medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2014, Number 02

<< Back Next >>

Ginecol Obstet Mex 2014; 82 (02)

Diagnosis and prognosis of fetal Ebstein anomaly

San Luis–Miranda R, Arias–Monroy LG, Alcantar-Mendoza MA, Cabrera-Arroyo C, Mendoza-Reyes E, Córdova Jarero S

Language: Spanish
References: 44
Page: 93-104
PDF size: 867.01 Kb.


ABSTRACT

Background: Fetal echocardiography is possible to confirm with great certainty the diagnosis, in utero, Ebstein’s anomaly, as well as determine its perinatal prognosis.
Objective: Review the experience of 16 cases diagnosed with Ebstein’s anomaly, using fetal echocardiography, analyzing “forecast echocardiographic parameters” set by Pavlova, Huhta and Barre.
Material and method: retrospective and descriptive analysis. We analysed echocardiographic parameters and its correlation with the perinatal development of 16 cases diagnosed with Ebstein’s anomaly.
Results: Maternal age of our patients was 27.94 ± 5.7 years, gestational age 31.3 ± 3.6.) Mortality: in-utero 37.5% (n = 6), neonatal 50% (n = 8), survived 12.5% (n = 2). Cardiothoracic index 0.61 ± 0.074, relationship foramen oval/heart atrial 0.6 ± 0.015; obstruction to the way out of the right ventricle in 14 cases (87.5%). The deceased 81% presented degree of valvular displacement › 2.5; relationship RV/LV 2.24 ± 0.37).
Conclusions: Cardiothoracic index fetal stage > 0.55, relationship oval foramen/interatrial septum ‹ 0.3, obstruction to the way out and a degree of valvular displacement › 2.5, absence of back flow in arteriosus ductus and a ratio RV/LV › 2 are poor prognostic factors for Ebstein’s anomaly.


REFERENCES

  1. Anderson KR, Zuberbuhler JR, Anderson RH, Becker AE, Lie JT. Morphologic spectrum of Ebstein’s anomaly of the Herat. A review. Mayo Clin Proc 1979,54:174-180.

  2. Muñoz-Castellanos L, Barros W, García F, Salinas HC. Estudio patológico de la displasia y el adosamiento valvulares en la enfermedad de Ebstein. Arch Inst Cardiol Mex 1993;63:101- 109.

  3. Roberson DA, Silverman NH. Ebstein’s anomaly: echocardiographic and clinical features in the fetus and neonate. J Am Coll Cardiol 1989;14:1300-1307.

  4. Allan L, Hornberger KL, Sharland G. Textbook of Fetal Cardiology. Londres: Greenwich Medical Media Limited, 2000.

  5. Schwartz Marcy L. Fetal Progression of Ebstein’s Anomaly. Circulation 2003;108:e86.

  6. Wood D, Respondek LM, Puerto B, Weiner S. Perinatal echocardiography: protocols for evaluating the fetal and neonatal heart. J Perinat Med 2009;37:5–11.

  7. Rychik J, Ayres N, Cuneao B, Gotteiner N, Hornberger L, Spevak PJ. American Society of Echocardiography Guidelines and Standards for performance of the fetal echocardiogram. J Am Soc Echocardiogr 2004;17: 803-810.

  8. Maratz P, Garcia GC. Ecocardiografia Fetal. Rev Argent Cardiol 2008;76;392-398.

  9. Perolo DA, Prandstraller TG, Randstraller TG, et al. Diagnosis and management of fetal cardiac anomalies: 10 years of experience at a single institution. Ultrasound Obstet Gynecol 2001;18:615–618.

  10. Roberson DA, Silverman NH. Ebstein’s anomaly: echocardiographic and clinical features in the fetus and neonate. J Am Coll Cardiol 1989;14:1300-1307.

  11. Hornberger LK, Shan DJ, Kleinman CS, Copel JA, Reed KL. Tricuspid valve disease with significant tricuspid insufficiency in the fetus: diagnosis and outcome. J Am Coll Cardiol 1991;17:167-173.

  12. Pavlova M, Fouron JC, Drblik SP, Van Doesburg NH, Bigras JL, et al. Factors affecting the prognosis of Ebstein’s anomaly during fetal life. Am Heart J 1998;135:1081-1085.

  13. Oberhoffer R, Cook AC, Lang D, Sharland G, Allan LD, Fagg NL, Anderson RH. Correlation between echocardiographic and morphological investigations of lesions of the tricuspid valve diagnosed during fetal life. Br Heart J 1992;68:580-5.

  14. Appendino CA, Martin HA, Cheryl T, Jeanty P. Ebstein anomaly. ©Sierra. www.thefetus.net/2002.

  15. Muñoz CL, Nilda Espinola ZN, Kuri NM, Keirns C. Ebstein’s Anomaly: Anatomo-echocardiographic correlation. Cardiovascular Ultrasound 2007;5:43.

  16. Shiina A, Seward JA, Edwards WD, Hagler DJ, Tajik AJ. Two-dimensional echocardiographic spectrum of Ebstein’s anomaly detailed anatomic assessment. J Am Coll Cardiol 1984, 3:356-70.

  17. Paladini D, Chita SK, Allan LD. Prenatal measurent of cardiothoracic ratio in –evaluation of heart disease. Arch dis Child 1990;65:203.

  18. Omoto R, Yokoto Y,Takamoto S, et al. Diagnostic significance of real time-two dimensional Doppler echocardiography in congenital heart disease acquired valvular disease, and disecting aortic aneurysm. J Cardiogr 1984;14(suppl.V):103-107.

  19. Feit LR, Copel JA, Kleinman CS. Foramen oval size in the normal and abnormal human fetal heart: and indicator of transatrial flow physiology. Ultrasound Obstet Gynecol 1991;1:313-19.

  20. Rizzo G, Arduini D, Romanini C. Umbilical vein pulsations; a physiologia finding in early gestation. Am J Obstet Gynecol 1992;167:675-77.

  21. Cafici D, Mejides A, Sepulveda W. Ultrasonografia en obstetricia y diagnostico prenatal. Ed. Journal reimpresión 2005, Buenos Aires Argentina.

  22. Bass JL, Berry JM, Einzig S. Flow in the aorta and patent ductus arteriosus in infants with aortic atresia or aortic stenosis: a pulsed Doppler ultrasound study. Circulation 1986;74:315–22.

  23. Guntheroth WG, Cyr DR, Winter T, Easterling T, Mack LA. Fetal Doppler echocardiography in pulmonary atresia. J Ultrasound Med 1993;12:281–4.

  24. Viñals F, Tapia J, Giuliano A. Prenatal detection of ductal-dependent congenital heart disease: How can things be made easier? Ultrasound Obstet Gynecol 2002;19:246–249.

  25. Yasuki Maeno, Akiko Hirose, Taro Kanbe, Daizo Hori. Fetal arrhythmia: Prenatal diagnosis and perinatal management. oJ Obstet Gynaecol 2009;35:623–629.

  26. Fouron CJ, Fournier A, Proulx F, Lamarche J, Bigras LJ, Boutin C, Brassard M, Gamache S. Arritmias Management of fetal tachyarrhythmia based on superior vena cava/aorta Doppler flow recordings. Heart 2003;89:1211–1216.

  27. De Vore GR, Horenstein. Color Doppler identification of pericardial effusion. Ultrasound Obst Gynecol 1994;4:115- 120.

  28. Hada Y. Cardiothoracic ratio. J Cardiol 1995;26:51-4.

  29. Huhta J. Fetal congestive heart failure. Seminars in Fetal & Neonatal Medicine 2005;10:542-52.

  30. Schneider C, McCrindle W, Carvalho SJ, Hornberger KL, Mc- Carthy PK, Daubeney FE. Development of Z-scores for fetal cardiac dimensions from echocardiography. Ultrasound Obstet Gynecol 2005;26:599–605.

  31. Barre E, Durand I, Hazelzet T, David N. Ebstein’s anomaly and tricuspid valve dysplasia: prognosis after diagnosis in utero. European Society of Cardiology Congress 2011. Scientific programe on line. Abstrac P.796.

  32. Hada Y. Cardiothoracic ratio. J Cardiol 1995;26:51-4.

  33. McElhinney BD, Salvin WJ, Colan DS, Thiagarajan R, et al. Improving outcomes in fetus and neonates with congenital displacement (Ebstein´Malformation) or dysplasia of the tricuspid valve. Am J Cardiol 2005;96:582-586.

  34. Gurleen K, Sharland BS, Chita SK. Tricuspid valve Dysplasia or Displacement in intrauterine life. J am Coll Cardiol 1991;17:944-949.

  35. Yohimura S, Masuzaki H, Gotoh H, et al. Ultrasonographic prediction of lethal pulmonary hipoplasia: Comparision of eight different ultrasonographic parameters. Am J Obstet Gynecol 1996:175;477.

  36. Satomi G, Momoi N, Kikuchi N, Nakazawa M, Momma K. Prenatal Diagnosis and Outcome of Ebstein’s Anomaly and Tricuspid Valve Dysplasia in Relation to Lung Hypoplasia. Echocardiography 1994;11:215-220.

  37. Pinilla-LMJ. García C MD, Lazaro AA. Prenatal Diagnosis of Ebstein’s Anomaly Rev Esp Cardiol 2008;61:971.

  38. Trines J, Hornberger LK. Evolution of Heart Disease In Utero. Pediatr Cardiol 2004;25:287–298.

  39. Hofstaetter C, Gudmundsson S. Venous Doppler in the Evaluation of Fetal Hydrops. Obstetrics and Gynecology International 2010;2:1-7.

  40. Delhaas T, Marchie SJ, Rijlaarsdam ME, Strengers JL, et al. A Multicenter, Long-Term Study on Arrhythmias in Children With Ebstein Anomaly Pediatr Cardiol 2010;31:229–233.

  41. Dangel J, Hamela-Olkowska. Functional pulmonary atresia – a sign of severe right ventricular failure A. Archives of Perinatal Medicine 2008;14:15-19.

  42. Peterson R, Levi D, Williams R. Echocardiographic predictors of outcome in fetuses with pulmonary atresia with Intact Ventricular Septum. J Am Soc Echocardiogr 2006;19:1393- 400.

  43. Celermajer DS, Cullen S, Sullivan ID, Spiegelhalter DJ, Wyse RKH, Deanfield JE. Outcome in Neonates With Ebstein’s Anomaly. J Am Coll cardiol 1992;19:1041-6.

  44. Celermajer DS, Bull C, Till JA, Cullen S, Vassillikos VP, Sullivan ID, Allan L, Nihoyannopoulos P, Somerville J, Deanfield. Ebstein’s anomaly: Presentation and outcome from fetus to adult. J Am Coll Cardiol 1994,23:170-176.




2020     |     www.medigraphic.com