Possible usefulness of echocardiographic Z-scores in autopsy routine of the foetal great vessels

• Autorzy: Grzyb A. , Skrzypecki J. , Kolesnik A. , Niszczota C. S.
• Języki publikacji: EN

Abstrakty

EN

Background: Abnormal diameters of foetal vessels are common findings in congenital heart defects. However, it is difficult for pathologist to assess whether the diameters of the vessels are normal or not and to compare with echocardiographic data. The Z-score is a dimensionless quantity representing the distance between the raw score and population mean in standard deviation units. Using Z-score, we can compare single cases to average standards in the population. Aim: To compare diameters of great arteries measured in specimens fixed in 10% formalin solution to normal values obtained on echocardiography using Z-scores. Material and methods: The study was performed on 43 formalin-fixed normal foetal hearts aged from 19 to 40 weeks of gestation. Each specimen was dissected and the following diameters were measured: aortic valve (AoV), ascending aorta (AAo), descending aorta (DAo), aortic isthmus (AoI), ductus arteriosus (DA), pulmonary trunk valve (PV), and pulmonary arteries (RPA and LPA). Z-score parameters were calculated for all structures using the Foetal Echo Z-score Calculator. Results: Z-score values of all measured foetuses were mostly found to fit within the echocardiographic norms, although the most reliable results were obtained for foetuses aged 23 weeks. This group was represented by the highest number of specimens. The minimal and maximal Z-score values were, respectively: AoV –3.45, 1.4; AAo –4.24, –0.11; DAo –2.12, 1.29; PV –3.21, 0.69; RPA –3.4, 0.84; LPA –2.25, 0.31; AoI –1.97, 0.96; DA –3.56, –1.52. Conclusions: The diameters of great arteries measured on autopsy are comparable to the results obtained from echocardiographic measurement. Z-score values for foetal echocardiography can be applied to post-mortem examination. (Folia Morphol 2012; 71, 2: 86–92)

• Wydawca: -
• Czasopismo: Folia Morphologica
• Rocznik: 2012
• Tom: 71
• Numer: 2
• Opis fizyczny: p.86-92,fig.,ref.

Twórcy

autor

Grzyb A.

• Department of Descriptive and Clinical Anatomy, Centre of Biostructure Research, Medical University of Warsaw, ul.Chalubinskiego 5, 02–004 Warszawa, Poland

autor

Skrzypecki J.

• Department of Descriptive and Clinical Anatomy, Centre of Biostructure Research, Medical University of Warsaw, ul.Chalubinskiego 5, 02–004 Warszawa, Poland

autor

Kolesnik A.

• Department of Descriptive and Clinical Anatomy, Centre of Biostructure Research, Medical University of Warsaw, ul.Chalubinskiego 5, 02–004 Warszawa, Poland

autor

Niszczota C. S.

• Department of Descriptive and Clinical Anatomy, Centre of Biostructure Research, Medical University of Warsaw, ul.Chalubinskiego 5, 02–004 Warszawa, Poland

Bibliografia

• 1. Anderson RH, Becker AE, Freedom RM, Macartney FJ, Quero-Jimenez M, Shinebourne EA, Wilkinson JL, Tynan M (1984) Sequential segmental analysis of congenital heart disease. Pediatr Cardiol, 5: 281–287.
• 2. Angelini A, Allan LD, Anderson RH, Crawford DC, Chita SK, Ho SY (1998) Measurements of the dimensions of the aortic and pulmonary pathways in the human fetus: a correlative echocardiographic and morphometric study. Br Heart J, 60: 221–226.
• 3. Castillo EH, Arteaga-Martinez M, Garcia-Pelaez I, Villasis-Keever MA, Aguirre OM, Moran V, Vizcaino AA (2005) Morphometric study of the human fetal heart. I. Arterial segment. Clin Anat, 18: 260–268.
• 4. Chiruvolu A, Jaleel MA (2009) Pathophysiology of patent ductus arteriosus in premature neonates. Early Hum Dev, 85: 143–146.
• 5. Christian J, Kellenberger CJ (2010) Aortic arch malformations. Pediatr Radiol, 40: 876–884.
• 6. Clyman RI, Brett C, Mauray F (1980) Circulating prostaglandin E2 concentrations and incidence of patent ductus arteriosus in preterm infants with respiratory distress syndrome. Pediatrics, 66: 725–729.
• 7. Coceani F, Kelsey L, Seidlitz E (1992) Evidence for an effector role of endothelin in closure of the ductus arteriosus at birth. Can J Physiol Pharmacol, 70: 1061–1064.
• 8. Coceani F, Olley PM (1973) The response of the ductus arteriosus to prostaglandins. Can J Physiol Pharmacol, 51: 220–225.
• 9. Comstock CH, Riggs T, Lee W, Kirk J (1991) Pulmonaryto-aorta diameter ratio in the normal and abnormal fetal heart. Am J Obstet Gynecol, 165: 1038–1044.
• 10. Drayton MR, Skidmore R (1987) Ductus arteriosus blood flow during first 48 hours of life. Arch Dis Child, 62: 1030–1034.
• 11. Elliott RB, Starling MB, Neutze JM (1975) Medical manipulation of the ductus arteriosus. Lancet, 1: 140–143.
• 12. Elzenga NJ, Gittenberger-de Groot AC (1983) Localised coarctation of the aorta. An age dependent spectrum. Br Heart J, 49: 317–323.
• 13. Heymann MA, Rudolph AM (1975) Control of the ductus arteriosus. Physiol Rev, 55: 62–78.
• 14. Hornberger LK, Weintraub RG, Pesonen E, Murillo-Olivas A, Simpson IA, Sahn C, Hagen-Ansert S, Sahn DJ (1992) Echocardiographic study of the morphology and growth of the aortic arch in the human fetus observations related to the prenatal diagnosis of coarctation. Circulation, 86: 741–747.
• 15. Hornblad PY, Larsson KS (1967) Studies on closure of the ductus arteriosus. Cardiologia, 51: 231–41.
• 16. Hyett J, Moscoso G, Nicolaides K (1995) Morphometric analysis of the great vessels in early fetal life. Hum Reprod, 10: 3045–3048.
• 17. Karamlou T, Bernasconi A, Jaeggi E, Alhabshan F, Williams WG, Van Arsdell GS, Coles JG, Caldarone CA (2009) Factors associated with arch reintervention and growth of the aortic arch after coarctation repair in neonates weighing less than 2.5 kg. J Thorac Cardiovasc Surg, 137: 1163–1167.
• 18. Lee W, Riggs T, Amula V, Tsimis M, Cutler N, Bronsteen R, Comstock CH (2010) Fetal echocardiography: z-score reference ranges for a large patient population. Ultrasound Obstet Gynecol, 35: 28–34.
• 19. Manlhiot C, Millar K, Golding F, McCrindle BW (2010) Improved classification of coronary artery abnormalities based only on coronary artery z-scores after Kawasaki disease. Pediatr Cardiol, 31: 242–249.
• 20. Nakanishi T, Gu H, Hagiwara N, Momma K (1993) Mechanisms of oxygen-induced contraction of ductus arteriosus isolated from the fetal rabbit. Circ Res, 72: 1218–1228.