570 results on '"Helena M. Gardiner"'
Search Results
2. Fetal ventricular strain in uncomplicated and selective growth‐restricted monochorionic diamniotic twin pregnancies and cardiovascular response in pre‐twin–twin transfusion syndrome
- Author
-
A. Agarwal, Ramesha Papanna, Kenneth J. Moise, Anthony Johnson, Cynthia S. Bell, Roopali Donepudi, Christoph Wohlmuth, I. E. Averiss, Blair Stevens, and Helena M. Gardiner
- Subjects
selective intrauterine growth restriction ,sIUGR ,Twins ,Intrauterine growth restriction ,0302 clinical medicine ,Obstetrics and gynaecology ,Pregnancy ,Single-Blind Method ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Twin Pregnancy ,ventricular strain ,Fetal Growth Retardation ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,Obstetrics ,cardiovascular ,Obstetrics and Gynecology ,Gestational age ,Fetofetal Transfusion ,General Medicine ,Original Papers ,Fetal Weight ,Multilevel Analysis ,Regression Analysis ,Female ,Ductus venosus ,Adult ,medicine.medical_specialty ,Heart Ventricles ,Gestational Age ,Ultrasonography, Prenatal ,03 medical and health sciences ,Fetal Heart ,Fetus ,twin–twin transfusion syndrome ,medicine ,Humans ,Placental Circulation ,Radiology, Nuclear Medicine and imaging ,monochorionic ,Original Paper ,business.industry ,Reproducibility of Results ,medicine.disease ,TTTS ,Reproductive Medicine ,Pregnancy, Twin ,business - Abstract
Objectives Our primary aim was to confirm whether intertwin discordance in ventricular strain and ductus venosus (DV) time intervals predicts twin–twin transfusion syndrome (TTTS). Secondary aims were to create gestational‐age ranges for ventricular strain in uncomplicated monochorionic diamniotic (MCDA) twin pregnancies without selective intrauterine growth restriction (sIUGR) and to characterize the relationship of ventricular strain with gestational age in MCDA twin pregnancies with sIUGR that did not develop TTTS. Methods In the period 2015–2018, we enrolled 150 MCDA twin pregnancies consecutively into this prospective, blinded study of global longitudinal left and right ventricular strain. With the observer blinded to twin pairing and pregnancy outcome, videoclips of the four‐chamber view, which had been recorded during ultrasound surveillance in the usual window for development of TTTS (16–26 completed gestational weeks), underwent offline measurement of strain. Uncomplicated MCDA twin pregnancies, without sIUGR, were used to test the association between strain, gestational age and estimated fetal weight using mixed‐effects multilevel regression. Inter‐rater reliability was tested in 208 strain measurements in 31 fetuses from pregnancies which did not develop TTTS and within‐fetus variation was assessed in 16 such fetuses, in which multiple four‐chamber views were taken on the same day. The effect of sIUGR on strain in otherwise uncomplicated MCDA twin pregnancy was analyzed. MCDA twin pregnancies were defined as ‘pre‐TTTS’ when, having been referred for TTTS evaluation, they did not satisfy Quintero staging criteria, but subsequently developed TTTS requiring laser treatment. MCDA pregnancies which did not develop TTTS comprised the ‘non‐TTTS’ group. Cardiovascular parameters measured in these cases included tissue Doppler parameters and DV early filling time as a percentage of the cardiac cycle (DVeT%). Intertwin strain and DVeT% discordance was compared between non‐TTTS and pre‐TTTS cases, matched for gestational age. Results Paired strain data were available for intertwin comparison in 127/150 MCDA twin pregnancies, comprising 14 pre‐TTTS and 113 non‐TTTS pregnancies, after exclusions. Scans were collected at a median frame rate of 97 (range, 28–220) Hz. Laser therapy was performed at a median gestational age of 20.6 (range, 17.2–26.6) weeks. There were no group differences in right (RV) or left (LV) ventricular strain discordance between 68/113 non‐TTTS and 13/14 pre‐TTTS MCDA twin pregnancies 3.6% was found in eight of 13 pre‐TTTS pregnancies. In non‐TTTS pregnancies, the estimated variability in ventricular strain within each twin during the day was high (RV, 19.7; LV, 12.9). However, within each pair (intertwin variation), variability was low (RV, 5.5; LV, 2.9). Interclass correlation reflecting the proportion of total variability represented by the variability between twin pairs was low (RV, 0.22; LV, 0.18). Both RV (P
- Published
- 2020
3. Development of standard definitions and grading for Maternal and Fetal Adverse Event Terminology
- Author
-
Francesc Figueras, Kurt Hecher, Eduard Gratacós, Alan W. Flake, Kathleen J. Beach, Gillian Yaz, Mehali Patel, Anna L. David, Helena M. Gardiner, Karel Marsal, Albert Batista, Christoph Lees, James Power, Steve Thornton, Anke Diemert, Jan Deprest, Rebecca Spencer, Helen Turier, Neil Marlow, Magnus Westgren, Gill Norman, Donald Peebles, Beverley Power, Fatima Crispi, Marcy Powell, and Jana Brodszki
- Subjects
medicine.medical_specialty ,MedDRA ,POSTPARTUM HEMORRHAGE ,Psychological intervention ,INCLUSION ,GUIDELINES ,DIAGNOSIS ,CLASSIFICATION ,Terminology ,Fetus ,Terminology as Topic ,Humans ,Medicine ,Obstetrics & Reproductive Medicine ,Grading (education) ,Intensive care medicine ,Adverse effect ,Genetics (clinical) ,Genetics & Heredity ,Pregnancy ,Science & Technology ,HYPERTENSION ,business.industry ,Obstetrics & Gynecology ,Obstetrics and Gynecology ,1103 Clinical Sciences ,Reference Standards ,medicine.disease ,PREVENTION ,IRON-DEFICIENCY ,Pregnancy Complications ,Clinical trial ,PREGNANCY ,1114 Paediatrics and Reproductive Medicine ,CLINICAL MANAGEMENT ,Female ,business ,Life Sciences & Biomedicine - Abstract
OBJECTIVE: Adverse event (AE) monitoring is central to assessing therapeutic safety. The lack of a comprehensive framework to define and grade maternal and fetal AEs in pregnancy trials severely limits understanding risks in pregnant women. We created AE terminology to improve safety monitoring for developing pregnancy drugs, devices and interventions. METHOD: Existing severity grading for pregnant AEs and definitions/indicators of 'severe' and 'life-threatening' conditions relevant to maternal and fetal clinical trials were identified through a literature search. An international multidisciplinary group identified and filled gaps in definitions and severity grading using Medical Dictionary for Regulatory Activities (MedDRA) terms and severity grading criteria based on Common Terminology Criteria for Adverse Event (CTCAE) generic structure. The draft criteria underwent two rounds of a modified Delphi process with international fetal therapy, obstetric, neonatal, industry experts, patients and patient representatives. RESULTS: Fetal AEs were defined as being diagnosable in utero with potential to harm the fetus, and were integrated into MedDRA. AE severity was graded independently for the pregnant woman and her fetus. Maternal (n = 12) and fetal (n = 19) AE definitions and severity grading criteria were developed and ratified by consensus. CONCLUSIONS: This Maternal and Fetal AE Terminology version 1.0 allows systematic consistent AE assessment in pregnancy trials to improve safety. ispartof: PRENATAL DIAGNOSIS vol:42 issue:1 pages:15-26 ispartof: location:England status: published
- Published
- 2022
4. Fetal Cardiac Intervention for Pulmonary Atresia with Intact Ventricular Septum: International Fetal Cardiac Intervention Registry
- Author
-
Renuka E. Peterson, Roland Devlieger, Shaine A. Morris, Queralt Ferrer, Gary F. Sholler, Sarah Gelehrter, Dick Oepkes, John M. Simpson, Joanna Dangel, Aimee K. Armstrong, Alberto Galindo, Edgar Jaeggi, Joana O. Miranda, Michele A. Frommelt, Annette Wacker-Gussmann, James Strainic, Helena M. Gardiner, Lisa Howley, Ulrike Herberg, Trisha V Vigneswarran, Simone Rolim Fernandes Fontes Pedra, Whitnee Hogan, Sofía Grinenco, and Anita J. Moon-Grady
- Subjects
Embryology ,medicine.medical_specialty ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Pregnancy ,Fetus ,030219 obstetrics & reproductive medicine ,Tricuspid valve ,Fetal cardiac intervention ,Fetal echocardiography ,medicine.diagnostic_test ,business.industry ,Congenital heart defect ,Pulmonary atresia with intact ventricular septum ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,medicine.disease ,Stenosis ,Valvuloplasty ,medicine.anatomical_structure ,Pulmonary valve ,Pediatrics, Perinatology and Child Health ,Cardiology ,business ,Pulmonary atresia - Abstract
Introduction: Invasive fetal cardiac intervention (FCI) for pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (PS) has been performed with small single-institution series reporting technical and physiological success. We present the first multicenter experience. Objectives: Describe fetal and maternal characteristics of those being evaluated for FCI, including pregnancy/neonatal outcome data using the International Fetal Cardiac Intervention Registry (IFCIR). Methods: We queried the IFCIR for PAIVS/PS cases evaluated from January 2001 to April 2018 and reviewed maternal/fetal characteristics, procedural details, pregnancy and neonatal outcomes. Data were analyzed using standard descriptive statistics. Results: Of the 84 maternal/fetal dyads in the registry, 58 underwent pulmonary valvuloplasty at a median gestational age of 26.1 (21.9–31.0) weeks. Characteristics of fetuses undergoing FCI varied in terms of tricuspid valve (TV) size, TV regurgitation, and pulmonary valve patency. There were fetal complications in 55% of cases, including 7 deaths and 2 delayed fetal losses. Among those who underwent successful FCI, the absolute measurement of the TV increased by 0.32 (±0.17) mm/week from intervention to birth. Among 60 liveborn with known outcome, there was a higher percentage having a biventricular circulation following successful FCI (87 vs. 43%). Conclusions: Our data suggest a possible benefit to fetal therapy for PAIVS/PS, though rates of technically unsuccessful procedures and procedure-related complications, including fetal loss were substantial. FCI criteria are extremely variable, making direct comparison to nonintervention patients challenging and potentially biased. More uniform FCI criteria for fetuses with PAIVS/PS are needed to avoid unnecessary procedures, expose only fetuses most likely to sustain a benefit, and to enable comparisons to be made with nonintervention patients.
- Published
- 2020
5. Attitudes of clinicians toward cardiac surgery and trisomy 18
- Author
-
Meagan Kaulfus, S. Shahrukh Hashmi, Blair Stevens, Rebecca D. Carter, Victoria J. Miller, Helena M. Gardiner, and Hector Mendez-Figueroa
- Subjects
Adult ,Heart Defects, Congenital ,Male ,Postnatal Care ,medicine.medical_specialty ,Palliative care ,Adolescent ,Attitude of Health Personnel ,Genetic counseling ,MEDLINE ,Psychological intervention ,Young Adult ,medicine ,Humans ,Cardiac Surgical Procedures ,Psychiatry ,Intensive care medicine ,Genetics (clinical) ,Descriptive statistics ,business.industry ,Palliative Care ,Infant, Newborn ,Infant ,Middle Aged ,medicine.disease ,Cardiac surgery ,Female ,Trisomy ,business ,Trisomy 18 Syndrome - Abstract
Trisomy 18 is an autosomal trisomy condition characterized by minor to major birth defects, severe disabilities, and high rates of pre- and postnatal mortality. Interventions for these infants have traditionally been withheld with focus instead on palliative support. The issues and attitudes surrounding corrective surgery of congenital heart defects, which is a birth defect that occurs in approximately 90% of infants with trisomy 18, is of our study's interest as recent literature has indicated that cardiac surgery is being performed and may lead to improved survival compared to palliative care. Thus, our study aimed to describe clinician attitudes toward cardiac surgery and trisomy 18. We surveyed 378 clinicians from multiple specialties, including genetic counselors, involved in the pre- and postnatal care of infants with trisomy 18. Descriptive statistics were performed to describe all clinicians' responses, and a secondary analysis with stratifications by clinician type was also performed. Forty-eight percent (n = 378) of clinicians felt it was appropriate to discuss the option of cardiac surgery. Ethical concerns and insufficient outcome data were the most agreed upon reasons for not offering cardiac surgery. Trisomy 18 not being uniformly lethal and expressed parental wishes were the most agreed upon justifications for offering surgery. Clinicians felt the discussion of the option of cardiac surgery is appropriate, however are hesitant due to ethical concerns and insufficient outcome data. Results from this study aim to promote discussion and collaboration among clinicians to improve consistency in patient care.
- Published
- 2019
6. List of Contributors
- Author
-
Ganesh Acharya, Michael Aertsen, Yalda Afshar, Cande V. Ananth, Michael Ashworth, Patrick Au, Spyros Bakalis, Guillaume Benoist, Colleen G. Bilancia, Caterina M. Bilardo, Louise D. Bryant, Colin R. Butler, Frank Van Calenbergh, Steve N. Caritis, Lyn S. Chitty, Patricia Collins, James Cook, Howard Cuckle, Anna L. David, Luc De Catte, Paolo De Coppi, Elisabeth de Jong-Pleij, Bart De Keersmaecker, Jan Deprest, Roland Devlieger, Guido M. de Wert, Jan E. Dickinson, Mark Dilworth, Wybo J. Dondorp, Caroline E. Dunk, Thomas R. Everett, Jane Fisher, Henry L. Galan, Mythily Ganapathi, Helena M. Gardiner, Cecilia Gotherstrom, Richard Harding, Jenny Hewison, Richard J. Hewitt, Liran Hiersch, Melissa Hill, Sara L. Hillman, An Hindryckx, Stuart B. Hooper, Berthold Huppertz, J. Ciaran Hutchinson, Jon Hyett, Luc Joyeux, Davor Jurkovic, John C. Kingdom, Sylvie Langlois, Lara S. Lemon, Marianne Leruez-Ville, Liesbeth Lewi, Brynn Levy, Y.W. Loke, Enrico Lopriore, George A. Macones, Fergal D. Malone, Anahit Martirosian, Fionnuala McAuliffe, Annie R.A. McDougall, Kenneth J. Moise, Ashley Moffett, Sieglinde M. Müllers, Ran Neiger, John P. Newnham, Sarah G. Obican, Anthony O. Odibo, Dick Oepkes, Pranav P. Pandya, Lawrence D. Platt, Rosalind Pratt, Kuhan Rajah, Rashmi Rao, Jute Richter, Joshua I. Rosenbloom, Francesca Maria Russo, Anthony R. Scialli, Neil J. Sebire, Andrew Sharkey, Susan C. Shelmerdine, Colin Sibley, Saul Snowise, Sylke Steggerda, Emily J. Su, Mary Tang, Arjan B. Te Pas, Alan T. Tita, Fred Ushakov, Ignatia B. Van den Veyver, Jeanine M. van Klink, Raman Venkataramanan, Yves Ville, Magdalena Walkiewicz, Colin Wallis, Lilian Walther-Jallow, Ronald J. Wapner, Magnus Westgren, Scott W. White, Louise C. Wilson, R. Douglas Wilson, Dian Winkelhorst, Paul J.D. Winyard, Christoph Wohlmuth, Karen Wou, Yuval Yaron, Kwok Yin Leung, and Angela Yulia
- Published
- 2020
7. The Heart
- Author
-
Christoph Wohlmuth and Helena M. Gardiner
- Published
- 2020
8. Prenatal Detection-The Real Oxygen of Success?
- Author
-
Helena M. Gardiner
- Subjects
Pregnancy ,medicine.medical_specialty ,Heart Diseases ,business.industry ,Obstetrics ,MEDLINE ,Prenatal diagnosis ,General Medicine ,medicine.disease ,Oxygen ,Prenatal Diagnosis ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Nevada - Published
- 2019
9. In UteroIntervention for Cardiac Disease
- Author
-
Helena M. Gardiner
- Subjects
Pediatrics ,medicine.medical_specialty ,In utero ,business.industry ,Intervention (counseling) ,medicine ,Disease ,business - Published
- 2019
10. Procedural, pregnancy, and short-term outcomes after fetal aortic valvuloplasty
- Author
-
Neil D. Patel, Alberto Galindo, Dick Oepkes, John M. Simpson, Edgar Jaeggi, Ramen H. Chmait, Anita J. Moon-Grady, Aimee K. Armstrong, Ulrike Herberg, Helena M. Gardiner, Jon A Detterich, Frank F. Ing, Shaine A. Morris, Jay D. Pruetz, Stephen Nageotte, and Sofía Grinenco
- Subjects
Balloon Valvuloplasty ,medicine.medical_specialty ,Cardiac Catheterization ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Pericardial effusion ,Risk Assessment ,Severity of Illness Index ,Ultrasonography, Prenatal ,Hypoplastic left heart syndrome ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Hypoplastic Left Heart Syndrome ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Registries ,Fetal Death ,Fetal Therapies ,business.industry ,Gestational age ,General Medicine ,Odds ratio ,Aortic Valve Stenosis ,medicine.disease ,Cannula ,Aortic valvuloplasty ,Surgery ,Europe ,Stenosis ,Treatment Outcome ,North America ,Female ,Cardiology and Cardiovascular Medicine ,business ,Live Birth - Abstract
OBJECTIVES We aimed to evaluate the effect of technical aspects of fetal aortic valvuloplasty (FAV) on procedural risks and pregnancy outcomes. BACKGROUND FAV is performed in cases of severe mid-gestation aortic stenosis with the goal of preventing hypoplastic left heart syndrome (HLHS). METHODS The International Fetal Cardiac Intervention Registry was queried for fetuses who underwent FAV from 2002 to 2018, excluding one high-volume center. RESULTS The 108 fetuses had an attempted cardiac puncture (mean gestational age [GA] 26.1 ± 3.3 weeks). 83.3% of attempted interventions were technically successful (increased forward flow/new aortic insufficiency). The interventional cannula was larger than 19 g in 70.4%. More than one cardiac puncture was performed in 25.0%. Intraprocedural complications occurred in 48.1%, including bradycardia (34.1%), pericardial (22.2%) or pleural effusion (2.7%) requiring drainage, and balloon rupture (5.6%). Death within 48 hr occurred in 16.7% of fetuses. Of the 81 patients born alive, 59 were discharged home, 34 of whom had biventricular circulation. More than one cardiac puncture was associated with higher complication rates (p
- Published
- 2019
11. Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study
- Author
-
Ulrike Herberg, Claudia Pedroza, Julene S. Carvalho, Joanna Dangel, Ian E Averiss, Taisto Sarkola, Gerald Tulzer, Vlasta Fesslova, Hana Jičínská, Mats Mellander, Helena M. Gardiner, Annika Öhman, and Alexander Kovacevic
- Subjects
Pediatrics ,medicine.medical_specialty ,Heart growth ,030204 cardiovascular system & hematology ,Hypoplastic left heart syndrome ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,Survival rate ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Hazard ratio ,Obstetrics and Gynecology ,Gestational age ,Retrospective cohort study ,General Medicine ,Fetal aortic stenosis ,medicine.disease ,3. Good health ,Reproductive Medicine ,Aortic valve stenosis ,Cardiology ,business - Abstract
Objective Fetal aortic stenosis may progress to hypoplastic left heart syndrome. Fetal valvuloplasty (FV) has been proposed to improve left heart hemo-dynamics and maintain biventricular (BV) circulation. The aim of this study was to assess FV efficacy by comparing survival and postnatal circulation between fetuses that underwent FV and those that did not. Methods This was a retrospective multicenter study of fetuses with aortic stenosis that underwent FV between 2005 and 2012, compared with contemporaneously enrolled natural history (NH) cases sharing similar characteristics at presentation but not undergoing FV. Main outcome measures were overall survival, BV-circulation survival and survival after birth. Secondary outcomes were hemodynamic change and left heart growth. A propensity score model was created including 54/67 FV and 60/147 NH fetuses. Analyses were performed using logistic, Cox or linear regression models with inverse probability of treatment weighting (IPTW) restricted to fetuses with a propensity score of 0.14-0.9, to create a final cohort for analysis of 42 FV and 29 NH cases. Results FV was technically successful in 59/67 fetuses at a median age of 26 (21-34) weeks. There were 7/72 10%) procedure-related losses, and 22/53 (42%) FV babies were delivered at < 37 weeks. IPTW demonstrated improved survival of liveborn infants following FV (hazard ratio, 0.38; 95% CI, 0.23-0.64; P = 0.0001), after adjusting for circulation and postnatal surgical center. Similar proportions had BV circulation (36% for the FV cohort and 38% for the NH cohort) and survival was similar between final circulations. Successful FV cases showed improved hemodynamic response and less deterioration of left heart growth compared with NH cases (P
- Published
- 2018
12. Cardiac pathophysiology in twin-twin transfusion syndrome: new insights into its evolution
- Author
-
Kenneth J. Moise, Anthony Johnson, Michael Bebbington, Helena M. Gardiner, Christoph Wohlmuth, Ramesha Papanna, and David S. Boudreaux
- Subjects
Cardiac function curve ,Cardiac output ,medicine.medical_specialty ,Fetus ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,Haemodynamic response ,business.industry ,Obstetrics and Gynecology ,Gestational age ,Hemodynamics ,General Medicine ,030204 cardiovascular system & hematology ,Pathophysiology ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,Internal medicine ,Ventricular pressure ,Cardiology ,medicine ,Radiology, Nuclear Medicine and imaging ,business - Abstract
OBJECTIVES In twin-twin transfusion syndrome (TTTS), unbalanced transfer of vasoactive mediators and fluid from the donor to the recipient cotwin alters their cardiovascular function. The aims of this study were to describe the impact of TTTS on fetal cardiac function in a large cohort of monochorionic-diamniotic (MCDA) pregnancies, and determine the early hemodynamic response to selective fetoscopic laser photocoagulation (SFLP). METHODS Echocardiography was performed in 145 MCDA pregnancies, including 26 uncomplicated MCDA, 61 TTTS Stages I+II and 58 TTTS Stages III+IV pregnancies, prior to SFLP for TTTS. Echocardiographic data after SFLP were available in a subset of 41/119 (34%) TTTS cases at a mean of 1.7 ± 1.9 days. Mitral (MAPSE) and tricuspid (TAPSE) annular systolic excursion, myocardial performance index (MPI), tissue Doppler velocities (E', A', S') and filling pressures (E/E') were measured and transformed into Z-scores. Ventricular pressure was estimated from peak atrioventricular regurgitation velocity. RESULTS Left ventricular hemodynamics of the recipient twin were affected in early TTTS. In all stages of TTTS, left MPI and E/E' of the recipient twin were elevated in comparison to those of the donor (all P
- Published
- 2018
13. Acardiac twin pregnancies part IV: Acardiac onset from unequal embryonic splitting simulated by a fetoplacental resistance model
- Author
-
Peter G. J. Nikkels, Martin J. C. van Gemert, K. Marieke Paarlberg, Helena M. Gardiner, and Jeroen P. H. M. van den Wijngaard
- Subjects
0301 basic medicine ,Embryology ,Fetus ,030219 obstetrics & reproductive medicine ,Health, Toxicology and Mutagenesis ,Gestational age ,Blood volume ,Late onset ,Anatomy ,030105 genetics & heredity ,Biology ,Toxicology ,Hypoxemia ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Acardiac twin ,Placenta ,Pediatrics, Perinatology and Child Health ,medicine ,medicine.symptom ,Perfusion ,Developmental Biology - Abstract
Background Benirschke postulated that acardiac twinning occurs when markedly unequal embryonic splitting combines with arterioarterial (AA) and venovenous placental anastomoses. We tested this hypothesis by model simulations and by comparison of outcomes with 18 “pseudo-” (twin fetus with beating heart but otherwise with clear signs of an acardiac) and 3 “normal” acardiac cases. Methods The smaller/larger cell volume ratio at embryonic splitting becomes the smaller/larger embryonic/fetal blood volume ratio (a). From a, we derived nonpulsating blood pressures using normal values (larger twin) and normal values at an appropriate earlier gestational age (smaller twin). These unequal pressure sources were used in a linear resistance fetoplacental network to calculate umbilical venous diameter ratios. Acardiac onset occurs when the smaller twin has 50% left of its normal, singleton placenta. Comparison with clinical cases approximated a by crown-rump-length-ratio to the 3rd power. Input parameters are a and the AA-radius at 40 weeks. Results Acardiacs can be small or large, can occur early or late, earlier at smaller a and larger AA, with larger umbilical venous diameter ratios at smaller a and smaller AA. Comparison with the 21 clinical cases was good, except for 2. Conclusion Our analysis supports Benirschke's hypothesis. The smaller twin has to share its placental perfusion with the larger twin, which is a novel finding. The AA size is essential for the future of both fetuses but complicates easy understanding of (pseudo-)acardiac clinical presentations. Late acardiac onset occurs infrequently. Using nonpulsating circulations may have caused our extensive predictions of late onset. An improved model requires including hypoxemia in the smaller twin from chronic placental hypoperfusion. Birth Defects Research (Part A), 2016. © 2016 Wiley Periodicals, Inc.
- Published
- 2017
14. Evaluation of an automated fetal myocardial performance index
- Author
-
Neama Meriki, David W. Chang, Simcha Yagel, Jingjing Wang, Alec W. Welsh, Fatima Crispi, Amanda Henry, Edgar Hernandez-Andrade, P. Maheshwari, Stephen J. Redmond, and Helena M. Gardiner
- Subjects
Reproducibility ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,Intraclass correlation ,business.industry ,Image quality ,Obstetrics and Gynecology ,Interobserver reproducibility ,General Medicine ,Repeatability ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Cohen's kappa ,Reproductive Medicine ,Absolute measurement ,Medicine ,Radiology, Nuclear Medicine and imaging ,Myocardial Performance Index ,business ,Nuclear medicine - Abstract
OBJECTIVE To compare automated measurements of the fetal left myocardial performance index (MPI) with manual measurements for absolute value, repeatability and waveform acceptability. METHODS This was a multicenter international online study using images from uncomplicated, morphologically normal singleton pregnancies (16-38 weeks' gestation). Single Doppler ultrasound cardiac cycle images of 25 cases were selected, triplicated and randomized (n = 75). Six senior observers, unaware of the repetition of images, manually calculated MPI for each waveform and the results were compared with automation. Intraobserver repeatability and interobserver reproducibility were assessed using intraclass correlation coefficients (ICCs) and 95% CI. The agreement between each observer's manual MPI measurements and corresponding automated measurements was evaluated using Bland-Altman plots and ICCs with 95% CI. The degree of variation between experts in the classification of fetal MPI waveform quality was assessed using individual cardiac cycle left MPI images previously classified by two authors as 'optimal', 'suboptimal' or 'unacceptable', with 30 images selected for each quality group. Ten images in each category were duplicated and the resulting 120 images were randomized and then classified online by five observers. The kappa statistic (κ) was used to demonstrate interobserver and intraobserver agreement and agreement of classifications by the five observers. RESULTS The automated measurement software returned the same value for any given image, resulting in an ICC of 1.00. Manual measurements had intraobserver repeatability ICC values ranging from 0.69 to 0.97, and the interobserver reproducibility ICC was 0.78. Comparison of automated vs manual MPI absolute measurements for each observer gave ICCs ranging from 0.77 to 0.96. Interobserver image quality classification agreement gave k = 0.69 (P
- Published
- 2016
15. Natural history of 107 cases of fetal aortic stenosis from a European multicenter retrospective study
- Author
-
I. E. Averiss, Ulrike Herberg, Julene S. Carvalho, A. Kovacevic, Joaquim Bartrons, Hana Jičínská, Joanna Dangel, Annika Öhman, Taisto Sarkola, Vlasta Fesslova, Helena M. Gardiner, Gerald Tulzer, and Mats Mellander
- Subjects
Aortic valve ,Aortic arch ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Hypoplastic left heart syndrome ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Internal medicine ,Mitral valve ,medicine ,Radiology, Nuclear Medicine and imaging ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,General Medicine ,Fetal aortic stenosis ,medicine.disease ,3. Good health ,Surgery ,Aortic valvuloplasty ,Stenosis ,medicine.anatomical_structure ,Reproductive Medicine ,Aortic valve stenosis ,cardiovascular system ,Cardiology ,business - Abstract
Objectives: Fetal aortic valvuloplasty (FV) aims to prevent fetal aortic valve stenosis progressing into hypoplastic left heart syndrome (HLHS), which results in postnatal univentricular (UV) circulation. Despite increasing numbers of FVs performed worldwide, the natural history of the disease in fetal life remains poorly defined. The primary aim of this study was to describe the natural history of fetal aortic stenosis, and a secondary aim was to test previously published criteria designed to identify cases of emerging HLHS with the potential for a biventricular (BV) outcome after FV. Methods: From a European multicenter retrospective study of 214 fetuses with aortic stenosis (2005-2012), 107 fetuses in ongoing pregnancies that did not undergo FV were included in this study and their natural history was reported. We examined longitudinal changes in Z-scores of aortic and mitral valve and left ventricular dimensions and documented direction of flow across the foramen ovale and aortic arch, and mitral valve inflow pattern and any gestational changes. Data were used to identify fetuses satisfying the Boston criteria for emerging HLHS and estimate the proportion of these that would have been ideal FV candidates. We applied the threshold score whereby a score of 1 was assigned to fetuses for each Z-score meeting the following criteria: left ventricular length and width > 0; mitral valve diameter -2; aortic valve diameter > -3.5; and pressure gradient across either the mitral or aortic valve > 20 mmHg. We compared the predicted circulation with known survival and final postnatal circulation (BV, UV or conversion from BV to UV). Results: Among the 107 ongoing pregnancies there were eight spontaneous fetal deaths and 99 livebirths. Five were lost to follow-up, five had comfort care and four had mild aortic stenosis not requiring intervention. There was intention-to-treat in these 85 newborns but five died prior to surgery, before circulation could be determined, and thus 80 underwent postnatal procedures with 44 BV, 29 UV and seven BV-to-UV circulatory outcomes.
- Published
- 2016
16. Aortic distensibility as a surrogate for intertwin pulse pressure differences in monochorionic pregnancies with and without twin-twin transfusion syndrome
- Author
-
Michael Bebbington, Ramesha Papanna, Kenneth J. Moise, Frank A. Osei, Helena M. Gardiner, Anthony Johnson, and Christoph Wohlmuth
- Subjects
Cardiac function curve ,medicine.medical_specialty ,Cardiac output ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,Cardiac cycle ,business.industry ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,030204 cardiovascular system & hematology ,Doppler echocardiography ,Pulse pressure ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,Afterload ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Systole ,business - Abstract
OBJECTIVES Twin-twin transfusion syndrome (TTTS) complicates 10-15% of monochorionic diamniotic (MCDA) twin pregnancies. The donor response to hypovolemia allows the transfer of vasoactive mediators to the recipient, causing increased recipient afterload and hypertension. Our objective was to apply a novel speckle-tracking technique to measure the aortic fractional area change (AFAC) during the cardiac cycle in MCDA twins with and without TTTS, and identify intertwin differences in AFAC and parameters of cardiac function. METHODS High-frame rate four-chamber views of the fetal heart, including the mid-thoracic aorta, were collected prospectively in MCDA twin pairs referred to our center between June 2014 and April 2015. Using speckle-tracking software, the endovascular border of the aorta was traced manually during systole, with guidance on cardiac cycle timing by anatomical M-mode. AFAC, defined as the difference between maximum and minimum area divided by minimum area, expressed as a percentage, was calculated offline and averaged over three cardiac cycles. Tissue Doppler and displacement were used to measure long-axis cardiac function. Intra- and interclass correlation coefficients were used to test observer variability. RESULTS Fifty-one MCDA twin pregnancies were included, comprising uncomplicated MCDA (n = 14), TTTS Stages 1/2 (n = 21) and TTTS Stages 3/4 (n = 16). Median gestational age was 20.4 (range, 16.2-27.5) weeks. Mean ± SD heart rate was 142.6 ± 7.2 bpm with no significant intertwin pair differences. AFAC was significantly higher in recipients than in donors of TTTS pairs (Stages 1/2: 72.3 ± 29.9% vs 43.7 ± 19.3%, P
- Published
- 2016
17. Acardiac twin pregnancies part II: Fetal risk of chorangioma and sacrococcygeal teratoma predicted by pump/acardiac umbilical vein diameters
- Author
-
Peter G. J. Nikkels, Jeroen P. H. M. van den Wijngaard, Martin J. C. van Gemert, Helena M. Gardiner, and K. Marieke Paarlberg
- Subjects
0301 basic medicine ,Embryology ,medicine.medical_specialty ,Cardiac output ,030105 genetics & heredity ,Inferior vena cava ,03 medical and health sciences ,0302 clinical medicine ,Superior vena cava ,Internal medicine ,medicine ,Vein ,Fetus ,030219 obstetrics & reproductive medicine ,business.industry ,Chorangioma ,General Medicine ,medicine.disease ,Surgery ,medicine.anatomical_structure ,medicine.vein ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Cardiology ,Fetoplacental Circulation ,Sacrococcygeal teratoma ,business ,Developmental Biology - Abstract
Background: We recently published pump/acardiac umbilical venous diameter (UVD) ratios, representing the pump twin's excess cardiac output fraction, of 27 acardiac twin pregnancies. There was a clear separation between the 17 pump twins that had life-threatening complications and the 10 that did not. The hypothesis of this study is that placental chorangioma and sacrococcygeal teratoma (SCT), tumors whose perfusion also causes high-output complications, have the same fetal outcome as pump twins when perfusion of the tumor requires the same excess cardiac output fraction. Methods: We compared the three fetoplacental circulations. Fetuses with a placental chorangioma and acardiac twin pregnancies both have their feeding artery and draining vein located at the placental cord insertion. In contrast, SCT lacks a prescribed feeding artery and draining vein. We, therefore, had to modify our model to assume that the diameter of the hypothetical draining vein is related to the flow difference between inferior vena cava and superior vena cava. The latter flow has been estimated sonographically and is the same as the inferior vena cava flow in the absence of an SCT. Furthermore, a simple modification accounts for the different location of the tumor with respect to the placental cord insertion. Results: We propose to apply the clinical pump/acardiac UVD ratios to pregnancies complicated by placental chorangiomas and the modified pump/acardiac UVD ratios for SCT. Conclusion: Risk prediction of these rare fetal tumors may be possible based on application of data on excess cardiac output fractions from pump/acardiac UVD ratios and will require future clinical validation.
- Published
- 2016
18. Prenatal counseling for neurodevelopmental delay in congenital heart disease: results of a worldwide survey of experts' attitudes advise caution
- Author
-
Julene S. Carvalho, Josep M. Martinez, Gustavo Malinger, Asma Khalil, Dario Paladini, Jack Rychik, Helena M. Gardiner, Zarko Alfirevic, Paladini, Dario, Alfirevic, Z., Carvalho, J. S., Khalil, A., Malinger, G., Martinez, J. M., Rychik, J., and Gardiner, H.
- Subjects
Heart Defects, Congenital ,Pediatrics ,medicine.medical_specialty ,Heart disease ,Prenatal counseling ,Genetic counseling ,Genetic Counseling ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Surveys and Questionnaires ,030225 pediatrics ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Practice Patterns, Physicians' ,Fetus ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,Abortion, Induced ,General Medicine ,medicine.disease ,Reproductive Medicine ,Neurodevelopmental Disorders ,Neurodevelopmental delay ,Female ,business - Published
- 2016
19. Fetal cardiovascular hemodynamics in twin-twin transfusion syndrome
- Author
-
Kurt Hecher, Christoph Wohlmuth, Helena M. Gardiner, and W. Diehl
- Subjects
medicine.medical_specialty ,Diastole ,Hemodynamics ,Regurgitation (circulation) ,Anastomosis ,030204 cardiovascular system & hematology ,Ultrasonography, Prenatal ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Internal medicine ,Hypovolemia ,medicine ,Humans ,Fetus ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Fetofetal Transfusion ,General Medicine ,medicine.disease ,Cardiovascular physiology ,Stenosis ,Atresia ,Cardiology ,Female ,Monochorionic twins ,medicine.symptom ,business ,Hypervolemia - Abstract
Twin-twin transfusion syndrome (TTTS) complicates 10-15% of monochorionic-diamniotic (MCDA) pregnancies. It originates from unbalanced transfer of fluid and vasoactive mediators from one twin to its co-twin via placental anastomoses. This results in hypovolemia in the donor and hypervolemia and vasoconstriction in the recipient twin. Consequently, the recipient demonstrates cardiovascular alterations including atrioventricular valve regurgitation, diastolic dysfunction, and pulmonary stenosis/atresia that do not necessarily correlate with Quintero-stages. Selective fetoscopic laser photocoagulation of placental vascular anastomoses disrupts the underlying pathophysiology and usually improves cardiovascular function in the recipient with normalization of systolic and diastolic function within weeks after treatment. Postnatal studies have demonstrated early decreased arterial distensibility in ex-donor twins, but 10-year follow up is encouraging with survivors showing normal cardiovascular function after TTTS. However, prediction and appropriate early management of TTTS remain poor. Assessment of the cardiovascular system provides additional insight into the pathophysiology and severity of TTTS and may permit more targeted early surveillance of MCDA pregnancies in future. It should form an integral part of the diagnostic algorithm.
- Published
- 2016
20. Clinical Monitoring of Sacrococcygeal Teratoma
- Author
-
Eric P. Bergh, Kenneth J. Moise, Martin J. C. van Gemert, Ian Averiss, Iris Wohlmuth-Wieser, Helena M. Gardiner, Jeroen P. H. M. van den Wijngaard, Christoph Wohlmuth, Anthony Johnson, Cynthia S. Bell, Academic Medical Center, and Biomedical Engineering and Physics
- Subjects
Embryology ,medicine.medical_specialty ,Polyhydramnios ,Cardiac output ,Adverse outcomes ,Term Birth ,medicine.medical_treatment ,Clinical Decision-Making ,Gestational Age ,Risk Assessment ,Ultrasonography, Prenatal ,Decision Support Techniques ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Pregnancy ,Risk Factors ,Gestational Weeks ,Fetal hydrops ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Fetal Monitoring ,Fetal Death ,Fetus ,Fetal Therapies ,030219 obstetrics & reproductive medicine ,Spinal Neoplasms ,business.industry ,Fetal surgery ,Sacrococcygeal Region ,Patient Selection ,Models, Cardiovascular ,Teratoma ,Obstetrics and Gynecology ,Reproducibility of Results ,Ultrasonography, Doppler ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,Regional Blood Flow ,Pediatrics, Perinatology and Child Health ,Premature Birth ,Female ,business ,Sacrococcygeal teratoma - Abstract
Background: Sacrococcygeal teratomas (SCT) are often highly vascularized and may result in high-output cardiac failure, polyhydramnios, fetal hydrops, and demise. Delivery is guided by the SCT to fetus volume ratio (SCTratio), SCT growth rate, and cardiac output indexed for weight (CCOi). Methods: We compared measurements and outcome in 12 consecutive fetuses referred with SCT. Adverse outcomes were: fetal surgery, delivery < 32 gestational weeks or neonatal demise. Only SCTratio and CCOi were used to manage the cases. SCT vascularization index (VI%) was derived from the 3D virtual organ computer-aided analysis (VOCAL) software. The SCTModel (modified from acardiac twins) calculated a hypothetical SCT draining vein size and derived a risk line, using diameters of the superior and inferior vena cava, the azygous and umbilical veins. VI% and a model of systemic and umbilical venous volumes (SCTModel) were tested as indicators for outcome in SCT. Results: Fetuses were monitored from 20.1 to 36.4 gestational weeks and 5/12 had adverse outcomes: 1 had successful open fetal surgery at 23.8 weeks and delivered at term, 4 delivered at < 32 weeks with 3/4 having neonatal demise between 25 and 29 weeks. VI% was significantly higher in cases with adverse outcomes (mean 10.3 [8.9–11.6] vs. 4.4 [3.4–5.3], p < 0.0001). The additional fraction of the fetal cardiac output required to perfuse the SCT-draining vein (XSCO%) (p = 0.46), SCTratio (p = 0.08), and CCOi (p = 0.64) were not significant. All cases with adverse outcome had VI% > 8%. The SCTModel risk line predicted nonadverse outcomes well but lacked data in 2/5 cases with adverse outcomes. Conclusions: VI% is a significant indicator of SCT cases with adverse outcomes and combined with SCTratio may guide timing of delivery better than current measures.
- Published
- 2018
21. Home Monitoring for Fetal Heart Rhythm During Anti-Ro Pregnancies
- Author
-
Katherine Jacobs, Peter Van Eerden, Elena Sinkovskaya, Marie Josee Raboisson, Aimee Lam, Sven Erik Sonesson, Lisa K. Hornberger, Anita Szwast, Helena M. Gardiner, Mary T. Donofrio, Edgar Jaeggi, Alexander M. Kaizer, Anita J. Moon-Grady, Anita Krishnan, Grace Freire, Bettina F. Cuneo, Stéphanie Levasseur, D. Woodrow Benson, Alfred Abuhamad, Lisa Howley, and Bhawna Arya
- Subjects
Adult ,medicine.medical_specialty ,Cardiotocography ,Gestational Age ,Home Care Services, Hospital-Based ,030204 cardiovascular system & hematology ,Time-to-Treatment ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Prenatal Diagnosis ,medicine ,Humans ,Lupus Erythematosus, Systemic ,Prospective Studies ,Atrioventricular Block ,Fetus ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,Cardiac cycle ,Obstetrics ,business.industry ,Pregnancy Outcome ,Heart Rate, Fetal ,medicine.disease ,Fetal Arrhythmia ,Pregnancy Complications ,Fetal Diseases ,Antibodies, Antinuclear ,cardiovascular system ,Gestation ,Observational study ,Female ,Cardiology and Cardiovascular Medicine ,business ,Fetal echocardiography ,Atrioventricular block ,Anti-SSA/Ro autoantibodies - Abstract
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.Outcome of anti-Ro pregnancies was surveilled with twice-daily home fetal heart rate and rhythm monitoring (FHRM) and surveillance echocardiography.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.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 attention12 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.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).
- Published
- 2018
22. Long-term outcomes for monochorionic twins after laser therapy in twin-to-twin transfusion syndrome
- Author
-
Kurt Hecher, Anke Diemert, Peter Bartmann, and Helena M. Gardiner
- Subjects
medicine.medical_specialty ,Time Factors ,Heart Diseases ,medicine.medical_treatment ,Renal function ,Anastomosis ,Twin-to-twin transfusion syndrome ,Cardiovascular System ,Nervous System ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Internal medicine ,Developmental and Educational Psychology ,medicine ,Ventricular outflow tract ,Humans ,030212 general & internal medicine ,Fetus ,030219 obstetrics & reproductive medicine ,business.industry ,Fetofetal Transfusion ,medicine.disease ,Treatment Outcome ,Pediatrics, Perinatology and Child Health ,Cardiology ,Female ,Monochorionic twins ,Laser Therapy ,business ,Laser coagulation ,Forecasting - Abstract
Summary Twin-to-twin transfusion syndrome typically occurs in the second trimester in 10–15% of monochorionic twin pregnancies. Vascular anastomoses of monochorionic placentae are the underlying cause of the development of the syndrome. If a blood flow imbalance occurs, one fetus becomes the so-called donor twin and the other the recipient. If untreated, perinatal mortality is 80–90%. Fetoscopic laser coagulation of the vascular anastomoses destroys the cause of the syndrome and leads to dual twin survival rates of around 70% and more than 90% of pregnancies with at least one survivor. However, unequal placental sharing, intrauterine death, and severe prematurity are still limiting factors for further improvement of survival rates and decreases in long-term morbidity. Prematurity and neurodevelopmental impairment affect the donor and recipient twins, whereas cardiovascular failure and obstruction of the right ventricular outflow tract are typical complications of recipients, which can lead to long-term morbidity. In this Review, we summarise the literature on follow-up data for survivors of twin-to-twin-transfusion syndrome after laser therapy, including neurodevelopmental outcomes, cardiovascular outcomes, growth, renal function, and ischaemic events, as well as the potential effects of intrauterine programming on later life.
- Published
- 2018
23. Advances in fetal echocardiography
- Author
-
Helena M. Gardiner
- Subjects
Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Biomedical Research ,Delayed Diagnosis ,First year of life ,Prenatal diagnosis ,030204 cardiovascular system & hematology ,Ultrasonography, Prenatal ,03 medical and health sciences ,0302 clinical medicine ,Imaging, Three-Dimensional ,Pregnancy ,medicine ,Humans ,Diagnostic Errors ,Intensive care medicine ,Referral and Consultation ,Fetus ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Perinatal morbidity ,Pregnancy Trimester, First ,Increased risk ,Echocardiography ,Technical innovation ,Pregnancy Trimester, Second ,Pediatrics, Perinatology and Child Health ,Practice Guidelines as Topic ,Female ,Clinical Competence ,Level of care ,business ,Fetal echocardiography - Abstract
The development of fetal echocardiography and success in prenatal cardiac screening programs over the past 30 years has been driven by technical innovation and influenced by the different approaches of the various specialties practicing it. Screening for congenital heart defects no longer focuses on examining a limited number of pregnant women thought to be at increased risk, but instead forms an integrated part of a high-quality anatomical ultrasound performed in the second trimester using the ‘five-transverse view’ protocol. A prenatal diagnosis is feasible in almost all cardiac lesions and the advantages to parents and to health professionals are well recognized. Prenatal evaluation can usually determine the level of care required at delivery, thereby reducing perinatal morbidity. However, only half of the babies undergoing surgery within the first year of life have a prenatal detection, and practical training programs to support and provide feedback to sonographers remain essential for continued improvement.
- Published
- 2017
24. Fetal Cardiac Arrhythmias
- Author
-
Helena M. Gardiner, Stephen C. Robson, Bernard Gonik, Philip J. Steer, Carl P. Weiner, Christoph Wohlmuth, and David James
- Subjects
medicine.medical_specialty ,Fetus ,business.industry ,Internal medicine ,Cardiology ,Medicine ,business - Published
- 2017
25. The Influence of Blood Pressure on Fetal Aortic Distensibility: An Animal Validation Study
- Author
-
Christoph Wohlmuth, Kenneth J. Moise, Ramesha Papanna, Ciprian P. Gheorghe, Yisel Morales, Helena M. Gardiner, and Anthony Johnson
- Subjects
Embryology ,medicine.medical_specialty ,Diastole ,Blood Pressure ,Femoral artery ,Distension ,Ultrasonography, Prenatal ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine.artery ,Internal medicine ,Jugular vein ,Heart rate ,medicine ,Thoracic aorta ,Animals ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Aorta ,030219 obstetrics & reproductive medicine ,Sheep ,Cardiac cycle ,business.industry ,Obstetrics and Gynecology ,General Medicine ,Blood pressure ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Cardiology ,Female ,business - Abstract
Background/Aims: Aortic distension waveforms describe the change in diameter or cross-sectional area over the cardiac cycle. We aimed to validate the association of aortic fractional area change (AFAC) with blood pressure (BP) in a fetal lamb model. Methods: Four pregnant ewes underwent open fetal surgery under general anesthesia at 107-120 gestational days. A 4-Fr catheter was introduced into the fetal femoral artery and vein, or the carotid artery and jugular vein. The thoracic aorta was imaged using real-time ultrasound; AFAC was calculated using offline speckle tracking software. Measurements of invasive BP and AFAC were obtained simultaneously and averaged over 10 cardiac cycles. BP was increased by norepinephrine infusion and the association of aortic distensibility with BP was assessed. Results: Baseline measurements were obtained from 4 lambs, and changes in aortic distensibility with increasing BP were recorded from 3 of them. A positive correlation was found between AFAC and systolic BP (r = 0.692, p = 0.001), diastolic BP (r = 0.647, p = 0.004), mean BP (r = 0.692, p = 0.001), and BP amplitude (r = 0.558, p = 0.016) controlled for heart rate. No association was found between BP and maximum or minimum aortic area. Conclusion: AFAC provides a quantifiable measure of aortic distensibility and correlates with systolic BP, diastolic BP, mean BP, and BP amplitude in a fetal lamb model.
- Published
- 2017
26. Unexpected resolution of first-trimester fetal valve stenosis: consequence of developmental remodeling?
- Author
-
Siew Yen Ho and Helena M. Gardiner
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Technology ,INTACT VENTRICULAR SEPTUM ,Prenatal diagnosis ,030204 cardiovascular system & hematology ,03 medical and health sciences ,PULMONARY-ATRESIA ,0302 clinical medicine ,Pregnancy ,Internal medicine ,Prenatal Diagnosis ,medicine ,1114 Paediatrics And Reproductive Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Obstetrics & Reproductive Medicine ,Fetus ,030219 obstetrics & reproductive medicine ,Science & Technology ,Radiological and Ultrasound Technology ,business.industry ,Radiology, Nuclear Medicine & Medical Imaging ,Valve stenosis ,Infant, Newborn ,Pregnancy Outcome ,Obstetrics and Gynecology ,Obstetrics & Gynecology ,General Medicine ,Acoustics ,Aortic Valve Stenosis ,medicine.disease ,Infant newborn ,First trimester ,Pregnancy Trimester, First ,Reproductive Medicine ,Aortic valve stenosis ,Cardiology ,Female ,Pulmonary atresia ,business ,Life Sciences & Biomedicine - Published
- 2017
27. Foetal cardiac function: assessing new technologies
- Author
-
Helena M. Gardiner
- Subjects
Cardiac function curve ,medicine.medical_specialty ,business.industry ,Emerging technologies ,Foetal heart ,General Medicine ,Echocardiography, Doppler ,Ultrasonography, Prenatal ,Foetal echocardiography ,Fetal Heart ,Echocardiography ,Pregnancy ,Pediatrics, Perinatology and Child Health ,Humans ,Medicine ,Female ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,reproductive and urinary physiology - Abstract
Assessment of foetal cardiac function is more challenging than in the adult, in whom emerging technologies are tested. The postnatal cardio-respiratory interaction is replaced by the cardio-placental circulation and impedance of the brain, and distal vascular beds play an important role in modulating flow to enable its redistribution in the foetal body. Prenatal specialists, comprising obstetricians and cardiologists, have tested a variety of traditional methodologies, as well as non-Doppler offline ultrasound methods in the foetus. This article reviews the development of techniques, outlines their use, and draws attention to pitfalls in adapting technologies validated in the adult heart to the small, fast beating, remote, and largely ungated foetal heart.
- Published
- 2014
28. The fetal three-vessel and tracheal view revisited
- Author
-
Helena M. Gardiner and Rabih Chaoui
- Subjects
Male ,Aortic arch ,Double aortic arch ,Heart Diseases ,Coronary Vessel Anomalies ,Ultrasonography, Prenatal ,Fetal Development ,Fetal Heart ,Pregnancy ,Superior vena cava ,medicine.artery ,medicine ,Humans ,Tetralogy of Fallot ,Arterial trunk ,medicine.diagnostic_test ,business.industry ,Models, Cardiovascular ,Anatomy ,medicine.disease ,Coronary Vessels ,Trachea ,Stenosis ,Great arteries ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Female ,business ,Fetal echocardiography - Abstract
The routine use of four-chamber screening of the fetal heart was pioneered in the early 1980s and has been shown to detect reliably mainly univentricular hearts in the fetus. Many conotruncal anomalies and ductal-dependent lesions may, however, not be detected with the four-chamber view alone and additional planes are needed. The three-vessel and tracheal (3VT) view is a transverse plane in the upper mediastinum demonstrating simultaneously the course and the connection of both the aortic and ductal arches, their relationship to the trachea and the visualization of the superior vena cava. The purpose of the article is to review the two-dimensional anatomy of this plane and the contribution of colour Doppler and to present a checklist to be achieved on screening ultrasound. Typical suspicions include the detection of abnormal vessel number, abnormal vessel size, abnormal course and alignment and abnormal colour Doppler pattern. Anomalies such as pulmonary and aortic stenosis and atresia, aortic coarctation, interrupted arch, tetralogy of Fallot, common arterial trunk, transposition of the great arteries, right aortic arch, double aortic arch, aberrant right subclavian artery, left superior vena cava are some of the anomalies showing an abnormal 3VT image. Recent studies on the comprehensive evaluation of the 3VT view and adjacent planes have shown the potential of visualizing the thymus and the left brachiocephalic vein during fetal echocardiography and in detecting additional rare conditions. National and international societies are increasingly recommending the use of this plane during routine ultrasound in order to improve prenatal detection rates of critical cardiac defects.
- Published
- 2013
29. Journal Editorial Board
- Author
-
Stuart Campbell, Sarah Hatcher, Vered Eisenberg, Catherine Garel, Emmanuel Bujold, Stefano Guerriero, Christoph Brezinka, Mark Kilby, Lindsey D. Allan, Greggory Devore, Lisa K. Hornberger, Helena M. Gardiner, Hans Peter Dietz, and Ranjit Akolekar
- Subjects
medicine.medical_specialty ,Reproductive Medicine ,Radiological and Ultrasound Technology ,Obstetrics ,media_common.quotation_subject ,medicine ,Obstetrics and Gynecology ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Art ,Medical science ,media_common - Published
- 2018
30. OC18.07: Reduced ventricular strain initiates cardiovascular compromise in monochorionic pregnancies
- Author
-
Blair Stevens, I. Averiss, Ramesha Papanna, A. Agarwal, Christoph Wohlmuth, Roopali Donepudi, Helena M. Gardiner, Anthony Johnson, and Kenneth J. Moise
- Subjects
medicine.medical_specialty ,Reproductive Medicine ,Radiological and Ultrasound Technology ,Strain (chemistry) ,business.industry ,Internal medicine ,Cardiology ,medicine ,Obstetrics and Gynecology ,Radiology, Nuclear Medicine and imaging ,General Medicine ,business - Published
- 2018
31. OC03.07: Clinical monitoring of sacrococcygeal teratoma using vascularisation index and modelling venous return
- Author
-
Iris Wohlmuth-Wieser, Kenneth J. Moise, E. Berg, Christoph Wohlmuth, Helena M. Gardiner, M. J. C. Van Gemert, I. Averiss, J.P.H.M. van den Wijngaard, and Anthony Johnson
- Subjects
medicine.medical_specialty ,Index (economics) ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Reproductive Medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Sacrococcygeal teratoma ,Venous return curve - Published
- 2018
32. The Cost-Effectiveness of Prenatal Detection for Congenital Heart Disease Using Telemedicine Screening
- Author
-
Hema Mistry and Helena M. Gardiner
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Pregnancy ,Telemedicine ,Cost–benefit analysis ,Heart disease ,business.industry ,Cost effectiveness ,Cost-Benefit Analysis ,MEDLINE ,Reproducibility of Results ,Health Informatics ,medicine.disease ,United Kingdom ,Health services ,Prenatal Diagnosis ,Family medicine ,Humans ,Medicine ,Female ,business ,Intensive care medicine ,Decision model - Abstract
We estimated the longer-term cost-effectiveness of using telemedicine screening for prenatal detection of congenital heart disease (CHD). One hospital in south-east England with a telemedicine service was connected to a fetal cardiology unit in London. A UK health service perspective was adopted. Evidence on costs and outcomes for standard-risk pregnant women during the antenatal period was based on patient-level data. Extrapolation beyond the end of the study (just after delivery) was carried out for the lifetime of children born with and without CHD. Expert opinion and data from published sources was used to populate a decision model. Future costs and benefits were discounted. The main outcome was quality-adjusted life years (QALYs) and results were expressed as cost per QALY gained. Various one-way sensitivity analyses were conducted. The model showed that offering telemedicine screening by specialists to all standard-risk pregnant women was the dominant strategy (i.e. cheaper and more effective). The sensitivity analyses found that the model was robust, and that telemedicine remained the most cost-effective strategy. The study showed that it would be cost-effective to provide telemedicine examinations as part of an antenatal screening programme for all standard-risk women.
- Published
- 2013
33. A Womb With a View
- Author
-
Helena M. Gardiner
- Subjects
medicine.medical_specialty ,High prevalence ,business.industry ,Ultrasound ,Gestational age ,Lumen (anatomy) ,Disease ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,Aortic wall ,Fetal Development ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Small for gestational age ,Radiology, Nuclear Medicine and imaging ,Abnormal Finding ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Measurement of carotid wall thickness is a research tool that has been used to risk-stratify adults with cardiovascular disease,1 but its clinical role is debatable according to the current American Heart Association guidelines.2 However, an increased aortic wall thickness has been described in individuals born small for gestational age (SGA) in early childhood, implying that they may be at risk for later cardiovascular events3 and more latterly increased intima-media thickness (IMT) reported in smaller vessels in these children. These findings are in support of the developmental origins hypothesis, linking an adverse intrauterine environment to the development of later disease. See Article by Olander et al The article by Olander et al4 in this issue of Circulation: Cardiovascular Imaging has used higher frequency ultrasound than previously described (between 35 and 55 Hz) to image the vascular walls of neonates and reached different conclusions, finding no evidence of increased IMT or intima-media adventitial thickness (IMAT) in babies born SGA. This raises the question whether IMT or IMAT has been reliably characterized in small babies using lower frequency ultrasound, particularly as an abnormal finding may have resulted in increased surveillance in childhood or perhaps the offer of early preventative treatment. In this article, the authors have imaged the carotid, brachial, and femoral arteries and report vessel diameters, IMT, and IMAT in 3 groups of babies below 1 week of age: appropriate, small, and large for gestational age. They calculated carotid wall stress and examined the association of measurements with sex, gestational age, and a variety of ratios combining somatic and vessel parameters. They describe an association between lumen diameters and carotid wall stress and body size and a weaker association of these with gestational age and male sex. In spite of the high prevalence of maternal disease in the …
- Published
- 2016
34. Acardiac twin pregnancies part IV: Acardiac onset from unequal embryonic splitting simulated by a fetoplacental resistance model
- Author
-
Martin J C van, Gemert, Jeroen P H M van den, Wijngaard, K Marieke, Paarlberg, Helena M, Gardiner, and Peter G J, Nikkels
- Subjects
Heart Defects, Congenital ,Umbilical Veins ,Fetus ,Pregnancy ,Placenta ,Diseases in Twins ,Pregnancy, Twin ,Humans ,Computer Simulation ,Female ,Fetofetal Transfusion ,Twins, Monozygotic ,Twins, Conjoined - Abstract
Benirschke postulated that acardiac twinning occurs when markedly unequal embryonic splitting combines with arterioarterial (AA) and venovenous placental anastomoses. We tested this hypothesis by model simulations and by comparison of outcomes with 18 "pseudo-" (twin fetus with beating heart but otherwise with clear signs of an acardiac) and 3 "normal" acardiac cases.The smaller/larger cell volume ratio at embryonic splitting becomes the smaller/larger embryonic/fetal blood volume ratio (a). From a, we derived nonpulsating blood pressures using normal values (larger twin) and normal values at an appropriate earlier gestational age (smaller twin). These unequal pressure sources were used in a linear resistance fetoplacental network to calculate umbilical venous diameter ratios. Acardiac onset occurs when the smaller twin has 50% left of its normal, singleton placenta. Comparison with clinical cases approximated a by crown-rump-length-ratio to the 3rd power. Input parameters are a and the AA-radius at 40 weeks.Acardiacs can be small or large, can occur early or late, earlier at smaller a and larger AA, with larger umbilical venous diameter ratios at smaller a and smaller AA. Comparison with the 21 clinical cases was good, except for 2.Our analysis supports Benirschke's hypothesis. The smaller twin has to share its placental perfusion with the larger twin, which is a novel finding. The AA size is essential for the future of both fetuses but complicates easy understanding of (pseudo-)acardiac clinical presentations. Late acardiac onset occurs infrequently. Using nonpulsating circulations may have caused our extensive predictions of late onset. An improved model requires including hypoxemia in the smaller twin from chronic placental hypoperfusion. Birth Defects Research 109:211-223, 2017. © 2016 Wiley Periodicals, Inc.
- Published
- 2016
35. Acardiac twin pregnancies part II: Fetal risk of chorangioma and sacrococcygeal teratoma predicted by pump/acardiac umbilical vein diameters
- Author
-
Martin J C, van Gemert, Peter G J, Nikkels, K Marieke, Paarlberg, Jeroen P H M, van den Wijngaard, and Helena M, Gardiner
- Subjects
Fetal Diseases ,Umbilical Veins ,Pregnancy ,Sacrococcygeal Region ,Pregnancy, Twin ,Teratoma ,Humans ,Female ,Organ Size ,Hemangioma - Abstract
We recently published pump/acardiac umbilical venous diameter (UVD) ratios, representing the pump twin's excess cardiac output fraction, of 27 acardiac twin pregnancies. There was a clear separation between the 17 pump twins that had life-threatening complications and the 10 that did not. The hypothesis of this study is that placental chorangioma and sacrococcygeal teratoma (SCT), tumors whose perfusion also causes high-output complications, have the same fetal outcome as pump twins when perfusion of the tumor requires the same excess cardiac output fraction.We compared the three fetoplacental circulations. Fetuses with a placental chorangioma and acardiac twin pregnancies both have their feeding artery and draining vein located at the placental cord insertion. In contrast, SCT lacks a prescribed feeding artery and draining vein. We, therefore, had to modify our model to assume that the diameter of the hypothetical draining vein is related to the flow difference between inferior vena cava and superior vena cava. The latter flow has been estimated sonographically and is the same as the inferior vena cava flow in the absence of an SCT. Furthermore, a simple modification accounts for the different location of the tumor with respect to the placental cord insertion.We propose to apply the clinical pump/acardiac UVD ratios to pregnancies complicated by placental chorangiomas and the modified pump/acardiac UVD ratios for SCT.Risk prediction of these rare fetal tumors may be possible based on application of data on excess cardiac output fractions from pump/acardiac UVD ratios and will require future clinical validation. Birth Defects Research (Part A) 106:733-738, 2016. © 2016 Wiley Periodicals, Inc.
- Published
- 2016
36. Fetal Cardiology
- Author
-
Frcp, Frcpch, Dch, and Helena M. Gardiner
- Subjects
medicine.medical_specialty ,Fetus ,business.industry ,Internal medicine ,Cardiology ,medicine ,business - Published
- 2012
37. Total anomalous pulmonary venous connection: impact of prenatal diagnosis
- Author
-
Steven A. Webber, Anna N. Seale, A. Tometzki, Julene S. Carvalho, Mats Mellander, Piers E.F. Daubeney, M. Roughton, Helena M. Gardiner, John M. Simpson, and O. Uzun
- Subjects
Pediatrics ,medicine.medical_specialty ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Pleural effusion ,Obstetrics and Gynecology ,Gestational age ,Prenatal diagnosis ,Retrospective cohort study ,General Medicine ,medicine.disease ,Venous Obstruction ,Reproductive Medicine ,Scimitar syndrome ,medicine ,Radiology, Nuclear Medicine and imaging ,Total anomalous pulmonary venous connection ,business ,Fetal echocardiography - Abstract
Objectives To investigate whether prenatal screening is effective in the detection of total anomalous pulmonary venous connection (TAPVC) and to identify common prenatal features. Methods This was a retrospective collaborative study involving 19 pediatric cardiac centers in the UK, Ireland and Sweden. Cases with TAPVC born between January 1, 1998 and December 31, 2004, and prenatally diagnosed cases whose estimated dates of delivery were within this time frame, were identified. Cases with functionally univentricular circulation or atrial isomerism were excluded. All available data and stored images were reviewed. Results Four-hundred and twenty-four cases with TAPVC were identified prenatally or postnatally, of whom eight (1.9%) had a prenatal diagnosis of TAPVC. Median gestational age at fetal diagnosis was 26 + 6 (range, 22 + 4t o 32+ 0) weeks. Six further fetuses with TAPVC had an abnormality diagnosed on prenatal ultrasound, but not the TAPVC. This included other congenital heart defects (four cases) and isolated pleural effusion (two cases). Seventeen (4.0%) of the 422 liveborn infants had a first-degree relative with congenital heart disease; and six of 17 had a sibling with TAPVC. Two died in utero .O f the liveborn infants diagnosed prenatally with TAPVC, none required urgent intervention for pulmonary venous obstruction and all were alive and well at a median of 2.3 (range, 1.0–7.0) years after surgical repair. Conclusion Prenatal diagnosis of TAPVC is infrequent using current screening methods. Where there is a family history of TAPVC, specialized fetal echocardiography at 20 and 28 weeks’ gestation may be indicated. Copyright 2012 ISUOG. Published by John Wiley & Sons, Ltd.
- Published
- 2012
38. Sonographic predictors of surgery in fetal coarctation of the aorta
- Author
-
Shalini Santhakumaran, Hana Jičínská, P. Aparicio, Helena M. Gardiner, V. Jowett, and Anna N. Seale
- Subjects
medicine.medical_specialty ,Pregnancy ,Fetus ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Coarctation of the aorta ,Obstetrics and Gynecology ,Gestational age ,Retrospective cohort study ,General Medicine ,Odds ratio ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,Predictive value of tests ,medicine ,Radiology, Nuclear Medicine and imaging ,business ,Prospective cohort study - Abstract
Objectives Isolated fetal coarctation of the aorta (CoA) has high false-positive diagnostic rates by cardiologists in tertiary centers. Isthmal diameter Z-scores (I), ratio of isthmus to duct diameters (I:D), and visualization of CoA shelf (Shelf) and isthmal flow disturbance (Flow) distinguish hypoplastic from normal aortic arches in retrospective studies, but their ability to predict a need for perinatal surgery is unknown. The aim of this study was to determine whether these four sonographic features could differentiate prenatally cases which would require neonatal surgery in a prospective cohort diagnosed with CoA by a cardiologist. Methods From 83 referrals with cardiac disproportion (January 2006 to August 2010), we identified 37 consecutive fetuses diagnosed with CoA. Measurements of I and I:D were made and the presence of Shelf or Flow recorded. Sensitivity, specificity and areas under receiver–operating characteristics curves, using previously reported limits of I < − 2 and I:D < 0.74, as well as Shelf and Flow were compared at first and final scan. Associations between surgery and predictors were compared using multivariable logistic regression and changes in measurements using ANCOVA. Results Among the 37 fetuses, 30 (81.1%) required surgery and two with an initial diagnosis of CoA were revised to normal following isthmal growth, giving an 86% diagnostic accuracy at term. The median age at first scan was 22.4 (range. 16.6–7.0) weeks and the median number of scans per fetus was three (range, one to five). I < − 2 at final scan was the most powerful predictor (odds ratio, 3.6 (95% CI, 0.47–27.3)). Shelf was identified in 66% and Flow in 50% of fetuses with CoA. Conclusion Incorporation of these four sonographic parameters in the assessment of fetuses with suspected CoA at a tertiary center resulted in better diagnostic precision regarding which cases would require neonatal surgery than has been reported previously. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
- Published
- 2012
39. Comparison of ex-vivo high-resolution episcopic microscopy with in-vivo four-dimensional high-resolution transvaginal sonography of the first-trimester fetal heart
- Author
-
Timothy J. Mohun, H. Matsui, Helena M. Gardiner, L. Gindes, Siew Yen Ho, and Reuwen Achiron
- Subjects
Heart Ventricles ,Ultrasonography, Prenatal ,Fetal Heart ,Pregnancy ,In vivo ,Microscopy ,Image Processing, Computer-Assisted ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Echocardiography, Four-Dimensional ,Fetus ,Radiological and Ultrasound Technology ,business.industry ,Ultrasound ,Obstetrics and Gynecology ,General Medicine ,Gold standard (test) ,Anatomy ,Sagittal plane ,Coronary arteries ,Pregnancy Trimester, First ,medicine.anatomical_structure ,Reproductive Medicine ,Vagina ,Female ,business ,Ex vivo - Abstract
Objective To compare the capability of three-dimen-sional (3D) reconstructed images produced by high-resolution episcopic microscopy (HREM) with that of in-vivo four-dimensional high-resolution transvaginal sonography (4D-HRTVS) to discern morphological features of the first-trimester human fetal heart. Methods This was a prospective study of fetal hearts between 9 and 14 weeks' gestation. For ex-vivo 3D analysis, 30 human fetal hearts (at 9 + 0 to 14 + 6 weeks) were retrieved from surgical terminations of pregnancy. The specimens were embedded in resin and episcopic (‘block-face’) imaging was used to obtain a digital volume dataset (HREM) using 3-micron slicing. 4D-HRTVS was performed in 28 separate pregnancies at 10 + 2 to 14 + 0 weeks using a Voluson E8 ultrasound machine with volumetric transvaginal RIC 6–12-MHz transducers. Heart volumes obtained by both methods were compared to assess their ability to demonstrate first-trimester cardiac morphology. Comparisons were made in the transverse and sagittal planes, and using volume rendering. Results All hearts were structurally normal, although abdominal situs was not examined in the isolated hearts that underwent HREM. 4D-HRTVS demonstrated each of the complete five transverse cardiac views in 32–86% of cases. HREM showed four features unique to the first-trimester human heart: prominent atrial appendages, spiral ventricular arrangement, prominent coronary arteries and thickened arterial walls. 4D-HRTVS could demonstrate the first two, but ultrasound resolution was too poor to quantify wall thickness and demonstrate coronary arteries in the 3–5-mm diameter heart. Conclusions 4D-HRTVS showed limited morphological features of the first-trimester fetal heart compared with HREM. HREM provides a gold standard of ex-vivo imaging against which developments in ultrasound resolution could be compared. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
- Published
- 2012
40. Fetal Treatment
- Author
-
Helena M. Gardiner
- Published
- 2012
41. Fetal Longitudinal Myocardial Function Assessment by Anatomic M-Mode
- Author
-
Stavros Sifakis, Ioannis Germanakis, Spyridon Pepes, and Helena M. Gardiner
- Subjects
Embryology ,medicine.medical_specialty ,Ultrasound beam ,Video Recording ,Gestational Age ,Fetal heart ,Cardiac axis ,Ultrasonography, Prenatal ,Cohort Studies ,Pregnancy ,Image Processing, Computer-Assisted ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,cardiovascular diseases ,Fetus ,business.industry ,Reproducibility of Results ,Obstetrics and Gynecology ,Gestational age ,Heart ,General Medicine ,Myocardial function ,Myocardial Contraction ,Surgery ,medicine.anatomical_structure ,Echocardiography ,Ventricle ,Pediatrics, Perinatology and Child Health ,Linear Models ,cardiovascular system ,Feasibility Studies ,Mitral Valve ,Female ,Tricuspid Valve ,business ,Nuclear medicine - Abstract
Aim: To evaluate the feasibility of offline anatomic M-mode (AMM) to study fetal atrioventricular annulus long-axis displacement (LAD) and compare its performance against real-time conventional M-mode (MM). Material and Methods: Paired AMM and MM LAD studies were recorded prospectively in 54 fetuses, and performance was compared. Insonation angles were less than 30° in all but 4 cases. The overall feasibility of AMM was tested in a composite total sample of 91 normal singleton pregnancies (median gestational age 23+6 weeks, range 12–36). AMM LAD was measured by placement of a virtual M-mode line on digitally stored raw data of fetal 4-chamber video loops. We studied annulus LAD at the lateral mitral (left ventricle; LV), proximal mitral (intraventricular septum; IVS), and lateral tricuspid (right ventricle; RV) myocardial segments. We compared LAD and its regression with gestational age measured using both methods in paired studies and AMM in the whole cohort. Results: Annulus LAD was measured using AMM, in all cases and segments, irrespective of cardiac axis alignment to the ultrasound beam. Good correlation existed between AMM and MM (RV r = 0.901, LV r = 0.899, IVS r = 0.815, p < 0.001). AMM recorded higher LAD values than MM in RV [mean 6.17 (SD 1.46) vs. 5.82 (SD 1.74) mm, p = 0.002] and LV [mean 4.18 (SD 1.11) vs. 3.98 (SD 1.12), p = 0.007]. Both methods showed LAD in RV > LV > IVS and a significant gestational increase in LAD values in all segments (p < 0.001) Conclusions: AMM permits offline evaluation of fetal longitudinal myocardial function in routinely obtained 2D fetal heart images with similar values to conventional MM in paired studies recorded
- Published
- 2012
42. Prenatal diagnosis of double aortic arch: can we predict airway obstruction (pseudo‐ <scp>CHAOS</scp> ) and need for airway <scp>EXIT</scp> ?
- Author
-
Christoph Wohlmuth, Helena M. Gardiner, and D. P. Naidu
- Subjects
medicine.medical_specialty ,Double aortic arch ,Aorta, Thoracic ,Gestational Age ,Prenatal diagnosis ,Ultrasonography, Prenatal ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Pregnancy ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,Aortic Arch Syndromes ,business.industry ,Obstetrics and Gynecology ,General Medicine ,Airway obstruction ,Delivery, Obstetric ,medicine.disease ,Airway Obstruction ,Reproductive Medicine ,Echocardiography ,Anesthesia ,Cardiology ,Female ,Airway ,business - Published
- 2017
43. ISUOG consensus statement on current understanding of the association of neurodevelopmental delay and congenital heart disease: impact on prenatal counseling
- Author
-
Asma Khalil, Julene S. Carvalho, Zarko Alfirevic, J. M. Martínez, Gustavo Malinger, Jack Rychik, Dario Paladini, Yves Ville, Helena M. Gardiner, Paladini, D., Alfirevic, Z., Carvalho, J. S., Khalil, A., Malinger, G., Martinez, J. M., Rychik, J., Ville, Y., and Gardiner, H.
- Subjects
Heart Defects, Congenital ,Pediatrics ,medicine.medical_specialty ,Consensus ,Heart disease ,Prenatal counseling ,Statement (logic) ,Genetic counseling ,Consensu ,Genetic Counseling ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Neurodevelopmental Disorder ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Pathology, Molecular ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Infant newborn ,Reproductive Medicine ,Neurodevelopmental Disorders ,Practice Guidelines as Topic ,Neurodevelopmental delay ,Female ,business ,Human - Published
- 2016
44. The in-utero development and treatment of Pulmonary Atresia with intact septum
- Author
-
Helena M. Gardiner
- Subjects
medicine.medical_specialty ,Fetus ,business.industry ,Regurgitation (circulation) ,medicine.disease ,medicine.anatomical_structure ,Ventricular hypertrophy ,Ventricle ,In utero ,Pulmonary valve ,Internal medicine ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Ventricular pressure ,Cardiology ,Medicine ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary atresia - Abstract
Pulmonary Atresia with intact septum can be diagnosed by echocardiography from early pregnancy where a spectrum of morphology can be recognised. Important tricuspid regurgitation is common and the right ventricle develops at supra-systemic pressures leading to progressive ventricular hypertrophy and mineralisation that can be seen on serial echocardiograms. This is likely to compromise later ventricular function and only about a third of children achieve an eventual two-ventricle circulation. Fetal valvuloplasty has been proposed as a potential therapy to open the pulmonary valve, reduce right ventricular pressure and improve the potential for normal myocardial development. There is no evidence yet, however, that fetal pulmonary valvuloplasty alters the growth of the pulmonary or tricuspid valves or influences the ventricular size to change the eventual designation, although theoretical benefits in quality of the myocardium may lead to improved outcomes.
- Published
- 2010
45. Noninvasive fetal electrocardiography following intermittent umbilical cord occlusion in the preterm ovine fetus
- Author
-
Sara Paterson-Brown, Mark A. Hanson, Matthew J. Thomas, Jane K. Cleal, Helena M. Gardiner, and Lucy R. Green
- Subjects
Fetus ,education.field_of_study ,Pregnancy ,medicine.diagnostic_test ,business.industry ,Population ,Obstetrics and Gynecology ,medicine.disease ,Umbilical cord ,medicine.anatomical_structure ,Anesthesia ,medicine ,Fetal distress ,Gestation ,Umbilical Cord Occlusion ,education ,business ,Electrocardiography - Abstract
Objective: to investigate whether a noninvasive fetal electrocardiography (fECG) system can identify cardiovascular responses to fetal hypoxaemia and validate the results using standard invasive fECG monitoring techniques. Design: prospective cohort study. Setting: biological research facilities at The University of Southampton. Population or Sample: late gestation ovine fetuses; n = 5. Methods: five fetal lambs underwent implantation of vascular catheters, umbilical cord occluder and invasive ECG chest electrodes under general anaesthesia (3% halothane/O2) at 119 days of gestation (term ?147 days of gestation). After 5 days of recovery blood pressure, blood gases, glucose and pH were monitored. At 124 and 125 days of gestation following a 10-minute baseline period a 90-second cord occlusion was applied. Noninvasive fetal ECG was recorded from maternal transabdominal electrodes using advanced signal-processing techniques, concurrently with invasive fECG recordings. Main outcome measures: comparison of T:QRS ratios of the ECG waveform from noninvasive and invasive fECG monitoring systems. Results: our fECG monitoring system is able to demonstrate changes in waveforms during periods of hypoxaemia similar to those obtained invasively, which could indicate fetal distress. Conclusions: these findings may indicate a future use for noninvasive electrocardiography during human fetal monitoring both before and during labour in term and preterm pregnancies.
- Published
- 2010
46. The effect of late gestation foetal hypoglycaemia on cardiovascular and endocrine function in sheep
- Author
-
Helena M. Gardiner, Jane K. Cleal, Susan P. Bagby, Mark A. Hanson, and Lucy R. Green
- Subjects
medicine.medical_specialty ,Mean arterial pressure ,Fetus ,business.industry ,Medicine (miscellaneous) ,Gestational age ,Baroreflex ,Angiotensin II ,Umbilical cord ,medicine.anatomical_structure ,Blood pressure ,Endocrinology ,Internal medicine ,Heart rate ,Medicine ,business - Abstract
An appropriate foetal cardiovascular (CV) response to reduced substrate supply (e.g. oxygen or other nutrients) is vital for growth and development, and may impact on CV control. The prevailing nutritional environment and associated CV changes may influence subsequent CV responses to challenges during late gestation, for example, umbilical cord occlusion (UCO). We investigated the effect of low-circulating glucose on foetal CV control mechanisms and response to UCO. Under general anaesthesia, late gestation foetal sheep (n = 7, 119 days gestational age (dGA), term ∼147 days) were implanted with vascular catheters, a bladder catheter, electrocardiogram electrodes and an umbilical cord occluder. Mean arterial pressure (MAP), heart rate (HR) and kidney function were monitored during maternal saline (MSAL, 125dGA) and insulin (MINS, 126dGA) infusion, and foetal CV responses were assessed during incremental doses of angiotensin II, a 90-s total UCO, and administration of phenylephrine to assess baroreflex function. During MINS infusion, the decrease in maternal and foetal blood glucose was associated with a small but significant decrease in foetal HR and reduced foetal baroreflex sensitivity (P < 0.05). The increase in foetal MAP during a 90-s UCO was greater during hypoglycaemia (P < 0.05). The MAP response to angiotensin II was not affected by hypoglycaemia. Decreased foetal HR and baroreflex sensitivity and increased CV responsiveness to UCO during hypoglycaemia indicates altered CV homoestatic mechanisms. The combination of altered nutrition and a CV challenge, such as UCO, during late gestation may have a cumulative effect on foetal CV function.
- Published
- 2009
47. Cost implications of introducing a telecardiology service to support fetal ultrasound screening
- Author
-
Robin Dowie, Helena M. Gardiner, Tracey Young, Hema Mistry, and Rodney C. G. Franklin
- Subjects
medicine.medical_specialty ,Telemedicine ,Pediatrics ,Referral ,Health Informatics ,Ultrasonography, Prenatal ,Cost of Illness ,Pregnancy ,Risk Factors ,Ultrasound screening ,District hospital ,London ,medicine ,Humans ,Referral and Consultation ,Cost implications ,Service (business) ,medicine.diagnostic_test ,business.industry ,Prenatal Care ,medicine.disease ,Fetal Diseases ,England ,Echocardiography ,Emergency medicine ,Female ,Cardiology Service, Hospital ,business ,Delivery of Health Care ,Fetal echocardiography - Abstract
A district hospital in south-east England used a telecardiology service for fetal cardiac diagnosis alongside an existing arrangement for referring pregnant women directly to perinatal cardiologists in London for detailed fetal echocardiography. Women were identified for referral according to local protocols when having a second trimester anomaly scan. For the telemedicine referrals, the sonographers video-recorded images from the anomaly scans for transmission during monthly videoconferences. The cost of the women's antenatal care was calculated from the specialist assessment until delivery, while family costs were collected in a postal survey. Over 15 months, telemedicine was used in 52 cases, while 24 women were seen in London. The London women were more likely to have had an ultrasound abnormality (29% v 10%, P = 0.047). A telemedicine assessment of 5 min duration was more costly than an examination in London (mean cost per referral of £206 v £74, P < 0.001). However, the telecardiology service was cost neutral after 14 days and for the extended period until delivery. Travel costs for London women averaged £37 compared with £5.50 for the telemedicine referrals. Telemedicine may be useful to support perinatal cardiologists in the UK whose workloads are expanding in response to improved standards in antenatal ultrasound screening.
- Published
- 2008
48. Morphological and Physiological Predictors of Fetal Aortic Coarctation
- Author
-
Mats Mellander, Michael Roughton, Hana Jičínská, Helena M. Gardiner, and H. Matsui
- Subjects
Aortic arch ,medicine.medical_specialty ,Gestational Age ,Prenatal diagnosis ,Sensitivity and Specificity ,Aortic Coarctation ,Ultrasonography, Prenatal ,Coronary circulation ,Predictive Value of Tests ,Pregnancy ,Coronary Circulation ,Physiology (medical) ,medicine.artery ,Internal medicine ,medicine ,Humans ,False Negative Reactions ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Gestational age ,Retrospective cohort study ,Surgery ,medicine.anatomical_structure ,Echocardiography ,Descending aorta ,Predictive value of tests ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Fetal echocardiography - Abstract
Background— Prenatal diagnosis of aortic coarctation suffers from high false-negative rates at screening and poor specificity. Methods and Results— This retrospective study tested the applicability of published aortic arch and ductal Z scores (measured just before the descending aorta in the 3-vessel and tracheal view) and their ratio on 200 consecutive normal controls at a median of 22±0 gestational weeks (range, 15±4 to 38±4 weeks). Second, this study tested the ability of serial Z scores to distinguish fetuses with coarctation within a cohort with ventricular and/or great arterial disproportion detected at screening or fetal echocardiography. Third, it evaluated the diagnostic significance of associated cardiac lesions, coarctation shelf, and isthmal flow disturbance. We studied 44 fetuses with suspected coarctation at 24±0 weeks (range, 17±3 to 37±4 weeks). Receiver-operating characteristic curves were created. Logistic regression tested the association between z scores, additional cardiac diagnoses, and coarctation. Good separation was found of isthmal Z scores for cases requiring surgery from controls and false-positive cases, and receiver-operating characteristic curves showed an excellent area under the curve for isthmal Z score (0.963) and isthmal-to-ductal ratio (0.969). Serial isthmal Z scores improved to >−2 in suspected cases with normal outcomes; those requiring surveillance or surgery remained Conclusions— Isthmal Z scores and isthmal-to-ductal ratio are sensitive indicators of fetal coarctation. Serial measurements and abnormal isthmal flow patterns improve diagnostic specificity and may reduce false positives.
- Published
- 2008
49. CURRENT ASPECTS OF FETAL CARDIOVASCULAR FUNCTION
- Author
-
H. Matsui and Helena M. Gardiner
- Subjects
Cardiac function curve ,Cardiac response ,Fetal magnetic resonance imaging ,medicine.medical_specialty ,Fetus ,medicine.diagnostic_test ,business.industry ,media_common.quotation_subject ,Clinical course ,Obstetrics and Gynecology ,Hemodynamics ,Doppler echocardiography ,Internal medicine ,embryonic structures ,Pediatrics, Perinatology and Child Health ,medicine ,Cardiology ,Function (engineering) ,business ,media_common - Abstract
Investigation of fetal cardiac function remains a challenging task. Although the response of the heart to changes in load is well-known in animal models and the adult human, the developmental changes in fetal cardiac response remain poorly characterised. However, quantitative evaluation of cardiovascular function is important to predict the clinical course and to manage the fetus optimally. To date, the routine evaluation of fetal cardio vascular function has relied largely on Doppler echocardiography which enables an estimate of haemodynamics; newer modalities such as measurement of myocardial velocities are employed less routinely. Fetal magnetic resonance imaging still lacks the resolution necessary to contribute significantly to morphological or functional assessment of the fetal cardiovascular system.
- Published
- 2008
50. Fetal intervention for cardiac disease: The cutting edge of perinatal care
- Author
-
H. Matsui and Helena M. Gardiner
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Psychological intervention ,Disease ,Risk Assessment ,Hypoplastic left heart syndrome ,Fetal Heart ,Pregnancy ,Internal medicine ,Fetal intervention ,medicine ,Humans ,Cardiac Surgical Procedures ,Intensive care medicine ,Fetus ,business.industry ,medicine.disease ,Fetal Diseases ,Stenosis ,Great arteries ,Pediatrics, Perinatology and Child Health ,Disease Progression ,cardiovascular system ,Cardiology ,Female ,Clinical Competence ,Pulmonary atresia ,business - Abstract
Summary Fetal cardiac valvuloplasty has been proposed for progressive cardiac disease with a poor prognosis, such as critical aortic stenosis and pulmonary atresia with intact ventricular septum and balloon atrial septostomy for hypoplastic left heart syndrome, or simple transposition of the great arteries with closed or restrictive inter-atrial communication. It is anticipated that early rescue of ventricles or the pulmonary veins from an unfavourable environment may promote healthier ventricular and vascular growth and improve postnatal outcomes. While close collaboration between the fetal medicine specialist and perinatal cardiologist may optimize the chances of technical success, obstacles to progress include the relative rarity of suitable cases and late referral for therapy. In common with other interventions in fetal medicine, there is a learning curve, and it would benefit progress if the procedures were initially concentrated in just a few centres to enable them to develop skills and experience. Following careful evaluation, it may then be desirable to train further centres and roll out best practice models.
- Published
- 2007
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.