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Objective Pregnancy in women with surgically corrected tetralogy of Fallot (ToF) is associated with cardiac, obstetric and neonatal complications. We compared uteroplacental Doppler flow (UDF) measurements and pregnancy outcome in women with ToF and in healthy women and aimed to assess whether a relationship exists between cardiac function and UDF in women with ToF. Methods We evaluated prospectively pregnant women with ToF and healthy pregnant women from the ZAHARA studies. Clinical evaluation, standardized echocardiography and UDF measurements were performed at 20 and 32 weeks' gestation. Results We included 62 women with ToF and 69 healthy controls. Cardiac complications, mostly arrhythmia, occurred in 8.1% of women with ToF. There was a higher incidence of small-for-gestational age (21.0% vs 4.4%, P = 0.004) and low birth weight (16.1% vs 2.9%, P = 0.009) in the group of women with ToF than in healthy controls. In women with ToF, early diastolic notching of uterine artery waveform at 20 and 32 weeks occurred more frequently (9.8% vs 1.5%, P = 0.034 and 7.0% vs 0%, P = 0.025, respectively) and the umbilical artery pulsatility index at 32 weeks was higher (1.02 ± 0.20 vs 0.94 ± 0.17, P = 0.015) than in healthy controls. Right ventricular function parameters prepregnancy and at 20 weeks' gestation were significantly associated with abnormal UDF. UDF parameters were associated with adverse neonatal outcome. Conclusion The majority of women with surgically corrected ToF tolerate pregnancy well. However, UDF indices are more frequently abnormal in these women, suggesting impaired placentation. The association of impaired right ventricular function parameters with abnormal UDF suggests that cardiac dysfunction contributes to defective placentation or placental perfusion mismatch and may explain the increased incidence of obstetric and neonatal complications. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Objective Most severe pregnancy complications are characterized by profound hemodynamic disturbances, thus there is a need for validated hemodynamic monitoring systems for pregnant women. Pulmonary artery catheterization (PAC) using thermodilution is the clinical gold standard for the measurement of cardiac output (CO), however this reference method is rarely performed owing to its invasive nature. Transthoracic echocardiography (TTE) allows non-invasive determination of CO. We aimed to validate TTE against PAC for the determination of CO in severely ill pregnant women. Methods This study consisted of a meta-analysis combining data from a prospective study and a systematic review. The prospective arm was conducted in Pretoria, South Africa, in 2003. Women with severe pregnancy complications requiring invasive monitoring with PAC according to contemporary guidelines were included. TTE was performed within 15 min of PAC and the investigator was blinded to the PAC measurements. Comparative measurements were extracted from similar studies retrieved from a systematic review of the literature and added to a database. Simultaneous CO measurements by TTE and PAC were compared. Agreement between methods was assessed using Bland–Altman statistics and intraclass correlation coefficients (ICC). Results Thirty-four comparative measurements were included in the meta-analysis. Mean CO values obtained by PAC and TTE were 7.39 L/min and 7.18 L/min, respectively. The bias was 0.21 L/min with lower and upper limits of agreement of –1.18 L/min and 1.60 L/min, percentage error was 19.1%, and ICC between the two methods was 0.94. Conclusions CO measurements by TTE show excellent agreement with those obtained by PAC in pregnant women. Given its non-invasive nature and availability, TTE could be considered as a reference for the validation of other CO techniques in pregnant women. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. RESUMEN Objetivo Las complicaciones del embarazo mas graves se caracterizan por trastornos hemodinamicos serios, debido a los cuales existe la necesidad de sistemas validados de monitorizacion hemodinamica para mujeres embarazadas. Aunque la cateterizacion de la arteria pulmonar (CAP) mediante termodilucion es el patron de referencia clinico para la medicion del gasto cardiaco (GC), este metodo se usa con poca frecuencia debido a su naturaleza invasiva. La ecocardiografia transtoracica (ETT) permite la determinacion no invasiva del GC. El objetivo de este estudio fue validar la ETT frente al CAP para determinar el GC en mujeres embarazadas gravemente enfermas. Metodos Este estudio consistio en un metaanalisis que combino datos de un estudio prospectivo y una revision sistematica. El estudio prospectivo se llevo a cabo en Pretoria (Sudafrica) en 2003. Se incluyeron mujeres con complicaciones graves en el embarazo que requerian una monitorizacion invasiva mediante CAP segun las directrices de ese momento. Se realizo una ETT en un plazo de 15 minutos de haber realizado el CAP y el investigador no tuvo acceso a las mediciones del CAP. Las mediciones comparativas se extrajeron de estudios similares obtenidos a partir de una revision sistematica de la literatura y se anadieron a una base de datos. Se compararon las mediciones simultaneas del GC mediante ETT y CAP. La concordancia entre metodos se evaluo a traves del metodo estadistico de Bland-Altman y de coeficientes de correlacion intraclase (CCI). Resultados Se incluyeron treinta y cuatro mediciones comparativas en el metaanalisis. Los valores medios del GC obtenidos mediante CAP y ETT fueron de 7,39 l/min y 7.18 l/min, respectivamente. El sesgo fue de 0,21 l/min, siendo los limites inferior y superior de la concordancia de −1,18 l/min y 1.60 l/min; el error porcentual fue del 19,1%, y el CCI entre ambos metodos fue de 0,94. Conclusiones Las mediciones del GC en mujeres embarazadas mediante ETT muestran una excelente concordancia con las obtenidas mediante CAP. Dada su naturaleza no invasiva y su disponibilidad, la ETT podria considerarse como referencia para la validacion de otras tecnicas relacionadas con el GC en mujeres embarazadas. 目的 大多数严重妊娠并发症的特点是发生严重血流动力学紊乱,因此需要一个经过验证的孕妇血流动力学监测系统。采用热稀释法的肺动脉导管(pulmonary artery catheterization,PAC)是测定心输出量(cardiac output,CO)的临床金标准,然而由于是有创性操作,这种参考方法很少被采用。经胸超声心动图(transthoracic echocardiography,TTE)能够对CO进行无创性检查。我们的目的是验证危重症孕妇中与PAC相比TTE的CO检测结果。 方法 本研究将一项前瞻性研究和系统综述的数据合并进行meta分析。前瞻性研究于2003年在南非的比勒陀利亚进行。纳入根据目前的指南需要进行PAC有创性监测的发生严重妊娠并发症的患者。PAC 15 min内行TTE,研究人员不知晓PAC检测结果。从文献系统综述检索到的相似研究中选取具有可比性的检测结果,加入数据库。对TTE和PAC同时检测的CO结果进行比较。采用Bland-Altman法和组内相关系数(intraclass correlation coefficients,ICC)评价两种方法的一致性。 结果 meta分析中纳入34例具有可比性的检测结果。PAC和TTE得到的CO平均值分别为7.39 L/min和7.18 L/min。下限为–1.18 L/min、上限为1.60 L/min的一致性检验偏倚为0.21 L/min,百分比误差为19.1%,两种方法的ICC为0.94。 结论 孕妇中TTE的CO检测结果与PAC的CO检测结果具有高度一致性。由于具有无创性和易行性,TTE可以作为验证孕妇中其他CO技术的参考方法。

Objectives This study examines the outcome and procedural outcomes of percutaneous stent angioplasty for aortic coarctation in patients with Turner syndrome (TS). Background TS occurs in 1 in 2,500 live-born females and is associated with aortic coarctation. Methods In this multicenter, retrospective cohort study, all patients with TS and a coarctation of the aorta, treated with percutaneous stent implantation were included. The procedural strategies were dictated by local protocols. Adverse events at short- and long-term follow-up and qualitative parameters concerning the stent implantation were assessed. Results In the largest study to date of TS patients receiving aortic stents, a total of 19 patients from 10 centers were included. Twelve patients were treated for native and 7 for recurrent coarctation. Age at intervention was 16.9 (7–60) years (median; min–max). The coarctation diameter increased significantly from 8.0 mm (2–12) pre-intervention to 15.0 mm (10–19) post-intervention (P

Aims Evaluation of left ventricular (LV) myocardial deformation by speckle tracking echocardiography (STE) is useful for clinical and research purposes. However, strain measurements depend on the used software. Normative data for QLAB 10 (Philips) are scarce. Additionally, little is known about the influence of anthropometric factors. We aimed to establish normal adult STE-derived strain and strain rate values and to evaluate associations with anthropometrics. Methods One hundred fifty-five healthy subjects aged 20 to 72 years (≥28 subjects per decile) were prospectively gathered and examined with electrocardiography and two-dimensional echocardiography. With STE, we assessed peak systolic LV global longitudinal strain (GLS), segmental longitudinal strain, and strain rate from the three standard apical views. Results We included 147 healthy subjects (age 44.6±13.7 years, 50% female, GLS −20.8±2.0%). Men had significantly lower GLS than women (−20.1±1.8% vs −21.5±2.0%, P

Aims : To describe the outcomes of pregnancy in women with pulmonary hypertension. Methods and results : In 2007 the European Registry on Pregnancy and Heart Disease was initiated by the European Society of Cardiology. Consecutive patients with all forms of cardiovascular disease, presenting with pregnancy, were enrolled with the aim of investigating the pregnancy outcomes. This subgroup of the cohort included 151 women with pulmonary hypertension (PH) either diagnosed by right heart catheterization or diagnosed as possible PH by echocardiographic signs, with 26% having pulmonary arterial hypertension (PAH), in three subgroups: idiopathic (iPAH), associated with congenital heart disease (CHD-PAH), or associated with other disease (oPAH), and 74% having PH caused by left heart disease (LHD-PH, n = 112). Maternal mean age was 29.2 ± 5.6 years and 37% were nulliparous. Right ventricular systolic pressure was 70 mmHg in 11.9%. In more than 75% of patients, the diagnosis of PH had been made before pregnancy. Maternal death up to 1 week after delivery occurred in five patients (3.3%), with another two out of 78 patients who presented for follow-up (2.6%), dying within 6 months after delivery. The highest mortality was found in iPAH (3/7, 43%). During pregnancy, heart failure occurred in 27%. Caesarean section was performed in 63.4% (23.9% as emergency). Therapeutic abortion was performed in 4.0%. Complications included miscarriage (5.6%), fetal mortality (2%), premature delivery (21.7%), low birth weight (19.0%), and neonatal mortality (0.7%). Conclusion : Mortality in this group of patients with various forms of PH was lower than previously reported as specialized care during pregnancy and delivery was available. However, maternal and fetal mortality remains prohibitively high in women with iPAH, although this conclusion is restricted by limited numbers. Early advice on contraception, pregnancy risk and fetal outcome remains paramount.

Objective Nicardipine permits rapid control of blood pressure in women with severe pre-eclampsia (PE) and hypertensive crisis. Our objective was to investigate its maternal and fetal hemodynamic effects. Methods Ten severely pre-eclamptic pregnant women who required intravenous nicardipine for severe hypertension were included in this prospective observational trial. Maternal macrocirculation was assessed by transthoracic echocardiography. Maternal microcirculatory perfusion was examined sublingually with the sidestream dark field imaging technique. Fetal hemodynamics were assessed by Doppler examinations of the uteroplacental and fetal circulations. Maternal cardiac output, total vascular resistance, mitral E/A ratio and capillary heterogeneity index, uterine artery pulsatility index and fetal cerebroplacental ratio were considered primary outcomes. Paired measurements, obtained before administration of nicardipine infusion and after stabilization of blood pressure, were compared. Results Administration of nicardipine significantly reduced the mean arterial blood pressure (median difference, 26 mmHg; P = 0.002) and total vascular resistance (median difference, 791 dynes × s/cm5; P = 0.002) in all included women. This induced a reflex tachycardia with consequent increase in cardiac output of 1.55 L/min (P = 0.004). There were no significant changes in the other determinants of maternal or fetal hemodynamic parameters. Conclusions Nicardipine effectively reduces blood pressure through selective afterload reduction that triggers an increase in cardiac output, without affecting maternal diastolic function, or microcirculatory, uteroplacental or fetal perfusion. This hemodynamic response is uniform and predictable. Fetomaternal cardiovascular profiling can be achieved by combining transthoracic echocardiography with obstetric Doppler. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

The survival of patients with congenital heart disease (CHD) has increased immensely and nowadays, most children reach adulthood. The long-term outcome is hampered by the occurrence of late complications such as arrhythmias. Supraventricular and ventricular arrhythmias have an impact notably not only on morbidity but also on mortality in patients with congenital heart disease. Therefore, life-long follow-up in most of these patients is required.