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- ItemAcesso aberto (Open Access)Avaliação da evolução da área das valvas mitral e tricúspide fetal com ultrassonografia tridimensional(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2010-09-01) Rolo, Liliam Cristine [UNIFESP]; Nardozza, Luciano Marcondes Machado [UNIFESP]; Araujo Júnior, Edward [UNIFESP]; Simioni, Christiane [UNIFESP]; Zamith, Marina Maccagnano [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: to evaluate the areas of the atrioventricular valves (tricuspid and mitral) of normal fetuses by the use of three-dimensional ultrasound (3DUS) and the spatiotemporal image correlation (STIC) method. METHODS: a cross-sectional study was conducted on 141 women between the 18th and the 33rd week of pregnancy. Cardiac volumes were measured with a volumetric transabdominal transducer attached to the Voluson 730 Expert equipment. The four chamber plane was used as reference, with the region of interest (ROI) positioned from the ventricles, and the area of the valves was obtained manually. To determine the correlation of the areas with gestational age, scatter plots were constructed and the Pearson correlation coefficient (r) was calculated. Means, medians, standard deviations (SD) and maximum and minimum values were calculated. The simple linear regression model was used to determine reference ranges of valve areas according to the gestational age by the Altman method, with the level of significance set at p<0.05. To calculate the intraobserver reproducibility, we used the intraclass correlation coefficient (ICC) and the Bland-Altman graph. RESULTS: the mitral and tricuspid valve areas were correlated to the gestational age (r=0.80 for the tricuspid and r=0.79 for the mitral valve) and the mean value of the tricuspid and mitral valves increased from 0.22±0.10 cm² and 0.23±0.10 cm² on the 18th week to 0.92±0.29 cm² and 1.08±0.41 cm² on the 33rd of pregnancy, respectively. The intraobserver reproducibility resulted in an ICC=0.993 (95%CI 0.987; 0.996) and the mean difference was 0.01 cm² (SD±0.2 cm² and CI95%±0.4 cm²). CONCLUSION: reference intervals for the areas of the mitral and tricuspid valve between the 18th and the 33rd week of gestation were determined and proved to be highly reproducible.
- ItemAcesso aberto (Open Access)Avaliação do coração fetal no primeiro trimestre de gestação: influência do comprimento cabeça-nádega e índice de massa corporal materna(Sociedade Brasileira de Cirurgia Cardiovascular, 2013-12-01) Pares, David Baptista da Silva [UNIFESP]; Lima, Angélia Iara Felipe [UNIFESP]; Araujo Júnior, Edward [UNIFESP]; Nardozza, Luciano Marcondes Machado [UNIFESP]; Martins, Wellington P.; Moron, Antonio Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)OBJECTIVE: To evaluate the influence of the crown-rump length and body mass index on sonographic evaluation of the fetal heart using abdominal and vaginal routes in the first trimester of pregnancy. METHODS: We conducted a cross-sectional study with 57 pregnant women between 12-14 weeks (CRL< 84 mm). We evaluated the following fetal cardiac plans using the abdominal and vaginal routes: four-chamber view, right ventricle outflow tract, left ventricle outflow tract and aortic arch. We used the B-mode, color Doppler and four-dimensional ultrasonography (spatio-temporal image correlation). To evaluate the influence of crown-rump length and body mass index in the assessment of fetal cardiac planes, we used the t test unpaired. RESULTS: There were no statistically significant differences in the rates of success and failure between abdominal and vaginal routes in relation to body mass index, however, there was a higher failure rate in vaginal assessment using B mode associated with color Doppler (P<0.01). CONCLUSION: The crown-rump length and body mass index had no interference in fetal cardiac assessment in the first trimester of pregnancy.
- ItemAcesso aberto (Open Access)Avaliação ultrassonográfica do coração fetal pela técnica tridimensional XI VOCAL(Universidade Federal de São Paulo (UNIFESP), 2011-04-27) Barreto, Enoch Quinderé de Sá [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: Validating an in vitro method for XI VOCALTM (eXtended Imaging Virtual Organ Computer-Aided anaLysys) three-dimensional ultrasound study; establishing intervals of reference to evaluate fetal heart volume between 20 and 34 gestational weeks; assessing the intraobserver and interobserver reproducibility for this method. Methods: In order to validate an in vitro method, three plastic models filled with ultrasound gel were constructed. These models were measured by two different observers using three different scan methods: XI VOCALTM, VOCALTM and Multiplanar. In order to achieve a reference curve with normal values of fetal heart volume, a cross-sectional study including 303 pregnant women between 20 and 34 gestational weeks was evaluated. The assessment was performed using a 10 plane section for each case. Results: All methods had high reliability and were considered useful for in vitro studies. There was no difference between the methods, although the evaluation using XI VOCALTM closer to the real volume of the models (mean difference 0,18 cm ³). The fetal heart evaluation allowed the construction of a polynomial regression model, with increasing of variability according to gestational age progression. The intervals of reference were calculated according to the percentiles 5, 10, 25, 50, 75, 90 and 95. There was no difference regarding the results achieved intra or inter observers (p = 0.041 and p = 0.175, respectively). The reproducibility of the method was considered good (ICC> 0.90). Conclusions: The XI VOCALTM method can be used for in vitro evaluation, with good accuracy, mainly with 10 planes section. This method has good reproducibility in clinical practice. The fetal heart volume has a rising curve between 20 and 34 gestational weeks.
- ItemSomente MetadadadosA cardiotocografia em gestantes normais, no pré-termo(Universidade Federal de São Paulo (UNIFESP), 1987) Santos, Jorge Francisco Kuhn dos [UNIFESP]; Bertini, Anna Maria [UNIFESP]
- ItemAcesso aberto (Open Access)Curvas de referência dos escores Z dos parâmetros biométricos de corações fetais(Universidade Federal de São Paulo, 2024-10-07) Vieira, Márcio Fragoso [UNIFESP]; Araujo Júnior, Edward [UNIFESP]; Bravo-valenzuela, Nathalie Jeanne Magioli [UNIFESP]; http://lattes.cnpq.br/0874075465945934; http://lattes.cnpq.br/5590809884662013; http://lattes.cnpq.br/1087235714401355Objetivos: determinar equações para cálculo do escores Z de estruturas cardíacas fetais entre 18 e 34 semanas de gestação. Construir tabelas e curvas de referência de percentis das estruturas estudadas. Avaliar a reprodutibilidade intra e interobservador das medidas obtidas. Método: foi realizado um estudo prospectivo transversal envolvendo 340 fetos de gestações únicas entre 18 e 34 semanas de idade gestacional (IG). Avaliaram-se 19 estruturas cardíacas: diâmetro do anel da valva mitral, tricúspide, aórtica e pulmonar; comprimento, diâmetro e área dos ventrículos esquerdo e direito; área e circunferência cardíaca; diâmetro da aorta ascendente, istmo aórtico, tronco pulmonar, artéria pulmonar direita, artéria pulmonar esquerda e ducto arterioso. Realizou-se análise de regressão determinando-se equações para média e desvio-padrão (DP) de todas as estruturas utilizando como variáveis independentes a IG, diâmetro biparietal (DBP) e comprimento do fêmur (CF). Resultados: todas as equações obtiveram altos coeficientes de determinação (R²). O melhor desempenho foi utilizando-se a IG (R² 0,819 a 0,944), seguido pelo CF (R² 0,813 a 0,937) e DBP (R² 0,792 a 0,934). A estrutura que demonstrou maior R² foi circunferência cardíaca e a menor, o ducto arterioso. Criaram-se tabelas de referência dos percentis 2,5, 5, 10, 50, 90, 95 e 97,5 e curvas de referência dos percentis 5, 10, 50, 90 e 95 para todas as estruturas cardíacas em função da IG. Todas as medidas demonstram boa a excelente reprodutibilidade com coeficiente de correlação intraclasse (CCI) interobservador de 0,774 a 0,972 e intraobservador de 0,938 a 0,993. Conclusões: produziram-se equações para o cálculo dos escores Z, além de tabelas e curvas de percentis para 19 estruturas cardíacas fetais. Todas as medidas demonstraram boa reprodutibibilidade.
- ItemAcesso aberto (Open Access)Débito cardíaco e fração de ejeção fetal por meio do spatio-temporal image correlation (STIC): comparação entre fetos masculinos e femininos(Sociedade Brasileira de Cirurgia Cardiovascular, 2012-06-01) Simioni, Christiane [UNIFESP]; Araujo Júnior, Edward [UNIFESP]; Martins, Wellington P.; Rolo, Liliam Cristine [UNIFESP]; Rocha, Luciane Alves da [UNIFESP]; Nardozza, Luciano Marcondes Machado [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)OBJECTIVE: To compare the cardiac output (CO) and ejection fraction (EF) of the heart of male and female fetuses obtained by 3D-ultrasonography using spatio-temporal image correlation (STIC). METHODS: We conducted a cross-sectional study with 216 normal fetuses, between 20 and 34 weeks of gestation, 108 male and 108 female. Ventricular volumes at the end of systole and diastole were obtained by STIC, and the volumetric assessments performed by the virtual organ computer-aided analysis (VOCAL) rotated 30º. To calculate the DC used the formula: DC = stroke volume / fetal heart rate, while for the FE used the formula: EF = stroke volume / end-diastolic volume. The DC (combined male and female) and EF (male and female) were compared using the unpaired t test and ANCOVA. Scatter plots were created with the percentiles 5, 50 and 95. RESULTS: The average of DC combined, DC left, DC right, FE right and FE left, male and female were 240.07 mL/min, 122.67 mL/min, 123.40 mL/min, 72.84%, 67.22%, 270.56 mL/ min, 139.22 mL/min, 131.34 mL/min, 70.73% and 64.76% respectively, without statistical difference (P> 0.05). CONCLUSIONS: The fetal CO and EF obtained by 3Dultrasonography (STIC) showed no significant difference in relation to gender.
- ItemAcesso aberto (Open Access)Determinação da curva de referência das medidas funcionais e dos escores Z no coração de fetos normais por meio do ecodopplercardiograma bidimensional(Universidade Federal de São Paulo (UNIFESP), 2019-02-28) Amorim, Luciane Alves Da Rocha [UNIFESP]; Macedo Junior, Antonio [UNIFESP]; http://lattes.cnpq.br/5590809884662013; http://lattes.cnpq.br/0034994656390110; Universidade Federal de São Paulo (UNIFESP)Introduction: Fetal heart evaluation is comprises of the anatomical and functional examination. Currently, the anatomical study of the fetal heart is well established in the routine of health professionals. However, it is still not consensual which technique is optimal to be applied when evaluating fetal heart function, despite its undeniable importance. In the current literature, there are a tendency to describe the echocardiographic measurements using Z-score equations in pediatric echocardiograms, as they demonstrate greater practicality in establishing the normality or not of the findings. In fetal cardiology, however, the reference values and the Z-score equations are still under development. The objective of this study was to determine the reference values of fetal heart functional measurements at 24 and 34 weeks of gestation and to develop Z-score equations for all measures studied. Method: A single-center, prospective, cross-sectional study with normal fetuses between 24 and 34 weeks of gestation was performed. All pregnant women underwent a comprehensive Doppler echocardiogram with anatomical and functional analysis. Measurements of left and right cardiac output, mitral and tricuspid valves flow, inferior cava vein flow and pulmonary vein flow were made. Shapiro-Wilk test and histogram evaluation were performed on all variables. Linear regression was used to check the relationship between measurements and gestational age. Results: 612 pregnant women with single and normal fetuses were included. We determined the reference values and percentiles of the assessment measures for each gestational age. The variables that were not normally distributed were submitted to logarithmic or square root transformation. It was possible to develop 10 equations of Z score, being the equations of left and right ventricles output dependent on gestational age and the others being independent on gestational age. Conclusion: The present study accumulated a large database, allowing the demonstration of reference values and percentiles, as well as the development of Z score equations to facilitate echocardiographic evaluation of the fetal heart function.
- ItemSomente MetadadadosViabilidade e limitações do uso da ultrassonografia tridimensional (stic) para rastreamento pré-natal dos defeitos do coração fetal(Universidade Federal de São Paulo (UNIFESP), 2014-05-31) Novaes, Juliana Yoshinaga [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)To evaluate the feasibility of the use of STIC technology during routine obstetric scans as a screening program for congenital heart disease (CHD) and the influence of professional experience in those exams. Methods: 64 pregnant women with a normal fetal heart at gestational age between 20 and 34 weeks and 12 physicians participants divided in two groups: Group1- ?STIC specialist? and Group 2- ?STIC non-specialist?. STIC volume acquisition was performed during routine scans. Volumes were analyzed off-line to obtain the five axial views for optimal fetal heart screening: abdominal situs, four-chamber view (4CV), outflow tract views (OTV), three vessels and trachea view (3VT). Results: STIC volume acquisition was successful in 97.3% of cases in which it was attempted (Group 1: 100%, group 2:95%). 197 STIC volumes were used in this study. In 71%, it was possible to demonstrate 4CV and OTV (Group 1:88.9%, group 2:58.6%). 4CV, OTV and 3VT were visualized in 55.3% of the volumes dataset (Group 1:74.1% and group 2:42.2%). In 49% of volumes, all the five views for optimal fetal heart screening were seen (Group 1:67%, group 2: 36%). Conclusion: We believe that STIC can be used as a tool to improve the cardiac screening examination of the fetus. In 71% of the volumes used in this study, we could obtain 4CV and OTV, and those images have a detection rate of CHD of 70-86%. Professional experience was the most important influence in the image quality of the STIC volume.