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The effect of thickness and chemical composition on the electrical power and thermal resistance of dilatometric specimens heated by Joule heating are analyzed in different steels, using stepped tests of constant temperature and electrical current. In the stepped constant temperature tests, the electric current necessary to maintain the target temperature in a specific time is measured, while in the electric current tests the electrical current is maintained until the maximum temperature stabilizes. The results show that the electrical power behaves linearly with the thickness associated with the transfer area, while the thermal resistance behaves potentially; both values depend on the chemical composition due to electrical resistivity. The steels with a higher concentration of alloying elements have a better response to Joule heating. However, thickness is the parameter that most influences electrical power due to changes in transfer area and electrical current density, as well as in the mass of the specimen to be heated. Finally, based on the results obtained, predictions are realized for the design of thicker specimens, maintaining the observed behavior; i. e., as the thickness of the specimen increases, the increase in electrical power and thermal resistance is maintained. [ABSTRACT FROM AUTHOR]

This article discusses a study conducted to understand the cardiovascular remodeling and function in fetuses with tetralogy of Fallot (ToF) using echocardiography. The study included 63 ToF fetuses and 66 healthy fetuses as controls. The results showed that ToF fetuses had lower cardiac sphericity index with biventricular hypertrophy, prolonged filling time fractions, and increased cardiac index. Additionally, there were associations between certain echocardiographic parameters and postnatal outcomes. The study concludes that further research is needed to correlate these findings with postnatal echocardiography. [Extracted from the article]

This article, published in the journal Ultrasound in Obstetrics & Gynecology, discusses a study conducted from 2011 to 2023 that aimed to define the cardiovascular remodeling and function in fetuses with tetralogy of Fallot (ToF) using speckle tracking echocardiography (STE). The study included 63 ToF fetuses and 66 low-risk pregnancies as a control group. The results showed that ToF fetuses exhibited signs of cardiac remodeling, with a lower sphericity index and decreased biventricular deformation. Additionally, a higher incidence of placental diseases, such as pre-eclampsia and fetal growth restriction, was observed in pregnancies with ToF fetuses. [Extracted from the article]

This article, published in the journal "Ultrasound in Obstetrics & Gynecology," discusses a study conducted at BCNatal that aimed to describe the cord blood profile of cardiovascular biomarkers in fetuses with tetralogy of Fallot (ToF) and explore its correlation with fetal echocardiography. The study included 22 fetuses with ToF and 36 healthy controls. The results showed that ToF fetuses had significantly higher concentrations of Transforming growth factorβ (TGFβ) in their cord blood compared to normal fetuses, and these levels correlated with the severity of right ventricle outflow obstruction. The findings of this study provide new insights for further research on prognostic and preventive strategies for ToF. [Extracted from the article]

This article discusses the effectiveness of thoracoamniotic shunts in treating large macrocystic congenital cystic adenomatoid malformations (CCAM) in fetuses. The study, conducted at a fetal therapy center between 2013 and 2023, involved 8 fetuses with severe mediastinal shift and hydrops. Shunt insertion successfully reduced the size of CCAM, corrected mediastinal shift, and resolved hydrops in all cases. The study reported a postnatal survival rate of 87.5%, with premature delivery being the main complication. Overall, fetal thoracoamniotic shunting appears to have favorable outcomes for large macrocystic CCAM. [Extracted from the article]

Objective: To evaluate corpus callosum (CC) size by neurosonography (NSG) in fetuses with an isolated major congenital heart defect (CHD) and explore the association of CC size with the expected pattern of in‐utero oxygen supply to the brain. Methods: A total of 56 fetuses with postnatally confirmed isolated major CHD and 56 gestational‐age‐matched controls were included. Fetuses with CHD were stratified into two categories according to the main expected pattern of cerebral arterial oxygen supply: Class A, moderately to severely reduced oxygen supply (left outflow tract obstruction and transposition of the great arteries) and Class B, near normal or mildly impaired oxygenated blood supply to the brain (other CHD). Transvaginal NSG was performed at 32–36 weeks in all fetuses to evaluate CC length, CC total area and areas of CC subdivisions in the midsagittal plane. Results: CHD fetuses had a significantly smaller CC area as compared to controls (7.91 ± 1.30 vs 9.01 ± 1.44 mm2; P < 0.001), which was more pronounced in the most posterior part of the CC. There was a significant linear trend for reduced CC total area across the three clinical groups, with CHD Class‐A cases showing more prominent changes (controls, 9.01 ± 1.44 vs CHD Class B, 8.18 ± 1.21 vs CHD Class A, 7.53 ± 1.33 mm2; P < 0.05). Conclusions: Fetuses with major CHD had a smaller CC compared with controls, and the difference was more marked in the CHD subgroup with expected poorer brain oxygenation. Sonographic CC size could be a clinically feasible marker of abnormal white matter development in CHD. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: In fetuses with isolated left-sided congenital diaphragmatic hernia (LCDH), prenatal detection of severe pulmonary hypoplasia is important, as fetal therapy can improve survival. Cases with mild or moderate lung hypoplasia still carry a considerable risk of mortality and morbidity, but there has been less interest in the accurate prediction of outcome in these cases. In this study of fetuses with mild or moderate isolated LCDH, we aimed to investigate: (1) the association between intrapulmonary artery (IPA) Doppler findings and mortality at discharge; (2) whether adding IPA Doppler findings improves the prediction of mortality based on lung size and liver herniation; and (3) the association between IPA Doppler findings and early neonatal morbidity.Methods: This was a retrospective study of all consecutive fetuses assessed at the BCNatal and UZ Leuven hospitals between 2008 and 2020 with a prenatal diagnosis of isolated, non-severe LCDH, defined as observed-to-expected lung-to-head ratio (o/e-LHR) > 25%, that were managed expectantly during pregnancy followed by standardized neonatal management. An additional inclusion criterion was the availability of IPA Doppler measurements. The primary outcome was the association between IPA Doppler findings and mortality at discharge. Other predictors included o/e-LHR, liver herniation and gestational age at birth. Secondary outcomes were the association between IPA Doppler findings and the presence of pulmonary hypertension (PHT), need for supplemental oxygen at discharge and need for extracorporeal membrane oxygenation. IPA pulsatility index (PI) values were converted into Z-scores. Logistic regression analysis was performed to investigate the associations between predictor variables and outcome, and the best model was chosen based on the Nagelkerke R2 .Results: Observations for 70 non-severe LCDH cases were available. Fifty-four (77%) fetuses survived until discharge. On logistic regression analysis, higher IPA-PI was associated with an increased risk of mortality (odds ratio (OR), 3.96 (95% CI, 1.62-9.70)), independently of o/e-LHR (OR, 0.87 (95% CI, 0.79-0.97)). An IPA-PI Z-score cut-off of 1.8 predicted mortality with a detection rate of 69% and specificity of 93%. Adding IPA-PI to o/e-LHR improved significantly the model's performance (Nagelkerke R2 , 46% for o/e-LHR + IPA-PI vs 28% for o/e-LHR (P < 0.002)), with a detection rate of 81% at a 10% false-positive rate. IPA-PI was associated with PHT (OR, 2.20 (95% CI, 1.01-4.59)) and need for oxygen supplementation at discharge (OR, 1.90 (95% CI, 1.10-3.40)), independently of lung size.Conclusions: In fetuses with mild or moderate LCDH, IPA-PI was associated with mortality and morbidity, independently of lung size. A model combining o/e-LHR with IPA-PI identified up to four in five cases that eventually died, despite being considered to have non-severe pulmonary hypoplasia. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To construct nomograms for fetal cardiac, ventricular and atrial relative size and geometry parameters from 18 to 41 weeks' gestation using a low-risk population of singleton pregnancies.Methods: This was a prospective cohort study of 602 low-risk singleton pregnancies undergoing comprehensive fetal echocardiography, from 18 to 41 weeks of gestation, to assess fetal cardiac, atrial and ventricular relative size and sphericity, ventricular dominance, wall asymmetry and relative wall thickness. Intra- and interobserver measurement reproducibility was evaluated using intraclass correlation coefficients (ICC). In order to construct reference ranges across pregnancy, parametric regressions were tested to model each measurement against gestational age and estimated fetal weight. The measurements evaluated were: cardiothoracic ratio; atrial-to-heart area ratios; ventricular-to-heart area ratios; cardiac, ventricular and atrial sphericity indices; right-to-left basal and midventricular ratios; septal-to-free wall thickness ratios; and relative wall thickness.Results: Fetal cardiac, ventricular and atrial morphometry for assessing relative size and geometry could be successfully performed in > 95% of the population, with moderate-to-excellent interobserver reproducibility (ICC, 0.623-0.907) and good-to-excellent intraobserver reproducibility (ICC, 0.787-0.938). Cardiothoracic ratio and ventricular right-to-left ratio showed a modest increase throughout gestation. Atrial-to-heart and ventricular-to-heart area ratios, atrial sphericity indices and septal-to-free wall thickness ratios were constant with gestational age. Left and right ventricular basal sphericity indices showed a tendency to decrease at the end of gestation, while left and right midventricular sphericity indices tended to decrease in the second trimester. The cardiac sphericity index and left and right relative wall thickness showed a modest decrease with gestational age. Nomograms across gestation were constructed for all echocardiographic parameters described.Conclusions: The assessment of cardiac, ventricular and atrial relative size and geometry is feasible and reproducible in the fetus. We provide standardized reference ranges for these parameters throughout gestation, enabling the accurate assessment of cardiac remodeling patterns during fetal life. © 2020 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: Fetal cardiac function can be evaluated using a variety of parameters. Among these, cardiac cycle time‐related parameters, such as filling time fraction (FTF) and ejection time fraction (ETF), are promising but rarely studied. We aimed to report the feasibility and reproducibility of fetal FTF and ETF measurements using pulsed‐wave Doppler, to provide reference ranges for fetal FTF and ETF, after evaluating their relationship with heart rate (HR), gestational age (GA) and estimated fetal weight (EFW), and to evaluate their potential clinical utility in selected fetal conditions. Methods: This study included a low‐risk prospective cohort of singleton pregnancies and a high‐risk population of fetuses with severe twin–twin transfusion syndrome (TTTS), aortic stenosis (AoS) or aortic coarctation (CoA), from 18 to 41 weeks' gestation. Left ventricular (LV) and right ventricular inflow and outflow pulsed‐wave Doppler signals were analyzed, using valve clicks as landmarks. FTF was calculated as: (filling time/cycle time) × 100. ETF was calculated as: (ejection time/cycle time) × 100. Intraclass correlation coefficients (ICC) were used to evaluate the intra‐ and interobserver reproducibility of FTF and ETF measurements in low‐risk fetuses. The relationships of FTF and ETF with HR, GA and EFW were evaluated using multivariate regression analysis. Reference ranges for FTF and ETF were then constructed using the low‐risk population. Z‐scores of FTF and ETF in the high‐risk fetuses were calculated and analyzed. Results: In total, 602 low‐risk singleton pregnancies and 54 high‐risk fetuses (nine pairs of monochorionic twins with severe TTTS, 16 fetuses with AoS and 20 fetuses with CoA) were included. Adequate Doppler traces for FTF and ETF could be obtained in 95% of low‐risk cases. Intraobserver reproducibility was good to excellent (ICC, 0.831–0.905) and interobserver reproducibility was good (ICC, 0.801–0.837) for measurements of all timing parameters analyzed. Multivariate analysis of FTF and ETF in relation to HR, GA and EFW in low‐risk fetuses identified HR as the only variable predictive of FTF, while ETF was dependent on both HR and GA. FTF increased with decreasing HR in low‐risk fetuses, while ETF showed the opposite behavior, decreasing with decreasing HR. Most recipient twins with severe TTTS showed reduced FTF and preserved ETF. AoS was associated with decreased FTF and increased ETF in the LV, with seemingly different patterns associated with univentricular vs biventricular postnatal outcome. The majority of fetuses with CoA had FTF and ETF within the normal range in both ventricles. Conclusions: Measurement of FTF and ETF using pulsed‐wave Doppler is feasible and reproducible in the fetus. The presented reference ranges account for associations of FTF with HR and of ETF with HR and GA. These time fractions are potentially useful for clinical monitoring of cardiac function in severe TTTS, AoS and other fetal conditions overloading the heart. © 2020 International Society of Ultrasound in Obstetrics and Gynecology [ABSTRACT FROM AUTHOR]

Objectives: Coarctation of the aorta (CoA) is associated with left ventricular (LV) dysfunction in neonates and adults. Cardiac structure and function in fetal CoA and cardiac adaptation to early neonatal life have not been described. We aimed to investigate the presence of cardiovascular structural remodeling and dysfunction in fetuses with CoA and their early postnatal cardiac adaptation.Methods: This was a prospective observational case-control study, conducted between 2011 and 2018 in a single tertiary referral center, of fetuses with CoA and gestational age-matched normal controls. All fetuses/neonates underwent comprehensive echocardiographic evaluation in the third trimester of pregnancy and after birth. Additionally, myocardial microstructure was assessed in one fetal and one neonatal CoA-affected heart specimen, using synchrotron radiation-based X-ray phase-contrast microcomputed tomography and histology, respectively.Results: We included 30 fetuses with CoA and 60 gestational age-matched controls. Of these, 20 CoA neonates and 44 controls were also evaluated postnatally. Fetuses with CoA showed significant left-to-right volume redistribution, with right ventricular (RV) size and output dominance and significant geometry alterations with an abnormally elongated LV, compared with controls (LV midventricular sphericity index (median (interquartile range; IQR), 2.4 (2.0-2.7) vs 1.8 (1.7-2.0); P < 0.001). Biventricular function was preserved and no ventricular hypertrophy was observed. Synchrotron tomography and histological assessment revealed normal myocyte organization in the fetal and neonatal specimens, respectively. Postnatally, the LV in CoA cases showed prompt remodeling, becoming more globular (LV midventricular sphericity index (mean ± SD), 1.5 ± 0.3 in CoA vs 1.8 ± 0.2 in controls; P < 0.001) with preserved systolic and normalized output, but altered diastolic, parameters compared with controls (LV inflow peak velocity in early diastole (mean ± SD), 97.8 ± 14.5 vs 56.5 ± 12.9 cm/s; LV inflow peak velocity in atrial contraction (median (IQR), 70.5 (60.1-84.9) vs 47.0 (43.0-55.0) cm/s; LV peak myocardial velocity in atrial contraction (mean ± SD), 5.1 ± 2.6 vs 6.3 ± 2.2 cm/s; P < 0.05). The neonatal RV showed increased longitudinal function in the presence of a patent arterial duct.Conclusions: Our results suggest unique fetal cardiac remodeling in CoA, in which the LV stays smaller from the decreased growth stimulus of reduced volume load. Postnatally, the LV is acutely volume-loaded, resulting in an overall geometry change with higher filling velocities and preserved systolic function. These findings improve our understanding of the evolution of CoA from fetal to neonatal life. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives: To define the pattern of fetal echocardiographic changes associated with isolated pulmonary valve stenosis (PS) and to correlate the echocardiographic findings with neonatal outcome and the need for postnatal pulmonary valvuloplasty within the first 12 months postpartum.Methods: This was a prospective cohort study between January 2009 and October 2015 of 16 fetuses with isolated PS and 48 controls matched by gestational age at ultrasound examination (± 2 weeks) evaluated at the Fetal Cardiology Unit at BCNatal (Barcelona). Standard fetal ultrasound and comprehensive echocardiography, which included cardiovascular morphometric parameters, and systolic and diastolic functional and timing measurements, were performed in all cases. Baseline characteristics and perinatal outcome were retrieved from clinical records. Cases were followed up until 12 months of age, and admission to intensive care unit, days of hospitalization, need for prostaglandins and requirement for postnatal surgery were reviewed. Fetal PS cases were analyzed according to the need for postnatal pulmonary valvuloplasty.Results: The study groups were similar in terms of baseline, fetal ultrasound and perinatal characteristics. Median gestational age at diagnosis of PS was 33.4 (range, 20.0-36.5) weeks. Most cases corresponded to mild or moderate PS; only three fetuses had reversed flow in the ductus arteriosus before delivery. Six (37.5%) newborns, including all three with reversed flow in the ductus arteriosus prenatally, required postnatal pulmonary valvuloplasty. Fetuses with PS presented with larger and more globular hearts, with increased myocardial wall thickness in the third trimester. Despite preserved right ventricular (RV) ejection fraction and systolic longitudinal motion, PS cases showed increased right cardiac output and signs of diastolic dysfunction, with higher ductus venosus pulsatility index (0.72 ± 0.32 vs 0.53 ± 0.16, P = 0.004) and tricuspid E/E' ratio (7.52 ± 3.07 vs 5.76 ± 1.79, P = 0.022). In addition, fetuses with PS displayed a compensatory increase in left ventricular (LV) radial and longitudinal motion, as shown by a higher ejection fraction (79.3 ± 8.23% vs 67.6 ± 11.3%, P = 0.003) and mitral annular-plane systolic excursion (5.94 ± 1.38 vs 5.0 ± 1.22 mm, P = 0.035). Finally, fetuses requiring postnatal pulmonary valvuloplasty showed a different pattern of echocardiographic findings from those not requiring valvuloplasty, with a significantly smaller RV and pulmonary valve diameter, reduced tricuspid annular-plane systolic excursion (5.08 ± 1.59 vs 8.07 ± 1.93 mm, P = 0.028), increased LV cardiac output (340 ± 16 vs 176 ± 44 mL/min/kg, P = 0.003) and more pronounced signs of LV diastolic dysfunction (mitral E' velocity, 5.78 ± 0.90 vs 8.16 ± 1.58 cm/s, P = 0.008).Conclusions: Fetuses with PS present with more hypertrophic, larger and more globular hearts in the third trimester of pregnancy, associated with a higher right cardiac output and impaired biventricular relaxation. In addition, signs of increased LV contraction were observed. Our data suggest that RV and LV functional parameters could be useful for predicting the need for postnatal pulmonary valvuloplasty. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Fetus with IAI show a global concentric myocardial hypertrophy and fetus without IAI only present a left concentric hypertrophy when compared to the non-exposed group (table 1). To assess the influence of intra-amniotic infection and/or inflammation (IAI) on the fetal cardiac structure. The exposed group included women with preterm labour (PTL) and/or preterm prelabour rupture of membranes (PPROM) with IAI (positive amniotic fluid culture and/or high levels of IL6) (group A) and without IAI (group B). [Extracted from the article]

Carotid-subclavian artery index (CSAI) is a recently described promising parameter for prenatal diagnosis of coarctation of the aorta (COA). EP17.09: Carotid-subclavian artery index to predict coarctaction of the aorta in the second trimester of gestation Aortic arch diameter at the origin of the left subclavian artery (D1) and distance between left carotid and left subclavian artery (D2) were measured as shown in figure 1 to calculate CSAI (D1/D2). [Extracted from the article]

To explore whether they might have been under diagnosed I in utero i , we analysed the aortic arch and its branching patterns in a low-risk population between 19 and 22 weeks of gestation. Aortic arch branching variants have recently been found to have an impact for neonates undergoing surgical interventions such as repair of coarctation. Conclusions Left aortic arch branching variants were seen in 18.6 % by targeted fetal echocardiography. [Extracted from the article]

Objectives: To determine the longitudinal behavior of fetal biometric measures and cerebroplacental hemodynamics throughout gestation in fetuses with congenital heart disease (CHD).Methods: Fetal biometry and Doppler hemodynamics (uterine artery (UtA), umbilical artery (UA) and fetal middle cerebral artery (MCA)) were measured serially in a cohort of consecutive fetuses diagnosed with CHD. Evaluations were made at various time points, from diagnosis (20-25 weeks) to delivery, with at least two measurements per fetus that were at least 2 weeks apart. Fetuses were classified into three groups according to the pattern of blood supply to the brain (placental vs systemic) that would be expected on the basis of the type of CHD. All parameters were transformed into Z-scores. A linear mixed model to analyze repeated measurements was constructed for each parameter to assess its behavior throughout gestation.Results: Four hundred and forty-four ultrasound examinations were performed in 119 CHD fetuses, with a median of two measurements per fetus. The fetuses presented a small head at diagnosis (biparietal diameter (BPD) Z-score, -1.32 ± 0.99; head circumference (HC) Z-score, -0.79 ± 1.02), which remained small throughout gestation. UtA and UA pulsatility indices (PI) showed a significant increase towards the end of pregnancy, whereas no significant changes were observed in MCA-PI or cerebroplacental ratio (CPR) with gestational age. Both MCA and CPR presented significant differences in longitudinal behavior between CHD groups, while BPD and HC did not.Conclusions: CHD fetuses have a relatively small head from the second trimester of pregnancy, regardless of the type of CHD anomaly, and increasing resistance in the UtA and UA as pregnancy progresses, suggestive of increasing degree of placental impairment. Our findings indicate the early onset of mechanisms that could lead to poorer neurodevelopment later in life. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives: To construct gestational age (GA)-based reference ranges for the uterine artery (UtA) mean pulsatility index (PI) at 11-41 weeks of pregnancy. Methods: A prospective cross-sectional observational study was carried out of 20 consecutive singleton pregnancies for each completed gestational week at 11-41 weeks. UtAs were examined by color and pulsed Doppler imaging, and the mean PI, as well as the presence or absence of a bilateral protodiastolic notch, were recorded. Polynomials were fitted by means of least-square regression to estimate the relationship between the mean UtA-PI and GA. Results: A total of 620 women were included. A second-degree polynomial (Log(e) mean UtA-PI = 1.39 - 0.012 x GA + GA(2) x 0.0000198, with GA measured in days), after a natural logarithmic transformation, was selected to model our data. There was a significant decrease in the mean UtA-PI between 11 weeks (mean PI, 1.79; 95(th) centile, 2.70) and 34 weeks (mean PI, 0.70; 95(th) centile, 0.99). It then became more stable up until 41 weeks (mean PI, 0.65; 95(th) centile, 0.89). Conclusions: The mean UtA-PI shows a progressive decrease until the late stages of pregnancy. Reference ranges for mean UtA-PI may have clinical value in screening for placenta-associated diseases in the early stages of pregnancy, and in evaluating patients with pregnancy-induced hypertension and/or small-for-gestational age fetuses during the third trimester. [ABSTRACT FROM AUTHOR]

Amongst the various demyelinating diseases that affect the central nervous system, those induced by an inflammatory response stand out because of their epidemiological relevance. The best known inflammatory-induced demyelinating disease is multiple sclerosis, but the immune response is a common pathogenic mechanism in many other less common pathologies (e.g., acute disseminated encephalomyelitis and acute necrotizing haemorrhagic encephalomyelitis). In all such cases, modulation of the immune response seems to be a logical therapeutic approach. Cannabinoids are well known immunomodulatory molecules that act through CB1 and CB2 receptors. While activation of CB1 receptors has a psychotropic effect, activation of CB2 receptors alone does not. Therefore, to bypass the ethical problems that could result from the treatment of inflammation with psychotropic molecules, considerable effort is being made to study the potential therapeutic value of activating CB2 receptors. In this review we examine the current knowledge and understanding of the utility of cannabinoids as therapeutic molecules for inflammatory-mediated demyelinating pathologies. Moreover, we discuss how CB2 receptor activation is related to the modulation of immunopathogenic states. [ABSTRACT FROM AUTHOR]

Objective: To establish reference ranges for blood flow velocity waveforms (FVW) of the fetal aortic isthmus (AoI) during the second and third trimesters of pregnancy. Methods: This was a prospective cross-sectional observational study involving 458 uncomplicated singleton pregnancies between 19 and 37 weeks of gestation. Fetal AoI Doppler parameters were assessed in either the longitudinal aortic arch view or the three vessels and trachea view. Regression analysis was used to determine gestational-age-specific reference ranges and to construct nomograms for the following Doppler parameters: pulsatility index (PI), resistance index (RI) and peak systolic (PSV), end-diastolic (EDV) and time-averaged maximum (TAMXV) velocities. Intra- and interobserver reproducibility were evaluated by calculating intraclass correlation coefficients (ICCs) and limits of agreement. Results: Reliable FVW in the AoI were obtained in all cases. Acceptable intra- and interobserver reproducibility was obtained. With advancing gestation, there was a significant increase in PSV, TAMXV and PI, whereas RI and EDV remained constant during the second half of pregnancy. No cases of absent or reversed flow during diastole were detected. Conclusion: Normal data of the fetal AoI blood FVW throughout the second and third trimesters of pregnancy are provided. The reported Doppler profiles may be of clinical use in the assessment of hemodynamically compromised growth-restricted fetuses. [ABSTRACT FROM AUTHOR]

Objectives: Fetuses with congenital heart disease (CHD) show evidence of abnormal brain development before birth, which is thought to contribute to adverse neurodevelopment during childhood. Our aim was to evaluate whether brain development in late pregnancy can be predicted by fetal brain Doppler, head biometry and the clinical form of CHD at the time of diagnosis.Methods: This was a prospective cohort study including 58 fetuses with CHD, diagnosed at 20-24 weeks' gestation, and 58 normal control fetuses. At the time of diagnosis, we recorded fetal head circumference (HC), biparietal diameter, middle cerebral artery pulsatility index (MCA-PI), cerebroplacental ratio (CPR) and brain perfusion by fractional moving blood volume. We classified cases into one of two clinical types defined by the expected levels (high or low) of placental (well-oxygenated) blood perfusion, according to the anatomical defect. All fetuses underwent subsequent 3T-magnetic resonance imaging (MRI) at 36-38 weeks' gestation.Results: Abnormal prenatal brain development was defined by a composite score including any of the following findings on MRI: total brain volume <  10(th) centile, parietoccipital or cingulate fissure depth <  10(th) centile or abnormal metabolic profile in the frontal lobe. Logistic regression analysis demonstrated that MCA-PI (odds ratio (OR), 12.7; P = 0.01), CPR (OR, 8.7; P = 0.02) and HC (OR, 6.2; P = 0.02) were independent predictors of abnormal neurodevelopment; however, the clinical type of CHD was not.Conclusions: Fetal brain Doppler and head biometry at the time of CHD diagnosis are independent predictors of abnormal brain development at birth, and could be used in future algorithms to improve counseling and targeted interventions. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Conclusions Our preliminary data demonstrates than fetuses with isolated CHD have increased levels of the protein oxidation biomarker o-Tyr in amniotic fluid. The aim of this study is to evaluate protein OS biomarkers in amniotic fluid in fetuses with isolated major CHD. Recent evidence suggests that oxidative stress (OS) plays an important role in the pathogenesis of congenital heart defect (CHD). [Extracted from the article]

Five protein oxidation biomarkers, including orto-tyrosine (o-tyr), metatyrosine (m-tyr), 3NO2-tyrosine (3NO2-tyr), 3I-tyrosine (3I-tyr), were analysed to obtain preliminary data on the OS status of the fetuses, focusing on the correlation between the biomarkers and the gestational age. Oxidative stress (OS) is associated with poor perinatal outcomes but little is known regarding the levels of OS biomarkers in the fetus along the pregnancy. [Extracted from the article]

We report on the successful use of fetoscopic surgery to treat a case of prolapsed ureterocele in a female fetus. At 21 weeks' gestation, a double renal system with an intravesical ureterocele obstructing the bladder outlet was diagnosed, causing severe megacystis, bilateral hydronephrosis and progressive oligohydramnios. Ultrasound evaluation following referral to our center confirmed severe bilateral hydronephrosis with pelvic and calyceal dilatation, but amniotic fluid volume was normal and the ureterocele was not visualized in the bladder. Instead, a cystic mass within the external genitalia was observed, suggestive of a prolapsed ureterocele, causing intermittently severe obstruction of the urethra. The parents were counseled about the uncertain prognosis and fetal surgery to decompress the urinary system was proposed. The procedure involved firing a contact diode laser until perforation of the ureterocele was achieved. Following laser surgery, resolution of megacystis, reduction of hydronephrosis and normalization of amniotic fluid volume were observed. Our report demonstrates that fetoscopic decompression of a distal urethral obstruction is feasible in the rare event of congenital prolapsed ureterocele. [ABSTRACT FROM AUTHOR]

An abstract of the article "Longitudinal changes of fetal biometries and cerebrovascular hemodynamics in fetuses with congenital heart disease" by M. Cruz Lemini and colleagues is presented.

While right ventricular GLS was preserved in fetuses with AoS (AoS mean -19.26% ± 2.89 versus controls -18,58% ± 3.08, I p = 0,487 i ), left ventricular GLS was significantly reduced in AoS cases as compared to controls (AoS -11.21% ± 10.17 versus controls 20.17% ± 3.59, I p = 0.008 i ) as shown in figure 1. EP19.02: 2D speckle-tracking assessment of biventricular strain in fetuses with aortic stenosis To assess biventricular global longitudinal strain (GLS) in fetuses with aortic stenosis (AoS) using 2D speckle-tracking echocardiography (STE) by FetalHQ® and to compare it to healthy fetuses. [Extracted from the article]

To evaluate the feasibility of 4D spatiotemporal image correlation (4D STIC) in the 2D speckle-tracking echocardiography (STE) using FetalHQ® software. EP19.22: Feasibility of 2D speckle-tracking analysis from 4D spatiotemporal image correlation imaging Conclusions These results suggest that 4D STIC is feasible for the speckle-tracking analysis using FetalHQ® after completing a learning curve. [Extracted from the article]

To assess biventricular global longitudinal strain (GLS) in fetuses with pulmonary stenosis (PS) using 2D speckle-tracking echocardiography (STE) by FetalHQ® and to compare it to healthy fetuses. Conclusions Fetuses with PS showed reduced right GLS when compared to controls, with preserved left GLS. EP19.07: 2D speckle-tracking assessment of biventricular strain in fetuses with pulmonary stenosis. [Extracted from the article]

We aimed to assess fetal cardiac structure and function (including FTF and ETF) in fetuses exposed to maternal gestational diabetes mellitus (GDM) versus non-exposed fetuses. Exposure to intrauterine hyperglycemia associates fetal heart hypertrophy and dysfunction. Conclusions Fetuses exposed to GDM show signs of myocardial hypertrophy and diastolic dysfunction reflected by prolonged biventricular FTF. [Extracted from the article]

Conclusions Cardiac cycle timing parameters by pulse Doppler are feasible and reproducible in the first trimester of pregnancy. We aimed to assess the feasibility and reproducibility of cardiac cycle timing parameters by pulsed-Doppler in the evaluation of fetal cardiac function in the first trimester of pregnancy. [Extracted from the article]

Conclusions The systemic evaluation of OS in the routine examination of fetuses with major CHD is of value in the diagnosis of CHARGE syndrome. This study aimed to evaluate the systematic assessment of the olfactory sulci (OS) in fetuses with major congenital heart defects (CHD). [Extracted from the article]

ABSTRACT Objectives To evaluate the associations between congenital heart disease ( CHD) and head biometry and cerebrovascular blood flow dynamics at the time of diagnosis of CHD in the second trimester of pregnancy. Methods This was a study of 95 consecutive fetuses diagnosed with CHD. At the time of diagnosis, fetal biometry was performed and brain perfusion was assessed by middle cerebral artery pulsatility index ( MCA-PI), cerebroplacental ratio ( CPR) and fractional moving blood volume ( FMBV). The results were compared with those of 95 normal fetuses matched for gestational age. Results Median gestational age at diagnosis was 22 + 3 (range, 20 + 0 to 23 + 5) weeks. Fetuses with CHD showed significantly lower MCA-PI and CPR Z-scores (−0.23 vs 0.34 and −0.37 vs 0.30, respectively; both P < 0.001) and higher FMBV Z-scores (2.35 vs 0.15; P < 0.001). FMBV > 95th percentile was observed in 81.1% of cases as compared with 10.5% in controls ( P < 0.001). Moreover, cases showed significantly smaller biparietal diameter ( BPD) and head circumference ( HC) Z-scores (−1.61 vs −0.43 and −0.89 vs 0.09, respectively; both P < 0.001), with a higher proportion of BPD and HC measurements below the 5th percentile compared with controls (51.6% vs 13.7% and 26.3% vs 4.2%, respectively; both P < 0.001). These findings were more pronounced in those cases with types of CHD associated with compromised oxygenated blood delivery to the brain, such as left outflow tract obstruction and transposition of the great arteries. Conclusions A high proportion of fetuses with CHD have a smaller head and increased brain perfusion already in the second trimester, suggesting an early onset of the mechanisms leading to poorer neurodevelopment later in life. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives To evaluate, in a cohort of 248 fetuses seen at a tertiary referral center, the frequency of isolated ventricular septal defects ( VSD) among all congenital heart defects ( CHD), the association with chromosomal and postnatal anomalies and the rate of spontaneous closure. Methods This was a 6-year study on 10 800 women referred for fetal echocardiography, with 995 confirmed cases of CHD. The prevalence and characteristics of VSDs were analyzed, including follow-up until 1 year of age. Multivariate binary logistic regression analysis was performed to test the independent contribution of the ratio of the diameter of the VSD to that of the aorta ( VSD/aorta ratio) (< 0.5 or ≥ 0.5) and location of VSD (perimembranous or muscular) in the prediction of spontaneous closure before the age of 1 year. Results Two hundred and forty-eight VSDs (24.9% of all CHDs) were diagnosed, of which 216 (87.1%) were muscular and 32 (12.9%) perimembranous. Median gestational age at diagnosis was 30.4 (range, 17-41) weeks and mean size 2.6 ± 0.77 mm. Clinically relevant chromosomal anomalies were found in one (3.1%) perimembranous VSD compared with none in 216 muscular defects (P = 0.12). Postnatal malformations were diagnosed in eight of the 211 cases (3.8%) evaluated at 12 months postpartum. Spontaneous closure occurred prenatally in 13 fetuses (5.2%) and postnatally in 151 of the 198 infants (76.3%) who had an open VSD at birth. Closure was predicted by the VSD/aorta ratio (odds ratio ( OR) 0.445 (95% CI, 0.216-0.914); P < 0.03) and location ( OR 0.385 (95% CI, 0.160-0.926); P < 0.03). Conclusions In our fetal cardiology unit, isolated muscular VSD is today the most prevalent CHD. In contrast to the findings of postnatal studies, muscular VSDs were more common than perimembranous VSDs. Perimembranous VSDs were associated with a higher risk of chromosomal anomalies than were muscular VSDs, which had a similar risk to those of normal pregnancies. Spontaneous closure of the VSD was frequent and occurred in most cases postnatally. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To compare the ability of two different methods for longitudinal annular motion measurement, M-mode and tissue Doppler imaging ( TDI), to demonstrate cardiac dysfunction in intrauterine-growth-restricted ( IUGR) fetuses. Methods Cardiac longitudinal annular motion in the basal free wall of the left ventricle (mitral annulus), interventricular septum and tricuspid annulus was assessed in 23 early-onset IUGR cases and 43 controls by TDI (annular peak velocities) and M-mode (displacement). Results All annular parameters were significantly decreased in the IUGR group with respect to controls using both methods. M-mode showed a trend towards equal performance as classifier between cases and controls, as compared to TDI, mainly in the tricuspid annulus. Conclusions Both M-mode and TDI demonstrate annular motion changes and consequently cardiac dysfunction in IUGR fetuses. M-mode imaging is simpler to perform and could be as sensitive as TDI for detecting subtle changes. Copyright © 2012 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives To construct gestational age (GA)- and estimated fetal weight (EFW)-adjusted reference ranges for tissue Doppler cardiac function parameters from 24 to 41 weeks' gestation. Methods This was a prospective cross-sectional observational study involving 213 singleton pregnancies between 24 and 41 weeks' gestation. Myocardial peak velocities and myocardial performance index (MPI′) were measured by tissue Doppler ultrasonography (values indicated by 'prime') in the left and right annulus and interventricular septum. Left and right atrioventricular parameters were also measured by conventional Doppler and ratios between the values found by the two methods calculated. Regression analysis was used to determine GA- and EFW-adjusted reference ranges and to construct nomograms for tissue Doppler parameters. Results All myocardial peak velocities, left and right E′/A′ and left MPI′ showed a progressive increase with GA. In contrast, left and right E/E′ showed a progressive decline. Septal E′/A′, and right and septal MPI′ remained constant. Myocardial peak velocities showed a progressive increase with increasing fetal weight. Conclusions Normal data of fetal myocardial peak velocities, their ratios and MPI′ by tissue Doppler adjusted by GA and EFW are provided. The reported reference values may be useful in research or clinical studies and can be used in fetuses with intrauterine growth restriction. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article focuses on the question mark sign as an ultrasonographic marker in the diagnosis of tetralogy of Fallot (TOF) among fetuses. It states that 3998 pregnant women undergo fetal echocardiography due to high risk of congenital heart disease (CHD). It adds that CHD was diagnosed in 447 fetuses with a median gestational age of 24 weeks, in which 42 have TOF. An enlarged aorta with a question mark shape can be related to TOF, particularly the type with pulmonary atresia.

The article offers information on a study that assesses the accuracy of four-dimensional (4D) spatiotemporal image correlation (STIC) echocadiography for the diagnosis of fetal congenital heart disease (CHD) in a selected high-risk population. It states that 363 pregnant women who were suspected CHD on screening ultrasound was the subjects of the research. The study found out that 4D-STIC echocardiography conducted by experienced operators can be used in fetuses at risk for cardiac anomalies.

The article presents a study which evaluates the perfusion of lung tissue on human fetuses who have congenital diaphragmatic hernia (CDH) and its relationship with pulsed Doppler and the lung area to head circumference ratio (LHR). The study compares fetuses that were identified with isolated left CDH and fetuses group without CDH and uses fractional moving blood volume (FMBV) to measure the lung tissue perfusion. Results show the decrease in the lung tissue perfusion of the fetuses with CDH.

The article discusses a study which evaluates the repeatability of fetal cardiac examination between and within observers using spatiotemporal image correlation (STIC) technology from first to third trimesters of pregnancy. A cross-sectional study was performed on 150 women who have undergone scan in each trimester of pregnancy using four dimensional (4D) STIC. Results reveal that the cardiac examination using 4D STIC technology demonstrates a high inter- and intra-observer repeatability.

The article presents a study which assesses the contribution of ductus venosus (DV) blood flow at 11-14 weeks of pregnancy to the prediction of congenital heart defects (CHD) in normal fetuses. The study uses the fetal echocardiography to determine the normality of the fetuses and the postnatal examination to measure of perinatal death's termination. Moreover, the study concludes that blood flow assessment can detect CHD through the use of translucency thickness (NT) measurement.

The article presents a study on the impact of pre-eclampsia (PE) on the cardiovascular dysfunction of preterm intrauterine growth restriction (IUGR) fetuses with peripheral Doppler abnormalities. It measures the cord blood-type natriuretic peptide (BNP) levels of 31 normotensive IUGR case and 31 IUGR case with PE to assess the dysfunction. It reveals that PE does not cause cardiovascular dysfunction in IUGR fetuses as shown in the similar degree of dysfunction for IUGR fetuses with and without PE.

The article presents a study which demonstrated a new mean uterine artery pulsatility index (UtA-PI) charts derived from a cross-sectional study in a population of 620 women between 11 and 41 weeks of gestation. The authors note that these gestational age-based reference ranges for the uterine artery may be clinically useful to screen for pre-eclampsia and to evaluate patients with pregnancy-induced hypertension and/or small-for-gestational age fetuses.

Objective To determine whether the optimal cut-off value to predict low risk of preterm delivery in women admitted for preterm labor should be adjusted for gestational age. Methods A cohort of 333 women with singleton pregnancies admitted with preterm labor and intact membranes between 24 and <36 weeks’ gestation was studied. The women were categorized according to prematurity into one of two groups: those admitted at <32 weeks (Group 1, very preterm) and those admitted at ⩾ 32 weeks (Group 2, preterm). Transvaginal ultrasound was performed 24-48 h after admission and cervical length measured. The predictive value of different cut-off points was explored. Outcome variables were spontaneous preterm delivery within 7 days of admission and delivery at <34 weeks. Results The mean (± SD) gestational ages at admission and delivery were 31.9 (± 2.6) and 37.5 (± 2.2) weeks, respectively, and the mean (± SD) cervical length was 30.4 (± 8.9) mm. The rates of spontaneous delivery within 7 days and at <34 weeks were 6.3 and 7.0%, respectively. The cut-off value of 15-mm cervical length showed a sensitivity, negative predictive value and false positive rate for delivery within 7 days of 0, 96.5 and 2.7% in the very preterm group, and 35.3, 94.6 and 4% in the preterm group, respectively. For a cut-off point of 25 mm, these values were 75, 99 and 14.3%, and 70.6, 96.8 and 24.5%. Conclusions The predictive value of different cut-off points of cervical length is similar at different gestational ages. However, the higher false positive rate after 32 weeks’ gestation might justify the adoption of gestational-age related cut-off values in clinical protocols. In women admitted at <32 weeks’ gestation, a cut-off point of 25 mm may be used to predict a low risk of preterm delivery, whereas in women admitted at 32 weeks or later, 15 mm might be more appropriate. [ABSTRACT FROM AUTHOR]

Objective To describe sequential changes in uterine artery waveform between the first and second trimesters of gestation and to analyze their association with the subsequent risk of hypertensive disorders and fetal growth restriction (IUGR). Methods Sequential uterine artery Doppler recordings were obtained in a final cohort of 870 singleton pregnancies over two gestational age intervals: 11–14 weeks and 19–22 weeks. The left and right uterine arteries were examined by color and pulsed Doppler and the mean pulsatility index (PI) as well as the presence of a bilateral protodiastolic notch were recorded during both intervals. Pregnancies were followed for occurrence of hypertensive disorders and IUGR. Results Mean uterine artery PI showed a significant linear decrease within each of the two intervals considered, while the prevalence of a bilateral notch showed decreasing values only throughout 11–14 weeks of gestation. Sixty-four (7.3%) pregnancies developed a hypertensive disorder and/or IUGR, including three (0.34%) cases of gestational hypertension, 24 cases of pre-eclampsia (2.75%) and 37 (4.25%) of IUGR. Compared with pregnancies with a normal outcome, complicated pregnancies showed a significantly higher prevalence of a bilateral notch and a higher mean PI in each of the two intervals studied. Compared with normal pregnancies, complicated pregnancies had a significantly higher persistence of a bilateral notch (30% vs. 8%), a higher proportion of women with an abnormal first-trimester uterine artery PI shifting to normal in the second trimester (14% vs. 4%) and a higher incidence of a normal first-trimester mean PI that shifted to abnormal in the second trimester (13% vs. 4%). Persistence of an abnormal mean PI from the first to the second trimester identified the group with the greatest risk for adverse perinatal outcome (OR, 10.7; 95% Cl, 3.7–30.9). In addition, women in whom the uterine artery mean PI shifted from abnormal to normal between the two trimesters and women in whom the reverse shift occurred showed a similar intermediate risk (OR, 5; 95% CI, 2.1 –10.6), comparable to that in women with persistence of a bilateral notch (OR, 5.6; 95% CI, 2.9–10.7). Conclusions The sequence of changes in uterine flow between the first and second trimesters correlates with the subsequent development of hypertensive disorders and IUGR. Women with a persistent abnormal mean PI represent the group with the greatest risk for adverse perinatal outcome. [ABSTRACT FROM AUTHOR]

Four tomato lines introgressed from Lycopersicon chilense were compared with the commercial F1 hybrids ‘ARO 8479’ and ‘HA 3108’, which are tolerant to Tomato yellow leaf curl virus, and the cv. ‘Campbell 28’ as a susceptible control. Resistance was evaluated by the use of grafted diseased scions as well as in a field trial where plants infected by viruliferous whiteflies and disease-free plants were transplanted in paired rows. The new lines LD 3, LD 4, LD 5 and LD 6 showed no disease symptoms after grafting or in the field trial. Virus accumulation at 60 days after transplanting was low in the infected plants: 0.09, 0.60, 1.00 and 0.50 ng, respectively. No fruit-set or yield losses were registered under the high temperature conditions prevalent in the trial, in which lines LD 5 and LD 6 were better adapted to tropical conditions. Viral DNA concentrations were over 1000 ng in the cvs. ‘Campbell 28’, ‘ARO 8479’ and ‘HA 3108’. The last two are considered tolerant as they were asymptomatic or had mild symptoms, respectively, but achieved acceptable yields in the trial. By contrast, virus had a negative effect on fruit-set, number of fruit per plant and total yield in the cv. ‘Campbell 28’. [ABSTRACT FROM AUTHOR]

Objective The aim of our study was to obtain measurements of the jugular vein and carotid artery pulsatility index (PI) at 10–14 weeks' gestation in chromosomally normal and abnormal fetuses with or without increased nuchal translucency (NT), in order to explore whether a relationship exists between increased NT and overperfusion of the head. Methods This was a prospective study involving 179 pregnant women at high risk for chromosomal anomalies or structural malformations who were referred for chorionic villus sampling or first-trimester ultrasound examination at 10–14 weeks' gestation, respectively. Color and pulsed Doppler ultrasound were used to obtain jugular vein and carotid artery blood flow velocity waveforms at the level of the mid-neck. All Doppler measurements were obtained by a single investigator. The PIs of the jugular vein and carotid artery were correlated with NT measurement and fetal karyotype. Results Doppler measurements of the jugular vein and carotid artery were successfully obtained in 90.5% of the fetuses. The fetal karyotype was abnormal in 13 cases, including three trisomies 21 and two trisomies 18, and normal in 149 cases. In the group with normal karyotype the NT was above the 95th percentile in 22 cases (15%). No correlation between the jugular vein or the carotid artery PI and the thickness of the NT was found. There were no significant differences when comparing the values of the jugular vein and carotid artery PI between the group with normal NT and the group with increased NT, or between the group with a normal karyotype and an abnormal karyotype. Conclusion Our results suggest that NT is not related to blood flow impedance in either the carotid artery or the jugular vein. Overperfusion and venous congestion of the head do not appear to be a causative pathophysiological mechanism involved in increased NT. [ABSTRACT FROM AUTHOR]

We describe a case of early prenatal diagnosis of a major congenital heart anomaly and trisomy 18 in a low-risk pregnant woman. Nuchal translucency (NT) measurement at 13 weeks' gestation was 1.2 mm and Doppler evaluation of the ductus venosus detected a persistent reversed flow during atrial contraction. This finding prompted us to perform fetal echocardiography which showed hypoplastic left heart syndrome. Karyotyping following chorionic villus sampling diagnosed trisomy 18. Review of the recent literature suggests that the finding of an abnormal ductus venosus Doppler pattern in the late first trimester of pregnancy may be an early sign of either congenital cardiac or chromosomal abnormality, even in the presence of normal NT screening. [ABSTRACT FROM AUTHOR]