Division of Neonatology, Maternal and Perinatal Medical Center, Department of Pediatrics, Kurume University School of Medicine, Kurume, Japan.
J Perinatol. 2013 Jun;33(6):486-9. doi: 10.1038/jp.2012.93.
A 22-week fetus presented with a large left ventricular aneurysm, 24 × 21 × 18 mm in size, detected by abnormal four-chamber view, and severe fetal hydrops with pericardial effusion, ascites and skin edema. The aneurysm was thin-walled, hypokinetic, and had enlarged with gestational age, causing compression of the lung. Although the left ventricular function had progressively impaired as expressed by increase in Tei index, hydrops had resolved by 32 weeks of gestation, probably because of maternal digoxin therapy and successful compensation by the right ventricle, as represented by retrograde blood flow in the distal aortic arch via the patent arterial duct. Because of the significant risk of severe cardiorespiratory failure, we transported the mother to a neonatal cardiac surgical center at 38 weeks of gestation. Indeed, the baby showed severe cardiopulmonary failure after birth, showing 100% of cardiothoracic ratio on the chest X-ray film, but was saved by the successful Dor procedure, including surgical resection of the aneurysm at 10 h of life. In this case, serial echocardiographic evaluation can allow us to monitor the hemodynamics and lead to successful postnatal management.
一个 22 周的胎儿通过异常的四腔心切面检查发现一个大小为 24×21×18mm 的巨大左心室动脉瘤，同时伴有严重的胎儿水肿，有心包积液、腹水和皮肤水肿。动脉瘤壁薄，运动减弱，随着胎龄增大而增大，压迫肺部。尽管左心室功能通过 Tei 指数的增加逐渐受损，但水肿在 32 周时已经消退，这可能是由于母亲使用地高辛治疗和右心室成功代偿所致，表现为通过未闭的动脉导管在远端主动脉弓逆行血流。由于严重心肺衰竭的风险很大，我们在 38 周时将母亲转运到新生儿心脏外科中心。事实上，婴儿出生后立即出现严重的心肺衰竭，胸部 X 光片显示心胸比达到 100%，但通过成功的 Dor 手术（包括在出生后 10 小时对动脉瘤进行手术切除）得以挽救。在这种情况下，连续的超声心动图评估可以帮助我们监测血液动力学，并导致成功的产后管理。
