Tulzer G, Gudmundsson S, Wood D C, Cohen A W, Weiner S, Huhta J C
Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Ultrasound Obstet Gynecol. 1994 Jul 1;4(4):279-83. doi: 10.1046/j.1469-0705.1994.04040279.x.
Fetal ultrasound studies were performed on 24 fetuses with non-immune hydrops to evaluate echocardiographic and cardiovascular Doppler parameters that may be useful in assessing hemodynamics and in predicting outcome. Of all cardiovascular parameters analyzed, only the presence of abnormal pulsations in the umbilical vein (p < 0.001) was found to be significantly different between the 11 survivors and 13 non-survivors. In a smaller subset of 12 fetuses, in whom inferior vena caval waveforms were recorded, survivors (n = 6) had a significantly lower percentage of retrograde flow in the inferior vena cava (p < 0.001) and higher inferior vena caval E/V velocity ratio (p < 0.001) than non-survivors (n = 6). Sixteen of the 24 cases examined had abnormal umbilical venous pulsations; 12 of the 16 (75%) died including all fetuses with hydrops due to twin-to-twin transfusion or congenital heart disease. When fetuses with pulsatile flow in the umbilical vein were compared with fetuses with normal umbilical venous flow, the following significant differences were found: lower right and left ventricular output velocities, larger inferior vena caval diameter, decreased shortening fractions of the right and left ventricles, and lower peak velocities at the aortic and pulmonary valves and in the ductus arteriosus.
对24例非免疫性水肿胎儿进行了胎儿超声检查，以评估可能有助于评估血流动力学和预测预后的超声心动图及心血管多普勒参数。在所有分析的心血管参数中，仅发现脐静脉异常搏动的存在（p<0.001）在11例存活者和13例非存活者之间存在显著差异。在一个较小的12例胎儿亚组中记录了下腔静脉波形，存活者（n=6）下腔静脉逆向血流百分比显著低于非存活者（n=6）（p<0.001），下腔静脉E/V速度比显著高于非存活者（p<0.001）。在检查的24例病例中，16例有脐静脉搏动异常；16例中的12例（75%）死亡，包括所有因双胎输血或先天性心脏病导致水肿的胎儿。将脐静脉有搏动血流的胎儿与脐静脉血流正常的胎儿进行比较时，发现了以下显著差异：左右心室输出速度较低、下腔静脉直径较大、左右心室缩短分数降低，以及主动脉瓣、肺动脉瓣和动脉导管处的峰值速度较低。
