tricuspid flow) ultrasound examinations of the fetal heart and from the ductus venosus assessment. A total of 399 fetal cardiac examinations were evaluated. There was a significant increase in TI values from B-mode studies (0.07 ± 0.04 [mean ± SD]) to color flow mapping (0.2 ± 0.0) and pulsed-wave Doppler studies (0.36 ± 0.05). The TI from ductus venosus assessment (0.1 ± 0.01) was significantly lower than those from Doppler examinations of the heart. MI values from B-mode scans (0.65 ± 0.12) and color flow mapping (0.71 ± 0.11) were comparable, although different, and both values were higher than those from pulsed-wave Doppler tricuspid evaluation (0.39 ± 0.03). There were no differences in MI values from power Doppler assessment between the tricuspid flow and ductus venosus. Safety indices were remarkably stable and were largely constant, especially for color Doppler (TI), tricuspid flow (MI) and ductus venosus assessment (TI, MI). We acquired satisfactory Doppler images and/or signals at acoustic levels that were lower than the actual recommendations and never reached a TI of 0.5. [ABSTRACT FROM AUTHOR]

Ultrasonography represents an important diagnostic tool used nowadays to better understand the complex process of delivery and its perturbations in order to ensure delivering a healthy baby to a healthy mother. Intrapartum ultrasound (IPU) offers a greater precision in evaluating fetal head position, station and descent than digital vaginal examination. Thus, IPU can become a reliable instrument in the hands of trained medical personnel for the management of normal and abnormal labor. We reviewed all current data and we present the experience of our unit in the County Emergency Hospital of Craiova with IPU. The goal of this paper is not meant to change the classic algorithm of labor monitoring, but to provide objective additional evaluations of the traditional labor parameters of crucial importance. Sonographic measurements reviewed and used include both linear methods of measurement such as fetal head-perineum distance (HPD), progression distance (PD) and fetal head-symphysis distance (HSD) and angular methods such as the angle of progression (AOP), the angle of direction (AOD) and rotation. A HPD less than 40 mm, an AOP of more than 110–120°, PD more than 35 mm, and an AOD of more than 105° represent good predictors in achieving an uncomplicated vaginal delivery. These cut-offs proved to be helpful in selecting those patients with such a high risk for Caesarean delivery that they should avoid a trial of labor. IPU has become a highly useful risk tool with the potential to greatly improve planning hospital service needs and minimizing patient risk. IPU can be considered a significant part of the point-of-care-ultrasound (POCUS) and should be available in most delivery rooms, even just for verifying the correctness of clinical examination when assessing fetal presentation, position and station in labor. This 'bedside' examination with no additional requirement for advanced equipment or special training provides an immediate diagnosis of obstetrical complications that can lead to critical outcomes for the mother and the fetus. Ultrasound in labor should become standard of care. [ABSTRACT FROM AUTHOR]

To establish the reference range of the anteroposterior diameter of the left brachiocephalic vein (LBCV) and evaluate the characteristics of fetal echocardiography with different types of LBCV abnormalities and its clinical significance. A retrospective study was undertaken involving 714 fetuses at 20 weeks to 38 weeks gestational age (GA). Of them, the anteroposterior diameter of fetal LBCV were continuously measured on the thymus section on the cephalic side of the three-vessel trachea. The reference range of anteroposterior diameter was created to the GA, and the relationship between both was analyzed. 20 cases were selected for reliability analysis. Moreover, the echocardiographic characteristics of 30 cases with fetal LBCV abnormalities were summarized. (1) The intra-class correlation coefficients of LBCV anteroposterior diameters detected by the same physician (0.978) and different physicians (0.970) were high. (2) With the increase of gestational age, the anteroposterior diameter of LBCV increased significantly (P<0.01), and the regression equation was Y(mm) =2.01+0.19*GA (r=0.914, P<0.001). (3) Among the 30 fetuses with LBCV abnormalities, 24 cases with abnormal LBCV route, including 22 cases with route under the aortic arch, 1 case with anomalous retroesophageal LBCV, and 1 case with intra-thymus route. There were 4 cases whose LBCV were absent and 2 cases were dilated. In addition, the 30 fetuses with LBCV abnormalities, complicated with aortic arch anomalies (13 cases), or conotruncal defects (4 cases), or ventricular septal defect (1 case), or anomalous pulmonary venous return with a supracardiac connection (1 case) or Galen vein aneurysm (1 case). Prenatal echocardiography is useful in assessing fetal LBCV. LBCV abnormalities is usually associated with fetal heart malformations. Evaluating fetal LBCV might be practical for screening fetal congenital heart disease. [ABSTRACT FROM AUTHOR]

To investigate the diagnostic value of transabdominal ultrasound combined with transvaginal ultrasound (two-step method) in screening fetal cardiac abnormalities in the first trimester. 1897 fetuses of 11∼13+6 weeks were screened by ultrasonography. The two-step method was used to screen the fetal hearts and diagnose congenital fetal heart malformations. Pregnancy outcomes of all positive cases were followed up. Of 1897 fetuses in the first trimester, 16 fetuses with fetal cardiac abnormalities were detected, including 14 cases of intracardiac structural abnormalities (3 cases of single atrium and single ventricle, 3 cases of ventricular septal defect, 4 cases of tetralogy of Fallot, 1 case of mitral atresia, ventricular septal defect and right heart enlargement, 1 case of complete atrioventricular septal defect, 2 cases of aberrant right subclavian artery), and 2 cases of cardiac axis abnormalities (2 cases of left diaphragmatic hernia). However, 15 fetuses with fetal abnormalities (6 cases of ventricular septal defect, 4 cases of atrial septal defect, 3 cases of aberrant right subclavian artery, 1 cases of complete transposition of the great arteries, and 1 cases of tetralogy of Fallot) were not detected by ultrasonographic scanning in the first trimester, but were found in the second and third trimesters or postpartum period by ultrasonography. The sensitivity, specificity, positive predictive value, and negative predictive value of the two-step method in screening fetal cardiac abnormalities in early pregnancy were 51.6%, 100%, 100% and 98.4% respectively when compared to the postnatal follow-up results. Transabdominal ultrasound combined with transvaginal ultrasound (two-step method), to some extent, has diagnostic value in screening fetal cardiac abnormalities in the first trimester. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to evaluate the use of 4-D echocardiography with inversion mode and spatiotemporal image correlation (IM-STIC) in the detection of normal and abnormal fetal hearts. We retrospectively studied 112 normal fetuses and 16 fetuses with a confirmed diagnosis of congenital heart disease. Two volumes were acquired from each of the fetuses using transverse and sagittal sweeps. Volumes were reconstructed with IM-STIC. In normal fetuses, IM-STIC facilitated visualization of the interior structures of the fetal heart and great vessels. The visualization rates of intended planes obtained from IM-STIC 4D data ranged from 55% to 100%. In 16 fetuses with congenital heart disease, IM-STIC was able to display the cardiac malformations using digital casting. Some of the malformations were suspected during pre-natal 2-D echocardiography, and their pre-natal IM-STIC diagnoses were confirmed by post-natal echocardiography, surgery and/or autopsy. Hence, 4-D IM-STIC allows better visualization of complex congenital heart disease and should be considered a very useful addition to 2-D echocardiography. [Copyright &y& Elsevier]

Abstract: Our objective is to describe our experience with reconstruction of normal fetal cardiac structures and congenital heart anomalies using the 3-D HDlive rendering mode with spatiotemporal image correlation (STIC). Four normal fetuses and three fetuses with congenital heart anomalies (Ebstein’s anomaly, hypoplastic left heart syndrome and tetralogy of Fallot) at 25–35 wk of gestation were studied using the 3-D HDlive rendering mode with STIC. In normal fetuses, the natural appearance of the dynamic motion of the foramen ovale flap and both atrioventricular valves was clearly visualized in real time in the four-chamber view. Moreover, new, realistic sensations of each leaflet of atrioventricular valves and semilunar valves of the pulmonary artery were obtained in the en face view of both atrioventricular valves and great vessels. In the case of Ebstein’s anomaly, the procedure rendered the natural and anatomically realistic appearance of significantly low attachment of the tricuspid valve and atrialized portion of the right ventricle. In hypoplastic left heart syndrome, thickened tricuspid and dysplastic pulmonary valves were clearly revealed. In tetralogy of Fallot, an overriding aorta and ventricular septal defect were realistically depicted. The 3-D HDlive rendering mode with STIC provides entirely new visual experiences for obstetricians and pediatric cardiologists owing to the anatomically realistic depiction of normal and abnormal fetal cardiac structures of the beating heart. [Copyright &y& Elsevier]

Abstract: We hypothesized that in chronic fetal anemia, remodeling of the myocardium is related to abnormalities in regional wall motion and acutely increased afterload further disturbs myocardial strain. Chronic anemia was induced in one fetus of each of seven sheep twin pregnancies. The fetuses were studied by two-dimensional (2-D) strain echocardiography at baseline and during increased afterload via angiotensin II (AT II) infusion. At baseline, the peak systolic longitudinal, radial and circumferential strains in the left ventricular lateral wall in anemic fetuses were lower than those in the controls (all p <0.05). During AT II, the circumferential strain of right ventricular free wall decreased significantly both in the control and anemic fetuses. Left ventricular free wall systolic strains were not affected by AT II. Fetal myocardial remodeling in chronic anemia decreases left ventricular systolic free wall strains. The myocardial adaptation does not change ventricular responses to acutely increased afterload. (E-mail: sahnd@ohsu.edu) [Copyright &y& Elsevier]

Abstract: Recent advances in four-dimensional (4-D) ultrasound enable the acquisition and visualisation of the entire fetal heart. However, getting consistent, shadow free, data remains problematic due to the uncontrollable nature of fetal orientation. This article presents the first investigation into the utility of image fusion to improve the quality of volumetric fetal cardiac imaging. Multiple volume scans are registered using a semiautomatic approach and five fusion methods are assessed for their ability to remove artefacts and improve image quality. Image quality is assessed in terms of signal-to-noise ratio, contrast and contrast-to-noise ratio. Qualitative results are presented for the ability to remove artefacts. The fusion methods assessed were found to be divided into those that reduce noise and those that increase contrast. The effect of fusion on left ventricle segmentation using commercial state-of-the-art software is also considered. The use of image fusion is shown to reduce the variability of volume estimates by about 50% relative to measurement on a single scan. (E-mail: gooding@robots.ox.ac.uk) [Copyright &y& Elsevier]

Abstract: Children with hypoplastic left heart syndrome (HLHS) are at risk for neurodevelopmental dysfunction; prenatal factors may play a role in this predilection. Cerebral blood flow profiles are abnormal in fetuses with HLHS, raising the possibility that cerebral hemodynamics in utero may be related to neurodevelopmental abnormalities. Prenatal aortic valvuloplasty for fetal aortic stenosis with evolving HLHS is technically feasible and improves left heart hemodynamics. This study aimed to assess the effects of prenatal intervention on cerebral blood flow profiles and head circumference in fetuses with evolving HLHS. Seventy fetuses underwent prenatal aortic valvuloplasty for evolving HLHS (median 23 weeks gestation). Among 46 fetuses that had successful valvuloplasty and available data, middle cerebral artery (MCA) pulsatility (PI) and resistive (RI) indices were abnormal (Z-scores –1.7±1.1 and –2.2±1.4, p <0.001). Early post-valvuloplasty (n =33) and at late gestation follow-up (n =28), MCA PI and RI Z-scores remained low with no difference from pre- or early postintervention. Fetal head circumference was normal, as were umbilical artery PI and RI Z-scores. Cerebral blood flow characteristics are abnormal in mid-gestation fetuses with evolving HLHS, suggesting low cerebral vascular impedance. The mechanisms and significance of these abnormalities are unknown. Prenatal aortic valvuloplasty did not have a major impact on these indices. (E-mail: doff.mcelhinney@cardio.chboston.org) [Copyright &y& Elsevier]

Abstract: The objectives of this study were to measure the relative attenuation properties of the left and right ventricles in fetal pig hearts and to compare the spatial variation in attenuation measurements with those observed in previously published backscatter measurements. Approximately 1.0-mm-thick, short-axis slices of excised, formalin-fixed heart were examined from 15 midgestational fetal pigs using a 50-MHz single-element transducer. Measurements of the attenuation properties demonstrate regional differences in the left and right ventricular myocardium that appear consistent with the previously reported regional differences in apparent integrated backscatter measurements of the same fetal pig hearts. For regions of perpendicular insonification relative to the myofiber orientation, the right ventricular free wall showed larger values for the slope of the attenuation coefficient from 30–60 MHz (1.48 ± 0.22 dB/(cm·MHz) (mean ± SD) and attenuation coefficient at 45 MHz (46.3 ± 7.3 dB/cm [mean ± SD]) than the left ventricular free wall (1.18 ± 0.24 dB/(cm·MHz) and 37.0 ± 7.9 dB/cm (mean ± SD) for slope of attenuation coefficient and attenuation coefficient at 45 MHz, respectively). This attenuation study supports the hypothesis that intrinsic differences in the myocardium of the left and right ventricles exist in fetal pig hearts at midgestation. (E-mail: mrh@wuphys.wustl.edu) [Copyright &y& Elsevier]

Abstract: The goal of this study was to characterize and compare regional backscatter properties of fetal hearts through measurements of the apparent integrated backscatter. Sixteen excised, formalin-fixed fetal pig hearts, representing an estimated 53 to 63 days of gestation, were investigated. Spatially localized measurements of integrated backscatter from these specimens were acquired using a 50 MHz single-element transducer. The apparent integrated backscatter measurements demonstrate different patterns of backscatter from the myocardium of the right ventricle compared with that of the left ventricle. These backscatter measurements appear to be consistent with the anisotropy of the fiber orientation observed in histologic assessment of the same specimens. For each of the 16 hearts, the apparent integrated backscatter from the right ventricular myocardium was larger than that from the left ventricular myocardium, exhibiting mean apparent backscatter values of –35.9 ± 2.0 dB and –40.1 ± 1.9 dB (mean ± standard deviation; n = 16; p < 0.001), respectively. This study suggests that the intrinsic ultrasonic properties of the left and right ventricular myocardium are distinct in fetal pig hearts at mid-gestation. (E-mail: mrh@wuphys.wustl.edu) [Copyright &y& Elsevier]

A total of 15 fetuses were scanned using 2-D array volumetric ultrasound (US). Acquired cardiac data were converted for rendering dynamic 3-D surface views and reformatting cross-sectional views. The image usefulness was compared between the data obtained from subcostal/subxiphoid and other imaging windows; the former are usually free of acoustic shadowing. Of 60 data sets recorded, 12 (20%) were acquired through subcostal windows in 6 (40%) patients. Subcostal windows were unavailable from the remaining patients due to unfavourable fetal positions. Of the 12 sets, 6 (50%) provided the dynamic 3-D and/or cross-sectional views of either the entire fetal heart or a great portion of it for sufficient assessments of its major structures and their spatial relationships. Of 48 data sets from other windows, only 9 (19%) provided such 3-D and/or cross-sectional views; the lower rate being due to acoustic shadowing. Real-time 3-D US is a convenient method for volumetric data acquisition. Through subcostal windows, useful information about the spatial relationships between major cardiac structures can be acquired. However, to offer detailed information, considerable improvement in imaging quality is needed. (E-mail: jdeng@medphys.ucl.ac.uk) [Copyright &y& Elsevier]

During fetoscopic interventions, intraesophageal placement of intravascular ultrasound (US) catheters for fetal hemodynamic monitoring may result in esophageal injury in very small fetuses. Moreover, conventional fetal imaging by the transvaginal or transabdominal routes may be impossible in some high-risk pregnancies. The purpose of our study in sheep was to assess the potential of a phased-array intravascular US catheter for intra-amniotic fetal echocardiography. The catheter was percutaneously inserted into the amniotic cavity in seven pregnant ewes at between 78 to 98 days of gestation and permitted high-quality 2-D imaging of the fetal heart and multimodal Doppler assessment of fetal cardiovascular flows. Fetoscopic examination of intra-amniotic contents after intra-amniotic imaging was finished did not display any injury to intra-amniotic contents. The intra-amniotic imaging approach may provide an effective alternative in humans for monitoring during fetoscopic interventions, and to assess fetal anatomy and hemodynamics in high-risk pregnancies when sufficient images cannot be obtained by conventional routes.(E-mail: thokohl@t-online.de) [Copyright &y& Elsevier]

The most important consideration in dealing with fetal hydronephrosis is the overall welfare of the mother and the child, then one should consider the outcome for the kidneys and the bladder. What the Paediatric Urologist needs to know is if and when intervention is needed. While we await research that enables us to understand fetal hydronephrosis to the level that we can talk of preservation of the renal functioning unit, the nephron, we can look at the cruder markers of renal decline to suggest early intervention. Most importantly, we need to know the changes over time. And, the specifics of the renal parenchyma, the calyces, the pelvis, ureters and bladder and features of specific pathology, such as the key-hole sign or the presence of a ureterocele. There are also signs of severity, such as oligohydramnios and the eggshell sign, which assist the clinician to consider intervention and its timing. The various signs that help define the renal pathology and the severity of impact on the renal prognosis will be presented. [ABSTRACT FROM AUTHOR]

Congenital anomalies of the fetal chest typically consist of lung lesions that are echogenic on ultrasound. These lesions comprise congenital pulmonary airway malformations (CPAM), bronchopulmonary sequestrations (BPS), bronchial atresia, bronchogenic cysts, congenital lobar emphysema, and congenital high airway obstruction syndrome (CHAOS). CPAM and BPS account for a majority of these anomalies. Although rare, the apparent incidence of these echogenic lung lesions has increased recently, with CPAMs now occurring at a rate of 0.94 per 10,000 live births. This increase is likely a product of the improved resolution of ultrasound equipment, and the increasing uptake of routine fetal anomaly scanning in the second trimester. In utero, fetal echogenic lung lesions can result in mediastinal shift, fluid collections and hydrops. Following birth, they can cause substantial neonatal respiratory compromise. Determining the type of lesion prenatally can be challenging, even with complementary imaging such as MRI scanning, and the final histopathological diagnosis – where available – is often different to that suspected prior to birth. Of greater importance to prospective parents, however, is the likelihood of a favourable outcome, and the need for fetal intervention and/or intensive neonatal care. A range of sonographic predictors has been proposed for this purpose, but the best studied index is the CPAM-volume ratio – the ratio of the volume of the lesion (calculated as a prolate ellipse) to the fetal head circumference, to normalise for gestation. This presentation will review the performance of the CVR in the prediction of a range of fetal and neonatal concerns, including in a series from the author's own institution. It will also compare this index with other predictors, none of which has shown sufficient utility to replace the CVR at this stage. It will conclude with suggestions regarding future research in this field. [ABSTRACT FROM AUTHOR]

Diastematomyelia is a rare congenital anomaly where there is complete or partial duplication of the spinal cord as a result of a fibrous, cartilaginous or osseous spur. By 1994 only 100 cases had been reported worldwide. Diagnosis, if prenatal, is usually late 3rd trimester. This poster depicts a case study illustrating ultrasound appearances at 17 weeks gestation and prenatal diagnosis of Diastematomyelia at 24 weeks describing Epidemiology, Presentation, Associated Anomalies, Ultrasound appearances, Treatment and Prognosis. Due to the infrequent presentation and low recorded incidence of Diastematomyelia, limited literature is available on this condition. The purpose of this poster is to rectify this dilemma. 1. To raise awareness of the sonographic appearance of the extremely rare Diastematomyelia. 2. To disseminate the importance of an early diagnosis to promote 'Best Practice Care' and better patient outcomes. 3. To encourage sonographers to be vigilant and ensure thorough scanning. -A thorough obstetric ultrasound examination concentrating on morphology was performed utilising a Toshiba Aplio unit and 10 MHZ and 3.5MHZ curved array transducers. -Maternal and fetal structures were interrogated and documented paying particular attention to the transverse, longitudinal and coronal images of the fetal spine, skin-line and fetal cranium when a spinal abnormality was suspected. -Ultrasound appearances were compared with normal anatomy. Identification of an additional spinal cord posterior ossification centre is pathognomic for ultrasound antenatal diagnosis of Diastematomyelia. The resultant significance of this poster research is to promote earlier diagnosis of this fetal anomaly and associated abnormalities assisting parents with informed decisions concerning obstetric care if their baby is affected by Diastematomyelia. [ABSTRACT FROM AUTHOR]

To explore the feasibility, clinical significance and popularization value of tele-echocardiography consultation based on Internet cloud service technology. Relying on the 4G Internet cloud service platform, using unique dynamic image codec and synchronization technology to integrate multi-dimensional communication information such as voice, text and pictures, we have constructed the tele-echocardiography consultation platform of Henan Provincial People's Hospital and two primary hospitals 300 kilometers apart.45 patients were consulted through the tele-echocardiography consultation platform. 45 patients achieved teleconsultation through the tele-echocardiography consultation platform. The total time spent was about 341.31 minutes, and the average length of consultation for each patient was 7.58 ± 6.17 minutes. There were 5 patients diagnosed with congenital heart disease, 34 patients with acquired heart disease, and 6 patients excluded with cardiac abnormalities. Compared with the initial diagnosis results of the primary hospitals, the consultation specialists newly discovered 7 cases of abnormal diagnosis, accounting for 16% of the total number of consultations; confirmed 6 cases of initial diagnosis, accounting for 13% of the total number of consultations; excluded 6 cases of suspicious diagnosis, accounting for 13% of the total number of consultations; and answered a number of difficult questions. The expert opinions of the remaining 26 cases were basically consistent with the initial diagnosis of primary hospitals, accounting for 58% of the total number of consultations. Patient and doctor satisfaction is 100%. The three-synchronization dual real-time interactive tele-echocardiography consultation system based on Internet cloud service and unique dynamic image codec and synchronization technology has good feasibility and practicability, and is worthy of widespread application. [ABSTRACT FROM AUTHOR]