Cardiovascular Cast Fabrication And Comparative Study Between Cardiovascular Cast And Prenatal Echocardiography In Fetus With Congenital Cardiovascular Disease

Part ?Cardiovascular Cast Model Fabrication and Casting Effectiveness Evaluation in Fetus with Congenital Cardiovascular DiseaseObjective:To investigate the application and effectiveness of vascular corrosion technique in preparing fetal cardiovascular cast models.Methods:From March 2013 to June 2015, ten normal fetal heart specimens with other congenital disease (control group) and eighteen specimens with severe congenital heart disease (case group) in our hospital were enrolled in this study. Cast models were made by injecting casting material into vascular lumen to demonstrate real anatomic structures of fetal cardiovascular system. Casting effectiveness was analyzed at different levels as follows:?local anatomic structure;? different anatomical systems (including overall level, atrioventricular and great vascular system, left-sided and right-sided heart);? dfferent trimesters of pregnancy (second-and third-trimester).Results:All specimens were successfully casted. ?Casting effectiveness analysis of local anatomic structures showed a mean score from 1.90±1.45 to 3.60±0.52, without significant differences between case and control group in most local anatomic structures except left ventricle, which had a higher score in control group (P=0.027).? Inter-group comparison of casting effectiveness in different anatomical levels showed no significant differences between two groups. Intra-group comparison also revealed undifferentiated casting effectiveness between atrioventricular and great vascular system, or left-sided and right-sided heart in corresponding group. ? Third-trimester group had a significantly higher perfusion score in great vascular system than second-trimester group (P=0.046), while the other anatomical levels displayed no such difference.Conclusion:Vascular corrosion technique can be successfully used in preparation of fetal cardiovascular cast model, and is also a reliable method to demonstrate three-dimensional anatomy of severe congenital heart disease and normal heart in fetus.Part ? Comparative study between Cardiovascular Cast and Prenatal Echocardiography in the Demonstration of Fetal Congenital Cardiovascular DiseaseObjective:To compare the demonstration accuracy of fetal cardiac chambers and great vessels by cardiovascular casting and prenatal echocardiography.Methods:From March 2014 to June 2015,18 fetal specimens prenatally diagnosed with congenital cardiovascular disease were enrolled in this study. Prenatal echocardiography findings of these 18 cases were reviewed and analyzed. Fetal cardiovascular cast models were made by injecting ABS perfusate via umbilical vein. All the cast models were carefully observed and analyzed, and cast findings were compared with prenatal diagnosis in overall level, atrioventricular level and great vascular level.Results:In 18 cases,94 abnormalities were diagnosed by prenatal echocardiography, including 48 atrioventricular abnormalities and 46 great vascular abnormalities.18 fetal specimens were all successfully made into cast models. A total of 117 anomalies were detected in cast models, including 35 anomalies in atrioventricular level and 82 anomalies in great vascular level. When comparing the sonographic results and cast findings, we found 65 abnormalities were identified by both methods, including 29 and 36 abnormalities in atrioventricular and great vascular level, separately. There were 65 misdiagnosis in prenatal echocardiographic findings, which were corrected or added by casts, including 12 atrioventricular abnormalities and 53 great vascular abnormalities. However, there were also 18 malformations observed by fetal echocardiography could not be demonstrated in the cast models, including 16 atrioventricular malformations and 2 great vascular malformations.Conclusion:Fetal cardiovascular cast has more advantages in demonstrating anomalies of great vessels and their branches, but has some limitations in displaying intracardiac abnormalities. Cast models may help to understand the anatomic structure and spatial relationship of fetal congenital cardiovascular disease, which plays a vital role in prenatal diagnosis and clinical management.