Kurt Hecher - Academia.edu (original) (raw)

Papers by Kurt Hecher

Research paper thumbnail of Intertwin cardiac status at 10-year follow-up after intrauterine laser coagulation therapy of severe twin-twin transfusion syndrome: comparison of donor, recipient and normal values

Archives of disease in childhood. Fetal and neonatal edition, 2014

In twin-to-twin transfusion syndrome (TTTS), genetically identical twins are exposed to different... more In twin-to-twin transfusion syndrome (TTTS), genetically identical twins are exposed to different haemodynamic conditions during fetal life, which are considered to be the cause of prenatal and postnatal cardiovascular differences between the donor and the recipient. To assess intertwin differences on childhood cardiac outcome after intrauterine laser coagulation therapy (LC) of severe TTTS. Prospective, detailed, echocardiographic follow-up of 31 twin pairs aged 9.95±0.8 years (mean±SD) with severe TTTS treated by LC, and the comparison with reference values. Cardiac function was normal and did not show intertwin differences in twins without structural heart disease. Discordant birth weight or birth weight <3rd centile for gestational age had no influence on blood pressure and cardiac indices. Pulmonary stenosis was more common (5/62; 8.1%) than in the general population (prevalence 0.066%, relative risk 134.4, 95% CI 42.1 to 428.8, p<0.0001) and affected both donor and recip...

Research paper thumbnail of Intermittierender reverser Fluss im Ductus-venosus bei ansonsten normalen Doppler Parametern bei zwei IUGR Feten

Zeitschrift für Geburtshilfe und Neonatologie, 2007

Research paper thumbnail of Babies Galore; or recent findings and future perspectives of pregnancy cohorts with a focus on immunity

Journal of reproductive immunology, Jan 19, 2015

Population-based pregnancy cohorts recruiting women before or at the moment of childbirth allow a... more Population-based pregnancy cohorts recruiting women before or at the moment of childbirth allow a longitudinal follow-up on children's health later in life. Important findings arising from pregnancy cohorts are discussed in the present review. These insights have led to revised guidelines on how to minimize disease risks in children, e.g., in the context of chronic immune diseases including allergies and asthma. Moreover, insights from pregnancy cohorts also unveiled a collateral effect of pregnancy on maternal immunity, mirrored by an ameliorated course of certain autoimmune diseases, but also an increased risk of infection with influenza A virus. Future pregnancy cohort studies are still required to close gaps in knowledge on how parameters involved in the developmental origin of health or poor immunity observed in children later in life are operational. We discuss here features that should be covered by future pregnancy cohort studies. Expected insights from such studies will...

Research paper thumbnail of Twin-twin transfusion syndrome: treatment and outcome

Best practice & research. Clinical obstetrics & gynaecology, 2014

Twin-twin transfusion syndrome complicates up to 15% of monochorionic pregnancies in the mid-trim... more Twin-twin transfusion syndrome complicates up to 15% of monochorionic pregnancies in the mid-trimester, and results in high perinatal mortality and morbidity if left untreated. Although some humoral factors play a role in the pathogenesis of the disease, an unequal placental sharing and the presence of placental vascular anastomoses at the chorionic plate, allowing blood volume shifts between the twins, are the anatomic prerequisite for this complication unique to monochorionic twins. Within monochorionic pregnancies, it is possible to identify a subgroup of twin pairs at high risk of developing twin-twin transfusion syndrome or selective intrauterine growth restriction during the course of pregnancy as early as in the first or early second trimester. If progressive amniotic fluid discrepancy advances to moderate twin-twin transfusion syndrome, and finally reaches the stages of severe twin-twin transfusion syndrome, accurate classification of the clinical picture and diagnosis of th...

Research paper thumbnail of 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial

by Aleid Van Wassenaer-leemhuis, Kurt Hecher, Pasquale Martinelli, K. Schneider, Sandra Calvert, Adriana Valcamonico, Aris Papageorghiou, Neil Marlow, Eva Ostermayer, Hans Wolf, Jan Derks, and Christoph Lees

The Lancet, 2015

Background No consensus exists for the best way to monitor and when to trigger delivery in mother... more Background No consensus exists for the best way to monitor and when to trigger delivery in mothers of babies with fetal growth restriction. We aimed to assess whether changes in the fetal ductus venosus Doppler waveform (DV) could be used as indications for delivery instead of cardiotocography short-term variation (STV).

Research paper thumbnail of B cells in pregnancy: functional promiscuity or tailored function?

Biology of reproduction, 2015

Research paper thumbnail of Fetal growth restriction due to placental disease

Seminars in Perinatology, 2004

Normal fetal growth depends on the genetically predetermined growth potential and its modulation ... more Normal fetal growth depends on the genetically predetermined growth potential and its modulation by the health of the fetus, placenta and the mother. Fetuses that are small because of intrauterine growth restriction (IUGR) are at higher risk for poor perinatal and long-term outcome than those who are appropriately grown. Of the many potential underlying processes that may result in IUGR,

Research paper thumbnail of Fetal venous, intracardiac, and arterial blood flow measurements in intrauterine growth retardation: Relationship with fetal blood gases

American Journal of Obstetrics and Gynecology, 1995

OBJECTIVE: Our purpose was to investigate arterial, venous, and intracardiac blood flow in growth... more OBJECTIVE: Our purpose was to investigate arterial, venous, and intracardiac blood flow in growth-retarded fetuses and to relate the Doppler results to blood gases in umbilical venous blood obtained by cordocentesis.STUDY DESIGN: A cross-sectional, pulsed-wave color Doppler ultrasonographic study of 23 severely growth-retarded fetuses undergoing cordocentesis and measurement of blood gases was performed. Blood velocity waveforms were recorded from the

Research paper thumbnail of Cervical length as a prognostic factor for preterm delivery in twin-to-twin transfusion syndrome treated by fetoscopic laser coagulation of chorionic plate anastomoses

Ultrasound in Obstetrics & Gynecology, 2005

Objective To evaluate the risk of spontaneous preterm delivery in relation to cervical length in ... more Objective To evaluate the risk of spontaneous preterm delivery in relation to cervical length in severe cases of twin-to-twin transfusion syndrome (TTTS) diagnosed before 26 weeks of gestation and treated by laser coagulation of the intertwin placental anastomoses.

Research paper thumbnail of Successful outcome after Nd : YAG laser separation of chorioangiopagus-twins under sonoendoscopic control

Ultrasound in Obstetrics & Gynecology, 1992

Endoscopic laser coagulation of the chorioangiopagus was successfully performed at 25 weeks&#... more Endoscopic laser coagulation of the chorioangiopagus was successfully performed at 25 weeks&#39; gestation in a pregnancy presenting with acute polyhydramnios due to twin transfusion syndrome. Under local anesthesia, a rigid fetoscope housed in a 2.7 mm diameter cannula was introduced transabdominally into the amniotic cavity and the communicating vessels were coagulated by Nd : YAG laser through a fiber that was passed down the side-arm of the cannula. There was rapid normalization of urine output in both fetuses and resolution of the oligo- and polyhydramnios in the donor and recipient twins, respectively. Furthermore, there was normalization in both fetal circulations, as assessed by Doppler velocimetry, and there was gradual resolution of the hydrops in the recipient. Two healthy babies were born 9 weeks after the procedure.

Research paper thumbnail of Fetal surgery in animal models

International Journal of Gynecology & Obstetrics, 2000

Research paper thumbnail of Thresholds for intervention in severe early onset growth restriction (IUGR)

American Journal of Obstetrics and Gynecology, 2004

Research paper thumbnail of Predictors of necrotizing entercolitis (NEC) in fetal growth restriction (IUGR)

American Journal of Obstetrics and Gynecology, 2005

OBJECTIVE: Pulmonary hypoplasia (PH) is a feared complication of midtrimester premature rupture o... more OBJECTIVE: Pulmonary hypoplasia (PH) is a feared complication of midtrimester premature rupture of membranes (PROM) as it is associated with a neonatal mortality rate as high as 80%. Gestational age (GA) at PROM and residual volume of amniotic fluid (AF) are traditionally identified as predictors of PH. We evaluate the independent risk factors for PH in a large cohort of midtrimester PROM.

Research paper thumbnail of P254: Lung development in fetal sheep observed with Magnetic Resonance Imaging (MRI) and ultrasound B-scan

Ultrasound in Obstetrics & Gynecology - ULTRASOUND OBSTET GYN, 2003

Research paper thumbnail of OP10.14: Laser therapy of twin–twin transfusion syndrome in triplet pregnancies

Ultrasound in Obstetrics & Gynecology - ULTRASOUND OBSTET GYN, 2007

Research paper thumbnail of P238: There are no differences of Doppler indices between sheep fetuses with and without accelerated lung growth

Ultrasound in Obstetrics & Gynecology - ULTRASOUND OBSTET GYN, 2003

Research paper thumbnail of Characteristics of fetal venous, blood flow under normal circumstances and during fetal disease

Ultrasound in Obstetrics and Gynecology, 1996

Research paper thumbnail of OC100: TRAP sequence: fetoscopic laser treatment

Ultrasound in Obstetrics and Gynecology, 2004

Research paper thumbnail of Ductus venosus studies in fetuses at high risk for chromosomal or heart abnormalities: relationship with nuchal translucency measurement and fetal outcome

Ultrasound in Obstetrics and Gynecology, 2002

Objective To investigate, in a high-risk group of fetuses, the role of ductus venosus Doppler vel... more Objective To investigate, in a high-risk group of fetuses, the role of ductus venosus Doppler velocimetry as a prognostic factor, in addition to nuchal translucency measurement, for predicting chromosomal anomalies and, where the karyotype was normal, for predicting fetal outcome.

Research paper thumbnail of Pulmonary circulation of fetal sheep with lung hyperplasia following tracheal occlusion

Ultrasound in Obstetrics and Gynecology, 2005

To determine the alteration of blood flow velocity profile in the pulmonary arteries (PAs) of fet... more To determine the alteration of blood flow velocity profile in the pulmonary arteries (PAs) of fetal sheep after tracheal occlusion (TO). Doppler ultrasound investigations of the PAs, the pulmonary trunk and the ductus arteriosus were performed weekly in nine ewes (gestational age 92-98 days, term 145 days) with singleton pregnancies after TO (n = 5) and in control fetuses (n = 4). Histological examinations with morphometry of pulmonary arterial vessels and of airways were performed in both groups. In the control group the experiments lasted 38 +/- 6 days (mean +/- SD), and in the TO group 25 +/- 7 days. Relative lung weight was significantly higher in the TO group compared with the control group (14.5 +/- 3.4% and 4.0 +/- 0.5% of body weight). There were no significant differences in the Doppler parameters (pulsatility index, resistance index, the systolic peak, the diastolic minimum, time averaged maximum velocity) between groups. When the Doppler values of PAs in TO and control fetuses were combined, no significant differences between the left and right PA could be detected. The external diameter of peripheral PAs was significantly higher in the TO group as compared to control group (105.7 +/- 2.5 microm vs. 96.9 +/- 1.3 microm). We found a threefold increase of fetal lung volume after TO without significant changes of blood flow velocity profiles in the PAs of fetal sheep.

Research paper thumbnail of Intertwin cardiac status at 10-year follow-up after intrauterine laser coagulation therapy of severe twin-twin transfusion syndrome: comparison of donor, recipient and normal values

Archives of disease in childhood. Fetal and neonatal edition, 2014

In twin-to-twin transfusion syndrome (TTTS), genetically identical twins are exposed to different... more In twin-to-twin transfusion syndrome (TTTS), genetically identical twins are exposed to different haemodynamic conditions during fetal life, which are considered to be the cause of prenatal and postnatal cardiovascular differences between the donor and the recipient. To assess intertwin differences on childhood cardiac outcome after intrauterine laser coagulation therapy (LC) of severe TTTS. Prospective, detailed, echocardiographic follow-up of 31 twin pairs aged 9.95±0.8 years (mean±SD) with severe TTTS treated by LC, and the comparison with reference values. Cardiac function was normal and did not show intertwin differences in twins without structural heart disease. Discordant birth weight or birth weight <3rd centile for gestational age had no influence on blood pressure and cardiac indices. Pulmonary stenosis was more common (5/62; 8.1%) than in the general population (prevalence 0.066%, relative risk 134.4, 95% CI 42.1 to 428.8, p<0.0001) and affected both donor and recip...

Research paper thumbnail of Intermittierender reverser Fluss im Ductus-venosus bei ansonsten normalen Doppler Parametern bei zwei IUGR Feten

Zeitschrift für Geburtshilfe und Neonatologie, 2007

Research paper thumbnail of Babies Galore; or recent findings and future perspectives of pregnancy cohorts with a focus on immunity

Journal of reproductive immunology, Jan 19, 2015

Population-based pregnancy cohorts recruiting women before or at the moment of childbirth allow a... more Population-based pregnancy cohorts recruiting women before or at the moment of childbirth allow a longitudinal follow-up on children's health later in life. Important findings arising from pregnancy cohorts are discussed in the present review. These insights have led to revised guidelines on how to minimize disease risks in children, e.g., in the context of chronic immune diseases including allergies and asthma. Moreover, insights from pregnancy cohorts also unveiled a collateral effect of pregnancy on maternal immunity, mirrored by an ameliorated course of certain autoimmune diseases, but also an increased risk of infection with influenza A virus. Future pregnancy cohort studies are still required to close gaps in knowledge on how parameters involved in the developmental origin of health or poor immunity observed in children later in life are operational. We discuss here features that should be covered by future pregnancy cohort studies. Expected insights from such studies will...

Research paper thumbnail of Twin-twin transfusion syndrome: treatment and outcome

Best practice & research. Clinical obstetrics & gynaecology, 2014

Twin-twin transfusion syndrome complicates up to 15% of monochorionic pregnancies in the mid-trim... more Twin-twin transfusion syndrome complicates up to 15% of monochorionic pregnancies in the mid-trimester, and results in high perinatal mortality and morbidity if left untreated. Although some humoral factors play a role in the pathogenesis of the disease, an unequal placental sharing and the presence of placental vascular anastomoses at the chorionic plate, allowing blood volume shifts between the twins, are the anatomic prerequisite for this complication unique to monochorionic twins. Within monochorionic pregnancies, it is possible to identify a subgroup of twin pairs at high risk of developing twin-twin transfusion syndrome or selective intrauterine growth restriction during the course of pregnancy as early as in the first or early second trimester. If progressive amniotic fluid discrepancy advances to moderate twin-twin transfusion syndrome, and finally reaches the stages of severe twin-twin transfusion syndrome, accurate classification of the clinical picture and diagnosis of th...

Research paper thumbnail of 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial

by Aleid Van Wassenaer-leemhuis, Kurt Hecher, Pasquale Martinelli, K. Schneider, Sandra Calvert, Adriana Valcamonico, Aris Papageorghiou, Neil Marlow, Eva Ostermayer, Hans Wolf, Jan Derks, and Christoph Lees

The Lancet, 2015

Background No consensus exists for the best way to monitor and when to trigger delivery in mother... more Background No consensus exists for the best way to monitor and when to trigger delivery in mothers of babies with fetal growth restriction. We aimed to assess whether changes in the fetal ductus venosus Doppler waveform (DV) could be used as indications for delivery instead of cardiotocography short-term variation (STV).

Research paper thumbnail of B cells in pregnancy: functional promiscuity or tailored function?

Biology of reproduction, 2015

Research paper thumbnail of Fetal growth restriction due to placental disease

Seminars in Perinatology, 2004

Normal fetal growth depends on the genetically predetermined growth potential and its modulation ... more Normal fetal growth depends on the genetically predetermined growth potential and its modulation by the health of the fetus, placenta and the mother. Fetuses that are small because of intrauterine growth restriction (IUGR) are at higher risk for poor perinatal and long-term outcome than those who are appropriately grown. Of the many potential underlying processes that may result in IUGR,

Research paper thumbnail of Fetal venous, intracardiac, and arterial blood flow measurements in intrauterine growth retardation: Relationship with fetal blood gases

American Journal of Obstetrics and Gynecology, 1995

OBJECTIVE: Our purpose was to investigate arterial, venous, and intracardiac blood flow in growth... more OBJECTIVE: Our purpose was to investigate arterial, venous, and intracardiac blood flow in growth-retarded fetuses and to relate the Doppler results to blood gases in umbilical venous blood obtained by cordocentesis.STUDY DESIGN: A cross-sectional, pulsed-wave color Doppler ultrasonographic study of 23 severely growth-retarded fetuses undergoing cordocentesis and measurement of blood gases was performed. Blood velocity waveforms were recorded from the

Research paper thumbnail of Cervical length as a prognostic factor for preterm delivery in twin-to-twin transfusion syndrome treated by fetoscopic laser coagulation of chorionic plate anastomoses

Ultrasound in Obstetrics & Gynecology, 2005

Objective To evaluate the risk of spontaneous preterm delivery in relation to cervical length in ... more Objective To evaluate the risk of spontaneous preterm delivery in relation to cervical length in severe cases of twin-to-twin transfusion syndrome (TTTS) diagnosed before 26 weeks of gestation and treated by laser coagulation of the intertwin placental anastomoses.

Research paper thumbnail of Successful outcome after Nd : YAG laser separation of chorioangiopagus-twins under sonoendoscopic control

Ultrasound in Obstetrics & Gynecology, 1992

Endoscopic laser coagulation of the chorioangiopagus was successfully performed at 25 weeks&#... more Endoscopic laser coagulation of the chorioangiopagus was successfully performed at 25 weeks&#39; gestation in a pregnancy presenting with acute polyhydramnios due to twin transfusion syndrome. Under local anesthesia, a rigid fetoscope housed in a 2.7 mm diameter cannula was introduced transabdominally into the amniotic cavity and the communicating vessels were coagulated by Nd : YAG laser through a fiber that was passed down the side-arm of the cannula. There was rapid normalization of urine output in both fetuses and resolution of the oligo- and polyhydramnios in the donor and recipient twins, respectively. Furthermore, there was normalization in both fetal circulations, as assessed by Doppler velocimetry, and there was gradual resolution of the hydrops in the recipient. Two healthy babies were born 9 weeks after the procedure.

Research paper thumbnail of Fetal surgery in animal models

International Journal of Gynecology & Obstetrics, 2000

Research paper thumbnail of Thresholds for intervention in severe early onset growth restriction (IUGR)

American Journal of Obstetrics and Gynecology, 2004

Research paper thumbnail of Predictors of necrotizing entercolitis (NEC) in fetal growth restriction (IUGR)

American Journal of Obstetrics and Gynecology, 2005

OBJECTIVE: Pulmonary hypoplasia (PH) is a feared complication of midtrimester premature rupture o... more OBJECTIVE: Pulmonary hypoplasia (PH) is a feared complication of midtrimester premature rupture of membranes (PROM) as it is associated with a neonatal mortality rate as high as 80%. Gestational age (GA) at PROM and residual volume of amniotic fluid (AF) are traditionally identified as predictors of PH. We evaluate the independent risk factors for PH in a large cohort of midtrimester PROM.

Research paper thumbnail of P254: Lung development in fetal sheep observed with Magnetic Resonance Imaging (MRI) and ultrasound B-scan

Ultrasound in Obstetrics & Gynecology - ULTRASOUND OBSTET GYN, 2003

Research paper thumbnail of OP10.14: Laser therapy of twin–twin transfusion syndrome in triplet pregnancies

Ultrasound in Obstetrics & Gynecology - ULTRASOUND OBSTET GYN, 2007

Research paper thumbnail of P238: There are no differences of Doppler indices between sheep fetuses with and without accelerated lung growth

Ultrasound in Obstetrics & Gynecology - ULTRASOUND OBSTET GYN, 2003

Research paper thumbnail of Characteristics of fetal venous, blood flow under normal circumstances and during fetal disease

Ultrasound in Obstetrics and Gynecology, 1996

Research paper thumbnail of OC100: TRAP sequence: fetoscopic laser treatment

Ultrasound in Obstetrics and Gynecology, 2004

Research paper thumbnail of Ductus venosus studies in fetuses at high risk for chromosomal or heart abnormalities: relationship with nuchal translucency measurement and fetal outcome

Ultrasound in Obstetrics and Gynecology, 2002

Objective To investigate, in a high-risk group of fetuses, the role of ductus venosus Doppler vel... more Objective To investigate, in a high-risk group of fetuses, the role of ductus venosus Doppler velocimetry as a prognostic factor, in addition to nuchal translucency measurement, for predicting chromosomal anomalies and, where the karyotype was normal, for predicting fetal outcome.

Research paper thumbnail of Pulmonary circulation of fetal sheep with lung hyperplasia following tracheal occlusion

Ultrasound in Obstetrics and Gynecology, 2005

To determine the alteration of blood flow velocity profile in the pulmonary arteries (PAs) of fet... more To determine the alteration of blood flow velocity profile in the pulmonary arteries (PAs) of fetal sheep after tracheal occlusion (TO). Doppler ultrasound investigations of the PAs, the pulmonary trunk and the ductus arteriosus were performed weekly in nine ewes (gestational age 92-98 days, term 145 days) with singleton pregnancies after TO (n = 5) and in control fetuses (n = 4). Histological examinations with morphometry of pulmonary arterial vessels and of airways were performed in both groups. In the control group the experiments lasted 38 +/- 6 days (mean +/- SD), and in the TO group 25 +/- 7 days. Relative lung weight was significantly higher in the TO group compared with the control group (14.5 +/- 3.4% and 4.0 +/- 0.5% of body weight). There were no significant differences in the Doppler parameters (pulsatility index, resistance index, the systolic peak, the diastolic minimum, time averaged maximum velocity) between groups. When the Doppler values of PAs in TO and control fetuses were combined, no significant differences between the left and right PA could be detected. The external diameter of peripheral PAs was significantly higher in the TO group as compared to control group (105.7 +/- 2.5 microm vs. 96.9 +/- 1.3 microm). We found a threefold increase of fetal lung volume after TO without significant changes of blood flow velocity profiles in the PAs of fetal sheep.