Prenatal diagnosis of congenital heart disease using four-dimensional spatio-temporal image correlation (STIC) telemedicine via an Internet link: a pilot study
F. ViÃ±als 1 *, L. Mandujano 2, G. Vargas 3, A. Giuliano 1
1Centro AGB UltrasonografÃa, Clinica Sanatorio AlemÃ¡n, ConcepciÃ³n, Chile – 2Centro Medico El Bosque, Punta Arenas, Chile
3Hospital La Serena, La Serena, Chile
email: F. ViÃ±als (firstname.lastname@example.org)
*Correspondence to F. ViÃ±als, Avda Sanhueza 55. 403 A, ConcepciÃ³n, Chile
4D â€¢ congenital heart disease â€¢ prenatal diagnosis â€¢ spatio-temporal image correlation â€¢ STIC â€¢ telemedicine
To assess whether the spatio-temporal image correlation (STIC) acquisition technique can be taught to a general obstetrician by e-mail; whether STIC volume datasets can be transmitted over the Internet; and whether STIC volume datasets analyzed offline at a remote setting can be used to confirm or exclude major cardiac defects (TELE-STIC).
This was a prospective study involving 50 pregnant women with gestational ages ranging between 20 and 36 weeks. These patients were selected by two general obstetricians (operators) working in geographically remote areas of Chile. Although both obstetricians were users of equipment capable of four-dimensional (4D) ultrasound with STIC, they lacked skill in the performance of fetal cardiac examination. A dedicated web disk was created to upload the acquired volume datasets using an Internet broadband connection. Offline analysis was performed by a single investigator experienced in fetal echocardiography (the administrator).
A telemedicine link via the Internet was possible in all cases. Seventy-seven volume datasets were sent to the web server. A complete cardiac examination according to set criteria was achieved by the administrator in 86% of the cases scanned by one operator and 95% of the cases scanned by the other operator. Three patients had cardiac defects confirmed postnatally, two fetuses had extracardiac anomalies and one fetus had a suspected cardiac defect unconfirmed by second-opinion TELE-STIC. There were two isolated major congenital heart defects. Both patients were given advice by e-mail and teleconference using a web camera about the likely outcome and benefits of scheduling in utero transport to a tertiary care center.
STIC volumes can be obtained by operators inexperienced in fetal echocardiography, transmitted via the Internet, and their analysis enables recognition of most of the structures and views necessary to assess fetal cardiac anatomy. The preliminary use of TELE-STIC allowed us to demonstrate that some intracardiac anomalies can be ruled out and others confirmed, allowing perinatal management to be tailored accordingly.
Ultrasound in Obstetrics and Gynecology Volume 25, Issue 1
Copyright Â© 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Double-Orifice Mitral Valve with Intact Atrioventricular Septum: An
Echocardiographic Study With Anatomic and Functional Considerations
Bibhuti B. Das, MD, Linda B. Pauliks, MD, Ole A. Knudson, Jr, RDCS, Scott Kirby, RDCS,
Kak-Chen Chan, MD, Lilliam Valdes-Cruz, MD, and Raul O. Cayre, MD,
Denver, Colorado; Boston, Massachusetts; and Corrientes, Argentina
We identified 18 patients with double-orifice mitral
valve (DOMV) and intact atrioventricular (AV) septum
out of 40,179 echocardiographic studies performed
between 1997 and 2002 at Childrenâ€™s Hospital,
Denver, CO. In this study we describe (1) the
anatomic characteristics of the DOMV in the absence
of AV septal defect, (2) the function of the mitral
valve by spectral and color Doppler flow mapping,
and (3) associated lesions. The topographic location
of the orifices in the leaflets suggests possible embryologic
mechanisms of DOMV. In this series,
DOMV was most commonly associated with leftsided
obstructive lesions (in 39% of patients). Spectral
and color Doppler interrogation demonstrated a
normal flow profile in most cases; only 2 patients
had significant mitral regurgitation or stenosis.
Therefore, due to the uncertain natural history of
this lesion and the potential need for endocarditis
prophylaxis, careful imaging of the mitral valve is
recommended, particularly in the presence of leftsided
(J Am Soc Echocardiogr
Anatomoechocardiographic correlation double inlet left ventricle
Luis MuÃ±oz-CastellaÃ±os, MD – Nilda Espinola-Zavaleta, MD, PhD –
Candace Keirns, MD
Double inlet left ventricle (LV) is a type of atrioventricular connection in which the morphologically LV receives more than 50% of the atrioventricular valves when they are separate, or more than 75% of a common atrioventricular valve. The aim of this study was to establish an anatomoechocardiographic correlation between the morphologic features of equivalent anatomic specimens and the echocardiographic images of patients to provide a means of interpreting the image correctly and a more precise diagnosis of the cardiac defect. Echocardiography was used to study 18 patients with LV double inlet who were seen in a congenital heart disease clinic. The morphology of 17 hearts with this malformation from the department of embryology was analyzed to compare the anatomic features with their echocardiographic images. Echocardiography proved to be a noninvasive diagnostic tool that allowed characterization of anatomic and functional aspects of double inlet LV.
Anatomoechocardiographic correlation double inlet left ventricle
Task Force Report
Guidelines on management (diagnosis and treatment)
Task Force on Syncope, European Society of Cardiologyâ€ : M. Brignole (Chairman),
P. Alboni, D. Benditt, L. Bergfeldt, J. J. Blanc, P. E. Bloch Thomsen, J. G. van Dijk,
A. Fitzpatrick, S. Hohnloser, J. Janousek, W. Kapoor, R. A. Kenny, P. Kulakowski,
A. Moya, A. Raviele, R. Sutton, G. Theodorakis and W. Wieling
Table of contents
Preamble – Scope of the document 1256 – Method 1257
Part 1. Classification, epidemiology and prognosis
Brief overview of pathophysiology of syncope 1258
Epidemiological considerations 1259
Prognostic stratification: identification of factors
predictive of adverse outcome 1260
Part 2. Diagnosis
Strategy of evaluation (flow chart) 1262
Initial evaluation (history, physical examination,
baseline electrocardiogram) 1264
Carotid sinus massage 1266
Tilt testing 1268
Electrocardiographic monitoring (non-invasive
and invasive) 1271
Electrophysiological testing 1273
ATP test 1277
Ventricular signal-averaged electrocardiogram 1278
Exercise testing 1278
Cardiac catheterization and angiography 1279
Neurological and psychiatric evaluation 1279
Diagnostic yield and prevalence of causes
of syncope 1282
Part 3. Treatment
General principles 1282
Neurally-mediated reflex syncopal syndromes 1283
Orthostatic hypotension 1285
Cardiac arrhythmias as primary cause 1286
Structural cardiac or cardiopulmonary disease 1289
Vascular steal syndromes 1289
Part 4. Special issues in evaluating patients with syncope
Need for hospitalization 1290
Syncope in the older adult 1290
Syncope in paediatric patients 1292
Driving and syncope 1293
Glossary of uncertain terms 1293
Scope of the document
The purpose of this document is to provide specific
recommendations on the diagnostic evaluation and
management of syncope. The document is divided into
four parts: (1) classification, epidemiology and prognosis;
(2) diagnosis; (3) treatment; and (4) special issues
in evaluating patients with syncope. Each part reviews
background information and summarizes the relevant
literature. The details of pathophysiology and mechanisms
of various aetiologies were considered to lie
outside the scope of this document. Although the document
encompasses many of the important aspects of
syncope, the panel recommendations focused on the
following main questions:
1. What are the diagnostic criteria for causes of
2. What is the preferred approach to the diagnostic
work-up in various subgroups of patients with
3. How should patients with syncope be risk stratified?
Correspondence: Michele Brignole, MD, FESC, Department of
Cardiology and Arrhythmologic Centre, Ospedali Riuniti, 16033
*This document has been reviewed by members of the Committee
for Practice Guidelines (formerly Committee for Scientific and
Clinical Initiatives) and by the members of the Board of the
European Society of Cardiology (see Appendix 1), who approved
the document on 8 March 2001. The full text of this document is
available on the website of the European Society of Cardiology in
the section â€˜Scientific Informationâ€™, Guidelines.
â€ For affiliations of Task Force members see Appendix 2.
0195-668X/01/221256+51 $35.00/0 2001 The European Society of Cardiology
4. When should patients with syncope be hospitalized?
5. Which treatments are likely to be effective in preventing
Internet Registry on CHD
The incidence of congenital heart disease is about 8 for 1000 live births.
We propose a register for continuous monitoring of congenital heart diseases from fetus to young adult in the world through Internet W.W.W.This register have opened since 03/30/1996 a new perspective study to evaluate the incidence and the spectrum of congenital heart diseases diagnosed either during fetal or postnatal life. The data entry was separated for Fetal and Neonatal CHD.
The register is the most effective way to quickly compile and provides up to date informations on participating centers, summary and statistical data in DATA ENTRY , INSTITUTIONS and RESULTS pages and you will may send questions, suggestions and/or comments to improve this WWW service.
We are very grateful to all Institutions, Pediatric Cardiologists, Pediatric Cardiac Surgeons and Anybody who are devoted in diagnosis of congenital malformations, that have the pleasure in adding theirs data in this multi-institutional, cooperative endeavour.
All data collected will be presented up to date in these pages.
Copyright © 1996 S.Gerboni M.D.