CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
89
no difference between right versus left ventricle and main pulmonary
artery versus ascending aorta dimensions at any stage (
p
>
0.05).
Conclusions:
We have documented growth of cardiothoracic struc-
tures during the late first/early second trimesters and established
normal values. Pericardial effusion is almost universal in early preg-
nancy. The relatively large heart in the late-first trimester may relate
to atrial size, possibly reflecting the importance of atrial function to
filling the non-compliant early foetal ventricles. These data provide
insight into cardiac development and should assist in early diagnosis
of CHD.
1278: ANTENATAL FOETAL CARDIAC SCREENING: USE
OF OUTFLOW TRACT VIEWS IMPROVES DETECTION
OF TRANSPOSITION OF GREAT ARTERIES (TGA) AND
TRUNCUS ARTERIOSUS (TA): EXPERIENCE FROM TWO
REGIONAL FOETAL CARDIAC UNITS AND A SINGLE
PAEDIATRIC TERTIARY CARDIAC CENTRE.
Joyce Su-Ling Lim
1,2
, Sharon Clark
,2
, Devender Roberts
2
, Gordon
Gladman
1,3
1
Alder Hey Children’s Hospital, Liverpool, UK
2
Liverpool Women’s Hospital, Liverpool, UK
3
St Mary’s Hospital, Manchester, UK
Introduction
: Outflow tract assessment of foetal hearts was intro-
duced in the UK in 2008. We compared detection of transposition
of the great arteries (TGA) and truncus arteriosus (TA) in our region
before and after the introduction of the new recommendation.
Methods
: We undertook a retrospective review of foetal medicine
and cardiac database at two regional foetal cardiac units and a single
paediatric tertiary cardiac centre between January 2001 and June
2012. The detection rates for TGA and TA in babies scanned between
2001 and 2008 (before the introduction of the mandatory national
outflow tract guidelines) and after 2008 were compared. A survey of
practice at the referring obstetric units was also performed.
Results
: The antenatal detection percentage before mandatory
outflow tract guidelines (Jan 2001 – Dec 2008) was 12.5% for TGA
and 17.9% for TA, whereas after mandatory outflow tract guide-
lines (Jan 2009 – June 2012), percentages were 32.9% and 50%
respectively.Prior to the mandatory national guidelines, only 15/27
obstetric units within the region performed outflow tract views for
foetal cardiac screening. Now all obstetric units routinely perform 4
chamber as well as outflow tract views.
Conclusions:
There is significant improvement of antenatal cardiac
detection of outflow tract abnormalities with introduction of the
mandatory outflow tract views. It is hoped that as the screening sonog-
raphers get more used to the outflow tract views, and with more dedi-
cated training of sonographers, the detection rate will increase further.
1289: ASYMMETRIC RIGHT CARDIAC CHAMBERS
ENLARGEMENT IN FETUSES: A RESPONSE TO FOETAL
HYPOXIA AFTER THE 30THWEEK?
Pedro Osvaldo Weisburd, Esteban Roberto Vazquez, Juan Pablo
Feldman, Rodrigo Egues, Rolando Gomez, Graciela Citate
Hospital de Niños Sor María Ludovic, La Plata, Argentina
Introduction:
Foetal hypoxia (FH), with or without intrauterine
growth restriction (IUGR) evaluated by Doppler ultrasound (DU),
was defined by measuring the ratios between the index of the middle
cerebral (MCA) and umbilical arteries (UA) (Rc/u)
<
1. The lack
of symmetry between the cardiac chambers in favour of the right
chambers (relation right atrium(RA)/left atrium(LA) and right
ventricle(RV)/left ventricle (LV)
>
1.5:1) not detected before the 30
th
week of gestational age (GA) without cardiac malformation (CM)
could indicate the presence of a functional anomaly.
Objectives:
The asymmetric right predominant cardiac chambers
(ARPCC) manifested after week 30 could be an indicator of FH.
This does not occur before 30 weeks. We discuss the possible physi-
opathology.
Materials and methods:
Fifteen foetuses (f) were referred for
ARPCC between week 30 and 37(mean 32.5) and 10 f between week
26 and 29 (mean 27.1) with an Rc/u
<
1. A complete echocardiogram
and DU in the UA, MCA, aortic isthmus and A wave of the venous
duct were performed.
Results:
Of the 15 f, 4 (26.6%) had a weight above percentile 50 (P50),
4 f had P30 and 7 f (46.6%) had less than P5. All of them presented
with ARPCC
>
1.5:1 and Rc/u
<
1. The flow at the aortic isthmus was
reversed in all. The A wave was reversed in 8 f (100%) without IUGR
and 4/7 (57.1%) less than P5. Of 7f with IUGR, 6 (85,7%) presented
as a T21. In 1 foetus coronary flow was increased. Of the 10 f of
<
30
weeks with a Rc/u index
<
1, none presented with ACCD.
Conclusion:
After week 30, ARPCC without CM could indicate
severe FH for which foetal DU should be performed. ARPCC associ-
ated with RCIU
<
P5 can indicate risk of associated T21. ARPCC
apparently does not present in foetuses less 30
th
week with Rc
/
u
<
1.
1307: THE ABSENCE OF PHYSIOLOGICAL SHUNTS
DURING THE FOETAL PERIOD CAN HELP PREDICT
SEVERE POST-NATAL HYPOXIA IN FETUSES WITH
TRANSPOSITION OF THE GREAT ARTERIES WITH
INTACT VENTRICULAR SEPTUM
Laurence Vaujois, Isabelle Boucoiran, Christine Houde, Jean Claude
Fouron, Marie-Josée Raboisson
Ste Justine University Hospital Center, Quebec, Montréal, Canada
Background:
Transposition of the great arteries with intact ventricu-
lar septum (TGA-IVS) is amenable to complete repair with low
mortality rate. However, some neonates may experience profound
cyanosis leading to rapid haemodynamic compromise.
Objective:
We evaluated whether the assessment of physiological
shunts during the foetal period could help predict postnatal profound
hypoxia in neonates with TGA-IVS.
Methods:
Echocardiographic data of
35 foetuses with TGA-IVS
were retrospectively reviewed. The size of the foramen ovale (FO),
septum primum (SP), main pulmonary artery (MPA) and aorta were
measured. Doppler characteristics and output in the MPA, aorta and
ductus arteriosus (DA) were assessed. The net pulmonary output was
calculated as [output in the MPA – output in the DA]. Patients were
divided into 2 groups based on postnatal saturation: group 1 had
peripheral saturation
<
50% and group 2 had saturation
≥
50%.
Results:
Eleven of the 35 foetuses (31.4%) were in group 1. Foetuses
in group 1, in comparison with group 2, had smaller FO (2.93 vs 4.07
mm,
p
=
0.02). In addition, holo-diastolic intermittent or persistent
retrograde flow in the DA was observed in 10 of the 11 patients
(91%) in group 1 in contrast to only 6 of the 24 patients (25%) in
group 2 (
p
<
0.01). Patients with decreased mobility of the SP or a
thick septum experienced higher output in the DA (0.71 vs 0.32 ml/
min,
p
=
0.01). There was a positive linear correlation between the
size of the fossa ovalis and the net pulmonary output (r
=
0.54,
p
=
0.004).
Conclusion:
A decrease in the size of the FO with retrograde holo-
diastolic flow in the DA is predictive of severe postnatal hypoxia in
foetuses with TGA-IVS. Patients with smaller FO experience a lower
net pulmonary flow with higher output through the DA, possibly
related to greater pulmonary hypertension, and should be flagged for
a Rashkind immediately after birth.
1310: UHL’S ANOMALY: A DIFFICULT PRENATAL DIAG-
NOSIS
Laurence Vaujois, Nicolas Van Doesburg, Myriam Brassard, Marie-
Josée Raboisson,
Ste Justine University Hospital Center, Quebec, Montréal, Canada
Introduction:
Uhl’s anomaly is a rare form of congenital heart
disease with partial or complete absence of right ventricular (RV)
myocardium, parchment-like appearance of the RV wall, often asso-
ciated with tricuspid anomalies. Only 3 prenatal cases have been
