Wolter Aline, Kawecki Andrea, Stressig Rüdiger, Ritgen Jochen, Degenhardt Jan, Enzensberger Christian, Axt-Fliedner Roland
Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University and UKGM, Giessen, Germany.
Prenatal.de, Köln, Germany.
Ultraschall Med. 2017 Apr;38(2):198-205. doi: 10.1055/s-0035-1553269. Epub 2015 Oct 1.
The purpose of this study was to assess the cardiac axis in fetuses with conotruncal anomalies during four-chamber view scanning. We retrospectively evaluated the cardiac axis of 150 fetuses with conotruncal anomalies within the second and third trimester between October 2008 and August 2014. The cardiac axis was obtained by the angle of two lines in a transverse view of the fetal thorax at the level of the four-chamber view. The first line divided the thorax into two equal halves starting from the spine posteriorly ending at the sternum. The second line was placed through the interventricular septum of the fetal heart. The angle was calculated using OsiriX software. 23 had double outlet right ventricle (DORV), 17 had truncus arteriosus communis (TAC), 36 had tetralogy of Fallot (TOF), and 74 had complete transposition of the great arteries (d-TGA). In fetuses with DORV ≤ 24 + 6 weeks of gestation (wks), the mean cardiac axis was 52.5° (p = 0.005), at ≥ 25 + 0 wks it was 51.1° (p = 0.0003). In fetuses with TAC ≤ 24 + 6 wks, the mean cardiac axis was 56.8° (p = 0.01), at ≥ 25 + 0 wks it was 50.0° (p = 0.05). In fetuses with TOF ≤ 24 + 6 wks, the mean cardiac axis was 67.5° (p < 0.0001), at ≥ 25 + 0 wks it was 63.8° (p < 0.0001). In fetuses with d-TGA ≤ 24 + 6 wks, the mean cardiac axis was 45.6°, at ≥ 25 + 0 wks it was 45.4° (not significant). Throughout gestation, the cardiac axis did not show a difference in the two separate examinations. In fetuses with DORV, TAC and TOF, the cardiac axis is significantly different from the normal axis, but in fetuses with TGA there is no significant difference compared to the normal axis. Therefore, analysis of the heart axis could be useful for screening for conotruncal anomalies.
本研究的目的是在四腔心切面扫描时评估圆锥干畸形胎儿的心脏轴。我们回顾性评估了2008年10月至2014年8月期间孕中期和孕晚期的150例圆锥干畸形胎儿的心脏轴。心脏轴通过胎儿胸部四腔心水平横切面两条线的夹角获得。第一条线从脊柱后方开始将胸部分为两个相等的部分，止于胸骨。第二条线穿过胎儿心脏的室间隔。使用OsiriX软件计算角度。23例为右心室双出口（DORV），17例为共同动脉干（TAC），36例为法洛四联症（TOF），74例为完全性大动脉转位（d-TGA）。在孕周≤24+6周的DORV胎儿中，平均心脏轴为52.5°（p=0.005），孕周≥25+0周时为51.1°（p=0.0003）。在孕周≤24+6周的TAC胎儿中，平均心脏轴为56.8°（p=0.01），孕周≥25+0周时为50.0°（p=0.05）。在孕周≤24+6周的TOF胎儿中，平均心脏轴为67.5°（p<0.0001），孕周≥25+0周时为63.8°（p<0.0001）。在孕周≤24+6周的d-TGA胎儿中，平均心脏轴为45.6°，孕周≥25+0周时为45.4°（无显著性差异）。在整个孕期，两次独立检查的心脏轴无差异。在DORV、TAC和TOF胎儿中，心脏轴与正常轴有显著差异，但在TGA胎儿中与正常轴相比无显著差异。因此，心脏轴分析可能有助于圆锥干畸形的筛查。
