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How "fast" reading of prenatal cardiac diagnosis may badly influence the neonatal management - case report from tertiary center in 2015 and literature review

100%
Piątek K., Zych-Krekora K., Płużańska J., Gulczyńska E., Respondek-Liberska M.
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issue 3
38-41
EN
Complains about prenatal diagnoses usually touch late diagnosis, missed diagnosis or uncomplete diagnosis. Prenatal diagnose provides usually important information for parents, obstetrician and neonatologist. Successful perinatal care is based on a good cooperation of the perinatal team. This time we present a peculiar situation when improper reading of prenatal diagnosis had caused a lot of troubles for the patient, parents and hospital staff.
2
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Early neonatal surgery for congenital heart defects after prenatal diagnosis of restricted foramen ovale as the priority procedure?

86%
Respondek-Liberska M., Płużańska J., Zych-Krekora K., Czichos E., Słodki M., Moll J.
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issue 3
24-29
EN
From 2012-2014 we selected fetuses who had an isolated congenital heart defect and restriction of the foramen ovale defined as its diameter of 4 mm or less, shunt across foramen ovale, V max > 70 cm/sec along with a typical harsh sound during fetal ausculation during echocardiography and reversal flow in pulmonary veins, no extracardiac anomalies, singleton pregnancies and delivery > 37 weeks of gestation. It was retrospective analysis of 16 cases: There were 10 non-survivors and 6 survivors The only significant difference between survivors and non-survivors pertained to the fraction of newborns operated on up to 11th day, which was significantly higher among the survivors (5/6 vs. 2/8, p=0.031). Conclusions: 1) In the event of prenatal restriction of the foramen ovale early surgery by day 10 had a statistically better outcome in terms of survival compared to cases that underwent surgery at a later period at our Institute. 2) Prenatal restriction of the foramen ovale was more often related to male gender and in 75% of cases in our series had complicated follow-up: neonatal death or prolonged hospital stay.3) Information from prenatal echocardiography regarding restriction of the foramen ovale should be taken into consideration as valuable information suggesting priority for early cardiac surgery.
3
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Retrospective analysis of prenatal echcardiography findings in cases of congenital heart defects: comparison with postnatal pulmonary hypertension revealed by lungs histopathology (2010-2015)

86%
Romanowicz H., Czichos E., Zych-Krekora K., Krekora M., Słodki M., Respondek-Liberska M.
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issue 4
12-18
EN
Introduction: It was retrospective analysis of prenatal echocardiography findings in fetuses with congenital heart defects, who died in our institution and had an autopsy exams in years 2010 - 2015. Material and methods: Among total 115 deaths the pulmonary hypertension based on histopathology criteria was present in 83 cases (72%) as a leading cause of their deaths. Out of 83 neonates 40 underwent prenatal echo, 43 did not, however in both groups there were similar types of heart defects. Results: The prenatal echo findings from study group (n=40), from the last echo before the delivery were compared with control group and group of HLHS who did survive neonatal surgery and were discharged from hospital. There were statistical differences between pulmonary artery/aorta ratio in fetuses in control group and fetuses in study group („pulmonary hypertension” after birth) (p=0,044). There were statistical differences between pre-delivery pulmonary artery/aorta ratio in fetuses in study group (with „pulmonary hypertension” after birth) and in group of fetuses with HLHS, alive & well after first surgery (p=0,027). There were no differences between pulmonary artery/ aorta ratio fetuses in control group and fetuses with HLHS, alive & well after first surgery (p=0,38) Conclusion: 1) Pulmonary hypertension was a frequent cause of neonatal deaths among our series of congenital heart defects 2) Dilatation of pulmonary artery (and increased pulmonary/artery ratio ) in fetal echo just before delivery may be an important risk factor for poor neonatal outcome in congenital heart defects.)
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The International Prenatal Cardiology Collaboration Group – a new concept for global research study

52%
Słodki M., Zych-Krekora K., Axt-Fliedner R., Bianchi A., Junior E. A., Blickstein I., Kelekci S., Yeo L., Pruetz J. D., Rizzo G., Seligman N., Sklansky M., de Catte L., Weiner S., Chervenak F., Cruz J., Kurkevych A., Krekora M., Respondek-Liberska M.
Journal of Ultrasonography
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2016
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vol. 16
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issue 64
94-96
EN
Congenital heart defects are among the most common congenital defects and contribute substantially to the mortality of newborns and young infants, in spite of well-developed medical and surgical treatments. It is estimated that the mortality of children with congenital heart defects in developing countries is as high as 20%, whereas the incidence of congenital heart defects is approximately 1/100 live births(1). Currently, there is an emphasis on early fetal screening for chromosomal abnormalities and neural tube defects, despite the fact that congenital heart defects are four times more frequent than chromosomal abnormalities and six times more frequent than neural tube defects(2). It should be noted that basic in-utero screening for heart defects is possible as early as the first trimester, which in some cases prompts further work-up and treatment(3). Throughout the world, second trimester screening remains the mainstay of prenatal diagnosis of cardiac anomalies. However, a comprehensive work-up for fetal heart defects can be associated with substantial psychological burden on the mother and her family. Moreover, the prevalence of misdiagnosis can be as high as 36%, thus prompting the need for further training and multidisciplinary team work(4). Furthermore, 33% of heart defects are accompanied by other anomalies(5).
PL
Wrodzone wady serca należą do najczęstszych wad wrodzonych i mimo rozwiniętego leczenia zachowawczego, jak i operacyjnego w dalszym ciągu stanowią jedną z najczęstszych przyczyn zgonów w okresie noworodkowym i wczesnoniemowlęcym. Szacunkowo określa się, że śmiertelność może dotykać około 20% dzieci z wrodzonymi wadami serca w krajach rozwijających się, a każdego roku częstość wrodzonych wad serca oscyluje w granicach 1/100 żywych urodzeń(1). Obecnie uwaga jest kierowana głównie w stronę wczesnej diagnostyki genetycznej, tymczasem wrodzone wady serca są aż 6 razy częstsze od wad chromosomalnych i 4 razy częstsze od wad cewy nerwowej(2). Podstawowa diagnostyka kardiologiczna u płodu jest możliwa już w I trymestrze ciąży i w wybranych przypadkach klinicznych przyczynia się do dalszego postępowania diagnostycznego i terapeutycznego(3). Mimo to w dalszym ciągu podstawowe pozostaje badanie serca płodu w II trymestrze. Kompleksowa diagnoza kardiologiczna płodu niesie ze sobą duże obciążenie psychiczne dla ciężarnej i jej rodziny. Wynika z tego konieczność dalszego szkolenia oraz pracy wielodyscyplinarnej, gdyż – jak pokazują dane z piśmiennictwa – odsetek prenatalnie nieprawidłowo postawionych diagnoz może sięgać nawet 36%(4), a aż 33% wad serca nie jest wadą izolowaną(5).
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