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Biomedical subjects

P Zielinsky

Publications and source records attributed to P Zielinsky.

At least 19 recordsLinked to original sources
PubMed2005

Repeatability of the sonographic assessment of fetal sucking and swallowing movements.

OBJECTIVE: To test the repeatability of sonography in the assessment of fetal sucking and swallowing movements. METHODS: Eighty normal fetuses of pregnant women with no systemic abnormalities were examined sonographically at 30-38 weeks of gestation. Sucking and swallowing movements were observed for 15 min and the face was visualized in frontal and lateral views. The examinations were recorded for later analysis by two independent observers and the 95% limits of agreement (Bland and Altman) method was used for inter- and intraobserver comparison. RESULTS: The mean +/- SD number of swallowing movements, sucking bursts and total sucking movements recorded by Observer 1 were 8.3 +/- 4.7, 9.9 +/- 9.3 and 35.8 +/- 48.0 and the equivalent values for Observer 2 were 8.2 +/- 4.8, 9.8 +/- 9.3 and 36.4 +/- 49.0, respectively. The mean (95% limits of agreement) interobserver difference was 0.1 (-1.4; 1.6), 0.1 (-2.2; 2.3) and -0.6 (-9.0; 7.9), and the mean (95% limits of agreement) intraobserver difference was 0.4 (-3.1; 3.9), 0.1 (-2.0; 2.2) and 1.0 (-10.7; 12.7) for swallowing movements, sucking bursts and total sucking movements, respectively. CONCLUSIONS: The high degree of intra- and interobserver repeatability disclosed in the sonographic analysis of fetal sucking and swallowing movements supports the applicability of sonographic assessment in normal fetuses.

Cross-Sectional Studies↗
PubMed2003

Alternative parameters for echocardiographic assessment of fetal diastolic function.

Alternative methods to assess ventricular diastolic function in the fetus are proposed. Fetal myocardial hypertrophy in maternal diabetes was used as a model of decreased left ventricular compliance (LVC), and fetal respiratory movements as a model of increased LVC. Comparison of three groups of fetuses showed that, in 10 fetuses of diabetic mothers (FDM) with septal hypertrophy (SH), the mean excursion index of the septum primum (EISP) (ratio between the linear excursion of the flap valve and the left atrial diameter) was 0.36 +/- 0.09, in 8 FDM without SH it was 0.51 +/- 0.09 (P=0.001), and in the 8 normal control fetuses (NCF) it was 0.49 +/- 0.12 (P=0.003). In another study, 28 fetuses in apnea had a mean EISP of 0.39 +/- 0.05 which increased to 0.57 +/- 0.07 during respiration (P<0.001). These two studies showed that the mobility of the septum primum was reduced when LVC was decreased and was increased when LVC was enhanced. Mean pulmonary vein pulsatility was higher in 14 FDM (1.83 +/- 1.21) than in 26 NCF (1.02 +/- 0.31; P=0.02). In the same fetuses, mean left atrial shortening was decreased (0.40 +/- 0.11) in relation to NCF (0.51 +/- 0.09; P=0.011). These results suggest that FDM may have a higher preload than normal controls, probably as a result of increased myocardial mass and LV hypertrophy. Prenatal assessment of LV diastolic function by fetal echocardiography should include analysis of septum primum mobility, pulmonary vein pulsatility, and left atrial shortening.

Analysis of Variance↗
PubMed2003

Behavior of septum primum mobility in third-trimester fetuses with myocardial hypertrophy.

OBJECTIVES: The mobility of the septum primum (SP) in the fetus is a diastolic phenomenon and could be related to left atrial pressure. We studied the linear displacement of the SP in the left atrium in fetuses of diabetic mothers (FDM) with and without septal hypertrophy (SH) and in normal fetuses of normoglycemic mothers. In this study we set out to test the hypothesis that the linear displacement of the SP flap valve is less marked in fetuses with SH than in those without SH. METHODS: The ratio between the linear displacement of the flap valve and the left atrial diameter (excursion index (EI)) was compared in ten FDM with SH, eight FDM with normal septal thickness and eight normal fetuses of non-diabetic mothers. Atrioventricular flow velocities were also compared in the three groups. RESULTS: Comparison of the three groups showed that in FDM with SH, the mean EI was 0.36 +/- 0.09, in FDM without SH it was 0.51 +/- 0.09 (P = 0.001) and in the control fetuses it was 0.49 +/- 0.12 (P = 0.03). There was a significant negative correlation between septal thickness and EI in FDM with SH. There was no correlation between septal thickness and atrioventricular flow velocities. CONCLUSION: Mobility of the SP in FDM with SH is reduced and there is an inverse correlation between the linear displacement of the SP and septal thickness. These findings may be related to changes in left ventricular diastolic function secondary to myocardial hypertrophy.

Cardiomegaly↗
PubMed2001

Fetal myocardial hypertrophy in an experimental model of gestational diabetes.

INTRODUCTION: The frequent occurrence of prenatal hypertrophy of the muscular ventricular septum has been widely reported in fetuses of diabetic mothers. OBJECTIVES: This experimental study was carried out to test the hypothesis that the weight of the heart, the ratio of the cardiac weight to that of the body, the thickness of the muscular ventricular septum, and the myocytic profile within the ventricular septum are all increased in fetuses of diabetic rats in comparison to fetuses of normal rats. METHODS: Diabetes was induced in 5 pregnant Wistar rats, bearing 30 fetuses, on the eighth day after conception, by intraperitoneal injection of 50 mg/kg of streptozotocin. Five normal pregnant Wistar rats, bearing 20 fetuses, made up the control group. Morphometric data were obtained by a computer-assisted method applied to the measurements of the thickness of the ventricular septum, and myocytic nuclear area. Statistical analysis utilized Student's t-test and Kruskal-Wallis test. RESULTS: The mean thickness of the septum was 675.56 microm (+/-159) in the control fetuses, and 904.39 microm (+/-262) in the fetuses carried by diabetic mothers (p < 0.001). The cardiac weight was 0.016 g (+/-0.004) in the control group, and 0.023 g (+/-0.005) in the group of diabetic fetuses (p < 0.001). The ratio of cardiac to body weight was 0.294% (+/-0.079) in the control group, and 0.514% (+/-0.073) in the diabetic group (p < 0.001). The myocytic nuclear area was 14.70 microm2 in the control group, and 21.43 microm2 in the diabetic group (p < 0.001). CONCLUSIONS: The presence of cellular and morphologic cardiac hypertrophy in fetuses of diabetic rats was demonstrated by the significant difference between the two groups for each analyzed feature.

Animals↗
PubMed2001

Diagnosis and therapeutics of pulmonary arteriovenous fistula in childhood. Case report and review of the literature.

We report the case of a 3-year-old female patient, who, since birth, had cyanosis difficult to explain with usual diagnostic tests. The only findings on physical examination were cyanosis and clubbing of her fingers. Chest computerized tomography showed images of excessive attenuation in the right lung, which resembled arteriovenous fistulae that were later confirmed on cardiac catheterization. The fistulous trajectories were then embolized with 7 Gianturco coils, which resulted in an immediate increase in the arterial saturation of blood oxygen.

Arteriovenous Fistula↗
PubMed2000

World experience of percutaneous ultrasound-guided balloon valvuloplasty in human fetuses with severe aortic valve obstruction.

Prenatal alleviation of severe fetal aortic valve obstructions by percutaneous ultrasound-guided balloon valvuloplasty has been performed to improve the fate of affected fetuses. The purpose of this study was to analyze the current world experience of these procedures in human fetuses. Data from 12 human fetuses were available for analysis. The mean gestational age at intervention was 29.2 weeks (range 27 to 33). The mean time period between initial presentation and intervention was 3.3 weeks (range 3 days to 9 weeks). Technically successful balloon valvuloplasties were achieved in 7 fetuses, none of whom had an atretic valve. Only 1 of these fetuses remains alive today. Of the 5 remaining technical failures, 1 patient with severe aortic stenosis underwent successful postnatal intervention and remains alive. Six patients who survived prenatal intervention died from cardiac dysfunction or at surgery in the first days or weeks after delivery. Four fetuses died early within 24 hours after the procedure, 1 from a bleeding complication, 2 from persistent bradycardias, and 1 at valvotomy after emergency delivery. Thus, the early clinical experience of percutaneous ultrasound-guided fetal balloon valvuloplasty in human fetuses with severe aortic valve obstruction has been poor due to selection of severe cases, technical problems during the procedure, and high postnatal operative mortality in fetuses who survived gestation. Improved patient selection and technical modifications in interventional methods may hold promise to improve outcome in future cases.

Aortic Valve↗
PubMed2000

Ebstein's anomaly with imperforate tricuspid valve. Prenatal diagnosis.

Ebstein's anomaly is an uncommon congenital heart defect, with a prevalence of 0.3-0.5%. Its association with an imperforate tricuspid valve is an even more rare situation (less than 10% of cases). Prenatal diagnosis of this association by means of fetal echocardiography has not been reported. We describe here this association diagnosed before birth and confirmed after birth. The diagnostic potential and importance of fetal echocardiography during prenatal evaluation of cardiac malformations allows for adequate perinatal planning and management, with an obvious impact on morbidity and mortality.

Adult↗
PubMed2000

Fetal tachyarrhythmia with 1:1 atrioventricular conduction. Adenosine infusion in the umbilical vein as a diagnostic test.

This is the report of a case of fetal tachyarrhythmia with 1:1 atrioventricular conduction detected by pre-natal echocardiography in a fetus at 25-weeks gestation. Adenosine infusion via cordocentesis was performed as a diagnostic test to differentiate between atrioventricular nodal reentrant supraventricular tachyarrhythmia and atrial flutter. After infusion, transient 2:1 atrioventricular dissociation was obtained and the diagnosis of atrial flutter was made. Transplacental therapy with digoxin and amiodarone was then successfully used.

Adenosine↗
PubMed1998

Mobility of the flap valve of the primary atrial septum in the developing human fetus.

It has already been suggested that redundancy of the primary atrial septum could be associated with primary fetal arrhythmias. There are few reports, however, concerning the mobility of the primary septum and its behavior during fetal life. In this study, fifteen fetuses without anatomic heart disease were serially evaluated by fetal echocardiography. The time interval between three separate examinations was at least two weeks. A redundancy index was calculated as the ratio between the maximum excursion of the flap valve of the septum and the maximal left atrium as seen in a four chamber view. The indexes observed in the three examinations were: 0.55 +/- 0.15, 0.48 +/- 0.13 and 0.41 +/- 0.13, respectively. Analysis of variance for normal distribution and Tukey's test were performed. A significant decrease (p < 0.05) in the redundancy index was observed with increasing gestational age. We postulate that this finding may be related to the decrease in frequency of premature atrial beats throughout fetal life.

Echocardiography, Doppler, Pulsed↗
PubMed1998

[Fetal supraventricular tachyarrhythmias. Experience of a fetal cardiology referral center].

PURPOSE: To describe the presentation, diagnosis and treatment of fetal supraventricular tachyarrhythmias in a series of fetuses followed in a tertiary Fetal Cardiology Center. METHODS: Twenty-five fetuses with diagnosis of supraventricular tachyarrhytmia were reported from January 1989 to October 1997, among 3117 pregnant women referred for fetal cardiac evaluation. RESULTS: There were 17 fetuses with the diagnosis of supraventricular tachycardia (SVT) and 8 patients with atrial flutter (AF). Gestational age ranged from 26 to 40 weeks. Twelve patients were hydropic at presentation (6 with SVT and 6AF). Four fetuses with SVT showed structural abnormalities (two with Ebsten's anomaly and two with VSD). All patients were admitted to the Fetal Cardiology Unit for monitoring and treatment. Among 17 fetuses with SVT, twelve showed good response to digoxin administration, but this drug was not useful in any of the patients with flutter. In two patients with SVT and in six with AF, the pregnancy was interrupted to perform post-natal cardioversion. The mortality rate was 3/17 in the SVT group (including 2 patients with ebstein's anomaly and 0/8 in the flutter group) CONCLUSION: Fetal supraventricular tachyarrithmias are rare in the general population. Nevertheless, the fetus may present with severe heart failure and death. Considering the satisfactory therapeutic response, accurate diagnosis and early treatment of these conditions are extremely important.

Atrial Flutter↗
PubMed1998

[Aneurysm of arterial duct associated to aortic arch interruption].

Aneurysm of the arterial duct is an infrequent finding, which is very rarely detected prenatally. A case of antenatal diagnosis in a pregnant patient (33 weeks) is reported. The fetus presented an aneurysmatic dilation of the arterial duct with uniformly enlarged diameter, inserting into the descending aorta, which was interrupted. The neonate was born by cesarean section and was kept on postaglandins till the 9th day of life, when he was sent to surgery. During the surgical procedure, the baby died as a result of biventricular failure. This is the first report of prenatal association of aneurysm of the ducts anteriosus with other cardiovascular malformations and emphasizes that this finding does not always have a benign course.

Adult↗
PubMed1997

[Risk factors for atherosclerosis in children: an epidemiologic study].

PURPOSE: To obtain a profile of risk factors for coronary atherosclerosis in a pediatric population from Bento Gonçalves, Rio Grande do Sul, from May 1990 to June 1991. METHODS: One thousand five hundred and one children with ages from 6 to 15 years were studied to assess serum cholesterol levels and their association with other risk factors, such as arterial hypertension, obesity and family history of cardiovascular disease. RESULTS: Four hundred and twenty (27.98%) children showed cholesterol levels over 180 mg%; 75 (5%) had systolic hypertension and 48 (3.20%) diastolic hypertension. The family history was important to search for risk factors such as hypercholesterolemia, but did not exclude risk factors when negative. One hundred and thirty six (9.06%) children showed hipetriglyceridemia; 155 (10.33%) presented LDL-cholesterol above 130 mg% and showed a strong association with hypercholesterolemia. Obesity was present in 111 children, but none showed a major prevalence of hypercholesterolemia. CONCLUSION: Risk factors for atherosclerosis are present in children and their search should be performed, independent of family income, family history, age and sex. The pediatrician must have a significant role in this setting.

Adolescent↗
PubMed1997

[Natural history of myocardial hypertrophy and its association with hyperinsulinism in infants of diabetic mothers].

PURPOSE: To test the hypothesis that myocardial hypertrophy is associated with increased serum insulin levels in children of diabetic mothers and to determine the frequency and timing of this spontaneous regression. METHODS: Seventy-two patients were studied (54 children of diabetic mothers and 18 controls). Diagnosis of myocardial hypertrophy was made by fetal echocardiography. Amniotic fluid insulin levels were obtained from a previous prenatal study on hypertrophic cardiomyopathy, since the participation of the mothers was common to both projects. RESULTS: There were 10 cases of myocardial hypertrophy among children of diabetic mothers (18.52%). Septal thickness was significantly different between the 2 groups (children of diabetic mothers and controls) in the evaluation performed at the age of 1 month (p = 0.04). Insulin levels were still increased in children of diabetic mothers until the age of 3 months. During this period insulin levels were significantly higher than those of controls (p = 0.003 and p = 0.001, at 1 and 3 months, respectively). The association between regression of ventricular septum thickness and the decrease of insulin levels occurred up to the age of 1 month. CONCLUSION: There was spontaneous regression of ventricular septum thickness in children of diabetic mothers during the first 6 months of life. The association between hyperinsulinism and hypertrophic cardiomyopathy was present up to the first month of life.

Cardiomyopathy, Hypertrophic↗
PubMed1997

[Prenatal restriction of the foramen ovale].

The parallel arrangement of the fetal intracardiac circulation requires unrestricted flow of blood through the foramen ovale in the atrial septum. Restriction to this flow is a significant cardiac abnormality, with potentially serious sequelae in post-natal life. A wide spectrum of abnormalities has been associated to the restriction of flow through the foramen ovale, including enlargement of right atrium, hypertrophy of right ventricle, enlargement of tricuspid valve annulus, hypoplastic syndrome of left heart, non-immune hydrops fetalis and supraventricular tachycardias. We report the diagnosis and follow-up of a fetus identified in the prenatal period, in whom the restriction of the foramen ovale originated severe tricuspid regurgitation and severe right ventricular hypocontractility, despite the morphologically normal tricuspid valve. After delivery, there was complete resolution of the clinical findings. The paramount importance of complete assessment of interatrial flow in high risk fetuses, allowing for the early detection and intervention, is emphasized.

Adult↗
PubMed1996

[Prenatal study of hypertrophic cardiomyopathy and its association with insulin levels in fetuses of diabetic mothers].

PURPOSE: To test the hypothesis that hypertrophic cardiomyopathy during prenatal life in diabetic pregnancies is related to fetal hyperinsulinism. METHODS: Thirty seven fetuses of diabetic mothers and 28 of non-diabetic mothers were studied by echocardiography and fetal insulin levels measured. RESULTS: Mean fetal insulin levels were 22.16 (+/- 44.25) microU/ml (3.20 to 240 microU/ml) in the group with diabetes and 6.50 (+/- 3.45) microU/ml (3.10 to 17.00 microU/ml) in the control group (p = 0.004). Ten out of 37 fetuses of the diabetic group were considered to have hypertrophic cardiomyopathy (27.02%), while none of the fetuses of the control group showed increase in septal thickness (p = 0.001). A significant association between prenatal hypertrophic cardiomyopathy and fetal hyperinsulinism was demonstrated (p = 0.013). CONCLUSION: There is an association between hypertrophic cardiomyopathy and high levels of fetal insulin.

Adult↗
PubMed1996

[Intrauterine and perinatal management of complete atrioventricular block in the fetus].

PURPOSE: To report the experience of one of the most severe fetal rhythm disturbances, the complete atrioventricular block. METHODS: Descriptive study of 14 fetuses diagnosed and monitored at the Fetal Cardiology Unit, from January, 1991 to August, 1995. RESULTS: Fourteen cases of complete AV block were identified during the study period, with post-conceptional age between 22 and 38 weeks at the moment of diagnosis. Twelve cases were referred to the Fetal Cardiology Unit because of low heart rate during obstetric examination. Eight fetuses showed complete AV block without evidence of structural heart disease; maternal collagen tissue disease was diagnosed in three of these cases. Four neonates were discharged from the hospital, two of them with a permanent pacemaker, one with complete AV block but no pacemaker and the fourth with sinus rhythm. The remaining seven neonates presented with severe heart failure leading to death despite treatment. CONCLUSION: Complete AV block is a rare fetal condition, but carries a high morbidity and mortality. A several treatment techniques have been suggested to improve monitoring and survival of these patients, particularly in utero.

Adolescent↗