Ebishima Hironori, Kurosaki Kenichi, Yoshimatsu Jun, Shiraishi Isao
Department of Pediatric Cardiology,National Cerebral and Cardiovascular Center,Osaka,Japan.
Cardiol Young. 2017 Aug;27(6):1162-1166. doi: 10.1017/S1047951116002675. Epub 2017 Jan 12.
This study aimed to determine fetal echocardiographic features of tetralogy of Fallot in association with postnatal outcomes.
The Z-scores of the main and bilateral pulmonary arteries and the aorta were measured, and the following variables were calculated in 13 fetuses with tetralogy of Fallot: pulmonary artery-to-aorta ratio and main pulmonary artery cross-section ratio - the main pulmonary artery diameter squared divided by the sum of the diameter squared of the left and right pulmonary arteries. Fetuses were classified as having ductus arteriosus-dependent or ductus arteriosus-independent pulmonary circulation.
We included two infants with pulmonary atresia and six infants with ductus-dependent pulmonary circulation, who underwent systemic-to-pulmonary shunt surgeries at ⩽1 month of age. The Z-scores of the main pulmonary artery and the pulmonary artery-to-aorta ratio in fetuses with ductus-dependent pulmonary circulation were lesser than those in fetuses with ductus independence, but not significantly. The main pulmonary artery cross-section ratio in fetuses with ductus dependence was significantly lesser (0.65±0.44 versus 1.56±0.48, p<0.005). Besides, the flow of the ductus arteriosus was directed from the aorta to the pulmonary artery in the ductus arteriosus-dependent group during the fetal period.
The main pulmonary artery cross-section ratio was the most significant variable for predicting postnatal outcomes in fetuses with tetralogy of Fallot.
本研究旨在确定法洛四联症的胎儿超声心动图特征及其与产后结局的关系。
测量主肺动脉、双侧肺动脉及主动脉的Z值，并计算13例法洛四联症胎儿的以下变量：肺动脉与主动脉比值及主肺动脉横截面积比值（主肺动脉直径的平方除以左右肺动脉直径平方之和）。将胎儿分为动脉导管依赖性或非动脉导管依赖性肺循环。
我们纳入了2例肺动脉闭锁婴儿和6例动脉导管依赖性肺循环婴儿，他们在1月龄及以内接受了体肺分流手术。动脉导管依赖性肺循环胎儿的主肺动脉Z值及肺动脉与主动脉比值低于非动脉导管依赖性胎儿，但差异无统计学意义。动脉导管依赖性胎儿的主肺动脉横截面积比值显著更低（0.65±0.44对1.56±0.48，p<0.005）。此外，在胎儿期，动脉导管依赖性组的动脉导管血流方向为从主动脉至肺动脉。
主肺动脉横截面积比值是预测法洛四联症胎儿产后结局的最显著变量。
