Presentation on theme: "CV Profile Scoring and Assessment"— Presentation transcript:
1CV Profile Scoring and Assessment James C. Huhta, M.D.Perinatal CardiologyJHM-All Children’s Hospital5th Phoenix Fetal Cardiology SymposiumWed. April 23, 2014, 1:30-2:00 PM
2Perinatal Cardiology Cardiology for the fetus, child, and mother
3Faculty Disclosure Information In the past 12 months, I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity. I serve as co-PI of a study of Edoxaban for Daiichi-Sankyo. I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.
4Fetal congestive heart failure CV profile Score Hydrops-– a measure of capillary permeability and/or elevated capillary venous pressure and/or hypoproteinemiaVenous Doppler-– a measure of central venous pressure, and/or RV diastolic functionHeart size-– a measure of remodeling of the heart in response to increased preload, afterload or anemiaHeart function - heterogenous measure of afterload and/or anular dilation (tricuspid valve regurgitation), (ventricular shortening), extreme diastolic filling abnormality (monophasic filling), and dP/dt estimateArterial Doppler-a measure of placental resistance and/or combined cardiac stroke volume at falling outputs
26Validation of CVP score IUGR-Makikallio et al. Eight out of 75 neonates died before discharge or had severe CP (n=2)Delivery at earlier gestational age 28 (range 24-35) weeks vs. 35 (range 26-40) weeks, p<0.001Lower fetal CVP scores 4 (range 2-6) vs. 9 (range 5-10), p<0.001)All fetal subset scores of CVP except umbilical artery evaluation were lower (p<0.001) in the group with neonatal death.
27Validation of CVP score-IUGR Neonates with 5-minute Apgar scores < 7 had lower CVP scores than with scores > 7 (6 (2-10) vs. 9 (5-10), p<0.001)Umbilical artery NT-proANP levels of newborns with CVP score < 6 were greater (5208 ( ) pmol/L) than the levels of neonates with CVP exceeding 6 (1626 ( ) pmol/L), p=0.0001).All NT-proANP values of newborns with CVP score <6 were above the 95th percentile NT-proANP value in normal pregnancies, while 42 out of 67 (63%) fetuses with CVP > 6 showed NT-proANP concentrations exceeding the 95th percentile value in normal pregnanciesUmbilical artery NT-proANP values correlated inversely and significantly with CVP score values
30Validation of CVP score- Complete AV Block We have implemented a strategy that includes the biophysical profile, which assesses fetal well-being, in combination with the cardiovascular profile that assesses cardiac function and the circulation.Two cases of fetal complete heart block in which early delivery was recommended due to worsening cardiovascular profile scores. Biophysical profile scores were normal. Both babies were successfully treated, despite having risk factors that predicted poor outcomes. We hypothesize that our management protocol initiated intervention before fetal compromise, hydrops, and myocardial damage occurred.We recommend an evaluation of heart function in addition to an assessment of fetal well-being in fetuses with complete heart block. Early delivery should be considered if there is evidence of distress and/or deteriorating cardiac function.Donofrio MT, Gullquist SD, Mehta ID, Moskowitz WB.Congenital complete heart block: fetal management protocol, review of the literature, and report of the smallest successful pacemaker implantation. J Perinatol Feb;24(2):112-7.