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R Chaoui

Publications and source records attributed to R Chaoui.

At least 37 records · Page 2Linked to original sources
PubMed2004

Increased cardiac atrial-to-ventricular length ratio in the fetal four-chamber view: a new marker for atrioventricular septal defects.

OBJECTIVES: Atrioventricular septal defects (AVSDs) are the most common cardiac abnormality in fetuses with numerical chromosomal aberrations, in particular trisomy 21. The majority of AVSDs are not detected by routine ultrasound examination in pregnancy. We report two simple cardiac measurements that may substantially improve antenatal detection of AVSDs. METHODS: Cross-sectional ultrasound images through the fetal thorax demonstrating the four-chamber plane of the heart were obtained in 123 normal fetuses between 10 and 38 weeks of gestation. Heart length was measured at the level of interventricular septum by placing the calipers on the epicardium at the apex of the heart and on the endocardium at the top of the atrium. Ventricular length was measured by shifting the atrial caliper to the crossing point of the ventricular septum and mitral valve. Atrial length was calculated as the difference between the heart length and ventricular length. Based on these measurements, the atrial-to-ventricular length (AVL) ratio was calculated. Data were compared to measurements from 29 consecutive fetuses with AVSD between 13 and 39 weeks of gestation. RESULTS: In normal fetuses, the AVL ratio did not change with gestation and the mean AVL ratio was 0.47 (95% prediction interval 0.35 to 0.63). In the AVSD group, the mean AVL ratio was 0.77 (range, 0.59-0.99). If a cut-off value for the AVL ratio of 0.6 was chosen, the detection rate of AVSD was 86.2% at a 5.7% false-positive rate. For a 100% detection rate, the false-positive rate was 7.3%. CONCLUSIONS: The AVL ratio can accurately discriminate between hearts with AVSDs and normal cardiac anatomy. Incorporation of the AVL ratio measurement into routine antenatal ultrasonography may substantially improve the ability to diagnose AVSDs antenatally.

Case-Control Studies↗
PubMed2004

Congenitally corrected transposition of the great arteries: clues for prenatal diagnosis.

Congenitally corrected transposition of the great arteries (ccTGA) is an uncommon cardiac defect characterized by the atria connecting with the anatomically discordant ventricles and the ventricles connecting with discordant and transposed great arteries. Parallel vessels are evident in corrected TGA, but as this sign is also present in complete TGA, a heart anomaly requiring major cardiac surgery in the postnatal period, it is important to differentiate between the entities prenatally. Most cases of ccTGA have associated anomalies but isolated forms or those with a mild associated cardiac anomaly are infrequently detected prenatally. We report on three cases detected between 21 and 25 weeks' gestation on screening ultrasound with associated mild findings. One fetus had an isolated ventricular septal defect (VSD) first detected at 34 weeks. The child developed heart block at 4 years of age. The second case was associated with a small VSD, a tiny pulmonary trunk and a persistent right umbilical vein. After birth, mild pulmonary stenosis was found as an additional cardiac finding at 4 months of age. The third fetus had no additional cardiac anomalies prenatally, but after birth a bicuspid aortic valve was detected. The first case needed pacemaker implantation but the other two children required no cardiac surgery. Two of the cases were referred because abnormal vessel anatomy was detected on screening ultrasound. As prenatal detection of TGA is becoming a more frequent occurrence, this paper aims to present clues aiding in the prenatal diagnosis of atrioventricular and ventriculoarterial discordance, especially in its differentiation from complete transposition. These details are crucial for counseling and perinatal management.

Adolescent↗
PubMed2004

Enlarged adrenal glands as a prenatal marker of congenital adrenal hyperplasia: a report of two cases.

We report the prenatal findings of congenital adrenal hyperplasia (CAH) in two consecutive fetuses of one family. The first pregnancy was terminated at 23 weeks' gestation due to the presence of a complex heart anomaly. The adrenal glands appeared enlarged on prenatal ultrasound examination and autopsy confirmed CAH. The parents were subsequently examined and were found to be heterozygous for nucleotide 656 of the CYP21B gene. In a subsequent pregnancy, chorionic villus sampling at 11 weeks confirmed CAH in the male fetus. At this gestational age, mild body edema was present and the nuchal translucency measured 2.1 mm. From 14 weeks onwards, enlargement of the adrenal glands was the only sign of CAH. These findings suggest that enlarged adrenal glands may be a prenatal sign for CAH. In fetal medicine, when a pregnancy is terminated due to fetal malformations, autopsy should be performed because it can provide additional information that is helpful in counseling women with regard to subsequent pregnancies.

Adrenal Hyperplasia, Congenital↗
PubMed2004

[Three-dimensional power Doppler ultrasonography (3D-PDU) in fetal diagnosis].

AIM: 3D power Doppler ultrasonography (3D-PDU) is a new method which allows the spatial presentation of fetal vessels in utero. In the presented study we have examined the feasibility of this technique in prenatal diagnosis. Aim of our pilot study with normal human fetuses was to determine the adjustment of the system presets, the optimal insonation planes and the regions of interest. MATERIAL AND METHODS: Seven regions of interest were examined in three different planes. The 3D volume was acquired by a free hand sweep. The feasibility of the method was quantitatively determined for every plane and region. For each of the three planes a total of 25 examinations was planned and the successful rate per region of interest was then assessed for the total of these 75 examinations. In a two year period, a total number of 80 fetuses from 16 to 34 weeks' gestation could be enrolled in the study. RESULTS: Best examinations were achieved in the vessels of the umbilical cord (successful rate 100 %), followed by the placental and abdominal (84 % each), cerebral (80 %), pulmonary (64 %), and renal vessels (51 %). The most difficult conditions for examination and the most unreliable results were found for the fetal heart with a success rate of only 31 % of the cases. Similar to the experience in 2D power Doppler, a plane with blood flow towards the transducer was the best insonation plane. CONCLUSIONS: In our study we were able to show that a three dimensional demonstration of fetal vessels is possible with the system used. The feasibility is limited by fetal movements and unfavourable fetal positioning. The possible benefit of the method is to diagnose complex fetal vascular malformations in the future.

Female↗
PubMed2004

Advanced dynamic flow -- a new method of vascular imaging in prenatal medicine. A pilot study of its applicability.

INTRODUCTION: Vascular imaging by means of colour Doppler sonography is an established method in prenatal diagnostics, especially in fetal echocardiography. In recent years, new techniques for the imaging of vessels have been developed, attaining B-scan quality. One example of such techniques is the Advanced Dynamic Flow. The goal of the study was the comparison of the practical application of ADF under routine conditions with the established colour Doppler method, on the same machine. AIM OF THE STUDY: Comparison of conventional colour Doppler sonography with Advanced Dynamic Flow. STUDY DESIGN: a prospective, systematic study. PATIENTS AND METHOD: We used a representative cross-section through the fetal vessels and also carried out complete fetal echocardiography. Between January 1 (st), 2002 and December 31 (st), 2002, 100 pregnant women between the 12 (th) to 40 (th) gestational week were examined. RESULTS: The success rate for visualisation of blood flow was the same or higher for Advanced Dynamic Flow in all areas, compared with conventional colour Doppler. These results could also be achieved in fetal echocardiography. CONCLUSION: The Advanced Dynamic Flow technique is a new method for vascular imaging with B-scan quality. It offers high resolution, good lateral discrimination and high sensitivity. The present prospective study has demonstrated that ADF achieves better vascular imaging than conventional colour Doppler sonography. The fact that ADF offers an almost three-dimensional imaging of vessels is particularly valuable. The ease of use of the ADF technique qualifies this method as a serious alternative to conventional colour Doppler sonography.

Echocardiography↗
PubMed2004

Coronary arteries in fetal life: physiology, malformations and the "heart-sparing effect".

The present knowledge of coronary arteries in prenatal diagnosis is reviewed with a focus on three aspects: the physiology and visualization of coronary flow, malformations involving the coronary arteries, and the "heart-sparing effect". Visualization of coronary arteries in a healthy human fetus is possible in real-time and colour Doppler during the last 10 wk of gestation when ultrasound conditions are excellent. Visualization at an earlier gestational age (up to 13 wk) is feasible mainly in association with malformations and impending hypoxia. The main coronary malformations that can be visualized in utero are the ventriculo-coronary communications in fetuses with pulmonary atresia. In the last few years, interest has been focused on the "heart-sparing effect", defined as the increased perfusion of the coronary arteries in fetuses with severe growth restriction and abnormal Doppler velocimetry in the peripheral vessels. Increased perfusion detectable with colour and pulsed Doppler is a late sign of fetal compromise in hypoxaemia. It confirms animal experiments that have demonstrated dilatory reserves of the fetal coronary arteries under chronic hypoxaemia. The outcome of 21 fetuses showing the "heart-sparing effect" before 32 wk gestation was poor: nine fetuses died in utero and two after birth, the median weight at birth was 630 g. In summary, our knowledge of the coronary arteries in the fetus is based on the diagnostic means used in prenatal diagnosis. New information in this field may also contribute to a better understanding of coronary heart disease later in life.

Blood Flow Velocity↗
PubMed2003

Unusual case of a fetus with congenital cystic adenomatoid malformation of the lung associated with trisomy 13.

Congenital cystic adenomatoid malformation of the lung can be detected with antenatal ultrasound as hyperechogenic areas in the fetal chest. Associated extrapulmonary malformations as well as chromosomal aberrations are described as very rare. We present a case report of a fetus in the 23rd week of gestation who showed in the course of a routine ultrasound screening a large number of malformations: holoprosencephaly, arrhinencephaly, cleft palate, CCAM type III of the right inferior pulmonary lobe, ventricular septal defect and bilateral clubfeet. Chromosome analysis confirmed the suspicion of trisomy 13. The present case shows how important it is-even with malformations that are rarely accompanied by associated anomalies and which have a very good prognosis-to carry out a directed diagnosis including a fetal karyotyping.

Abnormalities, Multiple↗
PubMed2003

Caliber of the coronary sinus in fetuses with cardiac defects with and without left persistent superior vena cava and in growth-restricted fetuses with heart-sparing effect.

OBJECTIVE: To assess reference ranges for fetal coronary sinus (CS) diameter and to compare them with values from fetuses showing heart defects with and without left superior vena cava (LSVC) as well as with severe intrauterine growth retardation and heart-sparing effect on color Doppler. METHODS: The coronary sinus was visualized on two-dimensional ultrasound in a plane slightly caudal to the apical four-chamber view. For the normal range of the size of the CS in relation to gestational age, data was collected from 108/114 (95%) normal fetuses with good visualization between 20 weeks' gestation and term. Abnormal conditions comprised two groups: group 1 consisted of 52 fetuses with heart anomalies, including three subgroups: 11 fetuses with isolated LSVC emptying into the coronary sinus, 12 fetuses with LSVC associated with structural heart defects and 29 fetuses with structural heart defects but without LSVC. Group 2 consisted of 11 fetuses with severe intrauterine growth retardation and dilated coronary arteries as seen by color Doppler ultrasound. RESULTS: Under normal conditions, there was a significant increase in the CS diameter with advancing gestational age (1.2-2.7 mm). Significant dilatation was found only in the two groups with LSVC (range 2.7-6.5 mm), independent of whether the finding was isolated or associated with cardiac defects. CONCLUSION: CS visualization and measurements are easily feasible in the human fetus in the apical four-chamber view. Significant dilatation of the CS is a sign of LSVC. The examiner should be aware of this condition as such dilatation is commonly falsely diagnosed as atrial or atrioventricular septal defect.

Case-Control Studies↗
PubMed2003

Detection of an aneurysm of the vein of Galen following signs of cardiac overload in a 22-week old fetus.

OBJECTIVES: To present early prenatal diagnosis of an aneurysm of the Vein of Galen by detecting signs of cardiac overload in a 22-week old fetus. CASE: We report on a 22-week old fetus presenting with dilation of the heart, tricuspid and mitral valve regurgitation, reversed flow in the aortic arch and dilated neck vessels. Evaluation of the fetal brain revealed a dilated left ventricle, signs of brain hemorrhage and an anechoic structure between the two hemispheres. METHODS: By using the conventional Doppler technique, an intracerebral fistula and dilated vein of Galen was visualized. The complex vascular structure was demonstrated using 3-D color power angiography (3-D CPA). To our knowledge, this is the earliest diagnosis of this vascular malformation. CONCLUSION: Although signs of cardiac overload rarely appear before the third trimester in cases of arteriovenous fistulae, it was shown that these signs could lead to the correct diagnosis of an aneurysm of the vein of Galen. Additionally, we show that 3-D CPA is a promising technique to visualize complex vascular structures and make them easier to understand.

Abortion, Eugenic↗
PubMed2003

Three cross-sectional planes for fetal color Doppler echocardiography.

Routine use of color Doppler during every fetal cardiac examination remains controversial. Many examiners still believe that color should be reserved for cases of suspected congenital heart defect (CHD). In our opinion, color Doppler should be applied in every cardiac scan due to the increase in speed and accuracy that it allows. The purpose of this review is to first explain how color Doppler presets can be optimized and, second, to propose the use of three cross-sectional planes to simplify color Doppler fetal echocardiography: the four-chamber (4CV), five-chamber (5CV) and three-vessel (3VV) views. A practical approach to the detection of CHD with these planes is presented, with typical findings and possible abnormalities evident during systole and diastole. The diastolic pattern on the 4CV is characterized by two equal color stripes. Connection ('H'-sign) or size inequality of the two stripes, or a unilateral color stripe, are important abnormal findings. In systole valve regurgitation should be excluded. In the 5CV, turbulent flow, ventricular septal defect or an overriding aorta ('Y'-sign) can be detected. In the 3VV the aorta and pulmonary trunk should be of nearly equal size and demonstrate antegrade flow. Abnormal findings encountered include absence of one vessel, discrepant size of the vessels, retrograde flow in one of the vessels, or the 'U'-sign, where the trachea is enclosed between both vessels, suggesting right-sided aortic arch. In summary, we propose that color Doppler examination utilizing these three planes alone is sufficient to obtain adequate information for the detection of most common CHD.

Blood Flow Velocity↗
PubMed2003

Three-dimensional multiplanar time-motion ultrasound or anatomical M-mode of the fetal heart: a new technique in fetal echocardiography.

OBJECTIVE: To assess the application of a three-dimensional multiplanar rendering technique for examination of the fetal heart. MATERIAL AND METHODS: Free-hand acquisition of a three-dimensional volume was performed without moving or tilting the transducer. While the anatomical plane shows the four cardiac chambers, the two other orthogonal planes show vertical and horizontal time-axis planes as M-mode traces. Because off-line plane positioning is possible on three-dimensional multiplanar reconstruction, M-mode traces can be obtained from different stored cardiac structures independently of the fetal position. Fifty-two women with normal singleton pregnancies at 22-40 weeks underwent transabdominal ultrasound examination and five women with singleton fetuses between 13 and 15 weeks were assessed transvaginally. Clinical application of the echocardiographic technique was tested in a further two fetuses with arrhythmia. RESULTS: Off-line M-mode traces from atrioventricular valve excursions and myocardial contractions were possible in 45/52 (86.5%) cases examined at 22-40 weeks. Among the 32 fetuses in which visualization of the outflow tracts was attempted, M-mode traces of the aortic and pulmonary valves were possible in 22 (68.7%) and 20 (62.5%) cases, respectively. In three of five cases examined transvaginally, M-mode traces could be registered. Both cases with supraventricular extrasystoles (26 and 31 weeks) were easily diagnosed using this technique. CONCLUSION: The new technique presented here enables the easy acquisition of optimal M-mode traces from different fetal heart structures. Based on our promising findings we would recommend that, in the future, three-dimensional multiplanar imaging should not be limited to automatic volume acquisition but should include the free-hand technique.

Echocardiography↗
PubMed2002

Fetal pulmonary venous flow pattern is determined by left atrial pressure: report of two cases of left heart hypoplasia, one with patent and the other with closed interatrial communication.

We report two cases of fetal left heart hypoplasia with extremes of size of interatrial communication, i.e. a closed foramen ovale and an atrial septal defect. Doppler examinations of the pulmonary veins showed almost to and fro flow in the fetus with the closed foramen ovale and, in contrast, a normal flow velocity waveform in the fetus with the atrial septal defect, despite mitral atresia. Our observations support the importance of left atrial pressure in the creation of a pulmonary venous flow pattern in the fetus.

Adult↗
PubMed2002

Prenatal diagnosis of 22q11 microdeletion in an early second-trimester fetus with conotruncal anomaly presenting with increased nuchal translucency and bilateral intracardiac echogenic foci.

We report on a 16-week fetus, in which detection of increased nuchal translucency thickness and bilateral intracardiac echogenic foci led to the prenatal diagnosis of truncus arteriosus communis, interruption of the aortic arch and aplastic thymus. Cytogenetic examination confirmed a 22q11.2 microdeletion consistent with the suspected CATCH 22 syndrome. Subsequently hydrops fetalis developed and the fetus died in utero at 18 weeks. This case report supports the hypothesis that both cardiac failure and left ventricular outflow tract obstruction may cause increased nuchal translucency thickness. The association between increased nuchal translucency thickness and CATCH 22 syndrome should be considered in diagnostic procedures. The sonographic diagnosis of both increased nuchal translucency thickness and intracardiac echogenic foci requires specialist ultrasonography and echocardiography. In particular, identification of right-sided or bilateral echogenic foci should prompt further detailed examination.

Abnormalities, Multiple↗
PubMed2002

Fetal ovarian cysts: prenatal diagnosis, management and postnatal outcome.

OBJECTIVE: In female fetuses ovarian cysts represent the most important differential diagnosis for intra-abdominal masses. Analyzing our own patient population we investigated whether there was a connection between sonographic parameters and postnatal course, especially with regard to the need for surgical intervention. PATIENTS AND METHODS: This was a retrospective analysis of cases from the years 1986-1999. The pre- and postnatal data of 64 fetuses who were suspected prenatally to have an ovarian cyst were analyzed. The postnatal outcome was known for all the children. RESULTS: The diagnosis was made in all cases in the third trimester (median, 35; range, 26-40 weeks' gestation). In 34 of the 64 (53%) cases, resolution of the cyst occurred either prenatally (n = 18, 53%) or postnatally (n = 16, 47%). The cystic structure in the cases with resolution was isolated, smooth-walled (n = 29) or heterogeneous (n = 5). Postnatal surgery was performed in 30 of the 64 (47%) children. In 18 of the 30 children a fenestration of the ovary was performed (60%). In this group there were 13 children with an isolated, smooth-walled ovarian cyst and five children with a heterogeneous cyst. Twelve of the 30 (40%) children underwent an ovariectomy. Among these 12 children there were eight cases with a heterogeneous cystic structure and four cases with an isolated, smooth-walled cystic structure. Of the 30 cases that underwent surgery, 29 had a follicular cyst and one had an ovarian teratoma (with a heterogeneous internal structure). In three fetuses aspiration of cyst fluid was undertaken and subsequent resolution occurred in one case. The other two cases had to undergo postnatal fenestration. CONCLUSIONS: When an ovarian cyst is suspected prenatally, serial ultrasound monitoring should follow and delivery should take place in a perinatal center. The prenatal findings should also be checked postnatally by ultrasound. Prenatal aspiration of the cyst seems to be of no advantage and should be carried out only in special individual cases.

Cyst Fluid↗