14 th World Congress on Ultrasound in Obstetrics and Gynecology Poster abstracts P01.04 The consequences of termination after prenatal diagnosis of structural congenital heart disease M. Michon , J. A. Copel, A. H. Friedman Yale University School of Medicine USA Objective: To analyze the consequences of termination we studied the abortion rate, the distribution of CHD’s (in- and excluding the abortions) and the year of termination, and compared the data to a contemporaneous postnatal population. Methods: We reviewed data from all isolated structural CHD’s either born or terminated between January 1 1991 and July 1 2003 at the Yale New Haven Hospital. We subdivided CHD diagnoses into those altering and not altering the four-chamber view. We developed a severity score to code for all CHD’s. Code 1 was given to a CHD amenable to non-complex biventricular repair, code 2 to complex biventricular repair, code 3 to non-complex univentricular repair and code 4 to complex univentricular repair. Results: Of the 236 prenatally diagnosed patients, 110 opted for an abortion (47%) and the remaining 126 decided to carry out their pregnancy (53%). Within the group of 206 CHD’s with abnormal four-chamber views termination of pregnancy was chosen significantly more often than in the group (n = 30) that did not have an altered four-chamber view. The abortion rate is the highest in group 3 (75%), going down to group 4 (51%), to group 2 (30%), to group 1 (7%), with a p-value ≪ 0.0001 in all steps. The distribution of severity scores comparing pre- and postnatally (n = 127) diagnoses showed a different pattern with the in- or exclusion of abortions. The likelihood of abortion did not change in any severity score group over the 12.5 years this study covers. Conclusions: The spectrum of neonatal CHD’s is influenced by the option to terminate. Termination was chosen more often when the CHD alters the four-chamber view or when the CHD is not amenable to biventricular repair. The abortions changed the pattern of severity scores between the prenatal and postnatal diagnosis group. We have not seen a trend in the rate of termination within any of the severity score groups in the 12.5 year study period. P01.05 Fetal pulmonary arterial Doppler velocimetry in congenital heart defects F. Lenz , A. Machlitt, K. S. Heling, R. Chaoui Charit´ e Hospital, Humboldt University, Germany Objective: To examine Doppler flow velocity waveforms in the main stems of the pulmonary arteries in fetuses with cardiac defects. Methods: 60 fetuses (19–37 weeks of gestation) with diagnosed congenital heart defects were included in the cross-sectional study and classified into 5 subgroups: right ventricular outflow tract (RVOT) obstruction and retrograde perfusion of the ductus arteriosus (n = 10), left ventricular outflow tract (LVOT) obstruction (n = 21), atrioventricular or ventricular septal defect (n = 9), d-TGA (n = 8), various (n = 12). Peak systolic velocity, time velocity integral (TVI) and pulsatility index (PI) were calculated and compared to reference ranges. Results: Changes were mainly found in fetuses with RVOT obstruction and with d-TGA, showing decreased peak velocity and TVI in RVOT obstruction and increased in d-TGA. PI was decreased in the d-TGA group. Doppler parameters in the remaining groups were scattered within the normal ranges. Conclusions: Retrograde perfusion through the ductus arteriosus in RVOT obstruction causes low blood flow velocities in the pulmonary arteries. The high pulmonary blood flow velocities and low PI in d-TGA may be due to the higher oxygen content in the pulmonary arterial blood ejected from the left ventricle, leading to pulmonary vasodilatation. Further studies are needed to elucidate quantitative changes of blood flow under these conditions. P01.06 Significance of left superior caval vein in the fetus L. Pasquini 1 , A. Fichera 1 , T. Tan 1 , S. Y. Ho 2 , H. Gardiner 3 1 Queen Charlotte’s and Chelsea Hospital, London, UK, 2 Royal Brompton Hospital, London, UK, 3 Queen Charlotte’s and Chelsea Hospital and Royal Brompton Hospital, London, UK Objective: Left superior caval vein (LSVC) is reported in 0.3% to 0.5% of the population at autopsy. LSVC is easily recognised during fetal scanning but its significance is uncertain. We document the incidence, associations and outcome of LSVC in 1678 consecutive fetuses with suspected, or at increased risk of congenital heart disease (CHD) referred to a fetal medicine unit for echocardiography between 1997 and 2002. Methods: Systematic ultrasound examination was made using 5 transverse views (abdominal situs, 4 chamber, both outflow tracts and 3 vessel), colour flow mapping and pulsed Doppler. Diagnosis was confirmed by postnatal echocardiography, surgery or autopsy. Both the odds ratio (OR, 95% confidence intervals) for CHD in the presence of LSVC and the OR of the defect being coarctation (CoA) were calculated. Results: Four of the 1230 normal fetuses (0.3%) had a LSVC compared with 12/448 (2.7%) fetuses with CHD. Hence the OR for a cardiac defect if LSVC was detected is 8.43 (2.71, 26.29). Four of 16 fetuses (25%) with LSVC had extracardiac malformations and three (19%) aneuploidy. LSVC was present in 5 of 10 fetuses (50%) with CoA. The OR of the CHD being a CoA in fetuses with LSVC was 61.57 (14.48, 261.74). Conclusions: Persistent LSVC is not a benign finding in the fetus and is an indication for detailed echocardiography. It may aid in the diagnosis of fetal CoA. P01.07 Prenatal diagnosis of right ventricular diverticulum in the first trimester M. Del Rio , J. M. Mart´ ınez, O. G ´ omez, V. Borobio, A. Borrell, B. Puerto, O. Coll Hospital Clinico, Spain Congenital ventricular diverticulum is a rare cardiac anomaly scarcely reported prenatally. We describe a case diagnosed in the first trimester. A fetal scanning in a 30 year old pregnant woman at 13 + 1 weeks’ gestation demonstrated a large pericardial effusion and a right ventricular saccular dilatation measuring 5 mm, with bidirectional flow into and from the sac, as demonstrated by color Doppler. The nuchal translucency was 1.8 mm, and the rest of the fetal anatomy as well as an early fetal echocardiography appeared to be normal. The patient was counselled and opted for continuing the pregnancy. Chorionic villous sampling was performed and the karyotype was 46, XX. Strict follow-up with frequent ultrasound examinations every 2–3 weeks was initiated. The pericardial effusion disappeared completely by the 20th week gestation, and the size of the diverticulum increased up to 8–9 mm by the 22nd week of gestation, remaining stable in subsequent scans. A perimembranous ventricular septal defect of 3 mm was detected at 30 weeks of gestation, with an increased cardiothoracic ratio (50%) but with normal fetal Doppler studies, thus indicating normal cardiac function. The subsequent course of the pregnancy was uneventful until term. A 3.400 g female infant was vaginally delivered, with normal Apgar scores. Postnatal echocardiogram confirmed prenatal findings and a further atrial septal defect (ostium secundum type) of 3 mm was diagnosed. Conservative management was proposed. At three months of life, the baby had failed to thrive and needed drugs support. Cardiac catheterisation revealed pulmonary hypertension. Surgical repair of the diverticulum and both septal defects was successfully performed. At 8 months of life the child is growing well and developing normally. To the best of our knowledge, this 270 Ultrasound in Obstetrics & Gynecology 2004; 24: 269–372