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Biomedical subjects

C H Comstock

Publications and source records attributed to C H Comstock.

At least 37 records · Page 2Linked to original sources
PubMed1995

Ultrasonographic left cardiac axis deviation: a marker for fetal anomalies.

OBJECTIVE: To determine if a relation exists between left cardiac axis deviation and fetal anomalies. METHODS: Estimation of cardiac axis was attempted prospectively as part of the cardiac examination in approximately 41,500 second- and third-trimester fetuses scanned between 1987-1993. Those with heart axes greater than 75 degrees to the left were considered to have left axis deviation. Only cases with postnatal follow-up were included. RESULTS: Thirty-four fetuses with left cardiac axis deviation had postnatal follow-up; eight were normal and 26 abnormal (positive predictive value 76%). Twenty-one fetuses had cardiac abnormalities (ten of these had additional extracardiac findings), and five had extracardiac findings only. CONCLUSION: Although left cardiac axis deviation can occur as an isolated sonographic finding in an otherwise normal fetus, most cases will demonstrate abnormalities of cardiac and/or extracardiac anatomy. Left cardiac axis deviation is largely associated with cardiac abnormalities, especially conotruncal anomalies, which may not be detectable by a four-chamber view alone. Therefore, the cardiac axis should be examined routinely as part of the four-chamber view of the fetal heart.

Congenital Abnormalities↗
PubMed1995

Tetralogy of Fallot: prenatal diagnosis and postnatal survival.

OBJECTIVES: To correlate prenatal echocardiographic findings with infant outcome in a large screening population affected by tetralogy of Fallot. METHODS: Inclusion criteria required confirmed postnatal cardiac diagnosis, at least one fetal ultrasound examination with satisfactory heart visualization, and infant delivery at our institution. Aortic and pulmonary artery diameters were measured from real-time ultrasound or videotaped scans and compared against published nomograms. The pulmonary artery to aorta ratio was also evaluated in a similar manner. Infant survival was assessed 1 year after delivery. RESULTS: Seventeen fetuses were confirmed to have a ventricular septal defect and an overriding aorta with varying degrees of right ventricular outflow obstruction after delivery. All karyotypes were normal. Ultrasound screening identified 12 of 17 abnormal hearts at a mean gestational age of 22.9 +/- 5.1 weeks; two of these fetuses were thought to have only ventricular septal defect before delivery. Five fetuses had enlarged aortic roots during the initial scan. Only two of the ten fetuses with a measurable pulmonary artery had initial sonographic evidence for valve stenosis. Six other pulmonary arteries became abnormally small with advancing pregnancy. The pulmonary artery to aorta ratio was decreased in six of the ten fetuses with a measurable pulmonary artery. Sixteen infants survived at least 1 year after birth and successfully completed either corrective or palliative cardiac surgery. CONCLUSION: Fetuses with tetralogy of Fallot may present with only a ventricular septal defect and aortic septal override by prenatal ultrasound examination. Pulmonary artery stenosis is not always present at initial ultrasound examination, but this finding can develop or worsen during pregnancy. Furthermore, a normal aortic diameter does not exclude tetralogy of Fallot. Infant survival appears to be favorable in the absence of other major structural or chromosomal anomalies.

Female↗
PubMed1994

Prenatal diagnosis of Smith-Lemli-Opitz syndrome, type II.

Smith-Lemli-Opitz syndrome, type II (SLOS-II) is a severe autosomal recessive disorder characterized by a distinctive face, unusual cleft palate, postaxial polydactyly, congenital heart defects, renal anomalies, and male pseudohermaphroditism. We present the first report of prenatal diagnosis of SLOS-II, as well as an additional report of prenatal detection of multiple anomalies, in which a positive diagnosis of SLOS II was made postnatally. In neither case was the pregnancy known prospectively to be at risk for SLOS-II. In the former case, targeted sonographic examination at 31 weeks of gestation showed intrauterine growth retardation, atrioventricular septal defect, mesomelic shortening of the arms, small kidneys, overlapping fingers, and female external genitalia; a 46,XY chromosome constitution had been ascertained previously. A provisional diagnosis of SLOS-II was made prenatally. In the latter case, targeted sonographic examination at 18 weeks of gestation showed severe oligohydramnios, atrioventricular septal defect, and Dandy-Walker malformation. The kidneys and bladder were not visualized. The chromosome constitution was 46,XX. The diagnosis of SLOS-II was made postnatally. In both cases, additional findings compatible with SLOS-II were noted postnatally. Prenatal detection of congenital heart defects and renal abnormalities, in combination with certain additional findings (most notably, female external genitalia in the presence of a 46,XY karyotype, polydactyly, disproportionately short limbs, or intrauterine growth retardation) and a normal karyotype, suggests the diagnosis of SLOS-II, and warrants further investigation.

Abnormalities, Multiple↗
PubMed1994

Time-domain ultrasonography during pregnancy.

Time-domain ultrasonography is an alternative to Doppler analysis of blood flow direction and velocity. The technique uses timing information between successive echo pulses to measure flow velocities directly through a color display map. Volume flow quantification also can be achieved by combining time-domain methods with M-mode ultrasonography. This report describes our preliminary experiences with fetal vascular imaging by time-domain ultrasonography, compares Doppler peak velocity correlation to time-domain sonography, and examines the in vitro accuracy of time-domain sonography combined with M-mode volume flow measurements. Excellent agreement was found between peak Doppler velocity measurements and time-domain ultrasonography for a variety of maternal and fetal vessels (N = 29). Close volume-flow correlation was observed between a flow pump and time-domain ultrasonography under constant and pulsatile conditions. Time-domain ultrasonography appears to be a useful alternative to Doppler techniques for imaging small fetal vessels and also may provide the basis for accurate volume flow measurements during pregnancy.

Blood Circulation↗
PubMed1994

Prenatal screening for cardiac anomalies: the value of routine addition of the aortic root to the four-chamber view.

OBJECTIVE: To determine whether the addition of the aortic-root view would detect more congenital cardiac anomalies than a standard four-chamber view alone. METHODS: The study included fetuses of 14 weeks' gestation or more who were scanned in our unit during a 28-month period. Outcome information was obtained from postnatal echocardiograms and autopsies. Abnormal hearts were classified as to whether the four-chamber or aortic-root view was abnormal. RESULTS: There were 5967 fetuses in whom a four-chamber view could be obtained. In 5111 of these, an aortic-root view could also be obtained. The four-chamber view detected 24 (47%) of the 51 fetuses with abnormal hearts. Adding the aortic-root view increased the sensitivity to 78%. CONCLUSIONS: Visualization of the aortic root is a quick and easy means of evaluating the aortic outflow tract during routine scanning. Adding the aortic-root view to the standard four-chamber view will result in the detection of most cardiac anomalies prenatally.

Echocardiography↗
PubMed1991

Pulmonary-to-aorta diameter ratio in the normal and abnormal fetal heart.

In an attempt to establish the normal ratio of pulmonary artery to aorta diameters at varying gestational ages, the pulmonary artery and aorta diameters of 316 normally grown fetuses between 14 and 39 weeks' gestational age were measured. The ratios for each fetus were derived, and regression analysis was used to evaluate the relationship between gestational age and each diameter. We conclude that the diameters of the pulmonary artery and aorta are closely related to fetal age but that the ratio is independent of age (mean, 1.09; SD, 0.17). The diameters of the pulmonary artery and aorta in 21 fetuses with proved congenital heart disease were then compared with those of this normal population. The pulmonary artery/aorta ratio was abnormal in 13 of 21 fetuses with congenital heart disease. Actual measurements of the great vessels can be difficult and may be misleading, but a quick comparison of relative size by inspection is feasible.

Aorta↗
PubMed1991

Transverse cerebellar diameter: a useful predictor of gestational age for fetuses with asymmetric growth retardation.

There have been conflicting reports regarding the ability of cerebellar diameter to satisfactorily predict the gestational age of growth-retarded fetuses. Gestational age prediction intervals were derived from 270 normal fetuses between 14 and 40 weeks' gestation for biparietal diameter, head circumference, abdominal circumference, femur length, and transverse cerebellar diameter. We evaluated the ability of these parameters to predict gestational age for 19 small-for-gestational-age fetuses. The cerebellar diameter regression model led to the smallest differences between observed and predicted gestational age for all growth-retarded fetuses. Transverse cerebellar diameter satisfactorily predicted gestational age for all six fetuses with asymmetric intrauterine growth retardation and was associated with the least amount of underestimation bias when compared with other ultrasonographic parameters. However, transverse cerebellar diameter appeared to be no better than biparietal diameter, head circumference, or femur length for accurately predicting gestational age of fetuses with symmetric intrauterine growth retardation (n = 13) despite the finding that cerebellar growth was also relatively spared under these circumstances. We conclude that transverse cerebellar diameter can be used to reliably approximate gestational age in fetuses with asymmetric intrauterine growth retardation. However, caution is warranted when using it to predict the gestational age of fetuses affected by symmetric intrauterine growth retardation.

Anthropometry↗
PubMed1991

Arteriovenous malformations. Locations and evolution in the fetal brain.

Almost all cerebral arteriovenous malformations in the fetus involve the vein of Galen, although occasionally they may involve the frontal area of the brain instead. In all reported cases arteriovenous malformations have presented some time after 30 weeks as a sonolucent oval lesion located in the midline behind the third ventricle. Previous scans have been normal. Evidence of high output failure such as cardiomegaly, enlarged neck veins, or hydrops predicts a poor outcome.

Aneurysm↗
PubMed1990

Randomized prospective trial comparing ultrasonography and pelvic examination for preterm labor surveillance.

This study was designed to compare the effectiveness of cervical assessment by either ultrasonography or bimanual pelvic examination in a program for preterm labor surveillance. Patients (n = 57) at risk for preterm birth were seen once a week for patient education, review of symptoms, and cervical evaluation. Cervical evaluation was assigned randomly to either ultrasonographic evaluation or pelvic examination. The groups did not differ in demographic or obstetric factors. The overall rate of prematurity was 18%. Preterm labor was more frequent with ultrasonographic evaluation (52%) than with pelvic examination (25%) (p less than 0.05). The group evaluated by ultrasonography received oral tocolytic agents (55%) more than the group that had pelvic examinations (21%) (p less than 0.02). The groups did not differ in infant birth weights, length of gestation, or neonatal mortality or morbidity. In this prospective randomized study of patients at risk for preterm birth, patients under surveillance by ultrasonographic assessment of the cervix did not fare better than those assigned to bimanual examination.

Adult↗
PubMed1987

Normal fetal heart axis and position.

Cardiac position and axis were evaluated by ultrasound in 183 normal fetuses; both position and axis were found to be constant throughout gestational life. In the four-chamber view of the fetal heart, the normal axis lies at a 45 degree angle (range 22-75 degrees) to the left of an anteroposterior line drawn from the spine to the anterior chest wall. The normal position of the posterior portion of the heart can also be defined. The axis or position of the heart deviated from the established normal range in 15 cases, the outcome of which is discussed. Abnormal axis was associated with 50% mortality; abnormal position with 81% mortality. Deviation from the normal position of the fetal heart should initiate a search for an intrathoracic mass, whereas an abnormal axis is an indication for fetal echocardiography. Axis and position of the fetal heart are easily evaluated during a standard obstetric scan.

Female↗
PubMed1986

The antenatal diagnosis of diaphragmatic anomalies.

In an evaluation of eight fetal diaphragmatic anomalies a number of suggestive antenatal ultrasound findings were identified. The feature most suggestive of a posterolateral hernia (foramen of Bochdalek) is malposition of the heart. Peristalsis of chest contents or movement of abdominal contents into the chest on inspiration are more specific findings. Absence of an intra-abdominal stomach, a small abdominal circumference, and a cystic or solid mass in the chest are suggestive but not specific. It may be difficult or impossible to distinguish a posterolateral diaphragmatic defect from the much less frequent eventration of the diaphragm. An anteromedial defect of the diaphragm (foramen of Morgagni) presented as an intrathoracic anterior solid mass and should be considered in the differential diagnosis of an anterior chest mass. Although all three types of defects are frequently associated with additional anomalies, severe pulmonary hypoplasia is not a complication of eventration or anteromedial defects.

Abdomen↗
PubMed1985

Enlarged fetal cisterna magna: appearance and significance.

The differential diagnosis of a posterior fossa fluid collection in the fetus includes an enlarged cisterna magna, Dandy-Walker syndrome, or a posterior fossa cyst, each of which has differing implications for perinatal management. Causes of an enlarged cisterna magna include cerebellar hypoplasia, communicating hydrocephalus, and normal variation. Cerebellar hypoplasia is a frequent finding in the trisomies and therefore a careful search should be made for associated cardiac anomalies, growth retardation, and polyhydramnios.

Adolescent↗