Faculty Bibliography

OBJECTIVE: Our purpose was to evaluate the effects of chorionic villus sampling on the fetal heart rate, the fetal umbilical artery pulsatility index, and the maternal arcuate artery resistance index. STUDY DESIGN: M-mode fetal heart rate, pulsed Doppler fetal umbilical artery pulsatility index, and maternal arcuate artery resistance index measurements were obtained before and immediately after chorionic villus sampling in 50 patients and were compared with 50 procedure-free, gestational age--matched controls. Comparisons within groups were performed with paired T tests and mean changes between groups with two-sample T tests, and variance comparisons between groups were performed with F tests. RESULTS: The mean changes (SD) in fetal heart rate, umbilical artery pulsatility index, and arcuate artery resistance index in patients undergoing chorionic villus sampling and in controls were not statistically different from zero or from each other. However, the variance around the mean fetal heart rate change was 17.1 times larger in the chorionic villus sampling group than the control group (F 17.1, degrees of freedom 49,49, p < 0.0001), and the variance around the mean pulsatility index change was 2.7 times larger in the chorionic villus sampling group than in the control group (F 2.7, degrees of freedom 49,49, p = 0.0007). There was no significant difference in mean resistance index change or variance around the mean resistance index change between groups. CONCLUSION: Chorionic villus sampling induces significant but unpredictable fluctuations in fetal heart rate and umbilical artery pulsatility index but does not affect maternal arcuate artery resistance index

This study examines whether transcatheter closure of a patent ductus arteriosus (PDA) using a Rashkind PDA occluder device is safe and effective in adults, or if adults have complications not sited in children owing to prolonged aorticopulmonary communication, high surgical risks or calcified PDAs. Fifteen patients aged 22 to 76 years (mean 42 +/- 14) were referred for transcatheter PDA occlusion. Exercise intolerance was the most frequent clinical manifestation. Eleven of 15 patients had surgical risk factors that included left ventricular failure (n = 10), biventricular failure (n = 1), elevated pulmonary pressures (n = 1), and a calcified PDA (n = 5). Twelve millimeter devices were placed in 4 PDAs < or = 3 mm in diameter; 17 mm devices were placed in 11 PDAs 3 to 6 mm in diameter. Seven (47%) were occluded angiographically shortly after device placement; another 5 PDAs (33%) were occluded echocardiographically within 24 hours of the procedure. Completed occlusion in this time interval was more likely to occur in PDAs < 5 mm in diameter (p = 0.0009). Of the 3 remaining PDAs with follow-up ranging from 9 to 38 months, 2 have demonstrated gradual diminution of shunting and have trivial leaks by color/Doppler flow. The other patient with a residual PDA has no ductal flow after placement of a second device. No complications related to device implantation or closure of the PDA occurred in any patient. No complications were reported in the follow-up patients who received evaluation (14 of 15 patients; range 1 to 38 months).(ABSTRACT TRUNCATED AT 250 WORDS)

OBJECTIVES: The purpose of this study was to analyze cases in which antenatal improvement of absent fetal umbilical artery end-diastolic velocity was detected and to correlate improvement with perinatal outcome. STUDY DESIGN: Forty cases of umbilical artery absent end-diastolic velocity in singleton pregnancies were retrospectively reviewed. Maternal characteristics and perinatal outcomes were compared in cases where improvement of end-diastolic velocity was diagnosed and those in which no improvement was detected. RESULTS: Eleven cases of absent end-diastolic velocity showed antenatal improvement and were associated with more advanced gestational age at delivery, longer diagnosis-to-delivery interval, larger birth weights, and a lower incidence of neonatal death than those fetuses without antenatal improvement. CONCLUSION: Improvement of umbilical artery absent end-diastolic velocity can occur and is associated with improved pregnancy outcome when compared with patients without antenatal improvement of diastolic velocity

Nonimmune hydrops fetalis occurred secondary to a syphilitic infection. Ultrasonographic evaluation and cordocentesis were used to confirm the antenatal infection. An IgM antibody specific for Treponema pallidum wall antigen (anti-47-kDa) was used to document the fetal infection. High-dose intravenous penicillin was administered in an attempt to achieve adequate fetal levels

This is the first reported case of the idiopathic type of primary aldosteronism in pregnancy. The severely hypertensive patient was unresponsive to treatment with high doses of four antihypertensive agents administered concurrently. A drastic improvement in blood pressure was noted within 24 hours of beginning enalapril maleate, although subsequent deterioration in fetal status led to delivery at 26 weeks' gestation. Alternatives to standard medical therapy may be necessary for this rare but potentially life-threatening disease during pregnancy

Permanent pacing in small children may require placement of an epicardial pacing system. This report describes a young child who underwent pacemaker implantation with epicardial ventricular lead placement in infancy as an adjunct to antiarrhythmic therapy for congenital junctional ectopic tachycardia. At 5 years of age, a harsh systolic murmur was detected for the first time. Evaluation by catheterization and transluminal echocardiography showed right ventricular outflow obstruction (pressure gradient 40 mmHg) secondary to extrinsic compression by the epicardial lead. Surgical removal of the lead relieved the obstruction

Experience with three prenatally diagnosed pregnancies complicated by an acardiac twin reveals that ultrasonography and echocardiography are helpful in detecting early signs of in-utero congestive heart failure in the normal twin. The use of Doppler blood flow analysis to determine direction of blood flow, post-mortem placental and fetal angiography, and umbilical cord blood gas determination provided proof that retrograde arterial perfusion occurs in the acardiac fetus. In a fourth pregnancy, an experimental approach to occlude the acardiac twin's umbilical cord was attempted, but was unsuccessful

A hyperdynamic left ventricle can lead to post-dilation mid-cavitary obstruction in the absence of any preballoon mid-cavitary obstruction in children with aortic valve stenosis. The purpose of this study was to define the incidence and course of post-dilation mid-cavitary obstruction. We reviewed the catheterization and echocardiographic data of 35 patients, ages 3 days to 18 years (mean = 7.9 years), with isolated aortic valve stenosis who underwent balloon dilation with a fall in aortic valve gradient to less than 20 mm Hg. Post-dilation mid-cavitary obstruction was suspected from post-dilation left ventricular angiogram and was quantitated by echocardiographic and Doppler examinations performed immediately after dilation and in a 1-3 month follow-up period. Continuous wave Doppler directed by color flow Doppler was used for evaluation and differentiation of post-dilation mid-cavitary obstruction and residual aortic valve stenosis. Three children (3/35 [9%]) all under 2 years of age developed post-dilation mid-cavitary obstruction immediately after dilation. The obstruction within the cavity resolved spontaneously in all three patients. Conclusions: 1) Post-dilation left ventricular mid-cavitary obstruction can occur in children under 2 years of age after balloon dilation of severe aortic valve stenosis, and 2) total regression of post-dilation mid-cavitary obstruction occurs spontaneously in all patients