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PERINATAL HEMODYNAMIC PROFILE IN FETUSES WITH VEIN OF GALEN ANEURYSMAL MALFORMATION
S86 METHODS:
This is a prospective cohort study that included 89 mother-child dyads. Women were recruited during pregnancy and were classified according to the results of their oral glucose tolerance test: 19 mothers with gestational diabetes (treated according to national guidelines), 31 mothers with untreated insulin resistance (IR), and 39 control mothers. Children underwent echocardiography at a follow-up visit 3 years after birth. Echocardiographic measurements were performed by two experienced echocardiography technicians and evaluation of diastolic function was done by a pediatric cardiologist blinded to study groups. Abnormal diastolic function was defined as having abnormal pulsed waved Doppler and/or tissue Doppler velocities Z scores compatible with impaired myocardial relaxation. RESULTS: Nine out of the 89 children had abnormal velocities compatible with impaired relaxation. The proportions of subjects with abnormal diastolic function was 5.1% in the control group, 10.5% in the GD group, and 16.1% in the IR group. The relative proportions of children with impaired relaxation between study groups was statistically significant when comparing all study groups (p¼0.03), but not statistically significant when comparing individual groups with the control group (DG vs. control, p¼0.29; IR vs. control, p¼0.10). There was no difference between groups for the thickness of ventricular septum, thickness of posterior wall, or LV mass. CONCLUSION: In this study, children born from mothers that had high insulin resistance during pregnancy tended to have more frequent mild impairment of diastolic function at 3 years of age. Further research should aim to verify this association with larger study groups. Programme d’Aide de Financement Interne (PAFI) du CRCHUS
Canadian Journal of Cardiology Volume 32 2016
ventricular output, ductal flow and efficient pulmonary flow, which were compared to normal controls. Postnatal data included clinical status, pulmonary hypertension, cardiac failure and survival. RESULTS: Five fetuses with complete evaluation were seen between 35 and 36 weeks of gestation. Compared to a normal population, they had higher CTR (median 67% [60-69]), larger ascending aorta (median Z score 3 [1.9-3.8]) and smaller isthmus (median Z score -2.2 [-1.95- -2.9]). Isthmic flow index was highly abnormal for all fetuses (-2.8 [-1.7-3.5]), with retrograde flow in mid and tele-systole as well as in all diastole. Compared to normal controls, right ventricular output and net pulmonary flow was markedly increased: 1220 versus 672 ml/min (p¼0.01) and 873 versus 252 ml/min (p¼0.01), respectively. One pregnancy was terminated. All 4 neonates had suprasystemic pulmonary hypertension at birth and moderate to severe cardiac failure starting from 24 to 36 hours of life. Two patients survived (1 spontaneous occlusion and 1 embolization). CONCLUSION: Major hemodynamic anomalies are present in neonates with VGAM reflecting a long period of prenatal distress. Aggressive treatment should be started as soon as possible to improve outcome.
Canadian Cardiovascular Society (CCS) Oral INNOVATIONS IN ASSESSMENT AND MANAGEMENT OF CORONARY ARTERY DISEASE Saturday, October 22, 2016 034 NITROGLYCERINE DERIVED FRACTIONAL FLOW RESERVE FOR THE ASSESSMENT OF INTERMEDIATE CORONARY LESIONS Z Israeli, R Bagur, D Murariu, A Sultan, S Wall, S Lavi
033 PERINATAL HEMODYNAMIC PROFILE IN FETUSES WITH VEIN OF GALEN ANEURYSMAL MALFORMATION A Méndez Santos, M Brassard, F González Barlatay, A Berger, M Raboisson Montréal, Québec BACKGROUND:
Vein of Galen aneurysmal malformation (VGAM) is rare and poorly described in fetuses. Postnatal prognosis is related to heart failure, multi organ dysfunction and refractory pulmonary hypertension. We believe that detailed description of fetal circulation will help to clarify postnatal hemodynamic changes and to guide treatment. METHODS: Complete prenatal hemodynamic assessment was done for all fetuses with VGAM followed in our referral center from 2002 to 2014. Prenatal analysis included 2D measurement of aortic isthmus, cardiothoracic ratio (CTR), right ventricular size and aortic isthmus Doppler flow pattern. Calculations included isthmic flow index, right and left
London, Ontario BACKGROUND:
Adenosine-based FFR is currently the standard of care to guide optimal treatment strategy for intermediate coronary lesions. Nevertheless, procedure length, material costs, and side effects pose limitations for its extensive use. METHODS: A single center, prospective study, of consecutive patients with intermediate coronary lesions assessed by FFR between January 2014 and October 2015. Pd/Pa at baseline, post nitroglycerine administration and after incremental doses of intracoronary adenosine was measured. RESULTS: One-hundred thirty-four patients (27% females), mean age 65 years were included. The diagnostic performance of FFR(N) and identification of cutoff value for FFR(N) compared with FFR threshold of 0.8 using Receiver-Operating Characteristics area under the curve analysis was between 0.98, (95% CI¼ (0.95, 1.00), p<0.05) for 48mg and 0.86, (95% CI ¼ (0.79, 0.94), p<0.05) for 240mg adenosine. FFR(N) 0.8 had 100%
This is a prospective cohort study that included 89 mother-child dyads. Women were recruited during pregnancy and were classified according to the results of their oral glucose tolerance test: 19 mothers with gestational diabetes (treated according to national guidelines), 31 mothers with untreated insulin resistance (IR), and 39 control mothers. Children underwent echocardiography at a follow-up visit 3 years after birth. Echocardiographic measurements were performed by two experienced echocardiography technicians and evaluation of diastolic function was done by a pediatric cardiologist blinded to study groups. Abnormal diastolic function was defined as having abnormal pulsed waved Doppler and/or tissue Doppler velocities Z scores compatible with impaired myocardial relaxation. RESULTS: Nine out of the 89 children had abnormal velocities compatible with impaired relaxation. The proportions of subjects with abnormal diastolic function was 5.1% in the control group, 10.5% in the GD group, and 16.1% in the IR group. The relative proportions of children with impaired relaxation between study groups was statistically significant when comparing all study groups (p¼0.03), but not statistically significant when comparing individual groups with the control group (DG vs. control, p¼0.29; IR vs. control, p¼0.10). There was no difference between groups for the thickness of ventricular septum, thickness of posterior wall, or LV mass. CONCLUSION: In this study, children born from mothers that had high insulin resistance during pregnancy tended to have more frequent mild impairment of diastolic function at 3 years of age. Further research should aim to verify this association with larger study groups. Programme d’Aide de Financement Interne (PAFI) du CRCHUS
Canadian Journal of Cardiology Volume 32 2016
ventricular output, ductal flow and efficient pulmonary flow, which were compared to normal controls. Postnatal data included clinical status, pulmonary hypertension, cardiac failure and survival. RESULTS: Five fetuses with complete evaluation were seen between 35 and 36 weeks of gestation. Compared to a normal population, they had higher CTR (median 67% [60-69]), larger ascending aorta (median Z score 3 [1.9-3.8]) and smaller isthmus (median Z score -2.2 [-1.95- -2.9]). Isthmic flow index was highly abnormal for all fetuses (-2.8 [-1.7-3.5]), with retrograde flow in mid and tele-systole as well as in all diastole. Compared to normal controls, right ventricular output and net pulmonary flow was markedly increased: 1220 versus 672 ml/min (p¼0.01) and 873 versus 252 ml/min (p¼0.01), respectively. One pregnancy was terminated. All 4 neonates had suprasystemic pulmonary hypertension at birth and moderate to severe cardiac failure starting from 24 to 36 hours of life. Two patients survived (1 spontaneous occlusion and 1 embolization). CONCLUSION: Major hemodynamic anomalies are present in neonates with VGAM reflecting a long period of prenatal distress. Aggressive treatment should be started as soon as possible to improve outcome.
Canadian Cardiovascular Society (CCS) Oral INNOVATIONS IN ASSESSMENT AND MANAGEMENT OF CORONARY ARTERY DISEASE Saturday, October 22, 2016 034 NITROGLYCERINE DERIVED FRACTIONAL FLOW RESERVE FOR THE ASSESSMENT OF INTERMEDIATE CORONARY LESIONS Z Israeli, R Bagur, D Murariu, A Sultan, S Wall, S Lavi
033 PERINATAL HEMODYNAMIC PROFILE IN FETUSES WITH VEIN OF GALEN ANEURYSMAL MALFORMATION A Méndez Santos, M Brassard, F González Barlatay, A Berger, M Raboisson Montréal, Québec BACKGROUND:
Vein of Galen aneurysmal malformation (VGAM) is rare and poorly described in fetuses. Postnatal prognosis is related to heart failure, multi organ dysfunction and refractory pulmonary hypertension. We believe that detailed description of fetal circulation will help to clarify postnatal hemodynamic changes and to guide treatment. METHODS: Complete prenatal hemodynamic assessment was done for all fetuses with VGAM followed in our referral center from 2002 to 2014. Prenatal analysis included 2D measurement of aortic isthmus, cardiothoracic ratio (CTR), right ventricular size and aortic isthmus Doppler flow pattern. Calculations included isthmic flow index, right and left
London, Ontario BACKGROUND:
Adenosine-based FFR is currently the standard of care to guide optimal treatment strategy for intermediate coronary lesions. Nevertheless, procedure length, material costs, and side effects pose limitations for its extensive use. METHODS: A single center, prospective study, of consecutive patients with intermediate coronary lesions assessed by FFR between January 2014 and October 2015. Pd/Pa at baseline, post nitroglycerine administration and after incremental doses of intracoronary adenosine was measured. RESULTS: One-hundred thirty-four patients (27% females), mean age 65 years were included. The diagnostic performance of FFR(N) and identification of cutoff value for FFR(N) compared with FFR threshold of 0.8 using Receiver-Operating Characteristics area under the curve analysis was between 0.98, (95% CI¼ (0.95, 1.00), p<0.05) for 48mg and 0.86, (95% CI ¼ (0.79, 0.94), p<0.05) for 240mg adenosine. FFR(N) 0.8 had 100%