We present the prenatal diagnosis and management in a fetus of a large left ventricular aneurysm complicated by fetal arrhythmias. Images include thick slice 3/4D and subtraction volume 3/4D imaging to evaluate ventricular function as well as 2D imaging and Doppler techniques to evaluate the arrhythmia.

To show that the maternal hyperoxygenation test for pulmonary vascular reactivity (HPVR) is useful for prognosis in the fetus with very small lungs associated with congenital diaphragmatic hernia (CDH). Twenty four fetuses with severe CDH underwent HPVR after 30 weeks gestation. Severe CDH was defined as lung smaller than the cardiac mass in the transverse image of the fetal thorax. Doppler studies of the mid right pulmonary artery were performed before and after 10 minutes of the mother oxygenation by mask. Before and after pulsatility indices (PI) of the flow patterns were compared. A positive change was considered as a greater than 20% decrease in PI indicating increased pulmonary blood flow. Of the 24 fetuses with CDH, 12 are alive and 12 died after delivery. Of those alive, 12 of 12 (100%) had a positive HPVR. Of those who died, 8 of 12 had a negative HPVR. Of those infants who died with a positive HPVR, all underwent CDH surgical repair with Gore-Tex patch: one died at 85 days with sepsis, one who died at 60 days had meconium aspiration syndrome and respiratory failure, one died at 29 days with sepsis, and one died at 13 days from sepsis who also had single kidney and cleft palate. The maternal hyperoxygenation test for pulmonary vascular reactivity can be useful for prognosis when fetuses are found to have CDH with small lungs. Surgical expertise and experience and a dedicated neonatal extracorporeal membrane oxygenation team are required to maintain these infants.

To show that the ductus arteriosus (DA), in normal fetuses can react to third trimester maternal usage of acetominephen in a way similar to other non-steroidal anti-inflammatory agents. Seven women who underwent comprehensive fetal cardiovascular ultrasound (fecho) for non-anatomic reasons and one woman who had fecho for a dilated right ventricle were included in this study. All had taken self directed acetaminophen within 36 hours of the study for back pain associated with their pregnancies (24 to 35 weeks' gestation). The women were taking no other medications. The fetus of the women who had fecho for dilated right ventricle had total ductal occlusion with cardiomegaly, tricuspid valve regurgitation, abnormal venous Dopplers and mild pericardial effusion and ascites. The baby was delivered that same day by caesarian section with a normal newborn echocardiogram at 4 hours but with a closed DA. The other 7 fetuses had moderate to severe constriction of the DA at fecho but, after stopping acetominephen, had normal patent DA flow patterns at one week follow-up fecho with normal newborn outcomes. The fetal ductus arteriosus may be affected by incautious maternal use of acetaminophen. We believe that while the effects of non-steroidal anti-inflammatory agents on the fetal DA may be rare, patients and their caregivers should be made aware of the risks of self taking acetominephen in the third trimester.