Gardiner Helena M, Pasquini Lucia, Wolfenden Joanne, Barlow Anna, Li Wei, Kulinskaya Elena, Henein Michael
Royal Brompton Hospital, UK.
Int J Cardiol. 2006 Oct 26;113(1):39-47. doi: 10.1016/j.ijcard.2005.10.029. Epub 2005 Dec 19.
Current echocardiographic assessment of fetal ventricular function uses relatively crude measures and this has led to inconsistencies in assessment of diastolic function. Long axis parameters may be more insightful.
To describe fetal long axis cardiac function and construct reference ranges.
159 normal fetuses were studied cross-sectionally using long axis M-mode to measure displacement of the atrioventricular ring and pulsed wave Doppler ultrasound to record myocardial tissue Doppler velocities at the base of the heart.
There was a strong, almost linear gestational relationship for all but late left basal myocardial velocities. Systolic amplitude of the atrioventricular ring increased significantly. Wall thickness increased with gestation and heart rate reduced. Late diastolic mitral and tricuspid flow velocities showed no age-dependence. Right ventricular filling (p<0.0001) and myocardial lengthening (p<0.0001) and shortening velocities (p<0.0001) were higher than left. Aortic velocities were higher than pulmonary (p<0.0001). Right ventricular long axis amplitude was greater than left (p<0.0001). There were no significant differences in right (RV) and left (LV) ventricular and septal thicknesses (RV 2.5 mm [1.2-4.1]; LV (2.4 mm [1.0-4.0] and septum 2.6 mm [1.0-4.3]). Left and right myocardial tissue Doppler velocities showed similar maturation in systole (LV 0.14 vs. RV 0.10 cm/s/week) and early diastole (LV 0.16 vs. RV 0.14 cm/s/week).
This study demonstrates maturational changes occur in both fetal systolic and diastolic ventricular function and moreover the maturational rate of myocardial tissue velocities is similar in both ventricles, despite differential loading conditions.
目前胎儿心室功能的超声心动图评估采用的方法相对粗略，这导致舒张功能评估存在不一致性。长轴参数可能更具洞察力。
描述胎儿心脏长轴功能并构建参考范围。
对159例正常胎儿进行横断面研究，采用长轴M型测量房室环位移，并用脉冲波多普勒超声记录心脏基部心肌组织多普勒速度。
除左心室基底晚期心肌速度外，所有参数与孕周均呈强的、几乎线性的关系。房室环收缩幅度显著增加。室壁厚度随孕周增加，心率降低。舒张晚期二尖瓣和三尖瓣血流速度无年龄依赖性。右心室充盈（p<0.0001）、心肌延长速度（p<0.0001）和缩短速度（p<0.0001）高于左心室。主动脉速度高于肺动脉（p<0.0001）。右心室长轴幅度大于左心室（p<0.0001）。右心室（RV）和左心室（LV）及室间隔厚度无显著差异（RV 2.5mm[1.2 - 4.1]；LV 2.4mm[1.0 - 4.0]，室间隔2.6mm[1.0 - 4.3]）。左、右心肌组织多普勒速度在收缩期（LV 0.14对RV 0.10cm/s/周）和舒张早期（LV 0.16对RV 0.14cm/s/周）显示出相似的成熟度。
本研究表明胎儿心室收缩和舒张功能均发生成熟变化，而且尽管负荷条件不同，但两心室心肌组织速度的成熟率相似。
