Gembruch U, Meise C, Germer U, Berg C, Geipel A
Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.
Ultrasound Obstet Gynecol. 2003 Oct;22(4):345-50. doi: 10.1002/uog.242.
To assess the influence of isolated congenital heart disease (CHD) on fetal venous Doppler blood flow velocity waveforms.
Doppler flow velocimetry was performed in the inferior vena cava and ductus venosus in 146 consecutive fetuses with antenatally diagnosed CHD. Gestational age ranged between 19 and 39 weeks. Fetuses with isolated CHD without non-immune hydrops fetalis (NIHF) (Group A, n = 89) were separated from seven fetuses showing isolated CHD with NIHF (Group B) and 50 cases complicated by chromosomal or other extracardiac malformations, intrauterine growth restriction or non-cardiogenic NIHF (Group C). The control group comprised 109 healthy fetuses of uncomplicated pregnancies. Individual peak velocity index for veins (PVIV) measurements were converted into their Z-scores (delta values) for statistical analysis.
There was no statistical difference between fetuses with isolated CHD (Group A) and controls, for the delta PVIV of neither the ductus venosus nor the inferior vena cava. Statistical analysis revealed significant differences between non-isolated CHD fetuses (Group C) and controls for both vessels. However, in a separate analysis of isolated right heart malformations compared with the remaining isolated heart malformations (Groups A and B), a significant difference was observed for the ductus venosus, but not the inferior vena cava. There was an overall survival of 62%. In Group A, 58% of fetuses survived despite increased PVIV and 22% of fetuses with normal venous Doppler had an adverse outcome. All fetuses with cardiogenic NIHF (Group B) died.
Doppler studies of the ductus venosus and inferior vena cava in fetuses with isolated CHD do not present sufficient alterations to be a reliable marker for screening purposes for CHD in mid-second- and third-trimester fetuses. Furthermore, venous Doppler did not predict fetal outcome in cases of isolated CHD. Abnormal venous Doppler results were mainly attributable to myocardial dysfunction and also to severe right heart obstruction even in the absence of congestive heart failure. Therefore, venous Doppler studies are clinically helpful in indirectly monitoring cardiac function in fetuses with cardiac malformations.
评估孤立性先天性心脏病（CHD）对胎儿静脉多普勒血流速度波形的影响。
对146例产前诊断为CHD的连续胎儿进行下腔静脉和静脉导管的多普勒血流测速。孕周在19至39周之间。将无非免疫性水肿胎儿（NIHF）的孤立性CHD胎儿（A组，n = 89）与7例伴有NIHF的孤立性CHD胎儿（B组）以及50例合并染色体或其他心外畸形、宫内生长受限或非心源性NIHF的病例（C组）分开。对照组包括109例无并发症妊娠的健康胎儿。将静脉的个体峰值速度指数（PVIV）测量值转换为Z评分（差值）进行统计分析。
孤立性CHD胎儿（A组）与对照组相比，静脉导管和下腔静脉的PVIV差值均无统计学差异。统计分析显示，非孤立性CHD胎儿（C组）与对照组在这两条血管上均存在显著差异。然而，在对孤立性右心畸形与其余孤立性心脏畸形（A组和B组）进行单独分析时，发现静脉导管存在显著差异，而下腔静脉无显著差异。总体生存率为62%。在A组中，尽管PVIV升高，但58%的胎儿存活，22%静脉多普勒正常的胎儿出现不良结局。所有有心源性NIHF的胎儿（B组）均死亡。
对孤立性CHD胎儿进行静脉导管和下腔静脉的多普勒研究未显示出足够的改变，不足以作为孕中期和晚期胎儿CHD筛查的可靠标志物。此外，静脉多普勒不能预测孤立性CHD病例的胎儿结局。静脉多普勒异常结果主要归因于心肌功能障碍，也归因于严重的右心梗阻，即使在无充血性心力衰竭的情况下也是如此。因此，静脉多普勒研究在临床上有助于间接监测心脏畸形胎儿的心脏功能。
