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Ventricular Septal Defect (ventricular + septal_defect)

Distribution by Scientific Domains

Medical Sciences	84%
Life Sciences	15%

Distribution within Medical Sciences

Cardiovascular Disease	53%
Pediatrics	11%
Anesthesia & Pain Management	8%
9 Other Subdomains	28%

Kinds of Ventricular Septal Defect

congenital ventricular septal defect

muscular ventricular septal defect

Terms modified by Ventricular Septal Defect

ventricular septal defect closure

Selected Abstracts

Large Apical Muscular Ventricular Septal Defect: Asymptomatic due to Anomalous Muscle Bundles in the Right Ventricle

CONGENITAL HEART DISEASE, Issue 1 2007
Anant Khositseth MD
ABSTRACT This case report demonstrated an apical muscular ventricular septal defect (VSD) that was a large defect but behaved like a small defect because of the restrictive flow across the anomalous muscle bundles in the right ventricular (RV) apex. The anomalous muscle bundles separated the RV sinus into two parts: the RV apex connecting with the left ventricle through the apical muscular VSD on one side, and the rest of the RV sinus connecting with RV inflow and RV outflow on the other side. These findings explained why the 11-year-old girl in this study remained asymptomatic without evidence of volume load. Thus far, it was not necessary to close her defect because of the hemodynamic insignificance. [source]

Perimembranous Ventricular Septal Defect and Gerbode Defect

ECHOCARDIOGRAPHY, Issue 2 2010
Adolfo A. Blanco M.D.
A 27-year-old male presented with a known history of congenital ventricular septal defect (VSD). A Gerbode-type defect was discovered intraoperatively that was originally misinterpreted as pulmonary hypertension. The case report will review the Gerbode defect and the transesophageal echocardiography findings. It is important, in patients with history of perimembranous VSD, to consider Gerbode-type defect when the tricuspid regurgitation jet velocity is high (Echocardiography 2010;27:215-217) [source]

Simultaneous Left Ventricular Pseudo-Aneurysm and Ruptured Ventricular Septal Defect Following an Acute Myocardial Infarction

JOURNAL OF CARDIAC SURGERY, Issue 5 2010
Mohammed Hassan M.D.
No abstract is available for this article. [source]

Tricuspid Valvectomy to Facilitate Repair of Postinfarction Ventricular Septal Defect

JOURNAL OF CARDIAC SURGERY, Issue 5 2008
Elena A Ashikhmina M.D.
Avoidance of ventriculotomy by transatrial repair may decrease risks of bleeding and impairment of ventricular function secondary to suture placement; however, adequate exposure of the defect through the tricuspid valve is not always possible. We present a case of successful transatrial repair of posterior postinfarction VSD with concurrent tricuspid valvectomy and coronary artery grafting. [source]

Ross Procedure for Aortic Insufficiency Due to Doubly Committed Subarterial Ventricular Septal Defect in Adults

JOURNAL OF CARDIAC SURGERY, Issue 5 2005
Ph.D., Shoh Tatebe M.D.
Preoperatively, she developed congestive heart failure because of less compliance to oral medication, raising concerns regarding life-threatening thromboembolism if she undergoes mechanical valve replacement. Despite the pulmonary autograft being defective, there were no difficulties in completing the surgery. The defect of pulmonary autograft and the VSD was closed by an expanded polytetrafluoroethylene patch. She tolerated the procedure well and now enjoys improved quality of life. We present a discussion of the indication of Ross procedure in the rare presentation of congenital heart disease, as well as several issues raised in this case. [source]

Percutaneous Closure of Postmyocardial Infarction Ventricular Septal Defect

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2006
FRANCISCO GARAY M.D.
Postinfarction ventricular septal defect remains an important complication for myocardial infarction. It is associated with high mortality and morbidity. Despite early surgical closure attempts, mortality remains about 19,49%. Percutaneous approach, especially in high surgical risk patients is a promising alternative to traditional surgical closure, thus avoiding the deleterious effects of cardiopulmonary bypass and the ventriculotomy. The Amplatzer P.I. Ventricular Septal Defect Occluder is a device specifically designed to percutaneously close these defects in adult patients. The results reported using this device are comparable (if not better) to those for surgical closure. Here, we review the experience using this device and depict in detail the technical aspects of the procedure. [source]

Transcatheter Closure of a Perimembranous Ventricular Septal Defect in a Dog

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 6 2007
Claudio Bussadori
First page of article [source]

Transcatheter closure of high-risk muscular ventricular septal defects with the CardioSEAL occluder: Initial report from the CardioSEAL VSD Registry

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 5 2007
D. Scott Lim MD
Abstract Objectives: The CardioSEAL VSD registry was created to track safety of the device to close high-risk Ventricular Septal Defect (VSD). Background: This is the first report from the multi-centered CardioSEAL VSD registry reviewing demographics and initial results. Methods: Centers recruited patients with VSD who were high-risk for surgery due to medical condition or anatomic features. Results: 18 centers contributed data on 55 high-risk patients who had 61 VSD-occlusion procedures, with age of range of 5 days to 65 years and using one to six devices. Implantation approach was transvenous in 48, perventricular in five, and by combined approach in two patients. Ninety-two percent of intended VSD device implants were judged successful. Twenty-two patients had single VSD closed by single device in 18 and by two devices in four patients. All patients <8 kg underwent perventricular device implantation. Thirty-three patients had multiple VSDs which were closed by a single device in 23, and multiple devices in 10. At discharge echocardiography showed total residual flow through all VSDs in which devices were used was classified as "Small" or less in 74%, "More than small" in 11%, and "Uncertain" in 15%. Eight major adverse events occurred in 5/61 cases (8% event rate), with 3/81 devices embolized (4% embolization rate), 5/81 devices surgically explanted (6% explant rate), and no deaths judged to be procedure-related. Conclusion: This initial report from the multi-centered CardioSEAL VSD registry demonstrates the safety of the device to close high-risk VSDs. © 2007 Wiley-Liss, Inc. [source]

Device Closure of Congenital Ventricular Septal Defects

CONGENITAL HEART DISEASE, Issue 2 2007
Karim A. Diab MD
ABSTRACT Ventricular septal defect is the most common congenital heart malformation. Surgical closure, when indicated, has been practiced for over 50 years with good results; however, surgical closure is still associated with significant morbidity and mortality. Over the past decade, several occluding devices have been developed that made catheter device closure an attractive alternative to surgery with widely satisfactory results. In this article, a comprehensive review of percutaneous and perventricular (hybrid) device closure of each type of ventricular septal defect is presented. [source]

Transcatheter Closure of Congenital Ventricular Septal Defects: Experience with Various Devices

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2003
RAMESH ARORA D.M.
Transcatheter closure of congenital ventricular septal defect (VSD) using various devices is gaining acceptance in selected cases of perimembranous and muscular defects, avoiding the inherent risks of cardiopulmonary bypass. The procedure was attempted in 137 patients having congenital defects using Rashkind Umbrella Device (RUD) in 29 patients, Amplatzer ventricular septal occluder (AVSO) in 107 patients, and Detachable Coil in one. All patients were selected using stringent criteria by detailed transthoracic echocardiography and/or transesophageal echocardiography. The location of VSD was perimembranous in 91 patients and was muscular trabecular in 46 patients. Seven patients had left ventricle (LV) to right atrium (RA) communication. Thirty-five patients with perimembranous and two with muscular VSD had aneurysm formation. The patients were 3 to 33 years old, and the diameter of VSD ranged from 3 to 12 mm. The pulmonary to systemic flow ratio was ,2:1 in 47 (34.3%) patients. The procedure was successful in 130 (94.8%) patients, with a success rate of 86.2% with RUD and 97.1% with AVSO. Residual shunt at 24 hours was seen in eight (32%) patients with RUD and in one patient (0.9%) with AVSO. Three (2.8%) developed transient bundle branch block, and two (1.9%) patients had complete heart block. New tricuspid stenosis and tricuspid regurgitation was observed in one patient each with AVSO. After immediate balloon dilatation, the mean pressure gradient across tricuspid valve decreased from 11 to 3 mmHg in the patient with tricuspid stenosis. On a follow-up of 1 to 66(mean 35.2 ± 10.7)months, the device was in position in all. None developed late conduction defect, aortic regurgitation, infective endocarditis, or hemolysis. At 9-month follow-up, the mean pressure gradient across the tricuspid valve was 3 mmHg in the patient with tricuspid stenosis. Complete occlusion of the shunt was achieved in 129 (99.2%) patients. One patient with RUD having persistent residual shunt underwent a second procedure with AVSO. Three out of 107 patients with AVSO had an unsuccessful procedure where the defect was perimembranous with a superior margin of defect less than 3 mm away from the aortic valve, and the specially designed perimembranous AVSO had to be retrieved because of hemodynamic compromise due to significant acute aortic regurgitation, whereas in all others, the defect was either ,3 mm away from the aortic valve or had aneurysm formation. All seven patients with LV to RA communication showed complete abolition of the shunt. Thus, in properly selected cases of perimembranous and muscular ventricular septal defects, the transcatheter closure is safe and efficacious using appropriate devices. The success rate is higher with AVSO compared with the previously used devices, as well as more successful for the muscular defects than those that are perimembranous in location. (J Interven Cardiol 2003;16:83,91) [source]

Device Closure of Congenital Ventricular Septal Defects

Congenital Cardiac Defects in Neonatal Foals: 18 Cases (1992,2007)

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010
T.L. Hall
Background: Literature available regarding congenital cardiac defects in foals is limited to reports of individual cases or small case series. Objective: To describe the clinical, echocardiographic, and necropsy findings and breed predilection of congenital cardiac defects in neonatal foals. Animals: Eighteen foals <15 days of age with 1 or more congenital cardiac defects. Methods: Medical records of foals diagnosed with congenital cardiac defects at the William R. Pritchard Veterinary Medical Teaching Hospital were reviewed. Data collected included history, signalment, clinical signs, laboratory data, diagnostic and necropsy results, and outcome. Results: Arabian foals represented 39% of cases with congenital cardiac defects and were significantly (P= .004) overrepresented (OR = 4.7 [CI: 1.8,12.4]) compared with the general hospital population. Ventricular septal defect (VSD) (14/18), tetralogy of Fallot (5/18), and tricuspid valve atresia (4/18) were the most common defects identified. A ,3/6 heart murmur (14/14) accompanied by tachycardia (14/17), tachypnea (17/17), and cyanosis of mucous membranes (7/16) were the most common clinical signs. Concurrent congenital defects were common (9/18). Two foals, both with VSD, survived for , 8 years after diagnosis and 1 was a successful performance horse. Conclusions and Clinical Relevance: Arabian horses appear to have a predisposition for cardiac defects. The presence of a loud murmur (, 3/6), cyanotic membranes, and tachycardia or tachypnea in a neonatal foal should warrant thorough evaluation of the heart for congenital defects. Foals with cardiac defects should be closely evaluated for concurrent congenital defects in other body systems. [source]

Combined catheter ventricular septal defect closure and multivessel coronary stenting to treat postmyocardial infarction ventricular septal defect and triple-vessel coronary artery disease: A case report

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2004
Rajaram Anantharaman
Abstract Ventricular septal defect following acute myocardial infarction is a rare but life-threatening complication. Early surgical closure improves survival but carries a considerable risk. Percutaneous transcatheter closure is an alternative but experience to date is limited. We report a case of successful transcatheter closure of postmyocardial infarction ventricular septal defect (VSD) in a 55-year-old male with the Amplatzer muscular VSD occluder device and complete percutaneous revascularization with successful multivessel coronary stenting for three-vessel disease as a staged procedure. The technique and its potential use as an alternative to surgical approach for treatment of acute myocardial infarction and its complication (VSD) are discussed. Catheter Cardiovasc Interv 2004;63:311-313 © 2004 Wiley-Liss Inc. [source]

Three-Dimensional Echocardiography of Post-Myocardial Infarction Cardiac Rupture

ECHOCARDIOGRAPHY, Issue 3 2004
Timothy Puri B.S.
Ventricular septal defects and pseudoaneurysms are two serious complications of acute myocardial infarction and are associated with a high mortality if not surgically treated. Two-dimensional echocardiography provides excellent diagnostic information in such cases, but three-dimensional echocardiography may provide superior anatomic data of these potentially fatal complications. We describe two cases in which three-dimensional echocardiography provided incremental morphological information. (ECHOCARDIOGRAPHY, Volume 21, April 2004) [source]

Teratogenic effect of bis-diamine on embryonic rat heart

CONGENITAL ANOMALIES, Issue 3 2000
Masao Nakagawa
ABSTRACT, Bis-diamine induces conotruncal anomalies including persistent truncus arteriosus, tetralogy of Fallot, interruption of the aortic arch, and ventricular septal defect in rat embryos when administered to the mother. Bis-diamine also induces extracardiac malformations including thymic hypoplasia, facial dysmorphism, forelimb anomalies and diaphragmatic hernia. However, the teratogenic mechanisms of this chemical in early developing rat hearts have not been fully established. Chimeric studies in chick and quail embryos demonstrated that the cranial neural crest cells reached the cardiac outflow tract, contributing to aorticopulmonary and truncal septation. Since an ablation of the cranial neural crest also produced the conotruncal anomalies, bis-diamine is proposed to disturb the normal migration of cardiac neural crest cells to the heart. Based on our data concerning cardiac anomalies induced by bis-diamine, we reviewed how the cardiac malformations were morphologically established in early developing rat hearts. Our data showed that 1) cardiovascular anomalies induced by bis-diamine are time- and species or strain- dependent. 2) bis-diamine reduces the number of neural crest cells migrating to participate in the conotruncal septation, 3) bis-diamine induces anomalous coronary arteries, thin ventricular walls and epicardial defects, and 4) some embryos cultured in the medium containing bis-diamine had extra-cardiac abnormalities including abnormal location of the otic placodes and delay in mid brain closure. Conclusively, bis-diamine does not appear to merely affect the cardiac development, but rather disturbs normal development of all the organs contributed to by neural crest cells. [source]

Device Closure of Congenital Ventricular Septal Defects

Large Apical Muscular Ventricular Septal Defect: Asymptomatic due to Anomalous Muscle Bundles in the Right Ventricle

Squamous cell carcinoma arising from a congenital duplication cyst of the esophagus in a young adult

DISEASES OF THE ESOPHAGUS, Issue 3-4 2001
S. Singh
Squamous cell carcinomas arising from the congenital anomalies in the esophagus are rare. One such case of an 18-year-old man, with an associated history of ventricular septal defect, who developed an epithelial malignancy within the duplication cyst extending to involve the lower third of esophagus is presented here. He responded well to radical treatment using concurrent chemo-irradiation, and continues to be free of disease after a follow-up of 14 months. [source]

Surgery for Ruptured Sinus of Valsalva Aneurysm into Right Ventricular Outflow Tract: Role of Intraoperative 2D and Real Time 3D Transesophageal Echocardiography

ECHOCARDIOGRAPHY, Issue 7 2010
Shrinivas Gadhinglajkar M.D.
A major limitation of the 2D echocardiography during surgery for a complex cardiac lesion is its inability to provide an accurate spatial orientation of the structure. The real time 3D transesophageal echocardiography (RT-3D-TEE) technology available in Philips IE 33 ultrasound machine is relatively new to an operation suite. We evaluated its intraoperative utility in a patient, who was operated for repair of a ruptured sinus of Valsalva aneurysm (RSOVA) and closure of a supracristal ventricular septal defect. The VSD and RSOVA were visualized through different virtual windows in a more promising way on intraoperative RT-3D-TEE than on the 2D echocardiography. The acquired images could be virtually cropped and displayed in anatomical views to the operating surgeon for a clear orientation to the anatomy of the lesion. RT-3D-TEE is a potential intraoperative monitoring tool in surgeries for complex cardiac lesions. (Echocardiography 2010;27:E65-E69) [source]

Severe Right Ventricular Outflow Obstruction by Right Sinus of Valsalva Aneurysm

ECHOCARDIOGRAPHY, Issue 3 2010
Anil Avci M.D.
Aneurysms of the sinus of Valsalva are rarely diagnosed cardiac anomalies, occurring in 0.14%,0.96% of patients who have undergone open heart surgical procedures. The most common congenital anomalies accompanying sinus of Valsalva aneurysm (SVA) are ventricular septal defect, bicuspid aortic valve, atrial septal defect, and coarctation of aorta. We report a patient with an unruptured right SVA presenting with severe right ventricular outflow tract (RVOT) obstruction, and coexisting patent foramen ovale (PFO) with a right to left shunt. It could be assumed that the increase in right atrial pressure due to RVOT obstruction had led to a right to left shunt across the patent foramen ovale. (Echocardiography 2010;27:341-343) [source]

Perimembranous Ventricular Septal Defect and Gerbode Defect

Tricuspid valve endocarditis in a horse with a ventricular septal defect

EQUINE VETERINARY EDUCATION, Issue 4 2006
W. F. Roehlich
First page of article [source]

Subcutaneous fat necrosis of the newborn associated with ventricular septal defect and patent ductus arteriosus

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2009
Jae Hwan Kim MD
No abstract is available for this article. [source]

Safety and Efficacy of Arterial Switch Operation in Previously Inoperable Patients

JOURNAL OF CARDIAC SURGERY, Issue 4 2010
Liu Ying-long M.D.
This study aimed to evaluate the safety and efficacy of ASO in these selected subset patients. Methods: The records of 86 patients older than six months with complete transposition of the great arteries and ventricular septal defect or Taussig-Bing anomaly and severe PAH who underwent ASO at our institution from May 2000 to October 2008 were reviewed retrospectively. Eighty survivors were followed-up. Results: There were six hospital deaths (7.0%, 95% confidence limit 1.6 to 12.4%). From January 2006 to October 2008, 46 consecutive ASOs were performed with no death. Operative mortality and mobility decreased significantly (p = 0.008 and p = 0.046, respectively). The median duration of follow-up was 42.1 ± 28.8 months (range, 2.0 to 99.5). Two late deaths occurred. Latest follow-up data showed that 2.8% of survivors were in New York Heart Association (NYHA) class II and 97.2% were in NYHA class I. Conclusions: Excellent early and mid-term results of ASO are obtained from patients older than six months with complete transposition of the great arteries and ventricular septal defect or Taussig-Bing anomaly and severe PAH in current era, and ASO is safe and effective in these selected subset patients. (J Card Surg 2010;25:400-405) [source]

The Effects of Pentoxifylline on the Myocardial Inflammation and Ischemia-Reperfusion Injury During Cardiopulmonary Bypass

JOURNAL OF CARDIAC SURGERY, Issue 1 2006
Hasim Ustunsoy M.D.
The aim of this study is to investigate whether the addition of Ptx into the cardioplegic solutions avoids myocardial inflammatory reactions and ischemia/reperfusion (I/R) injury during extracorpereal circulation. Methods: Between December 1999 and February 2002, we operated 75 patients with the diagnoses of atrial septal defect (ASD), ventricular septal defect (VSD), valve disease, and coronary disease. The average age of patients was 42.4 and male,female ratio was 1: 1.5. The patients were divided into two groups, which were the study group (n = 40) and the control group (n = 35). We used cold blood cardioplegia mixed with St. Thomas' Hospital II cardioplegic solution for both of the groups. Ptx was added into the cardioplegic solution (500 mg/L) in the study group. Interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrotisis factor-, (TNF-,) levels in coronary sinus blood samples during cross-clamp time (X-clamp) and after releasing of it and tissue TNF-, in the right atrial appendix biopsy material that was taken after X-clamp were studied to compare the both groups. Results: After releasing X-clamp, results of blood TNF-,, IL-6, and IL-8 of both groups were statistically significant (p < 0.005). At the pathological examination, we also observed that the amount of tissue TNF-, in the control group (66 ± 17.1) was much higher than the study group (16.6 ± 5.9, p <0.005). Conclusions: These results show that Ptx may be added into cardioplegic solution to avoid the myocardial inflammation and I/R injury during open heart surgery. [source]

Resternotomy for a Retrosternal Cardiac Pseudoaneurysm in a 1.5-Year- Old Child: A Case Report

JOURNAL OF CARDIAC SURGERY, Issue 5 2005
Ghassan M. Baslaim M.D.
The wall of the pseudoaneurysm consists of fibrous tissue and lacks the structural elements found in a normal cardiac wall, and it is contained by the pericardial adhesions or the epicardial wall. Early surgery is recommended even for asymptomatic patients due to the propensity for rupture and fatal outcome. We report our experience with the surgical approach of a child with a cardiac pseudoaneurysm who had undergone a biventricular repair of a double outlet right ventricle with non-committed ventricular septal defect in the form of intraventricular tunneling. [source]

The Results of Probe Technique for Transatrial Repair of Tetralogy of Fallot

JOURNAL OF CARDIAC SURGERY, Issue 6 2002
Ahmet Turan Yilmaz M.D.
The most critical point in transatrial repair of TOF is infundibular dissection. Right atrial approach provides better surgical exposure for parietal extension of the infundibular septum when compared to a right ventricular approach. However, it is not always easy to determine the localization and amount of muscle bundles to be resected and this surgical maneuver requires experience. Methods: Nineteen patients were reviewed who had repair of isolated TOF by this technique from 1993 to 2001. The mean age of patients was 5 ± 2 years . Transatrial-transpulmonary approach was performed for all patients. To make the infundibular muscle-bundle resection easier and to determine the localization and amount of muscle bundle to be resected, we placed a Hegar dilator into the right ventricle through pulmonary arteriotomy. The muscle bundles between the dilator and the anterior leaflet annulus of the tricuspid valve were totally excised until the intraventricular part of the dilator and pulmonary annulus became completely visible. The area between the Hegar dilator and the margins of the ventricular septal defect (VSD) was left untouched. None of the patients had transannular patch. Tricuspid valve detachment in order to improve the exposure was done in 11 patients. All patients were followed up in our clinic at regular six-month intervals by echocardiography. Results: There was no early or late mortality nor reoperation for residual VSD or residual right ventricle (RV) outflow obstruction. All patients were in NYHA class I. RV on the echocardiography was spared late dilatation and had a good late functional status. Eighteen patients had no or mild pulmonary regurgitation. One patient who had undergone tricuspid anterior leaflet detachment showed mild tricuspid insufficiency. Conclusions: On the basis of hemodynamic outcomes, this procedure for elective repair of TOF in selected cases gives excellent early and mid-term results.(J Card Surg 2002;17:490-494) [source]

Four-dimensional sonography with B-flow imaging and spatiotemporal image correlation for visualization of the fetal heart

JOURNAL OF CLINICAL ULTRASOUND, Issue 4 2008
Toshiyuki Hata MD
Abstract Purpose. To use B-flow imaging with 4-dimensional (4D) sonography and spatiotemporal image correlation (STIC) in the evaluation of normal fetal heart and congenital heart disease during pregnancy. Method. Volume data sets of the fetal heart were acquired with automated transverse and longitudinal sweeps of the anterior chest wall. We studied 13 normal fetuses and 2 fetuses with congenital heart disease (1 double-outlet right ventricle and 1 hypoplastic left heart syndrome) at gestation ages ranging from 13 to 39 weeks using transabdominal 4D B-flow sonography with STIC (4D BF-STIC). Results. 4D BF-STIC demonstrated dynamic angiographic features in both normal and abnormal fetal hearts. 4D BF-STIC images could not be obtained in 2 normal fetuses at 18.1 and 33.1 weeks because of the high fetal heart rate and inappropriate fetal position. In normal fetal heart, characteristic hemodynamic changes in both atria and ventricles were clearly demonstrated in systole and diastole. 4D BF-STIC also allowed visualization of the relationship, size, and course of the outflow tracts, thus helping the examiner to better understand the relationships between the vessels. In a case of hypoplastic left heart syndrome, dramatic hemodynamic changes including the right atrium, right ventricle, and pulmonary artery were evident. In a case of double-outlet right ventricle with ventricular septal defect, left-to-right shunt flow through a ventricular septal defect was clearly shown, as were great arteries originating in parallel from the right ventricle. Conclusion. 4D BF-STIC provides a means of real-time 3-dimensional evaluation of fetal intracardiac and extracardiac hemodynamics in the second and third trimesters. This novel technique assists in the evaluation of fetal cardiac hemodynamics and may play an important role in future fetal cardiac research and in the evaluation of congenital heart disease in the fetus. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2008. [source]