Feng Juan, Zhu Mei, Liang Hao, Li Qiao
Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China.
Chin Med J (Engl). 2017 Mar 5;130(5):574-580. doi: 10.4103/0366-6999.200544.
Right dominant heart (RDH) in fetuses can occur with a number of cardiac as well as noncardiac anomalies. Analysis of the enlargement of the right cardiac chamber in the fetus remains a major challenge for sonographers and echocardiographers. The aim of this study was to report the experience with prenatal diagnosis of RDH in the fetuses over a 7-year period.
Fetuses with prenatal diagnosis of RDH from July 2009 to July 2016 were evaluated in two different categories: according to the gestational age, Group I (n = 154, second trimester) and Group II (n = 298, third trimester); and according to the fetal echocardiography diagnosis, Group A (n = 452, abnormal cardiac structure) and Group B (n = 90, normal cardiac structure). Differences in categorical variables were assessed by Chi-square exact test and continuous variables were evaluated by independent Student's t-test or Mann-Whitney U-test depending on parametric or nonparametric nature of the data.
Over a 7-year period, 452 fetuses were referred for the assessment of suspected RDH. Left-sided obstructive lesions were observed most frequently in the fetuses with RDH. When comparing Group I with Group II and Group A with Group B, the latter groups exhibited significant differences in the right/left ventricle (RV/LV) ratio (1.435 vs. 1.236, P = 0.002; 1.309 vs. 1.168, P = 0.047), RV width Z-score (1.626 vs. 1.104, P < 0.001; 1.553 vs. 0.814, P = 0.014), and above +2 cutoff percentages (14.3% vs. 22.5%; P = 0.038; 21.5% vs. 12.2%, P = 0.046). Multivariable logistic regression revealed no variables associated with perinatal survival.
The study demonstrates that RDH warrants careful attention to the possible presence of a structural cardiac anomaly, especially left-sided obstructive lesions. A diagnosis of RDH is best supported by a combination of the RV Z-score and RV/LV ratio. Most of the fetuses with RDH and structurally normal hearts had favorable outcomes.
胎儿右优势型心脏（RDH）可伴有多种心脏及非心脏异常。分析胎儿右心腔增大对超声检查医师和超声心动图检查医师而言仍是一项重大挑战。本研究的目的是报告7年间胎儿RDH产前诊断的经验。
对2009年7月至2016年7月产前诊断为RDH的胎儿按两种不同类别进行评估：根据孕周，I组（n = 154，孕中期）和II组（n = 298，孕晚期）；根据胎儿超声心动图诊断，A组（n = 452，心脏结构异常）和B组（n = 90，心脏结构正常）。分类变量的差异通过卡方精确检验评估，连续变量根据数据的参数或非参数性质通过独立样本t检验或曼-惠特尼U检验进行评估。
在7年期间，452例胎儿因疑似RDH接受评估。RDH胎儿中最常观察到左侧梗阻性病变。比较I组与II组以及A组与B组时，后两组在右心室/左心室（RV/LV）比值（1.435对1.236，P = 0.002；1.309对1.168，P = 0.047）、右心室宽度Z评分（1.626对1.104，P < 0.001；1.553对0.814，P = 0.014）以及高于+2临界值百分比（14.3%对22.5%；P = 0.038；21.5%对12.2%，P = 0.046）方面存在显著差异。多变量逻辑回归显示无变量与围产期生存相关。
该研究表明，RDH需要仔细关注可能存在的心脏结构异常，尤其是左侧梗阻性病变。右心室Z评分和RV/LV比值相结合最有助于RDH的诊断。大多数心脏结构正常的RDH胎儿预后良好。
