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European Journal of Ultrasound 01-2023
Carina Nina Vorisek et al.
Peri- and postnatal management of left ventricular hypoplasia remains among the most challenging entities in congenital heart disease. The spectrum of hypoplastic left heart syndrome (HLHS) includes a variety of possible combinations of hypoplastic and obstructive left-sided lesions extending from a very diminutive left ventricle (LV) with mitral and aortic valve (AV) atresia to a fairly undersized LV. These patients are usually undergoing single-ventricle palliation (SVP) when the LV is not able to support systemic circulation. Biventricular repair (BVR) through surgical relief of left-sided heart obstruction might be considered in a subset of patients with milder forms of HLHS, i. e., the so-called borderline LV (bLV).
Reinhard Altmann et al.
This study was designed to show the midline structures of the developing fetus in the first trimester for the first time on living fetuses. In the median sagittal section the third ventricle is bounded ventrally by the commissural plate and the lamina terminalis, the floor shows the well-known structures of the optic chiasm and pituitary gland, while the opening to the aqueduct is present caudally. In the cranial portion of the commissural plate, the future cavum septi pellucidi (fcsp) is visible anterior/caudal to the choroid plexus of the third ventricle, which arises from a fusion of the plexus of the lateral ventricles through foramina of Monro.
Ladina Vonzun et al.
Today, fetal spina bifida (fSB) repair is a valid therapeutic option for selected cases.
It has been shown to reduce the need for ventriculoperitoneal shunt placement to treat hydrocephalus and to improve long-term neurological function. However, the risks for mother and fetus should not be underestimated and there is, among other problems, evidence that acute cardiovascular changes take place during fetal surgery. In a large study on acute cardiovascular effects of fetal surgery in humans, echocardiography revealed depressed fetal systolic ventricular function and atrioventricular valve insufficiency during fSB repair, with improvement after surgery. Moreover, absent or reversed end-diastolic (ARED) flow in the umbilical artery (UA) Doppler is a common phenomenon during fetal interventions such as fSB repair. The clinical importance of these echocardiographic observations and Doppler findings has not yet been conclusively clarified.