Echocardiographic evaluation of dilated cardiomyopathy in the human fetus (original) (raw)
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Echocardiographic Parameters and Outcomes in Primary Fetal Cardiomyopathy
Journal of Ultrasound in Medicine, 2016
etal cardiomyopathy, be it primary or secondary in nature, accounts for up to 11% of the cardiac disease diagnosed in utero. 1 Secondary fetal cardiomyopathy may be due to a number of conditions, including fetal arrhythmias, structural heart disease, twin-twin transfusion syndrome, fetal anemia, fetal infection with myocarditis, and maternal autoimmune disorders. 1 The prognosis in fetal cardiomyopathy is poor, with fetal demise reported in 63% (29 of 46) of affected fetuses reviewed in the largest case series. 1 Outcome data in fetal cardiomyopathy are based mainly on series of secondary cardiomyopathies. 1-8 In contrast, there are little outcome data available for primary fetal cardiomyopathy because of its rarity,
Neonatal dilated cardiomyopathy
Revista Portuguesa de Cardiologia, 2017
Cardiomyopathies are rare diseases of the heart muscle, of multiple causes, that manifest with various structural and functional phenotypes but are invariably associated with cardiac dysfunction. Dilated cardiomyopathy is the commonest cardiomyopathy in children, and the majority present before one year of age. Its etiology may be acquired or genetic. Myocarditis is an important cause and is responsible for the majority of acquired cases. Inherited (familial) forms of dilated cardiomyopathy may occur in 25-50% of patients. Echocardiographic and tissue Doppler studies are the basis for diagnosis of dilated cardiomyopathy in most patients. Marked dilatation of the left ventricle with global hypokinesis is the hallmark of the disease. This review will cover the classification, epidemiology and management of newborns with dilated cardiomyopathy. In particular, a comprehensive and up-to-date review of the genetic study of dilated cardiomyopathy and of detailed echocardiographic assessment of these patients will be presented.
Spectrum and Outcome of Primary Cardiomyopathies Diagnosed During Fetal Life
JACC: Heart Failure, 2014
The purpose of this study was to determine the phenotypic presentation, causes, and outcome of fetal cardiomyopathy (CM) and to identify early predictors of outcome. BACKGROUND Although prenatal diagnosis is possible, there is a paucity of information about fetal CM. METHODS This was a retrospective review of 61 consecutive fetal cases with a diagnosis of CM at a single center between 2000 and 2012. RESULTS Nonhypertrophic CM (NHCM) was diagnosed in 40 and hypertrophic CM (HCM) in 21 fetuses at 24.7 AE 5.7 gestational weeks. Etiologies included familial (13%), inflammatory (15%), and genetic-metabolic (28%) disorders, whereas 44% were idiopathic. The pregnancy was terminated in 13 of 61 cases (21%). Transplantation-free survival from diagnosis to 1 month and 1 year of life for actively managed patients was better in those with NHCM (n ¼ 31; 58% and 58%, respectively) compared with those with HCM (n ¼ 17; 35% and 18%, respectively; hazard ratio [HR]: 0.44; 95% confidence interval [CI]: 0.12 to 0.72; p ¼ 0.007). Baseline echocardiographic variables associated with mortality in actively managed patients included ventricular septal thickness (HR: 1.21 per z-score increment; 95% CI: 1.07 to 1.36; p ¼ 0.002), cardiothoracic area ratio (HR: 1.06 per percent increment; 95% CI: 1.02 to 1.10; p ¼ 0.006), $3 abnormal diastolic Doppler flow indexes (HR: 1.44; 95% CI: 1.07 to 1.95; p ¼ 0.02), gestational age at CM diagnosis (HR: 0.91 per week increment; 95% CI: 0.83 to 0.99; p ¼ 0.03), and, for fetuses in sinus rhythm, a lower cardiovascular profile score (HR: 1.45 per point decrease; 95% CI: 1.16 to 1.79; p ¼ 0.001). CONCLUSIONS Fetal CM originates from a broad spectrum of etiologies and is associated with substantial mortality. Early echocardiographic findings appear useful in predicting adverse perinatal outcomes. (J Am Coll Cardiol HF 2014;2:403-11) © 2014 by the American College of Cardiology Foundation. C ardiomyopathies (CMs) encompass a spectrum of heart muscle disorders that affect cardiac filling, contraction, or both, in the absence of correctible anatomic and/or hemodynamic abnormalities (1). Most children present with a dilated or hypertrophic phenotype (2-4) without an identifiable genetic, familial, infectious, or metabolic cause (5,6). CM is the most common indication for cardiac transplantation in infants (1,7). The condition is rarely diagnosed prenatally, and there is little knowledge of the disease spectrum and outcome when detected prenatally. In a study that predated this research, Pedra et al. (8) reported 55 fetuses with a hypertrophic (n ¼ 33) or dilated (n ¼ 22) phenotype, diagnosed at The Hospital for Sick Children in
Diagnosis of congenital heart disease by early and second-trimester fetal echocardiography
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2012
The aim of this study was to compare the cardiac findings at 11 to 14 weeks' gestation with the second-trimester findings to evaluate the reliability of first-trimester echocardiography and the possibility of congenital heart disease evolution. The database of our fetal medicine unit was searched for all patients who had undergone fetal echocardiography at 11 to 14 and 18 to 22 weeks' gestation from 2005 to 2010. In all of the antenatally suspected cases of congenital heart disease, the diagnosis was established conclusively by postnatal echocardiography, surgery, or autopsy. Among the 870 fetuses included in the study, 802 were considered to have no abnormalities on both examinations. Thirty-six cases had abnormal findings on both examinations, and 32 had discordant findings. Among the 32 discordant findings, 6 cases had a false-positive diagnosis of congenital heart disease on early echocardiography, and 26 had a different diagnosis. In 14 of these 26 cases, the diagnosis ...
Korean circulation journal, 2012
We hypothesized that fetal echocardiography (echoCG) is an accurate diagnostic tool reflecting well postnatal echoCG findings and outcomes. We reviewed the medical records of 290 pregnant women, including 313 fetuses, who were examined by fetal echoCG at the Seoul National University Children's Hospital from January 2008 through April 2011. The mean gestational age at diagnosis was 26.2±5.2 weeks. The mean age of mothers at diagnosis was 31.7±3.8 years. We identified indications for fetal echoCG in 279 cases. The most common indication was abnormal cardiac findings in obstetrical screening sonography (52.0%). Among the 313 echoCG results, 127 (40.6%) were normal, 13 (4.2%) were minor abnormalities, 35 (11.2%) were simple cardiac anomalies, 50 (16.0%) were moderate cardiac anomalies, 60 (19.2%) were complex cardiac anomalies, 16 (5.1%) were arrhythmias, and 12 (3.8%) were twin-to-twin transfusion syndrome. The most common congenital heart disease was tetralogy of Fallot (23 fetus...
Dilated cardiomyopathy and pregnancy outcome: a case report
International journal of reproduction, contraception, obstetrics and gynecology, 2022
Cardiomyopathy is a group of diseases that affect the heart muscle. Dilated cardiomyopathy, a form of cardiomyopathy, is characterised by ventricular chamber enlargement and contractile dysfunction, and has recurrences in subsequent pregnancies. Pregnancy by itself is associated with significant hemodynamic burden and cardiovascular changes, which when coupled with dilated cardiomyopathy results in increased morbidity and mortality in both mother and child. Management of such a condition presents serious therapeutic challenge to a multidisciplinary team. Here, we report a case of a 36-year-old woman primigravida with gestational age of 11 weeks, known case of dilated cardiomyopathy. Despite the risks and associated complications with the disease, she continued her pregnancy. Patient was managed by a team of obstetrician, cardiologist and anaesthesiologist and underwent caesarean section giving birth to a live baby. The aim of this article is to provide guidance on how to manage a patient with dilated cardiomyopathy throughout her pregnancy. Early diagnosis of heart disease, regular antenatal checkups , institutional delivery and multidisciplinary approach can reduce the maternal and perinatal morbidity and mortality.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Primary dilated cardiomyopathy is rare in women of childbearing age. Pregnancy in dilated cardiomyopathy carries high risk and can have adverse feto-maternal outcome even death. Traditionally patients of dilated cardiomyopathy with poor cardiac reserve are advised against pregnancy or termination of pregnancy in first trimester. A 26 year old patient with 5 abortions and no live issue diagnosed with Idiopathic dilated cardiomyopathy at 30 weeks at echocardiography (ECHO) with left ventricular ejection fraction (LVEF) of 25% (WHO class IV). She had no cardiac consultation earlier than in this pregnancy, though her earlier abortions were in hospital. Patient was kept with close monitoring. Dopplers parameters showed continued worsening. An emergency caesarean was done because of absent flow in ductus venosus at 34 weeks and a live child of 2.010 kg delivered. To date both mother and child are doing well. Awareness of such condition and a multidisciplinary approach is required in management of cardiomypathy in pregnancies, whose symptoms mimic that of normal pregnancy and can have adverse feto-maternal outcome.