Gardiner Helena M
Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London W12 ONN, UK.
Semin Fetal Neonatal Med. 2005 Dec;10(6):578-85. doi: 10.1016/j.siny.2005.08.001. Epub 2005 Oct 4.
The outcome of cardiac disease diagnosed before birth is paradoxically worse than that diagnosed postnatally. In part, this is because fetal screening detects cases that are already showing failure of cardiac growth which are usually progressive with secondary damage to the myocardium, lungs and brain. Fetal valvuloplasty has been proposed for cases of critical aortic and pulmonary stenosis or atresia, and atrial septostomy for a restrictive oval foramen associated with aortic stenosis, hypoplastic left heart syndrome and transposition of the great arteries. The rationale for fetal therapy is to restore forward flow and reduce intraventricular pressure, thus improving coronary perfusion and minimizing ischaemic damage. Successful valvuloplasty has reduced systemic venous pressures and reversed fetal hydrops, thus prolonging pregnancy. It has resulted in improved ventricular growth in some cases and spontaneous opening of a closed oval foramen with normalization of pulmonary venous waveforms. These signs suggest better fetal cardiopulmonary development and improved surgical outcomes.
出生前被诊断出的心脏病，其结果反常地比出生后诊断出的更糟。部分原因是胎儿筛查检测出的病例已经表现出心脏生长衰竭，这种情况通常会进展，并对心肌、肺和脑造成继发性损害。对于严重的主动脉和肺动脉狭窄或闭锁病例，已提出进行胎儿瓣膜成形术；对于与主动脉狭窄、左心发育不全综合征和大动脉转位相关的限制性卵圆孔，则进行房间隔造口术。胎儿治疗的基本原理是恢复前向血流并降低心室内压力，从而改善冠状动脉灌注并将缺血性损伤降至最低。成功的瓣膜成形术降低了体静脉压力并逆转了胎儿水肿，从而延长了孕期。在某些情况下，它还促进了心室生长，并使闭合的卵圆孔自发开放，肺静脉波形恢复正常。这些迹象表明胎儿心肺发育更好，手术结果也会得到改善。
