The fetal heart: from early life to the after life.
[Tesi di dottorato]
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|Tipologia del documento:
Tesi di dottorato
||The fetal heart: from early life to the after life
||29 Novembre 2010
|Numero di pagine:
||Università degli Studi di Napoli Federico II
|Scuola di dottorato:
||Medicina clinica e sperimentale
||Riproduzione, sviluppo ed accrescimento dell'uomo
|Ciclo di dottorato:
|Coordinatore del Corso di dottorato:
|Pignata, Claudio||[non definito]|
|Di Lieto, Andreaemail@example.com|
||29 Novembre 2010
|Numero di pagine:
||fetal heart, fetal ecocardiography, MRI, angiography, prenatal diagnosis
|Settori scientifico-disciplinari del MIUR:
||Area 06 - Scienze mediche > MED/40 - Ginecologia e ostetricia
||03 Dic 2010 09:40
||03 Dic 2014 12:01
Congenital heart disease (CHD) with an incidence of about 6 to 8 per 1000 live birth is a
leading cause of infant mortality. Prenatal detection of CHD allows in utero referral to tertiary
care centers witch plays an important role in improving perinatal care. Fetal
echocardiography (FE) is an easily accessible real-time technique and provides a relatively
high sensibility in detecting major CHD in second trimester screening programs. The recent
use of nuchal translucency, ductus venosus and tricuspid flow during the first trimester of
pregnancy allows selecting a higher risk population of CHD, early referral to specialists and
subsequently detection of abnormalities even as early as the first trimester. The first chapter
of this thesis will review the current literature on the use of first trimester fetal
echocardiography. The second chapter will be more dedicated specifically to the use of high
frequency ultrasound linear probes as well as the e-flow on improving the ability to visualise
cardiac anatomy in the first trimester of pregnancy.
Although FE is the screening modality of choice for cardiac evaluation, there are
circumstances during which ultrasound was reported to have some limitations such as
oligohydramnios, advanced gestation due to bone ossification, fetal position, maternal
abdominal wall scar and maternal obesity. The latest was shown to impair correct
visualisation of cardiac anatomy in about half of the cases. That led us as well as others
searching for alternative techniques in imaging the fetal heart. The third chapter of this thesis
will evaluate the feasibility of studying the fetal heart using MR imaging with its steady-state
free precession (SSFP) sequences.
Despite the technological advances in antenatal diagnosis and screening, the role of
perinatal autopsy in confirmation or refuting an antemortem diagnosis is undisputed.
However, an increased number of parents simply refuse traditional fetal autopsy. Added to
that, conventional autopsy is sometimes limited due to fetal size, maceration and autolysis,
thus not allowing adequate examination. As a consequence, alternative techniques of postmortem
assessment had to be developed. The last part of this thesis will dedicate 3 chapters
in studying alternative technique of non invasive autopsy.
In chapter 4, we will focus on studying the acceptance and the confidence of reporting fetal
virtuopsy as compared to conventional necropsy in our population. We will first study what
factors influenced the refusal of conventional necropsy. Subsequently, we will study the
confidence of virtuopsy using a whole-body MRI at 1.5 T.
Since accuracy of conventional post-mortem MRI at 1.5 T for organs such as the heart is
shown to be poor, in chapters 5 and 6 we studied the use of angiography and of high field
MRI at 9.4 T in fetuses in the second half, respectively the first half of pregnancy.
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