Jung Eui, Won Hye-Sung, Lee Pil Ryang, Kim Ahm, Park In-Sook
Department of Obstetrics and Gynecology, College of Medicine, KyungHee University, Seoul, Korea.
Prenat Diagn. 2007 Aug;27(8):695-8. doi: 10.1002/pd.1756.
To evaluate the clinical implication of isolated right dominant heart (RDH) in fetal echocardiography.
We reviewed the medical records of pregnant women diagnosed with fetal RDH at Asan Medical Center from December 1999 to December 2005. The criteria of RDH were the ratio of right-to-left atrial and ventricular width and the ratio of the diameter of pulmonary artery-to-aorta were greater than 1.5. Fetuses with congenital heart disease, including coarctation of the aorta (CoA), noncardiac anomalies or chromosomal abnormalities were excluded.
RDH was identified in 44 fetuses. Twenty-nine (66%) were confirmed to have normal heart and 15 (34%) had cardiac anomalies by postnatal echocardiogrphy; 11 CoA, 1 interruption of aortic arch, 1 patent ductus arteriosus, and 2 ventricular septal defect. Mean gestational age at presentation with RDH was later in normal fetuses as compared to fetuses with CoA (p < 0.005). Only 26% (4/15) of fetuses presenting with RDH during the second-trimester were found to have normal heart postnatally, compared with 86% (25/29) of those diagnosed in the third-trimester.
RDH in the fetus is a risk factor for postnatal CoA particularly when diagnosed in the second-trimester, and should be an indication for neonatal echocardiography.
评估胎儿超声心动图中孤立性右优势型心脏（RDH）的临床意义。
我们回顾了1999年12月至2005年12月在峨山医学中心被诊断为胎儿RDH的孕妇的病历。RDH的标准为右心房与左心房宽度之比以及肺动脉与主动脉直径之比大于1.5。排除患有先天性心脏病（包括主动脉缩窄（CoA））、非心脏畸形或染色体异常的胎儿。
44例胎儿被诊断为RDH。29例（66%）出生后超声心动图证实心脏正常，15例（34%）有心脏异常；11例CoA、1例主动脉弓中断、1例动脉导管未闭和2例室间隔缺损。与CoA胎儿相比，出现RDH时的平均孕周在正常胎儿中更晚（p<0.005）。孕中期出现RDH的胎儿中，只有26%（4/15）出生后心脏正常，而孕晚期诊断出的胎儿中这一比例为86%（25/29）。
胎儿RDH是出生后发生CoA的危险因素，尤其是在孕中期诊断出时，应作为新生儿超声心动图检查的指征。
