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Transcatheter valve replacement has experienced substantial growth in the past decade and this technique can now be used for any of the four heart valves. Transcatheter aortic valve replacement (TAVR) has overtaken surgical aortic valve replacement. Transcatheter mitral valve replacement (TMVR) is often performed in pre-existing valves or after prior valve repair, although numerous devices are undergoing trials for replacement of native valves. Transcatheter tricuspid valve replacement (TTVR) is similarly under active development. Lastly, transcatheter pulmonic valve replacement (TPVR) is most often used for revision treatment of congenital heart disease. Given the growth of these techniques, radiologists are increasingly called upon to interpret post-procedural imaging for these patients, particularly with CT. These cases will often arise unexpectedly and require detailed knowledge of potential post-procedural appearances. We review both normal and abnormal post-procedural findings on CT. Certain complications—device migration or embolization, paravalvular leak, or leaflet thrombosis—can occur after replacement of any valve. Other complications are specific to each type of valve, including coronary artery occlusion after TAVR, coronary artery compression after TPVR, or left ventricular outflow tract obstruction after TMVR. Finally, we review access-related complications, which are of particular concern due to the requirement of large-bore catheters for these procedures. • Transcatheter valve replacement has expanded tremendously and radiologists should be familiar with post-procedural findings. • Complications after transcatheter valve replacement can include device migration, paravalvular leak, or leaflet thrombosis. • Some complications are specific to each valve, including coronary artery occlusion after TAVR or LVOT obstruction after TMVR. • Large bore catheters are required for transcatheter valve replacement and may be associated with additional complications. [ABSTRACT FROM AUTHOR]

To review and summarise the clinical and imaging characteristics of intravenous leiomyomatosis (IVL), a rare smooth muscle tumour originating from the uterus. Twenty-seven patients with a histopathological diagnosis of IVL who underwent surgery were reviewed retrospectively. All patients underwent pelvic ultrasonography, inferior vena cava (IVC) ultrasonography, and echocardiography before surgery. Computed tomography (CT) with contrast enhancement was performed in patients with extrapelvic IVL. Some patients underwent pelvic magnetic resonance imaging (MRI). Mean age was 44.81 years. Clinical symptoms were non-specific. IVL was intrapelvic in seven patients and extrapelvic in 20. Preoperative pelvic ultrasonography missed the diagnosis in 85.7% of patients with intrapelvic IVL. Pelvic MRI was useful to evaluate the parauterine vessels. Incidence of cardiac involvement was 59.26%. Echocardiography showed a highly mobile sessile mass in the right atrium with moderate-to-low echogenicity that originates from the IVC. Ninety per cent of extrapelvic lesions showed unilateral growth. The most common growth pattern was via the right uterine vein–internal iliac vein–IVC pathway. The clinical symptoms of IVL are non-specific. For patients with intrapelvic IVL, early diagnosis is difficult. Pelvic ultrasound should focus on the parauterine vessels, the iliac and ovarian veins should be explored carefully. MRI has obvious advantages in evaluating parauterine vessel involvement, which is helpful for early diagnosis. For patients with extrapelvic IVL, CT should be performed before surgery as part of a comprehensive evaluation. IVC ultrasonography and echocardiography are recommended when IVL is highly suspected. • The preoperative misdiagnosis rate for intrapelvic IVL in our study was 85.7%. • 90% of patients with extrapelvic in our study IVL showed unilateral growth, more commonly on the right. • MRI is recommended to evaluate involvement of the parauterine vessels. • Pelvic ultrasound should focus on the iliac and ovarian veins. • Comprehensive evaluation before surgery is essential when IVL is highly suspected. [ABSTRACT FROM AUTHOR]

To describe the evolution of the intracranial features of congenital cytomegalovirus (cCMV) on magnetic resonance imaging (MRI). Sixteen infants with polymerase chain reaction (PCR)-confirmed cCMV who had undergone at least two MRI examinations of the brain were identified. Two paediatric neuroradiologists reviewed the baseline studies retrospectively for intracranial features of cCMV, including white matter signal abnormalities, subependymal cysts, malformations of cortical development, and intracranial calcification. The subsequent MRI studies were then reviewed and directly compared to the baseline examinations. White matter signal abnormalities were seen on all 16 baseline studies (100%); these persisted on all subsequent examinations but were patchier, more focal, and associated with an interval reduction in white matter volume. Subependymal cysts were present on 11 (69%) of the baseline scans; these almost universally regressed (in 10 of the 11 cases [91%]), with no new cysts appreciable on subsequent imaging. Malformations of cortical development, exclusively in the form of polymicrogyria, were seen in six (38%) patients and persisted, unchanged, on subsequent imaging. Intracranial calcification was seen in a minority of baseline studies (4 [25%]) and remained stable on subsequent scans. Children with cCMV who present later in life without an established or suspected underlying pathology can pose a challenge to the assessing radiologist. The radiological sequelae of cCMV can be non-specific; in some cases, white matter signal abnormalities and focal loss of white matter volume may be the only intracranial features. It is therefore important that radiologists are aware of cCMV as a potential differential for these findings. • White matter signal abnormalities in cCMV become patchier over time. • There is an associated reduction in white matter volume on subsequent scans. • Subependymal cysts tend to regress. • Structural malformations and intracranial calcification persist, unchanged. • White matter signal abnormalities and focal volume loss can be the only features. [ABSTRACT FROM AUTHOR]

This study aimed to screen for the eligibility of correction in cases of adult congenital heart disease (CHD). Pulmonary to systemic flow ratios (Qp/Qs) > 1.5 and pulmonary to systemic vascular resistance ratios (Rp/Rs) < 1/3, acquired by right heart catheterization (RHC), are two essential parameters. Nonetheless, performing RHC at every follow-up is impractical and even harmful. Thus, it is important to establish a model to predict Qp/Qs and Rp/Rs status before a RHC confirmation, using echocardiography parameters. A total of 1,785 patients with adult CHD were enrolled and randomly assigned to the derivation or validation groups. Echocardiogram parameters of the 974 patients in the derivation group were considered candidate predictors for surgery eligibility (Qp/Qs > 1.5 and Rp/Rs < 1/3). Binary logistic regression analyses were performed to identify the independent predictors and establish a scoring system. The scoring system was further examined in the validation group using a receiver operating characteristic (ROC) analysis. Estimated pulmonary artery systolic pressure, velocity through the pulmonary valve, and diameters of the left and right atria were identified as independent predictors. The area under the ROC curve of the predictive value in the validation group and its pre- and post-tricuspid valve malformation subgroups were 0.87 (95% confidence interval [CI]: 0.84−0.90, p < 0.01), 0.86 (95% CI: 0.82−0.91, p < 0.01), and 0.85 (95% CI: 0.79−0.90, p < 0.01), respectively. This scoring system could augment flexibility and convenience for pre-screening CHD patients' eligibility for surgery, before RHC. [Display omitted] [ABSTRACT FROM AUTHOR]

Fetal ultrasound (US) four-chamber (FC) views are essential in diagnosing congenital heart defects (CHD). Gathering a sufficient number of diverse and high-quality fetal US FC views within a short period remains a significant challenge for training novice physicians or assisted-diagnosis intelligent models. As an effective data augmentation technique, medical image editing synthesis enables the synthesis of various structural views within specific regions as desired, thereby greatly facilitating the training of novice physicians and intelligent models. However, due to the high noise and artifacts within the views, the existing approaches do not necessarily synthesize perfect texture aligned with external guidance in editable areas while also struggling to maintain a contextual style consistent with preserved areas. To address this issue, we propose an enhanced style-consistent modulation (ESCM), a two-stage modulation technology that combines external semantic and sketch contours with contextual style to produce enhanced context-aware modulation parameters. We also develop an ESCM-based progressive growing generative adversarial network (ESCMPGGAN), which decomposes the synthetic process into three stages to synthesize faithful textures using a coarse-to-fine approach. Moreover, we propose a sketch mask loss that promotes the ESCMPGGAN's emphasis on the background during training, thereby comprehensively exploiting sketch information to enhance the model's capacity for learning background textures. Our experimental results demonstrate that the proposed method successfully synthesizes high-quality views with a consistent contextual style between the editable and preserved regions and realistic appearance details. In addition, the synthesized views meet the requirements for clinical standards, confirming our approach's effectiveness. [ABSTRACT FROM AUTHOR]

Fetal ultrasound (US) four-chamber (FC) views are essential in diagnosing congenital heart defects (CHD). Gathering a sufficient number of diverse and high-quality fetal US FC views within a short period remains a significant challenge for training novice physicians or assisted-diagnosis intelligent models. As an effective data augmentation technique, medical image editing synthesis enables the synthesis of various structural views within specific regions as desired, thereby greatly facilitating the training of novice physicians and intelligent models. However, due to the high noise and artifacts within the views, the existing approaches do not necessarily synthesize perfect texture aligned with external guidance in editable areas while also struggling to maintain a contextual style consistent with preserved areas. To address this issue, we propose an enhanced style-consistent modulation (ESCM), a two-stage modulation technology that combines external semantic and sketch contours with contextual style to produce enhanced context-aware modulation parameters. We also develop an ESCM-based progressive growing generative adversarial network (ESCMPGGAN), which decomposes the synthetic process into three stages to synthesize faithful textures using a coarse-to-fine approach. Moreover, we propose a sketch mask loss that promotes the ESCMPGGAN's emphasis on the background during training, thereby comprehensively exploiting sketch information to enhance the model's capacity for learning background textures. Our experimental results demonstrate that the proposed method successfully synthesizes high-quality views with a consistent contextual style between the editable and preserved regions and realistic appearance details. In addition, the synthesized views meet the requirements for clinical standards, confirming our approach's effectiveness. [ABSTRACT FROM AUTHOR]

Fetal movement is a crucial indicator of fetal well-being. Characteristics of fetal movement vary across gestation, posing challenges for researchers to determine the most suitable assessment of fetal movement for their study. We summarize the current measurement strategies used to assess fetal movement and conduct a comprehensive review of studies utilizing these methods. We critically evaluate various measurement approaches including subjective maternal perception, ultrasound, Doppler ultrasound, wearable technology, magnetocardiograms, and magnetic resonance imaging, highlighting their strengths and weaknesses. We discuss the challenges of accurately capturing fetal movement, which is influenced by factors such as differences in recording times, gestational ages, sample sizes, environmental conditions, subjective perceptions, and characterization across studies. We also highlight the clinical implications of heterogeneity in fetal movement assessment for monitoring fetal behavior, predicting adverse outcomes, and improving maternal attachment to the fetus. Lastly, we propose potential areas of future research to overcome the current gaps and challenges in measuring and characterizing abnormal fetal movement. Our review contributes to the growing body of literature on fetal movement assessment and provides insights into the methodological considerations and potential applications for research. • Fetal movement is a hallmark of fetal neurobehavior and well-being. • Accurate measurement of fetal movement is needed by clinicians and researchers. • Current approaches to measuring fetal movement are critically considered. • Future directions in advancing the measurement of fetal movement are described. [ABSTRACT FROM AUTHOR]

Behcet's disease usually progresses with remission during pregnancy, but early subtle changes might be detected in the heart of these fetuses due to inflammation. We aimed to evaluate the cardiac functions in fetuses of pregnant women with Behcet's disease (BD). Prospective case-control study. This prospective study enrolled pregnant women diagnosed with Behcet's disease before pregnancy. Twenty-four pregnancies with Behcet's disease and 48 healthy pregnancies were included at 32–34 gestational weeks. Pulsed-wave Doppler and tissue Doppler imaging (TDI) were used to assess cardiac functions. Right ventricle (RV) E (early) wave and left ventricle (LV) E were significantly increased in pregnancies with BD (p =.008, p =.041, respectively). Decreased right ventricle E' (peak systolic velocity) was detected with TDI in the case group (6.2 ± 0.5, p <.001). E/E' ratios for RV and LV were significantly increased in the case group (p <.001, p =.001, respectively). The correlation between the duration of the disease and fetal cardiac functions was also evaluated. For RV, E (r = 0.735, p <.001), E' (r = −0.735, p <.001), E/E' (r = 0.894, p <.001), were strongly correlated with the disease duration. The study also showed the correlation between disease duration and LV E' (r = −0.735, p =.005), LV E (r = 0.750, p <.001), and LV E/E' (r = 0.820, p <.001). This is the first study to evaluate the fetal cardiac functions in fetuses of pregnancies with BD. Although BD usually progresses with remission during pregnancy, early subclinical diastolic changes might occur in the heart of these fetuses due to inflammation. • Little is known about how inflammatory diseases such as Behcet's Disease affect the fetal heart. • Fetal echocardiography has been widely used to assess changes in cardiac function in fetuses of high-risk pregnancies. • Fetuses of pregnant women with Behcet's disease may have subtle cardiac changes. [ABSTRACT FROM AUTHOR]

Fetal cardiac ultrasound is a valuable tool for screening fetal cardiac health during pregnancy. Ultrasound standard section testing is an essential part of fetal heart ultrasound diagnosis. Due to the many scattered and partially similar anatomical structures in standard ultrasound views of the fetal heart, the results strongly depend on the clinical experience and knowledge of the sonographer. To improve detection efficiency and reduce misdiagnosis and omission, we propose a single-stage fetal cardiac ultrasound standard plane detection model (FCUM) based on multitask learning and a hybrid attention mechanism to assist sonographers in diagnosis. The feature fusion pyramids of the backbone and detection networks of this model are each embedded with a hybrid attention mechanism module of our design, which enables the multitasking network to extract shared features more accurately and efficiently and improves the accuracy of the detection and classification networks. We designed a classification module for multilayer residual network feature fusion that leads to better classification and faster convergence time. We conducted comprehensive experiments on a dataset of fetal cardiac ultrasound images acquired with several types of devices and in different geographic regions. The experimental results show that our model outperforms baseline models such as YOLOv8 and ResNet-50 in terms of detection precision and classification accuracy. [ABSTRACT FROM AUTHOR]

What is the proportion of infants born as a result of assisted reproductive technology ART across different types of neonatal critical congenital heart disease (CCHD) in a Japanese population? A retrospective analysis of 418 consecutive infants with CCHD that required catheter treatment or surgery within the first 28 days of life or ductal-dependent lesions, in two paediatric centres in Japan, between January 2014 and December 2019. The proportion of ART in infants with each type of CCHD was evaluated. The proportion of ART in infants with univentricular heart defect (UVH) compared with those with biventricular heart defect (BVH) was evaluated. The study group included 229 boys and 189 girls, with a gestational age of 38 ± 2 weeks. Overall, 61 infants (14.6%) were conceived by fertility treatment with 46 (11.0%) conceived by ART. Univentricular heart defect and BVH were identified in 111 infants (26.6%) and 307 infants (73.4%), respectively. The proportion of infants conceived by ART was significantly higher in UVH (16.2%) than in BVH (9.1%) (OR 2.28, 95% CI 1.11 to 4.68, P = 0.025), regardless of maternal age and maternal history of miscarriage. The proportion of ART in infants with CCHD, especially UVH, was high. These findings could form the basis of a rationale for carrying out fetal echocardiography in fetuses conceived by ART. [ABSTRACT FROM AUTHOR]

Real-time spiral phase contrast MR (PCMR) enables rapid free-breathing assessment of flow. Target spatial and temporal resolutions require high acceleration rates often leading to long reconstruction times. Here we propose a deep artifact suppression framework for fast and accurate flow quantification. U-Nets were trained for deep artifact suppression using 520 breath-hold gated spiral PCMR aortic datasets collected in congenital heart disease patients. Two spiral trajectories (uniform and perturbed) and two losses (Mean Absolute Error -MAE- and average structural similarity index measurement -SSIM-) were compared in synthetic data in terms of MAE, peak SNR (PSNR) and SSIM. Perturbed spiral PCMR was prospectively acquired in 20 patients. Stroke Volume (SV), peak mean velocity and edge sharpness measurements were compared to Compressed Sensing (CS) and Cartesian reference. In synthetic data, perturbed spiral consistently outperformed uniform spiral for the different image metrics. U-Net MAE showed better MAE and PSNR while U-Net SSIM showed higher SSIM based metrics. In-vivo, there were no significant differences in SV between any of the real-time reconstructions and the reference standard Cartesian data. However, U-Net SSIM had better image sharpness and lower biases for peak velocity when compared to U-Net MAE. Reconstruction of 96 frames took ~59 s for CS and 3.9 s for U-Nets. Deep artifact suppression of complex valued images using an SSIM based loss was successfully demonstrated in a cohort of congenital heart disease patients for fast and accurate flow quantification. [ABSTRACT FROM AUTHOR]

Competitive athletes of all skill levels are at risk of sudden cardiac death (SCD) due to certain heart conditions. Prior to engagement in high-intensity athletics, it is necessary to screen for these conditions in order to prevent sudden cardiac death. Cardiac-CT angiography (CCTA) is a reliable tool to rule out the leading causes of SCD by providing an exceptional overview of vascular and cardiac morphology. This allows CCTA to be a powerful resource in identifying cardiac anomalies in selected patients (i.e. unclear symptoms or findings at ECG or echocardiography) as well as to exclude significant coronary artery disease (CAD). With the advancement of technology over the last few years, the latest generations of computed tomography (CT) scanners provide better image quality at lower radiation exposures. With the amount of radiation exposure per scan now reaching the sub-millisievert range, the number of CT examinations it is supposed to increase greatly, also in the athlete's population. It is thus necessary for radiologists to have a clear understanding of how to make and interpret a CCTA examination so that these studies may be performed in a responsible and radiation conscious manner especially when used in the younger populations. Our work aims to illustrate the main radiological findings of CCTAs and highlight their clinical impact with some case studies. We also briefly describe critical features of state-of-the-art CT scanners that optimize different acquisitions to obtain the best quality at the lowest possible dose. • Describe main causes of Sudden Cardiac Death in athletes worldwide • Illustrate radiological findings on cardiac CT examinations, underlying their clinical impact • Explain key features of state-of-the-art CT scanners in order to optimize acquisitions with lowest dose • Exhaustive visualization and description of cases [ABSTRACT FROM AUTHOR]

• Vector self-attention layer achieves spatial and channels reasoning synchronously. • Context aggregation loss considers global structure and contextual prior. • Contextual prior focuses on context dependencies of intra-classes and inter-classes. • The model achieves the best performance on two ultrasound segmentation datasets. Automatic ultrasound image segmentation is crucial for clinical diagnosis and treatment. However, ultrasound image segmentation is challenging because of the ambiguous structure, incomplete boundary and analogous appearance among different categories. To address above challenges, we propose a flexibly plug-and-play module called vector self-attention layer (VSAL) to conduct long-range spatial and channels reasoning simultaneously. Moreover, it also preserves translational equivariance and considers multi-scale information, by using geometric priors and multi-scale calibration. Besides, a novel context aggregation loss (CAL) is designed to consider the contextual dependences between inter-classes and intra-classes based on context prior. The proposed methods, VSAL and CAL, are flexible enough to be integrated in any CNN-based methods. We validate the effectiveness of the modules on two different ultrasound datasets, multi-target Fetal Apical Four-chamber dataset and one-target Fetal Head dataset. Experiment results reveal significant performance gain when using the proposed modules. [ABSTRACT FROM AUTHOR]

Objective: To evaluate ventricular contractility and profile heart deformations in fetuses of hyperglycemic mothers using the Speckle tracking imaging (STI). The fractional area change (FAC), global longitudinal strain (GLS) and global sphericity index (GSI) of the 4-chamber view (4-CV) were computed.Study Design: Dynamic 4-CV images of 60 fetuses exposed to maternal diabetes (MD) and 60 controls were retrospectively collected between 19 and 37 weeks of gestation. Speckle-tracking analysis was used to compute and compare GSI, GLS and FAC of the right ventricle (RV) and the left ventricle (LV) between the groups. By definition, GSI was the ratio of the epicardial basal-apical length in end-diastole (BAL) to the overall transverse length of RV and LV in end-diastole (TL). The FAC was calculated by dividing the difference between end-diastolic area and end-systolic area by the end-diastolic area. Similarly, the GLS of the RV and LV was obtained by dividing the difference between the endocardial length in end-systole and endocardial length in end-diastole to the endocardial length in end-diastole. Data for conventional echocardiographic parameters, standard biological measurements of fetus and maternal baseline characteristics were also recorded and compared between the groups. Linear regression analysis was performed to assess the association between age, BMI and the inter-ventricular septum thickness (IVST).Results: Gestational age at the time of examination did not differ significantly between the control and gestational diabetes group (p = 0.74). In fetuses exposed to MD, the thickness of the IVS was higher while the FAC of RV, GLS of RV and the GSI were all significantly lower. The FAC and global strain of LV generally decreased with progress in gestation but the difference between the two groups was not statistically significant. Conventional echocardiography in fetuses exposed to MD revealed a lower mitral E/A ratio and a larger myocardial performance index (MPI) of the RV and LV. Although the annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE) and septal annular plane systolic excursion (SAPSE) were also lower in this group, the difference was not statistically significant compared to fetuses of the control group. No regression relationship between age, BMI and IVST were noticed in any group.Conclusion: This study found that diastolic dysfunction among fetuses of gestational diabetic mothers is accompanied by global cardiac deformation and functional decrease of the RV in systole in the second and third trimester. The GSI, global strain and FAC acquired by SRI can be used as convenient and reliable quantitative parameters in the assessment of cardiac function in fetuses exposed to gestational diabetes. [ABSTRACT FROM AUTHOR]

Objective: To study the incidence and clinical significance of congenital heart defects (CHDs) detected by fetal echocardiography in pregnancies conceived by in vitro fertilization (IVF).Design: Cohort study comparing a prospectively maintained database of all fetal echocardiograms from 2012 to 2018 and pooled data from the Connecticut Birth Defects Registry and statewide hospital discharge data.Setting: Large tertiary care center.Patient(s): A total of 181,749 live births and 9,252 fetal echocardiograms were analyzed. Fetal echocardiograms in patients with a previous child with a CHD, a family history of CHD, medication exposure, diabetes, anomaly in previous pregnancy, cardiac or other abnormality noted on previous ultrasound, or monochorionic twins were excluded from the final analysis.Intervention(s): Treatment with IVF.Main Outcome Measure(s): Incidence of CHD and odds ratios with 95% confidence intervals (CIs). Infant outcomes for cases of CHD were evaluated for clinically significant disease, defined a priori as disease requiring any medical or surgical intervention or continued follow-up with pediatric cardiology.Result(s): Fetal echocardiography was performed in 2,230 IVF pregnancies, of which 2,040 were without other known risk factors for CHD. The mean gestational age at the time of fetal echocardiography was 22.2 ± 1.4 weeks. The odds ratio for CHD in the IVF group compared with statewide population rates was 1.4 (95% CI 0.9-2.1). CHD was diagnosed in 26 fetuses, of which 21 were clinically insignificant ventricular septal defects. One fetal echocardiogram was concerning for pulmonary stenosis that was not present at birth. Four defects were clinically significant, indicating that 510 fetal echocardiograms were performed for every diagnosis of one clinically significant CHD in the IVF group.Conclusion(s): The incidence of CHD in IVF pregnancies without other risk factors is not significantly different from baseline population rates, and most CHDs diagnosed by fetal echocardiography in this group are clinically insignificant. Routine screening with fetal echocardiography in all IVF pregnancies provides limited utility beyond routine prenatal care and need not be recommended without the presence of other risk factors. [ABSTRACT FROM AUTHOR]

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]

Objective: To assess the impact of withholding doxycycline on the success rate of natural cycle frozen embryo transfers (NC-FET).Design: Retrospective cohort study.Setting: Single academic institution.Patient(s): Women undergoing 250 NC-FET with euploid blastocysts performed by a single provider.Intervention(s): One hundred and twenty-five NC-FET cycles performed after January 2019 without antibiotic administration compared with 125 NC-FET cycles before January 2019 with doxycycline administration.Main Outcome Measure(s): Primary outcome: live birth (LB) or ongoing pregnancy rate (OPR, defined as pregnancies ≥13 weeks); secondary outcomes included positive β-human chorionic gonadotropin (β-hCG) level and clinical pregnancy rate (CPR, defined as the presence of fetal cardiac activity on ultrasound).Result(s): Each group of women comprised 125 NC-FET during the study period of March 2017 to March 2020. The women's mean age was 36.3 years and mean body mass index was 24 kg/m2. Between the two groups, the baseline characteristics were similar, including age, body mass index, race, smoking status, parity, endometrial thickness, Society of Assisted Reproductive Technology diagnosis, and number of prior failed transfers. Comparing NC-FET with doxycycline administration versus without, we found no statistically significant difference in LB-OPR (64% vs. 62.6%), positive β-hCG (72.8% vs. 74.0%), or CPR (68% vs. 65.9%). After controlling for all variables in a logistic regression, doxycycline still had no effect on LB-OPR.Conclusion(s): In this analysis of similar patients undergoing NC-FET by a single provider, withholding doxycycline does not reduce success rates. Given the risks of antibiotics, our findings support withholding their use in NC-FET. [ABSTRACT FROM AUTHOR]

Anti-Ro/SSA antibodies are associated with a risk of 1-2 % to develop complete atrioventricular block (AVB) in fetuses of positive mothers. Complete AVB is irreversible, but studies suggest that anti-inflammatory treatment during the transition period from a normal fetal heart rate (FHR) to an AVB might stop this progression and restore sinus rhythm. The most efficient method for diagnostic evaluation of this arrhythmia is the pulsed-Doppler fetal echocardiography. However, weekly or bi-weekly recommended fetal echocardiographic surveillance can rarely identify an AVB in time for treatment success, also because the transition from a normal rhythm to a third degree AVB is very fast. Daily FHR monitoring in a medical facility could increase the chances of identifying the AVB onset but is difficult to realize. For this reason, an alternative method of FHR monitoring, performed directly by mothers in their home context, has been recently proposed. We present a case report utilizing this approach and review the current evidence about this condition. [ABSTRACT FROM AUTHOR]

Cross-sectional imaging plays an essential role in the diagnosis and management of various structural and functional changes that occur in the postoperative period after palliative or corrective surgical procedures performed for congenital heart diseases (CHD). Although echocardiography is the mainstay for the evaluation of CHD, it is limited by poor acoustic window post-surgery in addition to being operator dependent. Computed tomography (CT) allows for the comprehensive evaluation of the post-surgical anatomy and complications after repair for cyanotic CHD. Radiologists and cardiac imagers should be familiar with these expected changes after surgeries performed for various cyanotic CHDs, to obtain diagnostic quality cardiac CT images and to promptly recognise the abnormal post-operative appearances in this patient population. In this review, we describe the various CT features of complications that can be encountered after repair of cyanotic CHDs. • CT is the mainstay in evaluation of complications associated with post-operative CHD • Knowledge of the expected post-operative anatomy and common complications is crucial for early diagnosis and management. • Careful observation of the heart, vasculature, lungs and mediastinum form the basis of reading a post-operative CHD scan. [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]

The altered maternal inflammatory milieu and changes in maternal vascular structure (arterial stiffness) and function may affect the fetal heart in pregnant women diagnosed with inflammatory bowel disease (IBD). To investigate fetal cardiac functions in IBD pregnancies and to reveal the relationship between IBD duration and fetal cardiac functions. Prospective case-control study. The case group included 19 pregnant women with ulcerative colitis and seven with Crohn's disease who were in remission at the time of the study. The control group consisted of 52 healthy pregnant women matched for gestational age in the third trimester of pregnancy (at 32 to 33 weeks). Fetal cardiac functions. The assessment was blinded as to whether the patients were cases or controls. The right ventricular E', E'/A', S′, and tricuspid annular plane systolic excursion (TAPSE) were significantly lower, and E/E', myocardial performance index (MPI'), and isovolumetric relaxation time (IVRT') were significantly higher in fetuses of IBD pregnancies. Diastolic functions (E/E', E', E'/A', and IVRT'), systolic functions (S′ and TAPSE), and global function (MPI') were changed in the case group. A significantly strong correlation was between maternal disease duration and fetal right ventricle diastolic function parameters (E/E', E, E', E'/A') in the case group (r2 = 0.780; p ≤0.001, r2 = 0.570; p ≤0.001, r2 = 0.604; p ≤0.001, r2 = 0.638; p ≤0.001, respectively). Diastolic and systolic fetal cardiac functions changed in IBD pregnancies. As the disease duration increases, especially fetal cardiac diastolic functions may be affected. [Display omitted] • Diastolic and systolic fetal cardiac functions changed in IBD pregnancies. • As the disease duration increases, especially fetal cardiac diastolic functions may be affected. • This study's results may lead to novel research lines that will explain the underlying mechanisms of cardiac adaptation. [ABSTRACT FROM AUTHOR]

ADNP syndrome, also known as the Helsmoortel-Van der Aa syndrome (HVDAS), is a neurodevelopmental disorder characterized by hypotonia, developmental delay, and intellectual disability. Diagnosis is typically made postnatally, and little is known about prenatal presentation of the disorder. We report a child who presented with intrauterine growth restriction, proportionate microcephaly, and an abnormal skull shape on fetal ultrasound. Whole exome sequencing performed on amniotic fluid cells showed a de novo pathogenic variant in the ADNP gene, corresponding to a diagnosis of ADNP syndrome. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate fetal cardiac function using myocardial deformation analyses, tricuspid annular plane systolic excursion (TAPSE), mitral annular plane systolic excursion (MAPSE) and diastolic function parameters in pregnancies complicated by maternal diabetes mellitus.Methods: Myocardial deformation using velocity vector imaging (VVI), TAPSE, MAPSE and diastolic function was measured in 126 women with uncomplicated singleton pregnancies and 50 women with diabetes mellitus. Women underwent ultrasound scans every four weeks from recruitment (18-28 weeks gestational age) until delivery.Results: Left ventricle strain and strain rate, right ventricle strain and strain rate, TAPSE, MAPSE and diastolic parameters were not different between the diabetic cohort and controls throughout gestation. We did not find any significant correlation between the fetal cardiac function parameters with parity or smoking status. There was however a significant difference in strain and strain rate values in the left ventricle, but not the right ventricle in women with BMI >30 kg/m2, and reduced TAPSE values in this same group. Fetuses in the diabetes group had thicker interventricular septum (IVS) throughout gestation.Conclusion: Myocardial deformation of the fetal left ventricle, as measured by VVI, and TAPSE were reduced in fetuses of mothers in association with maternal obesity but not in women with diabetes mellitus. No significant differences in the fetal cardiac function parameters measured were different between the two groups, except for IVS thickness. [ABSTRACT FROM AUTHOR]

• Established a cross-domain dataset consisting of placenta photos and medical records. • Designed attention and saliency-guided constraints to realize multi-object translation. • Devised an integrated pipeline for cross-domain placenta image segmentation. • Showed potential of our MSL model in detecting significant pathological/abnormal indicators. We propose a multi-region saliency-aware learning (MSL) method for cross-domain placenta image segmentation. Unlike most existing image-level transfer learning methods that fail to preserve the semantics of paired regions, our MSL incorporates the attention mechanism and a saliency constraint into the adversarial translation process, which can realize multi-region mappings in the semantic level. Specifically, the built-in attention module serves to detect the most discriminative semantic regions that the generator should focus on. Then we use the attention consistency as another guidance for retaining semantics after translation. Furthermore, we exploit the specially designed saliency-consistent constraint to enforce the semantic consistency by requiring the saliency regions unchanged. We conduct experiments using two real-world placenta datasets we have collected. We examine the efficacy of this approach in (1) segmentation and (2) prediction of the placental diagnoses of fetal and maternal inflammatory response (FIR, MIR). Experimental results show the superiority of the proposed approach over the state of the art. [ABSTRACT FROM AUTHOR]

Background Fetal growth restriction (FGR), defined as an estimated fetal weight (EFW)<10th percentile, is associated with an increased risk for adverse fetal and neonatal outcome. Early antenatal diagnosis is important and remains challenging. Deformation changes in the fetal myocardium are early signs of myocardial dysfunction. These changes can be measured using two-dimensional speckle tracking echocardiography (2D-STE) to predict impaired placental function in the growth restricted fetus. Aim To review the literature on fetal heart deformation values measured with 2D-STE, in fetuses with an EFW< 10th centile and appropriate for gestational age (AGA) fetuses, and to compare the results in both groups. Methods The EMBASE, Medline, and Cochrane databases were searched from inception until April 2020. Observational studies on evaluating the cardiac deformation values longitudinal strain, strain rate, and/or global dyssynchrony of both ventricles in FGR, using 2D-STE, were included. Methodological quality was assessed using the Newcastle-Ottowa risk of bias scale. Results Four studies met the inclusion criteria. The mean gestational age (GA) varied from 30 to 38 weeks in the FGR group and 20 to 40 weeks in AGA fetuses. The number of included FGR fetuses (with or without Doppler abnormalities), varied from 30 to 50. Longitudinal strain in FGR fetuses was described as comparable (n = 2), increased (n = 1) and>95th percentile (n = 1) compared to AGA fetuses. Strain rate was measured in two studies. One reported an increased strain rate, another showed comparable strain rate. Two studies addressed global left ventricle (LV) and right ventricle (RV) dyssynchrony. Dyssynchrony was increased in FGR compared to AGA fetuses. Conclusion The currently published data is limited and heterogeneous concerning GA and Doppler profiles. The data presentation and the interpretation thereof make qualitative comparisons impossible. Large prospective longitudinal cohort studies looking at the value of deformation measurements of the fetal heart in FGR and AGA fetuses are needed to assess the clinical significance of deformation values measured with 2D-STE. [ABSTRACT FROM AUTHOR]

Establishment of the maturational patterns of the fetal left and right ventricle strain and strain rate by two-dimensional speckle tracking echocardiography is a prerequisite for its routine clinical adaptation in pregnancy. The aim of this study is to review systematically current literature on the development of left and right ventricle strain and strain rate derived by speckle tracking during gestation. EMBASE, Medline and Central were searched, from inception to October 2019, for observational studies of singletons in uncomplicated, non-anomalous pregnancies, measuring global longitudinal strain and strain rate with 2D speckle tracking echocardiography in the fetal heart during gestation. 23 Studies met the inclusion criteria. The gestational age of the included fetuses varied from 12 to 42 weeks. Four studies used a longitudinal study design, with few consecutive measurements at varying gestational ages. 19 Studies performed either cross sectional or both longitudinal and cross sectional measurements. The ultrasound devices and speckle tracking algorithm software used, varied. Strain and strain rate during gestation increased, decreased or remained stable in the left and right fetal ventricle with increasing gestation. Due to considerable variation in the included gestational ages measured and inconsistency in the direction of strain and strain rate development, a meta-analysis could not be performed. Contradictory results concerning the development of strain and strain rate during gestation were shown, probably due to suboptimal study designs and varying algorithms and ultrasound devices used. A large longitudinal cohort study is needed to obtain reference values for fetal cardiac deformation in the uncomplicated, singleton pregnancy. [ABSTRACT FROM AUTHOR]

Objective: Maternal heart disease (HD) complicates 1-4 % of pregnancies and is associated with adverse maternal and fetal outcomes. Although vaginal birth is generally recommended in the guidelines, cesarean section (CS) rates in women with HD are often high. Aim of the present study was to evaluate mode of birth and pregnancy outcomes in women with HD in a tertiary care hospital in the Netherlands.Study Design: The study population consisted of 128 consecutive pregnancies in 99 women with HD, managed by a pregnancy heart team between 2012-2017 and ending in births after 24 weeks' gestation. Pregnancy risk was assessed per modified World Health Organization class. Mode of birth (planned and performed) and maternal and fetal complications (cardiovascular events, postpartum hemorrhage, prematurity, small for gestational age and death) were assessed for each pregnancy.Results: Pregnancy risk was classified as modified World Health Organization class I in 23 %, class II in 50 %, class III in 21 % and class IV in 6% of pregnancies. Planned mode of birth was vaginal in 114 pregnancies (89 %) and CS in 14 (11 %; nine for obstetric and five for cardiac indication). An unplanned CS was performed in 18 pregnancies (16 %; 16 for obstetric and two for cardiac indications). Overall mode of birth was vaginal in 75 % and CS in 25 %. Twelve cardiovascular events occurred in eight pregnancies (6 %), postpartum hemorrhage in nine (7 %) and small for gestational age in 14 (11 %). No maternal or fetal deaths occurred.Conclusions: Findings of this study indicate that - given that pregnancies are managed and mode of birth is meticulously planned by a multidisciplinary pregnancy heart team - vaginal birth is a suitable option for women with HD. [ABSTRACT FROM AUTHOR]

• Syntactic pattern recognition in fetal ultrasound examination. • New method supporting a doctor in fetal palate diagnostic. • Pattern processing with multiple binarization and segmentation techniques. Analyzing ultrasound images of relatively small fetal structures is a difficult task. This difficulty particularly applies to diagnosing congenital defects of the fetus, including one of the most common defects, which is the cleft palate. To date, no methods have been developed for visualizing the fetal palate. Therefore, there is a need to improve the effectiveness of diagnostics in this area by developing appropriate image analysis and recognition methods using computer-based techniques. At the same time, relatively fast algorithms are being sought that can be a part of the software of an ultrasound device. The contribution of the paper consists in defining a new computer method satisfying all the requirements mentioned above. The method applies syntactic pattern recognition approach to the analysis of the image of the fetus's palate. It is based on extracting of a sequence of images on multiple binarization thresholds (in the preprocessing phase), defining picture primitives on the basis of the histogram analysis, and applying a parser for a GDPLL(k) string grammar (Generalized Dynamically Programmed LL(k) grammar) for classifying abnormalities (in the recognition phase). The implementation of the method is computationally efficient and it can be a helpful tool for supporting doctors in the diagnostic process (as it has been verified in practice). The computer recognition of fetal defects on basis of the analysis of the structure of the fetus's palate is a novel achievement. Such results have never been reported before. [ABSTRACT FROM AUTHOR]

• Methylphenidate exposure in early pregnancy is associated with a small but significant increased risk for major malformations. • These can be attributed mostly to increased risk of cardiac malformations. • It may be advisable to consider fetal echocardiography in pregnant women using methylphenidate during pregnancy. While for decades attention deficit hyperactivity disorder (ADHD) was regarded as mostly a pediatric condition, it is apparent that many adults continue to be afflicted by this condition, and presently an estimated 30 %–40 % of patients continue with ADHD symptomatology into adulthood. With more adults using stimulants for ADHD, there is evidence of increased numbers using ADHD medications in pregnancy. Till recently the reports on ADHD medication safety have been sparse with insufficient power to address fetal safety. Methylphenidate has been a first line treatment for ADHD, with relatively large numbers of usage. We conducted a scoping review and meta-analysis of observational cohort studies that compared malformation rates among offspring exposed to methylphenidate during early pregnancy, to the rates in the general population. Meta- analysis of 4 cohort studies with almost 3000 women exposed to methylphenidate only, and almost 3 million unexposed controls, yielded an OR of 1.26(95 % confidence interval 1.05–1.51) for major malformations, and 1.59 (95 % confidence interval 1.02–2.49) for cardiac malformations. In conclusion, methylphenidate exposure in early pregnancy is associated with a small but significant increased risk for major malformations, which can be attributed mostly to increased risk of cardiac malformations. It may be advisable to consider fetal echocardiography in pregnant women using methylphenidate during pregnancy. [ABSTRACT FROM AUTHOR]

Pregnancy diagnosis is an essential part of successful breeding programs on dairy farms. Milk composition alters with pregnancy, and this is well documented. Fourier-transform mid-infrared (MIR) spectroscopy is a rapid and cost-effective method for providing milk spectra that reflect the detailed composition of milk samples. Therefore, the aim of this study was to assess the ability of MIR spectroscopy to predict the pregnancy status of dairy cows. The MIR spectra and insemination records were available from 8,064 Holstein cows of 19 commercial dairy farms in Australia. Three strategies were studied to classify cows as open or pregnant using partial least squares discriminant analysis models with random cow-independent 10-fold cross-validation and external validation on a cow-independent test set. The first strategy considered 6,754 MIR spectra after insemination used as independent variables in the model. The results showed little ability to detect the pregnancy status as the area under the receiver operating characteristic curve was 0.63 and 0.65 for cross-validation and testing, respectively. The second strategy, involving 1,664 records, aimed to reduce noise in the MIR spectra used as predictors by subtracting a spectrum before insemination (i.e., open spectrum) from the spectrum after insemination. The accuracy was comparable with the first approach, showing no superiority of the method. Given the limited results for these models when using combined data from all stages after insemination, the third strategy explored separate models at 7 stages after insemination comprising 348 to 1,566 records each (i.e., progressively greater gestation) with single MIR spectra after insemination as predictors. The models developed using data recorded after 150 d of pregnancy showed promising prediction accuracy with the average value of area under the receiver operating characteristic curve of 0.78 and 0.76 obtained through cross-validation and testing, respectively. If this can be confirmed on a larger data set and extended to somewhat earlier stages after insemination, the model could be used as a complementary tool to detect fetal abortion. [ABSTRACT FROM AUTHOR]

Background: Pregnancy can lead to complications in women with heart disease, and these complications can be life threatening. Understanding serious complications and how they can be prevented is important.Objectives: The primary objectives were to determine the incidence of serious cardiac events (SCEs) in pregnant women with heart disease, whether they were preventable, and their impact on fetal and neonatal outcomes. Serious obstetric events were also examined.Methods: A prospectively assembled cohort of 1,315 pregnancies in women with heart disease was studied. SCEs included cardiac death or arrest, ventricular arrhythmias, congestive heart failure or arrhythmias requiring admission to an intensive care unit, myocardial infarction, stroke, aortic dissection, valve thrombosis, endocarditis, and urgent cardiac intervention. The Harvard Medical Study criteria were used to adjudicate preventability.Results: Overall, 3.6% of pregnancies (47 of 1,315) were complicated by SCEs. The most frequent SCEs were cardiac death or arrest, heart failure, arrhythmias, and urgent interventions. Most SCEs (66%) occurred in the antepartum period. Almost one-half of SCEs (49%) were preventable; the majority of preventable SCEs (74%) were secondary to provider management factors. Adverse fetal and neonatal events were more common in pregnancies with SCEs compared with those without cardiac events (62% vs. 29%; p < 0.001). Serious obstetric events were less common (1.7%) and were primarily due to pre-eclampsia with severe features.Conclusions: Pregnant women with heart disease are at risk for serious cardiac complications, and approximately one-half of all SCEs are preventable. Strategies to prevent serious cardiac complications in this high-risk cohort of women need to be developed. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the association of nuchal septations with chromosomal anomalies during the first trimester of pregnancy. A total of 281 patients who were diagnosed to have elevated nuchal translucency (NT > 3 mm) or nuchal septations during the first trimester from Jan. 2014 to Dec. 2016 were included. These patients were divided into three groups: 1) patients with NT thickness between 3 and 5 mm and without nuchal septations (NT 3–5 mm group, n = 124), 2) patients with NT thickness > 5 mm and without nuchal septations (NT > 5 mm group, n = 96), and 3) patients with nuchal septations (NS group, n = 61). The rate of chromosomal abnormalities was significantly higher for patients in NS group compared to those in the NT 3–5 mm group (P <.01) and NT > 5 mm group (P <.01). After controlling for maternal age, maternal BMI, ethnicity and crown-rump length, nuchal septations were reported to be significantly associated with a higher risk of chromosomal anomalies compared with NT 3–5 mm (OR = 4.97; 95% CI: 2.76–10.77; P <.01) and NT > 5 mm (OR = 3.82; 95% CI: 1.87–7.21; P <.01) (P <.01). Measurement of nuchal septations during the first trimester of pregnancy proves to be a useful ultrasound prognostic indicator of chromosomal anomalies. • Fetal nuchal translucency thickness is a traditional sensitivity screening method. • Fetal cases with nuchal septations faced more perinatal handicaps. • Nuchal septations provide more diagnostic significance on chromosomal abnormalities. [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]

The present case illustrates cardiac magnetic resonance imaging (MRI) and three-dimensional (3D) printed anatomic model findings of a coronary-cameral fistula (CCF) and double-chambered right ventricle (DCRV). A pregnant woman presented with palpitations and near syncope. A non-contrast cardiac MRI showed CCF connecting to a DCRV. Post-delivery, the patient had a contrast-enhanced MRI and 3D printed anatomic model to better evaluate her aberrant anatomy. • Pregnant patient presented with coronary-cameral fistula (CCF) and double-chambered right ventricle (DCRV) cardiac anomalies. • Patient's anatomy could be explained by alterations in cardiac chamber, coronary artery and cardiac vessel development. • Patient's anatomy could be seen by multiple modalities: echocardiogram, MRI, and cardiac catheterization. • Cardiac MRI and a 3D printed anatomic model were used to better describe =the patient's CCF and DCRV. [ABSTRACT FROM AUTHOR]

Advances in fetal echocardiography training among pediatric cardiologists have led to substantial improvements in prenatal detection of congenital heart diseases (CHDs). Nevertheless, diagnostic accuracy varies among centers. Moreover, this subspecialty continues to evolve in developing countries, with limited studies assessing fetal echocardiography sensitivity, specificity, and accuracy in developing countries such as Egypt. High-risk pregnancies referred for fetal echocardiography from January 2011 to January 2019 were analyzed retrospectively. All of the cases included had one of the high-risk indications for fetal echocardiography. Maternal age and gestational age at the prenatal diagnosis were determined, and detailed fetal and neonatal echocardiograms were documented. The results of fetal and postnatal echocardiography were compared to assess the sensitivity, specificity, and accuracy of fetal echocardiography. A minor lesion was defined when no postnatal intervention was needed and a major anomaly when postnatal cardiac therapy, surgery, or intervention was required. Out of 615 pregnant patients referred, comparisons between fetal and neonatal echocardiography were possible in 458 fetuses, with 157 patients excluded from the study. The mean maternal age in the study was 26.97 ± 5.871 years and the mean gestational age at referral was 27.24 ± 5.407 weeks. The most common indication for prenatal echocardiography in this cohort was a family history of CHD (142; 31%) followed by nonimmune hydrops (97; 21.18%) and abnormal obstetrical ultrasound screening (64; 13.97%). We had three false-positive minor diagnoses and four false-negative cases with only one requiring intervention. Prenatal diagnosis in this study was accurate in 98.47% of cases. The sensitivity, specificity, and accuracy of fetal echocardiography in the current work were 97.03%, 99.07%, and 98.47, respectively. Fetal echocardiography is considered a highly sensitive specific tool for prenatal detection of congenital heart diseases in high-risk pregnancies even in developing countries. However, minor fetal cardiac disorders are challenging to diagnose and family counseling should emphasize the difficulty of excluding or confirming such lesions. [ABSTRACT FROM AUTHOR]

Major congenital heart diseases (CHD) often demand intervention in the neonatal period. Prenatal diagnosis may improve mortality by eliminating the diagnostic delay; however, there is controversy concerning its true effect. We aimed to evaluate the effect of general prenatal screening on prognosis by comparing a period without general prenatal screening to a period with general prenatal screening. We conducted a nationwide retrospective study including live born children and terminated fetuses diagnosed with major CHD. Prenatal screening was recommended only in high risk pregnancies between 1996 and 2004, whereas general prenatal screening was recommended between 2005 and 2013. We assessed the influence of general prenatal screening on all-cause mortality, cardiac death, preoperative and postoperative 30-day mortality and complication rate. 1-year mortality decreased over both periods, but the decrease was greater in the screening period (Odds ratio 0.92 (CI 0.83–1.00), p = 0.047). Prenatal detection of major CHD was associated with cardiac death in the period without general screening (Hazard Ratio 2.40 (CI 1.72–3.33), p < 0.001), whereas there was no significant association once general screening was implemented. Similarly, the association between prenatal diagnosis and pre- and postoperative mortality found in the period without general screening was insignificant after the implementation of general screening. Mortality in major CHD decreased throughout the study, especially in the period with general prenatal screening. However, comparing a prenatally diagnosed group with a postnatally diagnosed group is vulnerable to selection bias and proper interpretation is difficult. • Survival of major congenital heart disease is improving • The occurrence of complications is increasing, presumably due to improved survival • Prenatal diagnosis of major congenital heart disease is no longer associated with increased cardiac death. • Great care must be taken when comparing prenatally diagnosed congenital heart disease with postnatally diagnosed congenital heart disease [ABSTRACT FROM AUTHOR]

Background: Standardized treatment of fetal tachyarrhythmia has not been established.Objectives: This study sought to evaluate the safety and efficacy of protocol-defined transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL).Methods: In this multicenter, single-arm trial, protocol-defined transplacental treatment using digoxin, sotalol, and flecainide was performed for singleton pregnancies from 22 to <37 weeks of gestation with sustained fetal SVT or AFL ≥180 beats/min. The primary endpoint was resolution of fetal tachyarrhythmia. Secondary endpoints were fetal death, pre-term birth, and neonatal arrhythmia. Adverse events (AEs) were also assessed.Results: A total of 50 patients were enrolled at 15 institutions in Japan from 2010 to 2017; short ventriculoatrial (VA) SVT (n = 17), long VA SVT (n = 4), and AFL (n = 29). One patient with AFL was excluded because of withdrawal of consent. Fetal tachyarrhythmia resolved in 89.8% (44 of 49) of cases overall and in 75.0% (3 of 4) of cases of fetal hydrops. Pre-term births occurred in 20.4% (10 of 49) of patients. Maternal AEs were observed in 78.0% (39 of 50) of patients. Serious AEs occurred in 1 mother and 4 fetuses, thus resulting in discontinuation of protocol treatment in 4 patients. Two fetal deaths occurred, mainly caused by heart failure. Neonatal tachyarrhythmia was observed in 31.9% (15 of 47) of neonates within 2 weeks after birth.Conclusions: Protocol-defined transplacental treatment for fetal SVT and AFL was effective and tolerable in 90% of patients. However, it should be kept in mind that serious AEs may take place in fetuses and that tachyarrhythmias may recur within the first 2 weeks after birth. [ABSTRACT FROM AUTHOR]

Bio-magnetic field imaging systems are of great significance to biomedical research. This study proposes a compact and high-resolution four-channel optically pumped magnetometer for bio-magnetic field measurement. The pump light is transmitted through a single polarization-maintaining optical fiber and split by a cascade of specifically designed prisms. It has been theoretically demonstrated that the optics design used in this study exploits the backscattered light of the opposite glass cell to improve the uniformity of atomic polarization while achieving high consistency in pursuit of better low-frequency optical noise suppression under a first-order gradiometer configuration. The experimental results show that the non-linear error is less than 1%, and the maximum absolute error is less than 2 pT. Oriented to practical applications, a clearly distinguishable adult magnetocardiography (MCG) is obtained using the device, and a fetal MCG (fMCG) measurement is simulated with effective suppression of maternal cardiac signals. Without involving expensive and bulky fiber splitters, a miniaturized sensor composed only of prisms and a polarization-maintaining fiber is proposed. This module has great potential for future high-resolution bio-magnetic imaging systems. • A portable four-channel optically pumped magnetometer sharing a single fiber is proposed for high spatial resolution bio-magnetic field imaging system. • Compact and easily extended optical system is designed to replace the fiber splitter and improve the consistency between channels. • The backscattered light is analyzed and utilized to improve the uniformity of the atomic polarization. • Common-mode noise is proved to be effectively suppressed in gradient configuration. [ABSTRACT FROM AUTHOR]

• Radiologists are central to early detection of live pregnancies. • Maternal and fetal health outcomes are suffering in states with abortion bans. • Radiologists in states with abortion bans will need to anticipate confusion around first trimester ultrasound and fetal heartbeats. [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]

Background: Fetal atrioventricular block (AVB) occurs in 2% to 4% of anti-Ro antibody-positive pregnancies and can develop in <24 h. Only rarely has standard fetal heart rate surveillance detected AVB in time for effective treatment.Objectives: Outcome of anti-Ro pregnancies was surveilled with twice-daily home fetal heart rate and rhythm monitoring (FHRM) and surveillance echocardiography.Methods: Anti-Ro pregnant women were recruited from 16 international centers in a prospective observational study. Between 18 and 26 weeks' gestation, mothers checked FHRM twice daily with a commercially available Doppler monitor and underwent weekly or biweekly surveillance fetal echocardiograms. If FHRM was abnormal, a diagnostic echocardiogram was performed. Cardiac cycle length and atrioventricular interval were measured, and cardiac function was assessed on all echocardiograms. After 26 weeks, home FHRM and echocardiograms were discontinued, and mothers were monitored during routine obstetrical visits. Postnatal electrocardiograms were performed.Results: Most mothers (273 of 315, 87%) completed the monitoring protocol, generating 1,752 fetal echocardiograms. Abnormal FHRM was detected in 21 mothers (6.7%) who sought medical attention >12 h (n = 7), 3 to 12 h (n = 9), or <3 h (n = 5) after abnormal FHRM. Eighteen fetuses had benign rhythms, and 3 had second- or third-degree AVB. Treatment of second-degree AVB <12 h after abnormal FHRM restored sinus rhythm. Four fetuses had first-degree AVB diagnosed by echocardiography; none progressed to second-degree AVB. No AVB was missed by home FHRM or developed after FHRM.Conclusions: Home FHRM confirms the rapid progression of normal rhythm to AVB and can define a window of time for successful therapy. (Prospective Maternal Surveillance of SSA [Sjögren Syndrome A] Positive Pregnancies Using a Hand-held Fetal Heart Rate Monitor; NCT02920346). [ABSTRACT FROM AUTHOR]

Congenital heart defect (CHD) is one of the most common birth defects and is the leading cause of neonatal death. Currently, there are no biomarkers available for prenatal diagnosis of CHD. Clinical strategies to diagnose CHD mostly depend on fetal echocardiography. Recent advances in “omics” techniques have opened up new possibilities for biomarker discoveries. In this review, we discuss recent advances in prenatal detection of CHD using biomarkers obtained by “omics” approaches, including genomics, proteomics, metabolomics, and others. There is great potential in obtaining various kinds of parameters using “omics” studies to facilitate early and accurate diagnosis of CHD. [ABSTRACT FROM AUTHOR]

There is a growing body of knowledge regarding the integration of multiple imaging modalities into the care of fetuses with aortic arch anomalies. This study aims to present our experience and fetal cardiac output data from a cohort of patients with discrete aortic coarctation and aortic arch hypoplasia. Methods/Results Retrospective review identified 25 fetuses with discrete aortic coarctation ( n = 8) or aortic arch hypoplasia ( n = 17) (with mean gestational age at diagnosis, 27.2 weeks; at birth 37.6 weeks). Mean combined ventricular output in all fetuses with normal ventriculo-arterial concordance was 383 ml/min/kg (median 362) with mean R:L cardiac output ratio of 2.83 (median 2.13). Of 23 neonates with primary surgical arch repair, all 7 with discrete coarctation underwent lateral thoracotomy without re-intervention. Of 16 with arch hypoplasia, 10 underwent primary lateral thoracotomy (3 with re-intervention) and 6 underwent primary sternotomy (1 with re-intervention). Of 2 with mild coarctation without primary repair, one with coexistent severe LV dysfunction underwent stenting and dilatation; the other is followed in the context of transposition of the great arteries status post arterial switch. Pre-op CT and 3D cardiac printing were obtained in 19 neonates. During follow-up, five (20%) had systemic hypertension. Conclusion Fetal R:L cardiac output ratio may provide complementary hemodynamic information in prenatal diagnosis of aortic arch anomalies. As expected, characterization of arch conformation remains critical for surgical planning. Pre-operative cardiac CT remains a useful adjunct to delineate arch anatomy for surgical planning purposes but may not reduce re-intervention by itself. Benefit of 3D cardiac printing remains difficult to quantify but has become an invaluable tool for family education. Based on our data, neonates with arch hypoplasia may benefit from midline sternotomy for more extensive surgical exposure and potentially reduced re-intervention rate. [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]

This paper present a novel group sparse representation model to segment four cardiac chambers in fetal echocardiograms. By incorporating the group reconstruction error, sparsity and distinctive term in a unified framework, the model is able to exploit the inherent structure of echocardiograms, constructing a discriminative group dictionary. A novel adaptive group dictionary learning approach is developed to obtain a compact dictionary with high atoms’ utilization and low complexity. With the learned dictionary, the reconstruction residue is employed to discriminate the initial location of four chambers. The local appearances are used to regionally refine the final contours. Extensive experiments have been conducted to evaluate the performance of our proposed AGDL and its application in the fetal echocardiogram segmentation. The results demonstrate both representation and discriminative power of our approach and its superior performances to other competing state-of-the-art sparse representation methods and general intensity models. Our approach is capable of learning a more compact and discriminative group dictionary, providing robust and accurate four-chamber segmentation results. [ABSTRACT FROM AUTHOR]

Background and Objective We proposed a noninvasive method for separating the fetal ECG (FECG) from maternal ECG (MECG) by using Type-2 adaptive neuro-fuzzy inference systems. Methods The method can extract FECG components from abdominal signal by using one abdominal channel, including maternal and fetal cardiac signals and other environmental noise signals, and one chest channel. The proposed algorithm detects the nonlinear dynamics of the mother's body. So, the components of the MECG are estimated from the abdominal signal. By subtracting estimated mother cardiac signal from abdominal signal, fetal cardiac signal can be extracted. This algorithm was applied on synthetic ECG signals generated based on the models developed by McSharry et al. and Behar et al. and also on DaISy real database. Results In environments with high uncertainty, our method performs better than the Type-1 fuzzy method. Specifically, in evaluation of the algorithm with the synthetic data based on McSharry model, for input signals with SNR of -5 dB, the SNR of the extracted FECG was improved by 38.38% in comparison with the Type-1 fuzzy method. Also, the results show that increasing the uncertainty or decreasing the input SNR leads to increasing the percentage of the improvement in SNR of the extracted FECG. For instance, when the SNR of the input signal decreases to -30 dB, our proposed algorithm improves the SNR of the extracted FECG by 71.06% with respect to the Type-1 fuzzy method. The same results were obtained on synthetic data based on Behar model. Our results on real database reflect the success of the proposed method to separate the maternal and fetal heart signals even if their waves overlap in time. Moreover, the proposed algorithm was applied to the simulated fetal ECG with ectopic beats and achieved good results in separating FECG from MECG. Conclusions The results show the superiority of the proposed Type-2 neuro-fuzzy inference method over the Type-1 neuro-fuzzy inference and the polynomial networks methods, which is due to its capability to capture the nonlinearities of the model better. [ABSTRACT FROM AUTHOR]

Objective: To determine whether fetuses in severe early onset pre-eclampsia (EO-PET) with or without intrauterine growth restriction has cardiac dysfunction across deteriorating stages of placental vascular resistance and whether this dysfunction influences perinatal outcome.Study Design: This was a prospective cross-sectional study performed in a tertiary care university medical centre. Sixty pregnant patients with severe early-onset pre-eclampsia between 27 and 32 weeks were recruited and matched with 60 patients having normal pregnancies. An analysis of cardiac function using the myocardial performance index (MPI) and early ventricular filling (E) and late active atrial contraction (A) ratios (E/A ratios) in the study group was performed compared to controls and further analysis was performed based on worsening placental vascular resistance and presence of growth restriction.Results: MPI values were increased in the pre-eclamptic group, irrespective if growth restriction co-exists, compared to controls (0.61 vs 0.38, p<0.001). Its median value progressively increased with worsening placental vascular resistance. For adverse perinatal outcome cut-off MPI values have been suggested. The E/A ratios were significantly decreased in the pre-eclamptic group compared to controls (0.66 vs 0.79, p<0.0001). No adverse outcomes were noted in the control group.Conclusion: Fetal cardiac function is significantly impaired in pregnancies complicated by severe early onset pre-eclampsia, irrespective if growth restriction co-exists and worsens with deteriorating grades of placental vascular resistance. The MPI can potentially be integrated into routine fetal surveillance techniques. [ABSTRACT FROM AUTHOR]

Interpretation of ultrasound videos of the fetal heart is crucial for the antenatal diagnosis of congenital heart disease (CHD). We believe that automated image analysis techniques could make an important contribution towards improving CHD detection rates. However, to our knowledge, no previous work has been done in this area. With this goal in mind, this paper presents a framework for tracking the key variables that describe the content of each frame of freehand 2D ultrasound scanning videos of the healthy fetal heart. This represents an important first step towards developing tools that can assist with CHD detection in abnormal cases. We argue that it is natural to approach this as a sequential Bayesian filtering problem, due to the strong prior model we have of the underlying anatomy, and the ambiguity of the appearance of structures in ultrasound images. We train classification and regression forests to predict the visibility, location and orientation of the fetal heart in the image, and the viewing plane label from each frame. We also develop a novel adaptation of regression forests for circular variables to deal with the prediction of cardiac phase. Using a particle-filtering-based method to combine predictions from multiple video frames, we demonstrate how to filter this information to give a temporally consistent output at real-time speeds. We present results on a challenging dataset gathered in a real-world clinical setting and compare to expert annotations, achieving similar levels of accuracy to the levels of inter- and intra-observer variation. [ABSTRACT FROM AUTHOR]