title: Echocardiographic risk stratification of fetuses with sacrococcygeal teratoma and twin-reversed arterial perfusion.
abstract: OBJECTIVE
  To evaluate pre-intervention echocardiographic parameters of cardiac function in fetuses who survive without hydrops as compared to fetuses who develop hydrops or perinatal death in the setting of sacrococcygeal teratoma (SCT) and twin-reversed arterial perfusion sequence (TRAP).
  
  
  METHODS
  Clinical, echocardiographic and sonographic data of fetuses with SCT or TRAP during 1999-2009 were reviewed retrospectively. Measurements of cardiothoracic ratio (CTR), cardiac dimension Z-scores, combined ventricular output (CVO), valvular regurgitation, and cardiovascular profile scores (CVPS) were obtained.
  
  
  RESULTS
  In total, 19 fetuses (11 SCT, 8 TRAP) met the inclusion criteria and 26 detailed fetal echocardiographic studies were reviewed. Outcome was poor in 7 pregnancies (group A) and good in 12 (group B). Group A had worse CVPS (8.5 vs. 10, p < 0.01) and higher CTR (0.37 vs. 0.30, p = 0.04). At least one of the following was present in each group A fetus: CTR >0.5, CVO >550 ml/min/kg, tricuspid or mitral regurgitation, or mitral valve Z-score >2. No group B fetus had any of these abnormalities. No fetus in either group had abnormal venous Doppler waveforms at presentation.
  
  
  CONCLUSIONS
  Fetal echocardiography can identify abnormalities of cardiac size and systolic, but not diastolic, function in all fetuses who subsequently died or developed hydrops.
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA.
authors.forename: Francesca A
authors.initials: FA
authors.lastname: Byrne
authors.forename: Hanmin
authors.initials: H
authors.lastname: Lee
authors.forename: Alaina K
authors.initials: AK
authors.lastname: Kipps
authors.forename: Michael M
authors.initials: MM
authors.lastname: Brook
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Moon-Grady
mesh_terms: D004452:Echocardiography; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005330:Fetofetal Transfusion; D020141:Hemostatic Disorders / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D018570:Risk Assessment; D012445:Sacrococcygeal Region / Q000000981:diagnostic imaging; D013125:Spinal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D013724:Teratoma / Q000150:complications / Q000000981:diagnostic imaging*; D016216:Ultrasonography, Prenatal