태아수종을 동반한 태아 상실성빈맥증의 태반을 통한 자궁내 태아치료

노정래(JR Roh),강이석(IS Kang),문종택(JT Moon),양순하(SH Yang),정재현(JH Jeong),이흥재(HJ Lee),이제호(JH Lee) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

A case of fetal supraventricular tachycardia which caused fetal hydrops was diagnosed at 29 weeks of gestation by fetal echocardiography. Transplacental fetal therapy with ma-ternal intravenous digoxin administration resulted in restoration of normal fetal sinus rhythm and disappearance of fetal hydrops on 7th day after initiation of treatment when the mat-ernal serum digoxin level was 2.11 ng/mL. The fetus showed normal sinus rhythm when evaluated by fetal echocardiography during the remainder of pregnancy with maternal oral digoxin maintenence. At birth, the infant did not show any cardiac arrhythmia and hydropic appearance.

First reported case of fetal aortic valvuloplasty in Asia

( Sun-young Yoon ),( Hye-sung Won ),( Mi-young Lee ),( Min Kyong Cho ),( Euiseok Jung ),( Ki-soo Kim ),( Young-hwue Kim ) 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.1

Prenatal intervention of severe fetal aortic valve stenosis by ultrasound-guided percutaneous balloon valvuloplasty has been performed to prevent the progression to hypoplastic left heart syndrome, and achieve biventricular circulation in neonates. Here we report a case of fetal aortic valvuloplasty prenatally diagnosed with aortic stenosis at 24 weeks of gestation and showed worsening features on a follow-up echocardiography. Prenatal aortic valvuloplasty was performed at 29 weeks of gestation, and was a technical success. However, fetal bradycardia sustained, and an emergency cesarean delivery was performed. To the best of our knowledge, this is the first reported case of fetal aortic valvuloplasty which was performed in Asia.

산전 초음파영역의 최신지견

박용원 ( Yong Won Park ),황한성 ( Han Sung Hwang ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.7

An obstetrical ultrasound examination provides invaluable information regarding the fetus. Many publications from the last years have advanced the use of ultrasound in obstetrics. With the advent of high-resolution ultrasound and transvaginal scanning, a significant amount of information about the fetus have been gained, and provided to the patient. It must be emphasized to evaluate the fetus for structural malformations, and searches for the sonographic markers of fetal aneuploidy in first trimester because it allows the early diagnosis of many conditions. The presence of sonographic markers including the nuchal fold, short femur and humerus, pyelectasis, hyperechoic bowel, echogenic intracardiac focus, and any major abnormality, either singly or in combination, will raise the baseline risk of aneuploidy using likelihood ratios calculated for each individual marker. Fetuses with abnormal Doppler velocimetry in the uteroplacental, umbilical, and fetal circulations but normal chromosomes are at higher risk for adverse pregnancy outcome, including preeclampsia and growth restriction. Improved technology has lowered the gestational age at which fetal cardiac anatomy scanning can be reliably performed by properly trained and experienced examiners. Early fetal echocardiography can be offered as a screening examination to at-risk and low-risk patients, with the condition that it be repeated following screen-negative scans at mid-gestation to exclude later developing lesions. This review describes the recent advances in the role of first trimester ultrasound in screening and diagnosis of fetal anomalies, a number of new ultrasound markers for fetal aneuploidy, Doppler ultrasonography, and fetal echocardiography.

Atrioventricular Flow Wave Patterns before and after Birth by Fetal Echocardiography

김한울,이효연,백수진,홍영미 한국심초음파학회 2012 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.20 No.2

Background: Doppler echocardiographic measurements of both valves during intrauterine life can be used to calculate peak early filling velocity (E)/late peak atrial filling velocity (A) ratio as a single index of diastolic performance. The purposes of this study were to estimate the changes in atrioventricular valve flow from gestational age 37-40 weeks to 1 month of postnatal life and to clarify the difference in right and left ventricular diastolic filling patterns. Methods: Atrioventricular flow waves were analyzed in 24 full-term pregnant women by fetal echocardiography. Postnatal follow-up studies were performed at 1 hour, 6 hours, 24 hours, 3 days, 1 week and 1 month. In each time point, pulsed Doppler echocardiography was used to interrogate Doppler waveform of E velocity, A velocity, total area under the curve (time velocity integral) and heart rate. Results: Mitral E/A ratio significantly increased from 0.7 ± 0.1 before birth to 1.0 ± 0.3 at postnatal 1 hour, 1.0 ± 0.2 at 1 week,and 1.5 ± 1.0 at 1 month. Tricuspid flow E/A ratio was 0.8 ± 0.3 before birth, 0.8 ± 0.1 at 1 hour, 0.8 ± 0.2 at 3 days, 0.9 ± 1.0 at 1month. Time velocity integral of tricuspid flow was significantly higher than that of mitral flow before birth, but there was no difference after birth. Conclusion: The dominance of mitral A wave before birth was changed very quickly after birth to the dominance of E wave,but the dominance of tricuspid A wave was maintained at 1 month. Diastolic function and compliance of mitral valve were better than those of the tricuspid valve after birth.

태아 심초음파 검사로 진단 된 뒤 출생 후 Propafenone으로 치유된 신생아 심방조동 1례

이경화,하창우,김철호,송민섭,성문수,Lee, Kyung Hwa,Ha, Chang Woo,Kim, Chul Ho,Song, Min Seob,Sung, Moon Su 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.7

저자들은 재태 연령 $38^{+6}$주에 태아 심초음파 검사에 의해 태아 심방 조동이 발견되어 산모에게 digoxin을 투여하였으나 효과가 없어 제왕 절개술을 통해 분만한 후, digoxin, 전기적 심율동 전환에 의해서도 치료되지 않아 propafenone을 복용하여 정상 동율동으로 회복된 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Perinatal atrial flutter is a potentially lethal arrhythmia. Management of this disorder is difficult and controversial. Fetal atrial flutter is a serious and life threatening rhythm disorder particulary when it causes hydrops; it may be associated with fetal death or neurological damage. Although the initial episode of flutter may be difficult to control, recurrence of atrial flutter after successful resolution of the arrhythmia seems highly unlikely and long-term prognosis is excellent. We experienced a case of a atrial flutter diagnosed in utero at $38^{+6}$ weeks' gestation by fetal cardiac echocardiography. He was treated with maternal digoxin, but he continued to have atrial flutter until delivery. Restoration of sinus rhythm occured with propafenone therapy in this patient after failure of initial digoxin therapy and direct current cardioversion.

태아 심에코로 진단한 심실중격결손이 없는 대혈관 전위 2 례

이경술(KS Lee),김인규(IK Kim),김병성(BS Kim),조진호(JH Cho),김경률(KL Kim),서동만(DM Seo) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.9

Transposition of the great arteries with intact ventricular septum (TGA IVS) is a cyanotic congenital heart disease with high neonatal mortality without early diagnosis. But TGA IVS is known to have good prognosis if treated by arterial switch operation (ASO) within 2 weeks after birth with early diagnosis. We diagnosed two cases of TGA IVS prenatally by fetal echocardiography. A case was diagnosed at 26th weeks of gestation, and the mother was transferred to a cardiac center for planned delivery. The baby had received ASO on postpartum 7th day, but he died of right ventricular failure on postoperative 8th day. The second case was diagnosed at 37th gestational weeks and was transferred to Asan medical center immediately after birth. And he is doing well without any treatment after ASO.

산전 태아곤란증을 나타낸 신생아 제대동맥혈의 산염기 평형 및 가스분압

김종인,김택훈,조치흠,차순도 啓明大學校 醫科大學 1995 계명의대학술지 Vol.14 No.1

Comparing the umbilical arterial cord blood gas determinants and intrapartum fetal echo-cardiographic patterns, we analysed the deceleration patterns which were recorded during first stage of labor in 35 cases of fatal distress from Oct., 1993 to May, 1994. And we analysed umbilical cord arterial gas pH, PO₂,PCO₂,HCO₃in 15 cases normal controls, 8 early deceleration, 15 late deceleration, and 12 variable deceleration which all cases underwent Cesarean section. In control group, the mean values of fetal umbilical arterical pH, PO₂,PCO₂, HCO₃were 7.284±0.059, 24.13±7.417mmHg, 49.59±9.54mmHg and 23.17±2.789nmol/1 respectively. In early deceleration group, the mean values of fetal umbilical arterial pH, PO₂, PCO₂, HCo₃were 7.242±0.062, 16.29±6.395mmHg, 52.99±10.77mmHg, 22.76±4.195nmol/1, respectively. In variable deceleration group, the mean values of fetal umbilical arterial pH, PO₂, PCO₂, HCo₃were 7.216±0.084, 21.83±8.894mmHg, 5759±9.99mmHg and 23.27±2.941nmol/1, respectively. PO₂appeared to be statistically decreased in early and late deceleration. PCO₂were tend to be statistically increased in early and variable deceleration. These results suggest that all abnormal fetal echocardiographic patterns do not predict fetal hypoxia and fetal asphyxia. Therefore a combined correlation of acid-base determinants by percutaneous umbilical blood sampling and clinical finding of maternal and fetal condition is mandatory for the prediction of long term developmental outcome by fetal asphyxia.

Review : Technique of fetal echocardiography

( Mi Young Lee ),( Hye Sung Won ) 대한산부인과학회 2013 Obstetrics & Gynecology Science Vol.56 No.4

Congenital heart disease is the most common abnormality in the human fetus. Fetal echocardiography has been used to detect the majority of cardiac defects, and it is now part of the routine screening method for fetal evaluation. In this article, we present standard ultrasonographic views of the normal fetal heart obtained during the second trimester, first-trimester fetal echocardiography findings, and a modified myocardial performance index.

태아기에 좌심형성부전증후군으로 잘못 진단되었던 1례

신윤정,장성희,최정연,한은숙,Shin, Youn Jeong,Jang, Sung Hee,Choi, Jung Yun,Han, Eun Sook 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.2

저자들은 재태 $31^{+5}$주 산전 심초음파검사에서 좌심형성부전 및 대동맥축삭으로 진단되어 추적 관찰한 태아가 출생 후 전부하의 증가에 의해 단기간 내에 좌심실 용적의 증가를 보임으로 생후 최소 며칠은 심근세포 증식의 가능성이 있음을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Typical hypoplastic left heart syndrome(HLHS) is a distinct pathologic entity with aortic atresia, mitral atresia, very hypoplastic or absent left ventricle and thread like ascending aorta. Occasionally, the lesser degree of hypoplasia is found and is called hypoplastic left heart complex(HLHC) by some authors. This HLHC is often associated with critical aortic stenosis. Fetal echocardiography has enabled us to observe human fetal heart in-utero and to diagnose congenital heart disease prenatally over the last 20 years. The diagnosis of HLHS in fetal echocardiography is based on 2-dimensional echocardio -graphic evidence of a diminutive ascending aorta, aortic atresia, mitral atresia or severe stenosis and a hypoplastic left ventricle. Abnormal flow direction through atrial septum or through isthmus greatly aids the diagnosis. This report shows a fetal case who showed hypoplastic left side chambers and retrograde isthmic flow and was diagnosed with hypoplastic left heart syndrome. After birth, although the baby had tachy-dyspnea for the first 3 weeks, she finally recovered without any intervention and showed catch up growth of left side chambers. This case illustrates the extreme difficulty of assessing left ventricle in a fetus.

심초음파를 이용한 태아심장 기형의 평가

진병로,안인철,이윤이,길홍량 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

Congenital heart disease is the most common congenital malformation and its incidence is 8/1000 live birth, and contributes to significant perinatal morbidities and mortalities. With the advancement of echocardiogrphic equipment and technique, it is enable to detect the heart anomalies in utero. We performed 94 fetal (93 mothers) echocardiographic examinaton. 10 confirmed and 3 unconfirmed cardiac anomalies were identified. The common cardiac anomalies were ventricular septal defect(4), tetralogy of Fallot(2), and tricuspid valve regurgitation(2). The common indications of fetal echocardiography were as follows: family history of congenital heart disease(26), suspection by obstericians(24), fetal arrhythmia(13), and other organ anomaly(7). But the relative yield of indication were; suspected by obstericians 33.3%, other organ anomaly 14.3%, family history of congenital heart disease 7.6%, and fetal arrhythmia 7.6%. The false positive result was only 1 case of ventricular septal defect, which was normal in postnatal examination. The mean maternal age was 27years 5months in confirmed cases and 25years 5month s in unconfirmed cases. The fetal echocardiographic study for cardiac anomalies is reliable and accurate method in selected indicated groups, but systematic approach for screening method and identified cardiac anomalies would be needed.