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8th European Echocardiography Course in Congenital Heart Disease

The 8th European Echocardiography Course in Congenital Heart Disease will be organised in Bologna, from Wednesday 23rd to Saturday 26th October 2013.
his course provides a thorough overview of Echocardiography in Congenital Heart Disease and is aimed at Pediatric Cardiologists, Grown-up Congenital Heart Disease Specialists and Echocardiography Technicians working with Congenital Heart Disease patients. The programme strongly builds on the side-by-side comparison of morphology and imaging and discusses the major abnormalities found in clinical practice

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June 2013 Parma Echo Meeting From Fetus to Joung Adult

Dear colleagues and friends,

here is the Program of our June 2013 Parma Echo Meeting.

We invite you to partecipate to “…a very special and unique Meeting ! …“

“ .. Avec un programme scientifique de qualité et une hospitalité unique,

prenant soin de toute chose, de tous et de chacun!… “

“ L’atmosfera come sempre e’ affettuosa e charming …”

“ The Parma Meeting continues to have a unique place in our lives !”

Vi aspettiamo ! per un’altra “ wonderful experience ! “

M Ludovica Maramotti Prezioso Umberto Squarcia

Max Mara Universita’ di Parma

WEDNESDAY JUNE 19

Centro S.Elisabetta Campus Universitario

YOUNG ADULT SATELLITE SESSION

Structural Heart Diseases in Young Adult

9:00 – 9:30 Advanced 3D Imaging of Right Ventricle. Morphology and Function L Badano
( Padova , Italy )

9:30 – 10:00 Case Examination

10:00 – 10:30 Echocardiografic Assessment of Coronary Reserve F Rigo (Venice, Italy )

10:30 – 11:00 Case Examination

11:00 – 11:30 Coffee Break

11:30- 12:00 Rest Speckle Tracking in Coronary Arteries Diseases N. Gaibazzi

( Parma ,Italy )

12:30 Lunch

RV and PULMONARY HYPERTENSION

14:00 – 14:15 Echocardiographic Assessment of RV Function M Al-Obeyde ( Mosul, Iraq )

14:15- 14:45 New Echocardiographic Methods to evaluate the RV Function M Vogel
( London, UK )

14:45 – 15:00 Pulmonary Hypertension in CHD. An Overview. A Agnetti ( Parma, Italy )

15:00 – 15:30 Current Treatment of PH Associated With CHD N Galiè ( Bologna, Italy )

15:30 – 16:00 Echocardiography in the Management of Pediatric Pulmonary Hpertension
J Johnson ( Rochester , Minn. USA )

16:00 – 16:30 Panel and General Discussion

Aula Magna, Università degli Studi di Parma

18:30 – 19:30 Opening Ceremony

Rastelli Lecture by Norman Silverman ( S.Francisco, USA )
The History of Pediatric Echocardiography Where We Have Come and Where We Are Going!

20:00 – 22:00 Reception and Dinner at St. John Evangelist Church’s Refectory

THURSDAY JUNE 20

FETAL STUDIES

9:00 – 9:30 Embryological development of the heart –S Sanders ( Boston, Mass. USA )

9:30 – 10:00 Fetal detection of Congenital Heart Diseases L Fermont ( Paris, France )

10:00 -10:30 The future of 3D Fetal Echocardiography N Silverman ( S.Francisco , Cal. USA )

11:00 – 11:30 Coffee Break

11:30 – 12:00 “ Heaven can wait ! “ A Modern Vision of Fetal and Perinatal Cardiology

( Project born inside the Parma’s Gang ) M Guirgis ( Paris, France )

12:00 – 12:30 Isabelle Jue Lecture by Paul Julsrud ( Rochester, Minn. USA )

Anomalous Coronary Artery Anatomy –Revisited

12:30 Lunch

14:00 – 14:30 Post Mortem Imaging S Sanders ( Boston, Mass. USA )

14:30 – 15:00 Fibrosis, Cirrhosis or Worse: What Happens to the Liver in the Fontan
Circulation J Johnson ( Rochester, Minn. USA )

15:00 – 17:00 Case Examination

19:00 – 23:00 Max Mara Gala Dinner in Reggio Emilia

FRIDAY JUNE 21

MRI/CT/3D/Pathologic Correlation

9:00 – 9:20 MRI / CT / Pathology Correlation in Intracardiac Anatomy S Sanders
( Boston, Mass. USA )

9:20 – 9:30 3D Reconstruction of heart specimen S Sanders ( Boston, Mass. USA )

9:30 – 10:00 3D for RV Function G Shirali ( Kansas City , Miss. USA )

10:00 – 10:30 MRI / CT / Pathology Correlation in Vascular Rings S Sanders
( Boston, Mass. USA )

10:30 – 11:00 Coffee Break

11:00 – 11:30 MRI late FU in PO Fallot patients P Festa ( Pisa, Italy )

11:30 – 12:00 How do Echocardiographic Measures of Ventricular Function match up with

Catheter Measures in CHD. G.Shirali ( Kansas City , Miss. USA )

12:00 – 12.30 Panel Discussion ( Hagler, Sanders, Silverman, Shirali, Julsrud, Festa )

12:30 Lunch

14:00 – 14:30 Conventional Measures of LV Function : Implications of the Pediatric Heart

Network Studies G Shirali ( Kansas City , Miss. USA )

14:30 – 15:00 Catheter Interventional Procedures in ACHD D Hagler
( Rochester, Minn. USA )

!5:00 – 17:00 Case Examination

Aula Magna, Universita’ degli Studi di Parma

18:00 – 19:00 Premio Vincenzo Ferrante for young scientists
Chairperson R. Williams ( Los Angeles Cal. USA )

Macartney Lecture by Fernando and Madalena Maymone Martins
( Lisboa, Portugal )

“Helping people in difficulty – A view within and
beyond Pediatric Cardiology

20:00 – 23:00 Dinner and Music in the Countryside

“ Under the Stars of Mamiano “

The Accompanying Persons will be guided to visit the sites of Parma and Province

by Umberto Squarcia Jr., Architect in New York, Cortina and Parma

SATURDAY JUNE 22

Post Congress Tour

Umberto Squarcia MD FACC

Full Professor of Pediatrics and

Pediatric Cardiology

University of Parma Italy

Past Member of Board of Directors

Mayo Alumni Association

Rochester,Minn. USA

Cell. +39 338 6035868
email: umbertosquarcia@gmail.com
email: umberto.squarcia@unipr.it

PAX ET BONUM!

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Bicuspid Aortic Valve Disease

Bicuspid aortic valve disease (BAV) is the most common congenital heart abnormality, affecting 0.5–2% of the total population with a male predominance [1]. Although the majority of cases are sporadic, BAV can be familial and is commonly associated with other congenital heart abnormalities and genetic syndromes [1,2]. In addition to the obvious valvular sequelae to which BAV patients are predisposed, BAV disease is associated with an aortopathy and an associated predisposition to aneurysm formation and dissection of the thoracic aorta [1–3]. Patients with BAV therefore require lifelong evaluation and surveillance at various intervals, depending upon their specific condition. Advances in imaging and in molecular characterization of the underlying aortopathy hold promise to improve both evaluation and treatment of patients with BAV.
The defining feature of BAV is abnormal aortic valvular morphology, with the valve having two leaflets and two commissures instead of three. Most commonly, the two leaflets are asymmetric, and the larger has a central raphe or fibrous ridge in the area where a commissure that would otherwise be present has fused [1]. The leaflets may be of roughly equivalent size, and the raphe may be absent in certain cases [1]. Fusion may occur between any of the three valve leaflets, most commonly between the right- and left-coronary leaflets (70–86%), although also between the right- and non-coronary leaflets (12%) or between the left- and non-coronary leaflets (3%) [1]. Leaflet orientation may play a role in BAV disease progression and aortic dilatation [2,4]. Right- coronary and non-coronary leaflet fusion has been associated with more rapid progression of valvular pathology including stenosis and re- gurgitation [4]. The abnormal hemodynamic stress imposed by the atyp- ical valve anatomy on both the valve tissue and the aorta by BAV may contribute significantly to the ultimate development of valvular dysfunction and to aortopathy [2,5,6].

BAV patients may have many fates. Some patients with BAV are highly symptomatic in childhood with congenital AS or severe AR or have associated lesions such as coarctation of the aorta, which bring them to medical attention. However, many young people with BAV are completely asymptomatic and have “normally” functioning BAVs. It is nevertheless estimated that at least one third and perhaps a majority of patients with BAV will develop a complication during their lifetime. This implies that the vast majority of BAV patients will remain asymptomatic until adulthood, at which time they begin to experience progressive degeneration of valvular function and sequelae of aortopathy including aortic dilatation, aneurysm formation and risk of dissection. Early surgical and autopsy data indicate that progression of valvular dysfunction, particularly aortic stenosis, occurs at a significantly earlier age in BAV patients than in those with a trileaflet aortic valve.

The abnormal hemodynamic stress imposed by the atypical valve anatomy on both the valve tissue and the aorta by BAV may contribute significantly to the ultimate development of valvular dys- function and to aortopathy

References


[1] BravermanAC,GuvenH,BeardsleeMA,MakanM,KatesAM,MoonMR. The bicus-pid aortic valve. Curr Probl Cardiol 2005;30(9):470-522.

[2] Braverman AC. Beardslee. The bicuspid aortic valve. In: Otto C, Bonow R, editors. Valvular heart disease: a companion to Braunwald’s Heart Disease. Philadelphia: Saunders/Elsevier; 2009. p. 169-86.

[3] Braverman AC. Aortic involvement in patients with a bicuspid aortic valve. Heart 2011;97(6):506-13.

[4] Fernandes SM, Khairy P, Sanders SP, Colan SD. Bicuspid aortic valve morphology and interventions in the young. J Am Coll Cardiol 2007;49(22):2211-4.

[5] Wallby L, Janerot-Sjoberg B, Steffensen T, Broqvist M. T lymphocyte infiltration in non-rheumatic aortic stenosis: a comparative descriptive study between tricuspid and bicuspid aortic valves. Heart 2002;88(4):348-51.

[6] Robicsek F, Thubrikar MJ, Cook JW, Fowler B. The congenitally bicuspid aortic valve: how does it function? Why does it fail? Ann Thorac Surg 2004;77(1):177-85.

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Early fetal echocardiography and increased nuchal translucency

Increased NT is associated with a spectrum of fetal abnormalities.
The commonest association is with chromosomal defects. In fetuses
with increased NT and a normal karyotype, the risk of an adverse
outcome remains and increases with increasing NT.

Best practice Key guidelines
(by Shanthi Sairam a,⁎, Julene S. Carvalho a,b,c,
** a Fetal Medicine Unit, St. George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT, United Kingdom
** b St. George’s University of London, United Kingdom
** c Royal Brompton Hospital NHS Foundation Trust, United Kingdom

Early fetal echocardiography and anomaly scan in fetuses with increased nuchal translucency
Early Human Development 88 (2012) 269–272)

  1. • There is clear evidence that pregnancies with increased fetal NT
    thickness and normal karyotype are at higher risk of adverse outcome, cardiac or otherwise.
  2. • Abnormalities affecting the cardiovascular system are the most
    common defects encountered in chromosomally normal fetuses
    with increased NT.
  3. • Importantly, when abnormalities of all other systems (extra-cardiac)
    are put together, the overall number of defects is higher than cardiac
    abnormalities alone.
  4. • Early fetal echocardiography and early anomaly scan should be
    considered in these fetuses.
  5. • Each fetal medicine unit should aim to design a management protocol which
    is evidence-based but also takes into account expertise and facilities available locally.
  6. • A simple protocol, with clear instructions to non-medical as well as
    medical staff regarding arrangements for follow up scans for pregnancies
    with increased NT and normal karyotype should be in place.
  7. • Patients need to be informed of the plan of follow up in their pregnancy
    for the increased NT and the need for several scans to rule out
    associated structural defects in the baby.
  8. • Patients also need to be informed, that in the presence of increased
    NT and a normal anomaly scan and fetal echo by 21–23 weeks,
    there is a 95% chance of a good outcome.
  9. • Patients need to be aware that in a small percentage of pregnancies
    (about 5%), some genetic or syndromic causes may be identified
    postnatally, even with normal findings in the antenatal scans.

6. Research directions

  1. • The role of three-dimensional and four-dimensional scan (STIC,
    spatio-temporal image correlation) in the presence of increased
    NT needs to be explored. Once a volume is acquired, this can be
    remotely accessed and analyzed and may address the problem of
    lack of expertise particularly with a view to making more technicians
    available to screen the fetal hearts at an early gestation.
  2. • All units need to audit their practices regularly in order to ensure
    that they are up to date with current recommendations and evidence and
    to ensure that they deliver the intended services.
  3. • Focus needs to shift from using the 11 to 14 week scan as a screening
    platform for just Down syndrome to using it as a screening platform for
    most structural defects.

References

  • [1] Souka AP, Krampl E, Bakalis S, Heath V, Nicolaides KH. Outcome of pregnancy
    in chromosomally normal fetuses with increased nuchal translucency in the first
    trimester. Ultrasound Obstet Gynecol 2001;18:9–17.
  • [2] Schuchter K, Hafner E, Stangl G, Ogris E, Philipp K. Sequential screening for
    trisomy 21 by nuchal translucency measurement in the first trimester and maternal
    serum biochemistry in the second trimester in a low-risk population. Ultrasound
    Obstet Gynecol 2001;18:23–5.
  • [3] Michailidis GD, Economides DL. Nuchal translucency measurement and pregnancy
    outcome in karyotypically normal fetuses. Ultrasound Obstet Gynecol 2001;17:
    102–5.
  • [4] Schwarzler P, Senat MV, Holden D, Bernard JP, Masroor T, Ville Y. Feasibility of
    the second-trimester fetal ultrasound examination in an unselected population
    at 18, 20 or 22 weeks of pregnancy: a randomized trial. Ultrasound Obstet Gynecol
    1999;14:92–7.
  • [5] Makrydimas G, Sotiriadis A, Huggon IC, et al. Nuchal translucency and fetal cardiac
    defects: a pooled analysis of major fetal echocardiography centers. Am J Obstet
    Gynecol 2005;192:89–95.
  • [6] Makrydimas G, Sotiriadis A, Ioannidis JP. Screening performance of first-trimester
    nuchal translucency for major cardiac defects: a meta-analysis. Am J Obstet Gynecol
    2003;189:1330–5.
  • [7] Hyett J, Moscoso G, Papapanagiotou G, Perdu M, Nicolaides KH. Abnormalities
    of the heart and great arteries in chromosomally normal fetuses with increased
    nuchal translucency thickness at 11–13 weeks of gestation. Ultrasound Obstet
    Gynecol 1996;7:245–50.
  • [8] Clur SA, Ottenkamp J, Bilardo CM. The nuchal translucency and the fetal heart:
    a literature review. Prenat Diagn 2009;29:739–48.
  • [9] Westin M, Saltvedt S, Almstrom H, Grunewald C, Valentin L. By how much does
    increased nuchal translucency increase the risk of adverse pregnancy outcome
    in chromosomally normal fetuses? A study of 16,260 fetuses derived from an
    unselected pregnant population. Ultrasound Obstet Gynecol 2007;29:150–8.
  • [10] Carvalho JS. Screening for heart defects in the first trimester of pregnancy: food
    for thought. Ultrasound Obstet Gynecol 2010;36:658–60.
  • [11] Bilardo CM, Muller MA, Pajkrt E, Clur SA, van Zalen MM, Bijlsma EK. Increased
    nuchal translucency thickness and normal karyotype: time for parental reassurance.
    Ultrasound Obstet Gynecol 2007;30:11–8.
  • [12] Timor-Tritsch IE, Bashiri A, Monteagudo A, Arslan AA. Qualified and trained
    sonographers in the US can perform early fetal anatomy scans between 11 and
    14 weeks. Am J Obstet Gynecol 2004 Oct;191(4):1247–52.
  • [13] Ebrashy A, El Kateb A, Momtaz M, et al. 13–14-week fetal anatomy scan: a 5-year
    prospective study. Ultrasound Obstet Gynecol 2010;35:292–6.
  • [14] Souka AP, Pilalis A, Kavalakis Y, Kosmas Y, Antsaklis P, Antsaklis A. Assessment
    of fetal anatomy at the 11–14-week ultrasound examination. Ultrasound Obstet
    Gynecol 2004;24:730–4.
  • [15] Weiner Z, Goldstein I, Bombard A, Applewhite L, Itzkovits-Eldor J. Screening for
    structural fetal anomalies during the nuchal translucency ultrasound examination.
    Am J Obstet Gynecol 2007;197(181):e1–5.
  • [16] Gembruch U, Knopfle G, Bald R, Hansmann M. Early diagnosis of fetal congenital
    heart disease by transvaginal echocardiography. Ultrasound Obstet Gynecol 1993;3:
    310–7.
  • [17] Rustico MA, Benettoni A, D’Ottavio G, Fischer-Tamaro L, Conoscenti GC, Meir Y,
    et al. Early screening for fetal cardiac anomalies by transvaginal echocardiography
    in an unselected population: the role of operator experience. Ultrasound Obstet
    Gynecol Dec. 2000;16(7):614–9.
  • [18] Copel JA, Kleinman CS. Early screening for fetal cardiac anomalies. Ultrasound
    Obstet Gynecol 1993;3:308–9.
  • [19] Haak MC, van Vugt JM. Echocardiography in early pregnancy: review of literature.
    J Ultrasound Med 2003;22:271–80.
  • [20] Carvalho JS, Moscoso G, Ville Y. First-trimester transabdominal fetal echocardiography.
    Lancet 1998;351:1023–7.
  • [21] Rasiah SV, Publicover M, Ewer AK, Khan KS, Kilby MD, Zamora J. A systematic
    review of the accuracy of first-trimester ultrasound examination for detecting
    major congenital heart disease. Ultrasound Obstet Gynecol 2006;28:110–6.
  • [22] Bellotti M, Fesslova V, De Gasperi C, et al. Reliability of the first-trimester cardiac
    scan by ultrasound-trained obstetricians with high-frequency transabdominal
    probes in fetuses with increased nuchal translucency. Ultrasound Obstet Gynecol
    2010;36:272–8.
  • [23] Maiz NPW, Dagklis T, Faros E, Nicolaides K. Ductus venosus Doppler in fetuses
    with cardiac defects and increased nuchal translucency thickness. Ultrasound
    Obstet Gynecol 2008;31:256–60.
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7th European Echocardiography Course in Congenital Heart Disease

The 7th European Echocardiography Course in Congenital Heart Disease will be organised in

Barcelona, from Wednesday 3th to Saturday 6th October 2012.
This course provides a thorough overview of Echocardiography in Congenital Heart Disease and is aimed at Pediatric Cardiologists, Grown-up Congenital Heart Disease Specialists and Echocardiography Technicians working with Congenital Heart Disease patients.

The programme strongly builds on the side-by-side comparison of morphology and imaging and discusses the major abnormalities found in clinical practice. The course prepares for the accreditation exam for ‘Congenital Heart Disease Echocardiography’ organised by the EAE/AEPC.

Additionally, we will organise the 1st Symposium on Fetal Cardiac Function in conjunction with the EEC in Barcelona, on Tuesday 2nd of October 2012.

In this symposium, the basic principles of cardiac function and deformation will be explained and the techniques for measuring this in the fetus will be presented and discussed by experts in the field. Additionally, the changes in pathological situation will be highlighted.

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6th World Congress of Paediatric Cardiology and Cardiac Surgery 2013

The 6th World Congress of Paediatric Cardiology and Cardiac Surgery 2013 takes place from the 17th to the 22nd February 2013.
The World Congress is run for and on behalf of the International Steering Committee for the World Congress and builds on the solid scientific foundations established at the previous World Congresses.

We are putting together a first class 5 day program for everyone involved in the care of children with all forms of heart disease.

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11th INTERNATIONAL FETAL HEART SYMPOSIUM

11ème SYMPOSIUM INTERNATIONAL
COEUR FÅ’TAL
11th INTERNATIONAL FETAL HEART
SYMPOSIUM
HOTEL FAIRMONT MONACO
31 mai – 2 juin/ 31 May – 2 June, 2012

Dear Colleagues
Please view the preprogram of this event that will provide an update on diagnosis and management of fetal cardiac disease
Best regards
Maurice GUIRGIS
Professeur Associe Cardiology Paris VII
Head Perinatal Unit Hopital Europeen la ROSERAIE
Paris FRANCE

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Chiari Network as a Cause of Fetal and Neonatal Pathology

Chiari’s Network as a Cause of Fetal and Neonatal Pathology
Fatiha Bendadi • David A. van Tijn • Lou Pistorius • Matthias W. Freund

Keywords Additional heart sound  Chiari’s network 
Congenital heart disease  Fetal hydrops

Received: 17 June 2011 / Accepted: 26 August 2011

Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are credited.

The Author(s) 2011. This article is published with open access at Springerlink.com

Chiari’s Network as a Cause of Fetal and Neonatal PathologyAbstract Chiari’s network is a remnant of the eustachian valve located in the right atrium.

ABSTRACT
Chiari’s Network as a Cause of Fetal and Neonatal PathologyAbstract Chiari’s network is a remnant of the eustachian valve located in the right atrium. Incomplete involution of the fetal sinus venosus valves results in ‘‘redundant’’ Chiari’s network, which may compromise cardiovascular function. This report describes a case with the novel finding of prenatal compromise due to redundant Chiari’s network and an uncommon case with significant postnatal symptoms. In both cases, the symptoms (fetal hydrops and postnatal cyanosis) resolved spontaneously. The variety of cardiovascular pathologies described in the literature is believed to be associated with persistence of a Chiari network. Knowledge about this not always harmless structure is important for perinatologists, pediatricians, and pediatric cardiologists alike. The clinical importance of this rare
pathology is that prenatal counseling may anticipate a generally positive outcome and that surgical intervention generally should be avoided.

Received: 17 June 2011 / Accepted: 26 August 2011
The Author(s) 2011. This article is published with open access at Springerlink.com

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