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Neonatal Heart Disease New from PubMed 
Aggiornamebti sugli ultimi inserimenti su pubmed

Fetal Echocardiography New from PubMed 
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....on Practical practice 
Clinical examination alone is unreliable in postnatal screening for congenital heart disease in neonates with Down's syndrome.
An ECG demonstrating a superior frontal QRS axis is strongly suggestive of AVSD, but the "gold standard" investigation in confirming or excluding the diagnosis is transthoracic echocardiography

.....on atrioventricular septal defect (AVSD) 
1- The spectrum of AVSD diagnosed antenatally is different from that diagnosed postnatally. Up to 45% of those diagnosed antenatally may have associated heterotaxy syndromes
2- Early postnatal diagnosis is important in planning timely surgical intervention
3- A detailed transthoracic echocardiogram with Doppler is essential preoperatively to assess atrioventricular valve morphology and function and the relationship of the bridging leaflets to atrial and ventricular septum. Associated defects such as outflow tract obstruction or ventricular imbalance must be identified
4- Surgical correction should attempt to minimise residual left atrioventricular valve regurgitation as this is the most common reason for reoperation and the most important cause of long term morbidity
5- The operative mortality and outcome in AVSD is not significantly adversely affected in patients with Down’s syndrome

...on indications for fetal valvuloplasty  
1- Critical aortic stenosis or atresia
2- Cardiovascular profile score <732 LV length >2 SD for gestational age
3- Decreased biventricular cardiac output
4- Left-to-right shunting at atrial level
5- Severe pulmonary stenosis and/or
6- Elevated RV pressure (TR jet)
7- Reversal of flow in aortic arch
8- Hydrops LV, left ventricle; RV, right ventricle; TR, tricuspid regurgitation.

.......l'amniocentesi?
E' un esame che serve a prelevare un campione di liquido amniotico nel feto.
Su questo campione vengono fatti analisi e studi genetici.
L'esame consiste nell'inserimento di un ago, (con diametro simile ad una siringa per iniezione intramuscolare ma piu' lungo) attraverso la parete del ventre materno, fino a raggiungere la cavità amniotica nella quale si trova immerso il feto.
- Una volta inserito l'ago, si aspira, con l'aiuto della siringa, 20 millimetri di liquido amniotico.
- L'amniocentesi si pratica generalmente dopo 3 mesi e mezzo di gestazione (da 16 a 18 settimane a partire dall'inizio dell'ultima mestruazione).

.........on Rabdomioma in the fetus
1- Fetal cardiac rhabdomyoma is the most common cardiac tumor in fetal life, accounting for 60–86% of primary fetal cardiac tumors.
2- Rhabdomyomas appear on ultrasound as round, homogeneous, hyperechogenic masses in the ventricles, and they sometimes appear as multiple foci in the ventricles and septal wall.
3- The smallest detectable mass was 4 mm and the largest reported was 52 mm in diameter41. Cardiac rhabdomyoma might increase in size in utero, and when the tumor mass was = 20 mm in diameter, fetuses had a higher risk of perinatal death.
4- Histologically benign but larger tumors carry a greater risk of causing hemodynamic disturbance and dysrhythmia which could result in poorer outcome at the fetal stage.
5- Fetal arrhythmias, either bradyarrhythmias or tachyarrhythmias, were commonly associated with the hydropic condition.
6- Associated cardiac structural defects occur sporadically: hypoplastic left heart, tetralogy of Fallot and endocardial fibroelastosis
7- Rare extracardiac anomalies such as cleft palate, and polycystic kidney and clubfoot and chromosomal anomalies trisomy 13,18.
8-Tubero Sclerosis is associated in 50,70% patients with rhabdomyoma. A genetic method of screening for has not been established but aardiac rhabdomyoma may be the earliest sign of TS in utero and precede the detection of brain or kidney lesions.

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