Tuo Giulia, Volpe Paolo, Buffi Davide, De Robertis Valentina, Marasini Maurizio
Department of Pediatric Cardiology and Cardiac Surgery, Giannina Gaslini Institute, Genova, Italy.
Congenit Heart Dis. 2014 Sep-Oct;9(5):382-90. doi: 10.1111/chd.12158. Epub 2013 Dec 26.
To describe the antenatal and neonatal echocardiographic morphology and flow pattern of the ductus arteriosus in patients with tetralogy of Fallot.
We included patients with a prenatal diagnosis of tetralogy of Fallot between January 2006 and December 2012.
Among the 52 fetuses with tetralogy of Fallot the severity of right ventricular outflow obstruction was considered mild in 32, moderate in 14, and severe in 6. In the mild right ventricular outflow obstruction group (n = 32) all had normal ductal morphology and flow pattern, eight (25%) elected for termination of pregnancy and two died in the neonatal period from extracardiac causes. In the moderate right ventricular outflow obstruction group (n = 14) the fetuses had a small ductus arteriosus with antegrade but abnormal flow velocity, one (7%) elected for termination of pregnancy. Immediately after birth the ductus arteriosus was very small or already closed at echocardiographic examination. Two out of 13 patients (15%) developed severe hypoxic spells and underwent modified Blalock-Taussig shunt during the neonatal period. Six fetuses were considered to have severe right ventricular outflow obstruction with flow reversal in the ductus arteriosus, three (50%) of whom elected for termination of pregnancy. The other three newborns underwent modified Blalock-Taussig shunt.
In fetuses with tetralogy of Fallot, ductal diameter can be reduced even up to prenatal closure. Prenatal ductal morphology assessment may be useful for improving management of patients with moderate right ventricular outflow obstruction and small ductus arteriosus who may become cyanotic at birth.
描述法洛四联症患者动脉导管的产前及新生儿超声心动图形态和血流模式。
纳入2006年1月至2012年12月期间产前诊断为法洛四联症的患者。
在52例法洛四联症胎儿中，右心室流出道梗阻的严重程度被认为轻度的有32例，中度的有14例，重度的有6例。在轻度右心室流出道梗阻组（n = 32）中，所有胎儿的动脉导管形态和血流模式均正常，8例（25%）选择终止妊娠，2例在新生儿期因心外原因死亡。在中度右心室流出道梗阻组（n = 14）中，胎儿的动脉导管较小，有正向但异常的流速，1例（7%）选择终止妊娠。出生后立即进行超声心动图检查时，动脉导管非常小或已关闭。13例患者中有2例（15%）在新生儿期出现严重缺氧发作并接受了改良布莱洛克-陶西格分流术。6例胎儿被认为有严重的右心室流出道梗阻，动脉导管内血流逆向，其中3例（50%）选择终止妊娠。另外3例新生儿接受了改良布莱洛克-陶西格分流术。
在法洛四联症胎儿中，动脉导管直径可减小甚至在产前就闭合。产前评估动脉导管形态可能有助于改善对中度右心室流出道梗阻且动脉导管较小、出生时可能出现青紫的患者的管理。
