Franklin O, Burch M, Manning N, Sleeman K, Gould S, Archer N
Fetal Cardiology Unit, John Radcliffe Hospital, Oxford, UK.
Heart. 2002 Jan;87(1):67-9. doi: 10.1136/heart.87.1.67.
To investigate whether antenatal diagnosis of coarctation of the aorta results in reduced mortality and improved preoperative haemodynamic stability compared with postnatal diagnosis.
Retrospective review of all cases of coarctation of the aorta presenting to a tertiary fetal and neonatal cardiology service from January 1994 to December 1998.
Prenatal, postnatal, and necropsy records were reviewed to determine survival in the two groups. Markers of preoperative illness severity were recorded, including presence of femoral pulse, collapse, left ventricular function, ductal patency on echocardiography, coagulation status, duration of intensive care unit and total hospital stay, heart rate, respiratory rate, plasma creatinine, plasma potassium, and right upper limb blood pressure. A univarate and multivariate analysis was conducted on all variables and a cumulative score was created and subjected to logistic regression analysis.
Both collapse and death were more common in the postnatally diagnosed group (p < 0.05). Femoral pulses were more likely to be palpable and there was echocardiographic evidence of duct patency in the antenatally diagnosed infants (p < 0.001 and p < 0.05, respectively). An increased respiratory rate was associated with postnatal presentation (p < 0.05). Infants with haemodynamic instability preoperatively were more likely to have been diagnosed postnatally (p < 0.01).
Antenatal diagnosis of coarctation of the aorta is associated with improved survival and preoperative clinical condition.
探讨与出生后诊断相比，主动脉缩窄的产前诊断是否能降低死亡率并改善术前血流动力学稳定性。
对1994年1月至1998年12月在一家三级胎儿及新生儿心脏病服务机构就诊的所有主动脉缩窄病例进行回顾性研究。
查阅产前、产后及尸检记录以确定两组的存活率。记录术前疾病严重程度的指标，包括股动脉搏动情况、虚脱、左心室功能、超声心动图显示的动脉导管通畅情况、凝血状态、重症监护病房住院时间及总住院时间、心率、呼吸频率、血肌酐、血钾及右上肢血压。对所有变量进行单因素和多因素分析，并创建一个累积评分，进行逻辑回归分析。
出生后诊断组的虚脱和死亡更为常见（p<0.05）。产前诊断的婴儿股动脉搏动更易触及，且有超声心动图证据显示动脉导管通畅（分别为p<0.001和p<0.05）。呼吸频率增加与出生后就诊有关（p<0.05）。术前血流动力学不稳定的婴儿更可能是出生后诊断的（p<0.01）。
主动脉缩窄的产前诊断与存活率提高及术前临床状况改善相关。
