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The Usefulness of Ultrasound Fetal Screening in the Prenatal Diagnosis of Severe Congenital Heart Disease
S126
Ultrasound in Medicine and Biology
for improving a fetal diagnosis rate and prognosis of severely ill child. Methods: Comprehensive Perinatal Maternal and Child Medical Center and 21 obstetrics and gynecology clinics in the prefecture were connected through the system’s securely-protected Internet connection. The obstetrics and gynecology clinics send fetal ultrasonographic image data to a dedicated server when they determine a symptom as abnormal at the time of prenatal checkup. A fetal-neonatologist at the center analyzes the image data, prioritizes them with diagnostic support or severity, then send the report with results. In addition, bidirectional connection with a TV conference system is installed at 4 Perinatal Maternal and Child Medical Centers in the prefecture and allows us to share information and hold a conference as well as a hands-on ultrasonographic examination. The obstetrics and gynecology clinics provide information and explanation to a pregnant woman in reference to the received report (support for fetal diagnosis). Then, for those cases to be determined as a requirement of delivery management during the comprehensive perinatal period, they will be referred to the department of obstetrics at the center as outpatient or they will receive detailed examination (e.g. Fetal MRI)/ hospitalization management after maternal transport. In the periodical conference, medical team at the center discuss a delivery method and therapeutic strategy for early neonatal period. Results: The system has been partially initiated from April 2017 and there were approximately 30 cases requested for congenital disorder so far. Those disorder cases were 1 case for neurological disorder, 20 cases for cardiac disorder, 10 cases for surgical disorder, and 2 cases for other while 4 cases were for cases with a requirement of therapeutic intervention during the early neonatal period. Some severe cases such as total anomalous pulmonary venous return with pulmonic venous obstruction were included in the cardiac disorder cases. Conclusions: The system introduction is the first attempt in Japan and may possibly provide a proper medical treatment on the basis of team medicine against severe congenital disorder with a requirement of therapeutic intervention during the early neonatal period. While enhancing the widespread use/the effective operation of the system in future for overcoming a low fetal diagnosis rate by uneven distribution of medical resources, we need to analyze and feed back useful information collected from accumulated data of fetal diagnosis in server as an issue. OPT10-004 Assessment of the Cases of Fetal Cardiac Abnormalities Identified Before 22 Weeks’ Gestation Atsushi Yoshida, Ryoko Ono, Yoshiki Maeda, Ryo Suzuki, Takuya Kawamura, Masahiro Nakao, Shinji Katsuragi Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Japan Objectives: As a result of wide spread use of first and second trimester fetal screenings in Japan, the number of cases with fetal abnormalities pointed out prior to 22 weeks’ gestation has increased. In this study, we assessed the cases of fetal cardiac defects identified before 22 weeks’ gestation in our hospital. Methods: Transabdominal ultrasonography was made in 55 patients who were pointed out to have fetal abnormalities through the first or second trimester screening. In 36 of these 55 patients, fetal cardiac abnormalities were found. The recordings of the 36 patients were assessed retrospectively. Results: Mean gestational age at fetal abnormality detection was 19.163.6 weeks. The 36 cases consisted of 30 morphological abnormalities (83%) and 6 fetal arrhythmias without abnormal cardiac structures (17%). The abnormal findings at the detection included 23 cases of suspicious fetal morphological abnormalities (64%), 8 cases of fetal arrhythmia (8%) and 8 cases with increased nuchal
Volume 43, Number S1, 2017 translucency (NT) (8%). Five patients (14%) in 36 chose termination of the pregnancy. Conclusions: In this study, only 8% of fetal cardiac abnormalities were identified by increased NT. It is thought that fetal echocardiography for patients with increased NT is useful for the early detection of fetal cardiac defects. At this point in Japan, first trimester screening by NT measurement is not very common, but it has gradually been increasing. We think it desirable and appropriate to establish a fetal cardiac screening prior to 22 weeks’ gestation. Poster Session PPT10-001 Prenatal Solitary Complete Heart Block Kuan-Ying Lee,1 Peter Hsieh2 1 Taipei Chang Gung Memorial Hospital, 2Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital Objectives: To diagnose solitary complete heart block as early as we can, then we could establish the principal therapeutic decision for whether earlier intervention or not, and the timing of pacemaker insertion. Methods: Use fetal cardioechography with M-mode to diagnose prenatal solitary complete heart block. Results: The solitary complete heart block should be diagnosed as dissociation between atrial and ventricular contractions under M mode, without structural heart abnormalities. Conclusions: The congenital complete heart block without structural heart abnormalities might have fine outcome. If autoimmune related, the treatment would be maternal use of steroids, or autoantibody neutralization. The other choice of treatment would be pacemaker insertion for the newborn. PPT10-002 The Usefulness of Ultrasound Fetal Screening in the Prenatal Diagnosis of Severe Congenital Heart Disease Satoru Fukumoto, Tomomi Tanaka, Tomomi Kurosaki, Kayo Konari, Nobuo Akamatsu Department of Obstetrics and Gynecology, Oguni Hospital, Japan Objectives: We have carried out the Ultrasound Fetal Screening(UFS) since 5 years ago, by threeultra-sonographers. We have reviewed the data, focusing on the detectability of Congenital Heart Disease(CHD) and tried to improve our way of screening. Methods: We have analyzed the 3,321 cases carried out around 27th gestational weeks. From April 2012 till March 2014, UFS was carried out optionally and all cases were obligatory examined. from2014 until December 2016. Results: 76 cases out of 3321 cases were convinced as CHD by pediatric cardiologist, containing 11 severe cases. In these cases, 19 cases were prenatally detected and 9 cases of it were transferred. There were 4 false negative cases, that is; TAPVC, congestive heart failure, TOF in 2014 and one case of DORV+PA+VSD in 2016. Sensitivity of the severe CHD were 33%(2014), 75%(2015) and 100%(2016). Conclusions: We have tried to promote our screening capability of CHD by improving the following points. (1) Tenacious follow up study of the false negative cases (2) UFS of all patients (3) Several times US-exam of suspicious cases by mutiple sonographers and doctors. (4) Adoption the new method presented in the scientific meetings.These improvement of the system seemed to have progressed the accuracy of our clinic.
Ultrasound in Medicine and Biology
for improving a fetal diagnosis rate and prognosis of severely ill child. Methods: Comprehensive Perinatal Maternal and Child Medical Center and 21 obstetrics and gynecology clinics in the prefecture were connected through the system’s securely-protected Internet connection. The obstetrics and gynecology clinics send fetal ultrasonographic image data to a dedicated server when they determine a symptom as abnormal at the time of prenatal checkup. A fetal-neonatologist at the center analyzes the image data, prioritizes them with diagnostic support or severity, then send the report with results. In addition, bidirectional connection with a TV conference system is installed at 4 Perinatal Maternal and Child Medical Centers in the prefecture and allows us to share information and hold a conference as well as a hands-on ultrasonographic examination. The obstetrics and gynecology clinics provide information and explanation to a pregnant woman in reference to the received report (support for fetal diagnosis). Then, for those cases to be determined as a requirement of delivery management during the comprehensive perinatal period, they will be referred to the department of obstetrics at the center as outpatient or they will receive detailed examination (e.g. Fetal MRI)/ hospitalization management after maternal transport. In the periodical conference, medical team at the center discuss a delivery method and therapeutic strategy for early neonatal period. Results: The system has been partially initiated from April 2017 and there were approximately 30 cases requested for congenital disorder so far. Those disorder cases were 1 case for neurological disorder, 20 cases for cardiac disorder, 10 cases for surgical disorder, and 2 cases for other while 4 cases were for cases with a requirement of therapeutic intervention during the early neonatal period. Some severe cases such as total anomalous pulmonary venous return with pulmonic venous obstruction were included in the cardiac disorder cases. Conclusions: The system introduction is the first attempt in Japan and may possibly provide a proper medical treatment on the basis of team medicine against severe congenital disorder with a requirement of therapeutic intervention during the early neonatal period. While enhancing the widespread use/the effective operation of the system in future for overcoming a low fetal diagnosis rate by uneven distribution of medical resources, we need to analyze and feed back useful information collected from accumulated data of fetal diagnosis in server as an issue. OPT10-004 Assessment of the Cases of Fetal Cardiac Abnormalities Identified Before 22 Weeks’ Gestation Atsushi Yoshida, Ryoko Ono, Yoshiki Maeda, Ryo Suzuki, Takuya Kawamura, Masahiro Nakao, Shinji Katsuragi Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Japan Objectives: As a result of wide spread use of first and second trimester fetal screenings in Japan, the number of cases with fetal abnormalities pointed out prior to 22 weeks’ gestation has increased. In this study, we assessed the cases of fetal cardiac defects identified before 22 weeks’ gestation in our hospital. Methods: Transabdominal ultrasonography was made in 55 patients who were pointed out to have fetal abnormalities through the first or second trimester screening. In 36 of these 55 patients, fetal cardiac abnormalities were found. The recordings of the 36 patients were assessed retrospectively. Results: Mean gestational age at fetal abnormality detection was 19.163.6 weeks. The 36 cases consisted of 30 morphological abnormalities (83%) and 6 fetal arrhythmias without abnormal cardiac structures (17%). The abnormal findings at the detection included 23 cases of suspicious fetal morphological abnormalities (64%), 8 cases of fetal arrhythmia (8%) and 8 cases with increased nuchal
Volume 43, Number S1, 2017 translucency (NT) (8%). Five patients (14%) in 36 chose termination of the pregnancy. Conclusions: In this study, only 8% of fetal cardiac abnormalities were identified by increased NT. It is thought that fetal echocardiography for patients with increased NT is useful for the early detection of fetal cardiac defects. At this point in Japan, first trimester screening by NT measurement is not very common, but it has gradually been increasing. We think it desirable and appropriate to establish a fetal cardiac screening prior to 22 weeks’ gestation. Poster Session PPT10-001 Prenatal Solitary Complete Heart Block Kuan-Ying Lee,1 Peter Hsieh2 1 Taipei Chang Gung Memorial Hospital, 2Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital Objectives: To diagnose solitary complete heart block as early as we can, then we could establish the principal therapeutic decision for whether earlier intervention or not, and the timing of pacemaker insertion. Methods: Use fetal cardioechography with M-mode to diagnose prenatal solitary complete heart block. Results: The solitary complete heart block should be diagnosed as dissociation between atrial and ventricular contractions under M mode, without structural heart abnormalities. Conclusions: The congenital complete heart block without structural heart abnormalities might have fine outcome. If autoimmune related, the treatment would be maternal use of steroids, or autoantibody neutralization. The other choice of treatment would be pacemaker insertion for the newborn. PPT10-002 The Usefulness of Ultrasound Fetal Screening in the Prenatal Diagnosis of Severe Congenital Heart Disease Satoru Fukumoto, Tomomi Tanaka, Tomomi Kurosaki, Kayo Konari, Nobuo Akamatsu Department of Obstetrics and Gynecology, Oguni Hospital, Japan Objectives: We have carried out the Ultrasound Fetal Screening(UFS) since 5 years ago, by threeultra-sonographers. We have reviewed the data, focusing on the detectability of Congenital Heart Disease(CHD) and tried to improve our way of screening. Methods: We have analyzed the 3,321 cases carried out around 27th gestational weeks. From April 2012 till March 2014, UFS was carried out optionally and all cases were obligatory examined. from2014 until December 2016. Results: 76 cases out of 3321 cases were convinced as CHD by pediatric cardiologist, containing 11 severe cases. In these cases, 19 cases were prenatally detected and 9 cases of it were transferred. There were 4 false negative cases, that is; TAPVC, congestive heart failure, TOF in 2014 and one case of DORV+PA+VSD in 2016. Sensitivity of the severe CHD were 33%(2014), 75%(2015) and 100%(2016). Conclusions: We have tried to promote our screening capability of CHD by improving the following points. (1) Tenacious follow up study of the false negative cases (2) UFS of all patients (3) Several times US-exam of suspicious cases by mutiple sonographers and doctors. (4) Adoption the new method presented in the scientific meetings.These improvement of the system seemed to have progressed the accuracy of our clinic.