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Prenatal Diagnosis of Holt-Oram Syndrome

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EN
Holt-Oram syndrome is a rare genetic syndrome, characterized by upper limb anomalies and congenital heart defects. The overall prenatal detection rate is low. We report a case of fetus with Holt-Oram syndrome with the current review of the literature.
EN
Introduction: Numerous papers have proven that an increased nuchal translucency is connected with a raised risk of chromosomal aberrations, but few analyses are related to the further state of fetuses with a normal karyotype. The aim of the study was to estimate the risk of cardiac defects and other developmental disorders in fetuses with increased nuchal translucency and normal findings of a standard cytogenetic examination. Methods: The authors carried out a retrospective analysis of 5183 examinations of 3376 patients who reported to the Department of Diagnosis and Prophylaxis of Congenital Malformations in the Polish Mother’s Memorial Hospital in Łódź in the period from January 2008 to March 2011 for prenatal ultrasound and echocardiographic examinations. The authors analyzed the results of the examinations performed in the second and third trimesters of gestation in fetuses with an increased nuchal translucency of ≥3 mm in the first trimester and with a normal karyotype. Results: Fifty-seven patients (1.7% of the examined group) fulfilled the criteria necessary to be included in the study. In 31 pregnant women (54%) structural defects or anomalies of the fetus were found. Cardiac anomalies were detected in 17 fetuses (29.8%). The authors detected various types of cardiac defects such as tetralogy of Fallot, ventricular septal defect, atrioventricular septal defect, transposition of the great arteries and hypoplastic left heart syndrome. Conclusions: In more than half of the fetuses with an increased nuchal translucency (NT≥3 mm) and a normal karyotype, developmental defects of various organs appeared in the further course of pregnancy: mainly heart defects that were either isolated, or accompanied other anomalies.
PL
Wstęp: Liczne opracowania dowiodły, że poszerzona przezierność karku wiąże się ze zwiększonym ryzykiem aberracji chromosomowych, ale znacznie mniej analiz odnosi się do dalszych losów płodów z prawidłowym kariotypem. Celem pracy było zbadanie ryzyka wystąpienia wad serca i innych wad rozwojowych u płodów z poszerzoną przeziernością karku i prawidłowym wynikiem standardowego badania cytogenetycznego. Metody: Przeanalizowano retrospektywnie 5183 badania przeprowadzone u 3376 pacjentek, które zgłosiły się do Zakładu Diagnostyki i Profilaktyki Wad Wrodzonych Instytutu Centrum Zdrowia Matki Polki w Łodzi w okresie od stycznia 2008 do marca 2011 roku w celu wykonania ultrasonograficznych i echokardiograficznych badań prenatalnych. Przeanalizowano wyniki badań wykonanych w drugim i trzecim trymestrze ciąży u płodów z poszerzoną przeziernością karku ≥3 mm w pierwszym trymestrze ciąży oraz prawidłowym kariotypem. Wyniki: Pięćdziesiąt siedem pacjentek (1,7% analizowanej grupy) spełniło kryteria włączenia do badania. U 31 ciężarnych (54%) stwierdzono wady strukturalne lub anomalie u płodu. Wadę serca rozpoznano u 17 płodów (29,8%). Obserwowano różne wady serca: tetralogię Fallota, ubytek w przegrodzie międzykomorowej, wspólny kanał przedsionkowo-komorowy, przełożenie wielkich naczyń, zespół hipoplazji lewego serca. Wnioski: U ponad połowy płodów z poszerzoną przeziernością karku (NT≥3 mm) i prawidłowym kariotypem w dalszym przebiegu ciąży ujawniały się wady rozwojowe różnych narządów, w tym najczęściej wady serca – izolowane lub towarzyszące innym anomaliom.
EN
DORV [double outlet right ventricle] is defined as a defect in which the great vessels leave entirely or mostly from above the morphologically right ventricle. The proposed by us new prenatal classification of heart defects for the DORV defect including the division into isolated and coexisting with extracardiac defect, facilitates consultation and predicting prognosis for the fetus and newborn. Isolated DORV in fetuses is classified as a severe elective defect (expected cardiac intervention or surgery at 1 month of age) with a relatively good prognosis for newborns, regardless of the type of intracardiac anomalies (in our series of cases 100% survival). DORV in the fetus with coexisting extracardiac defects (ECM) regardless of type of anomaly had poor prognosis (in our study group 100% demise rate).
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EN
This was a retrospective analysis of ultrasonographic and echocardiographic examinations in 12 fetuses with postnatally confirmed Cloacal Malformation. All examinations were conducted at the tertiary fetal diagnostic center (none of the preliminary screening diagnoses were correct). The main manifestations of cloacal malformation were: signs of urinary tract malformations in 10 fetuses (83,33%), pelvic cyst, diagnosed or suspected as hydrocolpos in 9 fetuses (75%), signs of lower part of digestive tract obstruction in 6 fetuses (50%). In addition there were abnormalities in echocardiographic examinations in 6 cases, such as symptoms of cardiac failure (cardiomegaly, tricuspid regurgitation, monophasic inflow, pericardial effusion, ascites) and one case with AS ( aortal stenosis). Functional abnormalities in fetal echocardiography suggest increased preload or afterload and early circulation failure in this severe prenatal malformation. This malformation have never been published before. The data suggest, that fetal functional echocardiography abnormalities in cases of abnormal pelvic structures should alert the clican to possibility of the presence of cloaca.
EN
The primary aim of this study was to determine the predictive value of prenatal ultrasound and echocardiography for prognosis in congenital heart disease (CHD) with coexisting diaphragmatic hernia (DH) in a tertiary care center. Eleven records from the database of the Department for Diagnoses and Prevention of Congenital Malformations, Polish Mother’s Memorial Hospital Research Institute, were reviewed. The mean maternal age was 29,2 ± 5,1 years, and the mean gestational age at the time of diagnosis was 28,4 ± 6,7 weeks. No information was available for children discharged from hospital. Data of eight cases of prenatal DH and complex heart disease from the literature were also analyzed. Three fetuses survived the neonatal period. In each of these, CHD was other than the urgent or critical type, defined as not requiring cardiac surgical intervention in the first day or month of life. Both sets of data collected from our center and the published literature confirmed the unfavorable prognosis for fetuses with severe or critical CHD with coexisting DH.
EN
Pulmonary valve stenosis is a congenital heart defect that is possible to detect and diagnose during prenatal life. We present a retrospective analysis of ten cases with isolated critical pulmonary valve stenosis (IPVS) to establish echocardiographic criteria which could predict the possibility for postnatal balloon valvuloplasty performed shortly after delivery.
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