Uterine Fundus Remodeling after Hysteroscopic Metroplasty: A Prospective Pilot Study

The septate uterus is the most common congenital uterine malformation and is treated by hysteroscopic metroplasty. There are few studies on the fundal uterine changes that occur after surgery. We designed a pilot prospective observational study to evaluate by three-dimensional transvaginal ultrasound (3D-TVS) the changes not only of the internal fundal uterine profile, but also of the external one, after hysteroscopic metroplasty. Sixty women who underwent hysteroscopic metroplasty for partial or complete uterine septum (U2a and U2b subclasses of ESHRE/ESGE classification) were enrolled. We performed 3D-TVS after surgery confirming optimal removal of the septum. However, at ultrasound follow-up after three months, we observed a significant increase (p < 0.001) in the residual septum (Zr) (3.7 mm (95% CI: 3.1–4.4)), the myometrial wall thickness (Y) (2.5 mm (95% CI: 2.0–3.0)) and the total fundal wall thickness (Y + Zr) (6.2 mm (95% CI: 5.5–6.9)). Forty-three patients (72%) required a second step of hysteroscopic metroplasty. Moreover, the shape of uterine fundus changed in 58% of cases. We actually observed a remodeling of the uterine fundus with modifications of its external and internal profiles. Therefore, we propose to always perform a second ultrasound look at least three months after the metroplasty to identify cases that require a second- step metroplasty.

Download Full-text

Diagnosing Septate Uterus Using Three-Dimensional Ultrasound Using Three Different Classifications: An Interobserver and Intraobserver Agreement Study

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0041-1740271 ◽

2021 ◽

Vol 43 (12) ◽

pp. 911-918

Author(s):

Carla Peixoto ◽

Maite Castro ◽

Isabel Carriles ◽

Maria de Arriba ◽

Victoria Lapresa ◽

...

Keyword(s):

Wall Thickness ◽

European Society ◽

Interobserver Agreement ◽

Three Dimensional ◽

Classification Systems ◽

Human Reproduction ◽

Kappa Index ◽

Septate Uterus ◽

Uterine Malformation ◽

Good For

Abstract Objective Currently, there are up to three different classifications for diagnosing septate uterus. The interobserver agreement among them has been poorly assessed. Objective To assess the interobserver agreement of nonexpert sonographers for classifying septate uterus using the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), American Society for Reproductive Medicine (ASRM), and Congenital Uterine Malformations by Experts (CUME) classifications. Methods A total of 50 three-dimensional (3D) volumes of a nonconsecutive series of women with suspected uterine malformation were used. Two nonexpert examiners evaluated a single 3D volume of the uterus of each woman, blinded to each other. The following measurements were performed: indentation depth, indentation angle, uterine fundal wall thickness, external fundal indentation, and indentation-to-wall-thickness (I:WT) ratio. Each observer had to assign a diagnosis in each case, according to the three classification systems (ESHRE/ESGE, ASRM, and CUME). The interobserver agreement regarding the ESHRE/ESGE, ASRM, and CUME classifications was assessed using the Cohen weighted kappa index (k). Agreement regarding the three classifications (ASRM versus ESHRE/ESGE, ASRM versus CUME, ESHRE/ESGE versus CUME) was also assessed. Results The interobserver agreement between the 2 nonexpert examiners was good for the ESHRE/ESGE (k = 0.74; 95% confidence interval [CI]: 0.55–0.92) and very good for the ASRM and CUME classification systems (k = 0.95; 95%CI: 0.86–1.00; and k = 0.91; 95%CI: 0.79–1.00, respectively). Agreement between the ESHRE/ESGE and ASRM classifications was moderate for both examiners. Agreement between the ESHRE/ESGE and CUME classifications was moderate for examiner 1 and good for examiner 2. Agreement between the ASRM and CUME classifications was good for both examiners. Conclusion The three classifications have good (ESHRE/ESGE) or very good (ASRM and CUME) interobserver agreement. Agreement between the ASRM and CUME classifications was higher than that for the ESHRE/ESGE and ASRM and ESHRE/ESGE and CUME classifications.

Download Full-text

The developing athlete's heart: a cohort study in young athletes transitioning through adolescence

European Journal of Preventive Cardiology ◽

10.1177/2047487319862061 ◽

2019 ◽

Vol 26 (18) ◽

pp. 2001-2008 ◽

Cited By ~ 9

Author(s):

Anders W Bjerring ◽

Hege EW Landgraff ◽

Thomas M Stokke ◽

Klaus Murbræch ◽

Svein Leirstein ◽

...

Keyword(s):

Oxygen Uptake ◽

Endurance Training ◽

Wall Thickness ◽

Maximal Oxygen Uptake ◽

Three Dimensional ◽

Relative Wall Thickness ◽

Endurance Athletes ◽

Cardiac Morphology ◽

Athlete's Heart

Background Athlete's heart is a term used to describe physiological changes in the hearts of athletes, but its early development has not been described in longitudinal studies. This study aims to improve our understanding of the effects of endurance training on the developing heart. Methods Cardiac morphology and function in 48 cross-country skiers were assessed at age 12 years (12.1 ± 0.2 years) and then again at age 15 years (15.3 ± 0.3 years). Echocardiography was performed in all subjects including two-dimensional speckle-tracking strain echocardiography and three-dimensional echocardiography. All participants underwent cardiopulmonary exercise testing at both ages 12 and 15 years to assess maximal oxygen uptake and exercise capacity. Results Thirty-one (65%) were still active endurance athletes at age 15 years and 17 (35%) were not. The active endurance athletes had greater indexed maximal oxygen uptake (62 ± 8 vs. 57 ± 6 mL/kg/min, P < 0.05) at follow-up. There were no differences in cardiac morphology at baseline. At follow-up the active endurance athletes had greater three-dimensional indexed left ventricular end-diastolic (84 ± 11 mL/m2 vs. 79 ± 10 mL/m2, P < 0.05) and end-systolic volumes (36 ± 6 mL/m2 vs. 32 ± 3 mL/m2, P < 0.05). Relative wall thickness fell in the active endurance athletes, but not in those who had quit (–0.05 ΔmL/m2 vs. 0.00 mL/m2, P = 0.01). Four active endurance athletes had relative wall thickness above the upper reference values at baseline; all had normalised at follow-up. Conclusion After an initial concentric remodelling in the pre-adolescent athletes, those who continued their endurance training developed eccentric changes with chamber dilatation and little change in wall thickness. Those who ceased endurance training maintained a comparable wall thickness, but did not develop chamber dilatation.

Download Full-text

Misdiagnosed septate uterus: do we really need three dimensional transvaginal ultrasound (3D-US) to reevaluate arcuate uteri diagnosed by hystrosalpingography (HSG)?

Fertility and Sterility ◽

10.1016/j.fertnstert.2015.07.084 ◽

2015 ◽

Vol 104 (3) ◽

pp. e27-e28

Author(s):

A.M. Abdelmagied ◽

M.A. Kamel ◽

A.M. Abuelhasan ◽

T.A. Farghaly ◽

A.A. Nassr ◽

...

Keyword(s):

Transvaginal Ultrasound ◽

Three Dimensional ◽

Septate Uterus

Download Full-text

813 The added value of transthoracic three dimensional echocardiography in apical hypertrophic cardiomyopathy

European Heart Journal Supplements ◽

10.1093/eurheartj/suab149.007 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Valeria Rella ◽

Mara Gavazzoni ◽

Michele Tomaselli ◽

Giorgio Oliverio ◽

Valentina Volpato ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Sudden Cardiac Death ◽

Wall Thickness ◽

Cardiac Death ◽

Contrast Echocardiography ◽

Three Dimensional ◽

Added Value ◽

Maximal Wall Thickness ◽

Apical Hypertrophy

Abstract We present the case of a 73-year-old patient with a recent diagnosis of hypertrophic cardiomyopathy (HCM). He was asymptomatic and has no family history of sudden cardiac death (SCD), syncope or ventricular arrhythmias. An echocardiogram performed at the moment of diagnosis (2020), showed left ventricular (LV) asymmetric apical hypertrophy with maximal wall thickness of 21 mm. Cardiac magnetic resonance (CMR) confirmed LV apical hypertrophy with mid-ventricular obliteration, and late gadolinium enhancement in the apical segments, without wall motion abnormalities present at rest. According to 2014 ESC guidelines, his calculated risk score for sudden cardiac death was low (1.23% at 5 years). On 2021, a comprehensive transthoracic echocardiographic examination including advanced techniques (three-dimensional echo-3DE-, and two-dimensional speckle-tracking-2DSTE) was done as part of his routine follow-up in our cardiomyopathy outpatient clinic. The echo study showed an asymmetric pattern of LV hypertrophy with a maximal wall thickness of 21 mm at the level of the anterolateral apical segment, normal LV volumes (end-diastolic volume 55 mL/m2) and ejection fraction (69%) by 3DE. LV longitudinal strain analysis by 2DSTE showed impaired LV myocardial deformation mainly at the apical LV segments (GLS = −13.6%). There was evidence of dynamic intracavitary obstruction (maximal gradient 32 mmHg at rest and raised to 52 mmHg during Valsalva manoeuvre). 3DE views of the LV (both multi-slice display and 3D rendered image) allowed to avoid foreshortening of the LV apical views, and to appreciate the actual wall motion at the real LV apex. They revealed a LV apical aneurysm which was not detected in the conventional LV-focused apical 2D views (Figure 1A and B). Apical hypertrophic cardiomyopathy (ApHCM) is a variant of HCM that is characteristic of focal thickening of the LV apical myocardium and was reported to have a more benign course than other non-apical forms. However, the presence of LV aneurysm in ApHCM patients is associated with an increased risk for ventricular arrhythmias, sudden cardiac death and thromboembolism. Accordingly, the detection of apical LV aneurysms has significant impact on patient management. Guidelines recommend the use of contrast echocardiography or CMR when the apical region of the LV is suboptimally visualized by conventional 2D echocardiography. However, contrast echocardiography may still be affected by apical foreshortening resulting in suboptimal accuracy, as it is a 2D technique. On the other end, CMR may be contraindicated or not widely available for routine yearly follow-up for all HCM patients requiring regular imaging follow-up. Our clinical case emphasizes the added value of 3DE to increase the sensitivity of transthoracic echocardiography in detecting apical LV aneurysms in patients with apical HCM with important clinical implications for the management of the patient. 813 Figure 1(A) 2D 4chamber-view showing maximal wall thickness in the apical segments (21 mm) with apical obliteration. At a first evaluation, apical aneurism is not easily detected. (B) 4D rendering of the apex showing the apical aneurism.

Download Full-text

Spontaneous Twin Pregnancy in Uterus Bicornis Unicollis

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/834952 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Arzu Doruk ◽

Ilay Gozukara ◽

Güneş Burkaş ◽

Esin Bilik ◽

Talat Umut Kutlu Dilek

Keyword(s):

Caesarean Section ◽

Three Dimensional ◽

Rare Occurrence ◽

Premature Rupture ◽

Bicornuate Uterus ◽

Uterine Malformation ◽

Spontaneous Labour ◽

Mullerian Ducts ◽

Uterus Bicornis ◽

Congenital Uterine Malformation

Abnormal fusion of the Müllerian ducts or failure of resorption of the septum causes varying degrees of congenital uterine malformation. They are often associated with reproductive problems such as miscarriage, premature labour, premature rupture of the membranes, or malpresentation. Twin gestation in a case of bicornuate uterus is extremely rare. A 37-year-old multiparous woman conceived a twin dichorionic diamniotic pregnancy spontaneously. Three-dimensional ultrasound revealed bicornuate uterus with one embryo in each cavity. Perinatal course was uneventful. At 35 weeks of pregnancy, spontaneous labour started and twin babies were delivered by bilateral low transvers caesarean section. Because of the rare occurrence of twin gestation in bicornuate uterus, there is no uniform guideline to manage these cases appropriately. Delivery by planned caesarean section could avoid the possible obstetric complications by dystocia.

Download Full-text

Detection of congenital uterine malformation by using transvaginal three-dimensional ultrasound

Journal of Huazhong University of Science and Technology [Medical Sciences] ◽

10.1007/s11596-014-1352-7 ◽

2014 ◽

Vol 34 (5) ◽

pp. 782-784 ◽

Cited By ~ 1

Author(s):

Li-li Yu ◽

Xuan Zhang ◽

Ting Zhang ◽

Han-rong Chen ◽

Ze-hua Wang

Keyword(s):

Three Dimensional ◽

Uterine Malformation ◽

Congenital Uterine Malformation

Download Full-text

Three dimensional color Doppler transvaginal ultrasound morphologic features of uterine septum and residual cavity in women with reproductive failure

Middle East Fertility Society Journal ◽

10.1016/j.mefs.2014.03.006 ◽

2015 ◽

Vol 20 (1) ◽

pp. 21-26 ◽

Cited By ~ 4

Author(s):

Somayya M. Sadek ◽

Reda A. Ahmad ◽

Badeea S. Soliman

Keyword(s):

Color Doppler ◽

Transvaginal Ultrasound ◽

Three Dimensional ◽

Reproductive Failure ◽

Residual Cavity ◽

Uterine Septum

Download Full-text

The use of hysteroscopic metroplasty with diode laser to increase endometrial volume in women with septate uterus: preliminary results

Gynecological Surgery ◽

10.1186/s10397-021-01093-8 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Luigi Nappi ◽

Maddalena Falagario ◽

Stefano Angioni ◽

Vincenzo De Feo ◽

Michele Bollino ◽

...

Keyword(s):

Diode Laser ◽

Transvaginal Ultrasound ◽

Complete Removal ◽

Safe Procedure ◽

Septate Uterus ◽

Median Increase ◽

Mullerian Ducts ◽

Endometrial Volume ◽

3D Tv

Abstract Background Septate uterus is a common Mullerian ducts anomaly. The aim of our pilot study was the evaluation of diode laser hysteroscopic metroplasty efficacy to increase endometrial volume in women with septate uterus. Results We prospectively enrolled 10 consecutive patients with septate uterus undergoing office hysteroscopic metroplasty with diode laser between February and November 2019. Endometrial volume was evaluated before and 3 months after surgery using 3D transvaginal ultrasound. The surgical procedure was uncomplicated in all patients, the endometrial volume increased at 3 months follow-up (the median increase was 1.9 cm3 (range 1.7–2.1), and there was a complete removal of septum with no intrauterine synechiae at follow-up hysteroscopy. Conclusions Office hysteroscopic metroplasty with diode laser is a safe procedure and has preliminary showed to increase endometrial volume. The increase in endometrial volume by 3D-TV US could be used as a prognostic factor for the reproductive outcomes.

Download Full-text

The Use of Hysteroscopic Metroplasty With Diode Laser to Increase Endometrial Volume in Women With Septate Uterus: Preliminary Results

10.21203/rs.3.rs-106875/v1 ◽

2020 ◽

Author(s):

Luigi Nappi ◽

Maddalena Falagario ◽

Stefano Angioni ◽

Vincenzo De Feo ◽

Michele Bollino ◽

...

Keyword(s):

Diode Laser ◽

Surgical Procedure ◽

Transvaginal Ultrasound ◽

Complete Removal ◽

Safe Procedure ◽

Septate Uterus ◽

Preliminary Results ◽

Mullerian Ducts ◽

Endometrial Volume

Abstract Background Septate uterus is a common Mullerian ducts anomaly. The aim of our study was the evaluation of the efficacy of hysteroscopic metroplasty with diode laser to increase endometrial volume in women with septate uterus.Results We prospectively enrolled 10 consecutive patients with septate uterus who underwent office hysteroscopic metroplasty with diode laser between february 2019 and november 2019. Endometrial volume was evaluated before and 3 months after surgery using 3D transvaginal ultrasound. The surgical procedure was uncomplicated in all patients, the endometrial volume increased at 3 months follow up and there was a complete removal of septum with no intrauterine synechiae at follow up hysteroscopy. Conclusions Office hysteroscopic metroplasty with diode laser is a safe procedure and has preliminary showed to increase endometrial volume.

Download Full-text