Difetti interventricolari isolati nel feto


I Difetti Interventricolari Settali ( DIV ) isolati, diagnosticati nel feto non assumono rilevanza emodinamica, ma hanno un significato rilevante nel counseling prenatale dei genitori.
Tecnicamente sono, specialmente se di piccole dimensioni, di difficile rilievo perche’ non sono visibili sull’immagine 2D e possono essere visualizzati con il Color Doppler se adeguatamente regolato, dal momento che nel feto lo stato circolatorio intracardiaco e’ isobarico ( non si hanno gradienti di pressioni fra le cavita’ ) per cui si possono verificare shunt a basse velocita’ di difficile rilievo Doppler.
Dagli studi riferiti in letteratuta risulta che i DIV sia muscolari che perimembranosi isolati comportano :

  1. alta incidenza di anomalie cromosomiche ( trisomie 21,13 e 18 )
  2. possibile coesistenza di anomalie extracardiache
  3. che i DIV con cromosomi normali, oltre un terzo nel feto e oltre un’altro terzo nell’infanzia chiudono spontraneamente

Ogniqualvolta l’ecocardiografia fetale rilevi un DIV sara’ opportuno un esame cardiaco e morfologico generale
completo ed attento ad escludere anomalie associate, e indica l’esecuzione di in cariotipo fetale.

Isolated ventricular septal defects detected by color Doppler
imaging: evolution during fetal and first year of postnatal life
R. AXT-FLIEDNER*, A. SCHWARZE*, J. SMRCEK*, U. GERMER†, M. KRAPP* and
U. GEMBRUCH‡
Ultrasound Obstet Gynecol 2006; 27: 266–273
Published online in Wiley InterScience ()

Bibliografia :

1. Allan LD, Sharland GK,Milburn A, Lockhart SM, Groves AM,
Anderson RH, Cook AC, Fagg NL. Prospective diagnosis of
1,600 consecutive cases of congenital heart disease in the fetus.
J Am Coll Cardiol 1994; 23: 1452–1458.
2. Allan LD, Sharland GK, Chita SK, Lockhart S, Maxwell DJ.
Chromosomal anomalies in fetal congenital heart disease.
Ultrasound Obstet Gynecol 1991; 1: 8–11.
3. Anderson RH, Lenox CC, Zuberbuhler JR. Mechanisms of
closure of perimembranous ventricular septal defect. Am J
Cardiol 1983; 52: 341–345.
4. Anderson RH, Lenox CC, Zuberbuhler JR. The morphology
of ventricular septal defects. Perspect Pediatr Pathol 1984; 8:
235–268.
5. Ferencz C, Rubin DJ, Loffredo AC, Magee AC (eds). Epidemiology
of congenital heart disease. The Baltimore-Washington
Infant Study 1981-89. In Perspectives in Paediatric Cardiology
4. Mount Kisco Futura Publishing Company: New York, 1993;
31–33.
6. Alpert BS, Cook DH, Varghese PJ, Rowe RD. Spontaneous
closure of small ventricular septal defect: ten-year follow-up.
Pediatrics 1979; 63: 204–206.
7. Alpert BS,Mellitis ED, Rowe RD. Spontaneous closure of small
ventricular septal defects: probability rates in the first year of
life. Am J Dis Child 1973; 125: 194–196.
8. Anderson RH, Macarteney FJ, Shinebourne EA, Tynan M.
Ventricular septal defects. In Paediatric Cardiology, Anderson
RH (ed). MacGraw Hill: London, UK, 1987; 565–590.
9. Paladini D, Palmieri S, Lamberti A, Teodoro A, Martinelli P,
Nappi C. Characterization and natural history of ventricular
septal defects in the fetus. Ultrasound Obstet Gynecol 2000;
16: 118–122.
10. Rudolph AM. Congenital disease of the heart: clinicalphysiological
considerations. Mount Kisko Futura Publishing:
New York, 2001; 198–199.
11. Romero R, Pilu G, Jeanty P, Ghidini A, Hobbins JC. Ventricular
septal defects. In Prenatal diagnosis of congenital anomalies.
Appleton & Lange: Norwalk, CT, 1988b; 141–144.
12. Birk E, Silverman NH. Intracardiac shunt malformations. In
Fetal Cardiology, Yagel S, Silverman NH, Gembruch U (eds).
MD: London and New York, 2003; 201–211.
13. Gembruch U, Bald R, Redel DA, Hansmann M. Shunt patterns
of fetal ventricular septal defects. Ultrasound Obstet Gynecol
1991; 1 (Suppl. 1): 82.
14. Crawford DC, Chita SK, Allan LD. Prenatal detection of
congenital heart disease: Factors affecting obstetric management
and survival. Am J Obstet Gynecol 1988; 159: 352–356.
15. Roguin N, Du Z, Barak M, Nasser N, Hershkowitz S, Milgram
E. High prevalence of muscular ventricular septal defect
in neonates. J Am Coll Cardiol 1995; 26: 1545–1548.
16. Wenink AC, Oppenheimer-Dekker A, Moulaert AJ. Muscular
ventricular septal defects: A reappraisal of the anatomy. Am J
Cardiol 1979; 43: 259–264.
17. Montana E, Khoury MJ, Cragan JD, Sharma S, Dhar P, Fyfe D.
Trends and outcomes after prenatal diagnosis of congenital
cardiac malformations by fetal echocardiography in a well
defined birth population, Atlanta, Georgia, 1990–1994. J Am
Coll Cardiol 1996; 28: 1805–1809.
18. Paladini D, Russo MG, Vassallo M, Tartaglione A. The ‘in
plane view’ of the inter-ventricular septum. A new approach
to the characterization of ventricular septal defects in the fetus.
Prenat Diagn 2003; 23: 1052–1055.
19. Tegnander E, Eik-Nes SH, Johansen OJ, Linker DT. Prenatal
detection of heart defects at the routine fetal examination
at 18 weeks in a non-selected population. Ultrasound Obstet
Gynecol 1995; 5: 372–380.
20. Eronen M. Outcome of fetuses with heart disease diagnosed
in utero. Arch Dis Child Fetal Neonatal Ed 1997; 77: F41–46.
21. Stoll C, Garne E, Clementi M, Euroscan study group. Evaluation
of prenatal diagnosis of associated congential heart disease
by fetal ultrasonographic examination in Europe. Prenat Diagn
2001; 21: 243–252.
22. Yagel S, Valsky DV, Messing B. Detailed assessment of fetal
ventricular septal defect with 4D color Doppler ultrasound
using spatio-temporal image correlation technique. Ultrasound
Obstet Gynecol 2005; 25: 97–98.

Lascia un commento

Il tuo indirizzo email non sarà pubblicato. I campi obbligatori sono contrassegnati *

Questo sito usa Akismet per ridurre lo spam. Scopri come i tuoi dati vengono elaborati.