Volpe P, Campobasso G, Stanziano A, De Robertis V, Di Paolo S, Caruso G, Volpe N, Gentile M
Department of Obstetrics and Gynecology, Hospital Di Venere, Bari, Italy.
Ultrasound Obstet Gynecol. 2006 Jul;28(1):40-6. doi: 10.1002/uog.2818.
To assess the reliability of two-dimensional gray-scale (2D) and color Doppler echocardiography in the study of the size and anatomy of the central pulmonary arteries and of the sources of pulmonary blood flow in a case series of fetuses with pulmonary atresia and ventricular septal defect (PA-VSD), and to evaluate whether the use of 4D ultrasound with B-flow imaging and spatio-temporal image correlation (STIC) can improve prenatal diagnostic accuracy.
The study population comprised a group of seven PA-VSD fetuses that had been examined by 2D and color Doppler echocardiography exclusively, and a group of five additional cases identified initially by conventional echocardiography and examined further by 4D ultrasound, for all of which a thorough postnatal or autopsy study of the size and anatomy of the pulmonary arteries and blood supply was available.
2D and color Doppler echocardiography failed to assess the anatomy of the central pulmonary arteries and the source of the pulmonary blood supply in 33% and 25% of the 12 cases, respectively. 4D ultrasound with B-flow imaging and STIC assessed successfully the anatomy of the pulmonary arteries and the source of pulmonary blood supply in all five fetuses examined.
The prognosis of PA-VSD is influenced by the anatomy of the pulmonary arteries and the sources of the pulmonary blood supply, and by coexisting extracardiac and genetic anomalies. Our findings, although limited to a small sample size, suggest that 4D echocardiography with B-flow imaging and STIC, unlike 2D ultrasound, can provide thorough visualization of very small vessels and of the arterial blood supply to the lungs of fetuses with PA-VSD. 4D ultrasound may be used in the future to improve and help to detail the diagnosis of other fetal cardiac defects.
在一系列肺动脉闭锁合并室间隔缺损（PA-VSD）胎儿病例中，评估二维灰阶（2D）和彩色多普勒超声心动图在研究中央肺动脉大小及解剖结构以及肺血流来源方面的可靠性，并评估使用带有B-flow成像和时空图像相关（STIC）技术的四维超声是否能提高产前诊断准确性。
研究人群包括一组仅接受过2D和彩色多普勒超声心动图检查的7例PA-VSD胎儿，以及另一组最初通过传统超声心动图确诊并进一步接受四维超声检查的5例额外病例，所有这些病例均有关于肺动脉大小及解剖结构以及血液供应的详细产后或尸检研究资料。
在这12例病例中，2D和彩色多普勒超声心动图分别在33%和25%的病例中未能评估中央肺动脉的解剖结构及肺血供应来源。带有B-flow成像和STIC技术的四维超声成功评估了所有5例接受检查胎儿的肺动脉解剖结构及肺血供应来源。
PA-VSD胎儿的预后受肺动脉解剖结构、肺血供应来源以及并存的心外和基因异常影响。我们的研究结果虽然样本量有限，但表明与2D超声不同，带有B-flow成像和STIC技术的四维超声能够清晰显示PA-VSD胎儿肺部非常细小血管及动脉血供应情况。未来四维超声可能用于改善并有助于详细诊断其他胎儿心脏缺陷。
