Prenatal Diagnosis and Postnatal Outcome of Eight Cases with Criss-Cross Heart – A Multicenter Case Series

2020 ◽  
Author(s):  
Carina Nina Vorisek ◽  
Andrii Kurkevych ◽  
Viktoria Kuhn ◽  
Rüdiger Stessig ◽  
Jochen Ritgen ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Gestational Age ◽  
Septal Defect ◽  
Fetal Echocardiography ◽  
Pulmonary Stenosis ◽  
Case Series ◽  
Double Outlet Right Ventricle ◽  
Retrospective Case ◽  
Chamber View ◽  
Situs Solitus

Abstract Objective Criss-cross heart (CCH) is a rare congenital cardiac defect defined by crossing of ventricular inflow streams contributing to less than 0.1 % of all congenital heart anomalies. Due to its rarity and complexity, prenatal diagnosis in these patients remains challenging. We sought to describe prenatal findings and postnatal course in eight cases of prenatally diagnosed CCH. Methods This is a retrospective case series of prenatally diagnosed CCH in three centers between 2010–2017. We reviewed fetal echocardiograms as well as postnatal clinical charts and surgical reports. Results 8 cases of CCH were included. The median gestational age at diagnosis was 27 weeks. 7 patients were found with situs solitus, one fetus with situs ambiguous. In all patients, the four-chamber view was abnormal. There was atrioventricular discordance in half of the patients, while all patients showed ventriculoarterial discordance. All patients were found with additional cardiac anomalies, including ventricular septal defect, double outlet right ventricle, right aortic arch, atrial septal defect and pulmonary stenosis. Three patients underwent amniocentesis without pathological findings. All patients were born alive at a median gestational age of 38 + 2 weeks and survived our median follow-up of 181 days. Conclusion CCH can be diagnosed prenatally by detailed fetal echocardiography when observing an abnormal four-chamber view with crossing of inflow streams into both ventricles and a lack of parallel orientation of the atrioventricular valve axis due to a clockwise or counterclockwise rotation of the ventricular mass along its axis. With the help of prenatal ultrasound, parental guidance and counselling as well as postnatal pediatric cardiac management can be warranted.

Primary Intracardiac Repair of Double Outlet Right Ventricle and Ventricular Septal Defect without Pulmonary Stenosis

1995 ◽  
Vol 3 (3-4) ◽  
pp. 103-108
Author(s):  
KG Jaya Prasanna ◽  
Krishna Subramony Iyer ◽  
Rajesh Sharma ◽  
Balram Airan ◽  
Ivatury Mrityonjaya Rao ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Ventricular Septal Defect ◽  
Right Ventricle ◽  
Septal Defect ◽  
Arterial Switch Operation ◽  
Pulmonary Stenosis ◽  
Double Outlet Right Ventricle ◽  
Arterial Switch ◽  
Intracardiac Repair ◽  
Switch Operation

From January 1991' to May 1994, 29 patients with double outlet right ventricle with ventricular septal defect, without pulmonary stenosis underwent primary intracardiac repair at the All India Institute of Medical Sciences, New Delhi. Patients were classified into 4 groups based on location of the ventricular septal defect. The ventricular septal defect was subaortic in 11, subpulmonary in 13, doubly committed subarterial in 1, and noncommitted in 4 patients. Surgical treatment consisted of intraventricular routing of the left ventricle to the aorta (17), and the left ventricle to the pulmonary artery followed by an arterial switch operation (12). There were 4 (13.9%) early deaths. Follow-up ranged from 3 months to 3 years (mean, 1.5 years). There was no late mortality. Three patients had residual ventricular septal defect, one of whom has undergone reoperation. One patient has a gradient of 25 mmHg across the left ventricular outflow tract. Double outlet right ventricle with subpulmonic ventricular septal defect was found to be a significant risk factor for early mortality (p = 0.03). The subgroup of double outlet right ventricle with subpulmonic ventricular septal defect who had a combination of single coronary artery and post arterial switch operation was particularly prone to pulmonary hypertensive crisis and hospital death (p = 0.002).

scholarly journals Feasibility and accuracy of fetal echocardiography at routine 11 to 13 weeks 6 days ultrasound performed on unselected obstetric population in a tertiary maternity centre with high patient turnover

2017 ◽  
Vol 7 (1) ◽  
pp. 159
Author(s):  
Vidyashree G. Poojari ◽  
Arevidya Reddy ◽  
Akhila Vasudeva
Keyword(s):  
High Risk ◽  
Gestational Age ◽  
Fetal Echocardiography ◽  
Heart Defects ◽  
Nuchal Translucency ◽  
Limited Time ◽  
High Turnover ◽  
Chamber View ◽  
Obstetric Population ◽  
Turn Over

Background: Congenital heart defects (CHD) remain the most prevalent congenital malformations, with an estimated prevalence of 6-8 per 1000 live births. Routinely, fetal echo is performed around 18-22 weeks among high risk cases. A dedicated early fetal echo (EFEC) performed by experts between 11-16 weeks is emerging as an excellent screening tool among high risk cases. However, feasibility of obtaining such cardiac views during routine Nuchal Translucency scan by trained obstetricians, is yet to be known as there is limited time available with high patient turn over. Present study aimed to know the feasibility and accuracy of EFEC in unselected obstetric population in a tertiary maternity centre with high patient turnover.Methods: This was an observational cohort study from March 2015 to April 2017 at a tertiary maternity referral hospital. Singleton pregnant women undergoing routine 11-13+6 weeks scanning (NT scan) were recruited in the study including both high and low risk pregnancies. Possibility of obtaining 4 basic cardiac views within this limited time was assessed.Results: A total of 180 early fetal ECHO’s were performed during the course of this study. The 4-chamber view (79.44%) of the heart was the easiest parameter to visualize. RVOT (28.88%) was the most difficult view to be obtained. Complete visualization of all the cardiac views was possible in only 34 women (18.88%). The visualization rates of the cardiac views improved as the gestational age increased. TVS was essential to obtain cardiac views in 5 cases out of 138 (3.6%) in 12-13+6 scans. Whereas, TVS was essential to visualize cardiac views in 34 cases out of 42 (80.95%) between 11 weeks to 11 weeks 6 days. A total of 7 cardiac anomalies were detected during this study. There were 3 major and 4 minor cardiac malformations. Out of the 3 major anomalies, 2 were AVSDs which were diagnosed by EFEC. Minor defects were undetected.Conclusions: It is feasible to get the basic cardiac views in the limited time available to perform NT scan among unselected obstetric population in a tertiary maternity centre with a high turnover. Gestational age of 12 weeks and above seems to increase the accuracy. TVS is a useful adjunct throughout 11-14 weeks scan.

scholarly journals Case series: Criss-cross Heart

2021 ◽  
Author(s):  
Panthip Patrakunwiwat ◽  
Pirapat Makarapong ◽  
Thanarat Layangkool
Keyword(s):  
Surgical Intervention ◽  
Pulmonary Stenosis ◽  
Treatment Options ◽  
Case Series ◽  
Double Outlet Right Ventricle ◽  
Palliative Surgery ◽  
Total Correction ◽  
Complex Anatomy ◽  
Prominent Symptom ◽  
Cardiology Clinic

Abstract Criss-cross heart (CCH) is a rare cardiac malformation which is characterized by crossing of the inflow streams of the two ventricles due to rotation of ventricular axis. The anomalies can be identified both atrioventricular concordance and discordance. The etiology of CCH is remaining unknown. Prominent symptom is cyanosis. The primary investigation is transthoracic echocardiography to identify this abnormality. Many patients need further investigation to review anatomy. Total correction is the aim for treatment but it is difficult for this complex anatomy. There were 5 patients who visited cardiology clinic at Queen Sirikit National Institute of Child Health (QSNICH) from 2002 to 2017. The objective is to review the treatment options that we performed in CCH. Most common associated anomalies were double outlet right ventricle and pulmonary stenosis. One patient died before surgical intervention; others were performed palliative surgery.

Fluorescein Angiography of Persistent Incomplete Vascularization of the Retina After Bevacizumab Therapy in Retinopathy of Prematurity

2019 ◽  
Vol 3 (5) ◽  
pp. 304-308 ◽  
Author(s):  
Xihui Lin ◽  
Sagar B. Patel ◽  
Alice Y. Zhang ◽  
Daniel A. Brill ◽  
Kim H. Le ◽  
...  
Keyword(s):  
Fluorescein Angiography ◽  
Gestational Age ◽  
Retinopathy Of Prematurity ◽  
Case Series ◽  
Intravitreal Bevacizumab ◽  
Peripheral Retina ◽  
Medical Systems ◽  
Retrospective Case ◽  
Type 1 Rop

Purpose: This study evaluates the vascular development of premature infants at 50 weeks postconception after treatment with intravitreal bevacizumab for type 1 retinopathy of prematurity (ROP). Methods: A retrospective case series was conducted on type 1 ROP neonates with a high risk of general anesthesia complications. Patients were treated with bevacizumab between February 2013 and February 2016. At 50 weeks’ gestational age, all patients were imaged with RetCam (Clarity Medical Systems, Inc) fundus photographs and widefield fluorescein angiography (FA). Results: There were 4 boys and 7 girls with an average gestational age of 24.8 weeks and weight of 734.3 grams at birth. The estimated gestational age at injection was 37.1 weeks. Examination under anesthesia with FA was performed at a mean of 61 weeks posttreatment. Nineteen of 20 eyes (95%) of 11 infants had incomplete vascularization and peripheral nonperfusion on imaging. FA showed new vessels with increased tortuosity, microvascular abnormalities, and leakage past the original ridge. These 19 patients were treated with confluent ablative photocoagulation to the peripheral nonperfused retina. Patients were followed for a mean of 73.3 weeks after birth. None required incisional surgery. Conclusions: Patients with type 1 ROP treated with bevacizumab may have delayed vascularization of the peripheral retina and even late recurrence of active disease. Clinicians should regularly monitor patients after bevacizumab for potential neovascular complications.

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