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Visibility rate and reference ranges of papillary muscle areas of atrioventricular valves of fetal heart by three-dimensional ultrasonography and yours applicability in congenital heart diseases

Grant number: 13/00546-3
Support type:Scholarships in Brazil - Post-Doctorate
Effective date (Start): June 01, 2013
Effective date (End): May 20, 2014
Field of knowledge:Health Sciences - Medicine
Principal Investigator:Edward Araujo Júnior
Grantee:Liliam Cristine Rolo Paiato
Home Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil


Background: Congenital heart diseases (CHD) are the most frequent malformations yet antenatal detection using two-dimensional ultrasound (2DUS) has a low sensitivity. Some three-dimensional equipment has specific software known as spatio-temporal image correlation (STIC) that captures the fetal heart and vessels and allows off-line analysis in multiplanar and rendering modes. Many cases of atrioventricular insufficiency are due to intrauterine rupture of the papillary muscles; however etiological diagnosis is not possible using 2DUS. Objectives: 1. To assess the percentage of identification of the papillary muscles of the mitral and tricuspid valves of normal fetuses between 18 and 33 weeks using STIC in the rendering mode 2. To establish the reference ranges for the papillary muscles areas of the mitral and tricuspid valves between 18 and 33 weeks using STIC in the rendering mode 3. To assess the percentage and the area of the papillary muscles of the mitral and tricuspid valves of fetuses with CHD between 18 and 33 gestational weeks. Methods: It will be a retrospective and prospective cross-sectional study. This study will be divided into two parts, one performed in Brazil and the other in Italy. The Brazilian study will constitute of retrospective analysis of normal cardiac volumes by STIC collected between 2010 and 2012, as well as a part of prospective collection of new normal cases. The Italian study will consist of retrospective analysis of fetuses with CHD, which are part of the collection of 10 years of Department of Obstetrics and Gynecology, Università degli Studi di Roma Tor Vergata. The collection of volumes as well as offline analysis thereof shall be held only by the primary examiner (LCRP). The collection of cardiac volumes will occur at position of four chamber view with opening angle of 20 to 30º and acquisition time 10 to 20 seconds. To check the rate of visualization of the valves will be used percentage (%). To evaluate the correlation of the area of the atrioventricular valves with gestational age, the polynomial regression models will be created, with adjustments made by the coefficient of determination (R2). For calculations of reproducibility, we will use the intraclass correlation coefficient (ICC) and Bland-Altman graphs.