Fetal Heart Program at the Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Ultrasound Obstet Gynecol. 2013 Jan;41(1):47-53. doi: 10.1002/uog.11196. Epub 2012 Dec 5.
To identify prenatal echocardiographic markers that could predict the need for neonatal intervention in fetuses with right ventricular outflow tract obstruction.
This was a retrospective study of 52 fetuses with right ventricular outflow tract obstruction. Echocardiograms were evaluated for fetuses with either two-ventricle anatomy with a large ventricular septal defect or single-ventricle anatomy. Fetuses with pulmonary atresia were excluded. Parameters were compared between groups that did and did not require an intervention at age < 30 days.
Fifty-two fetuses were studied; 20 (38%) underwent neonatal intervention and 32 (62%) did not. The most common diagnosis was tetralogy of Fallot (n = 32). Fetuses with two ventricles that required an intervention had lower pulmonary valve diameter Z-score (PV-Z-score) (-4.8 ± 2.1 vs. -2.6 ± 1.1; P = 0.0002) and lower pulmonary valve to aortic valve annular diameter ratio (PV/AoV) (0.53 ± 0.15 vs. 0.66 ± 0.1; P = 0.003). Using a PV/AoV ratio of < 0.6 or a PV-Z-score of < -3 at final echocardiographic examination was highly sensitive (92%) but poorly specific (50%), whereas classifying direction of flow in the ductus arteriosus as either normal (all pulmonary-to-aorta) or abnormal (aorta-to-pulmonary or bidirectional) was both highly sensitive (100%) and specific (95%) for predicting the need for a neonatal intervention. Parameters for the single-ventricle cohort did not reach statistical significance.
Analysis of the pulmonary outflow tract and ductus arteriosus flow in the fetus with complex congenital heart disease can aid in identifying those that will require a neonatal intervention to augment pulmonary blood flow. This has important implications for the planning of delivery strategies.
确定产前超声心动图指标，以预测右心室流出道梗阻胎儿需要新生儿干预的情况。
这是一项对 52 例右心室流出道梗阻胎儿的回顾性研究。对具有大室间隔缺损的双心室解剖结构或单心室解剖结构的胎儿进行超声心动图评估。排除肺动脉闭锁的胎儿。比较在 30 天龄前需要和不需要干预的两组之间的参数。
研究了 52 例胎儿；20 例（38%）新生儿需要干预，32 例（62%）不需要。最常见的诊断是法洛四联症（n=32）。需要干预的双心室胎儿的肺动脉瓣直径 Z 评分（PV-Z 评分）较低（-4.8±2.1 比-2.6±1.1；P=0.0002），肺动脉瓣与主动脉瓣环直径比（PV/AoV）较低（0.53±0.15 比 0.66±0.1；P=0.003）。在最终超声心动图检查中，PV/AoV 比值<0.6 或 PV-Z 评分<-3 具有很高的敏感性（92%），但特异性（50%）较低，而将动脉导管内的血流方向分类为正常（均为肺动脉至主动脉）或异常（主动脉至肺动脉或双向）对预测新生儿干预的需要具有很高的敏感性（100%）和特异性（95%）。单心室队列的参数未达到统计学意义。
对患有复杂先天性心脏病的胎儿进行肺流出道和动脉导管血流分析，可以帮助识别需要新生儿干预以增加肺血流量的患者。这对分娩策略的规划具有重要意义。
