Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Fetal Medicine Unit, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom; Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, London, United Kingdom.
National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
J Am Soc Echocardiogr. 2017 May;30(5):485-492.e5. doi: 10.1016/j.echo.2017.01.011. Epub 2017 Mar 9.
The fetal heart at term is exposed to an increase in hemodynamic work as a consequence of fetal growth, increased circulating volume, and alteration in loading patterns due to maturational changes in fetoplacental circulation. The extent to which these cardiovascular changes influence human fetal and neonatal cardiac adaptation has not been fully elucidated. The aim of this study was to evaluate perinatal cardiovascular changes in ventricular geometry and myocardial performance in normal term fetuses.
Prospective study of 108 uncomplicated pregnancies delivering at term. M-mode, two-dimensional or B-mode, pulsed wave Doppler, pulsed wave tissue Doppler, and two-dimensional speckle-tracking imaging were performed a few days before and within 24 hours of birth.
Analysis of paired fetal and neonatal echoes demonstrated significant perinatal changes (P < .0001 for all) in right ventricular (RV) and left ventricular (LV) geometry (RV/LV end-diastolic dimension ratio, 1.2 vs 0.8; RV sphericity index, 0.53 vs 0.40; LV sphericity index, 0.46 vs 0.49). There were corresponding significant (P < .001 for all) perinatal changes in global myocardial performance: LV myocardial performance index, 0.60 versus 0.47; RV myocardial performance index, 0.61 versus 0.42; systolic function: LV longitudinal systolic strain rate, -1.4/sec versus -1.0/sec; RV longitudinal systolic strain rate, -1.5/sec versus -1.0/sec; RV S', 5.3 cm/sec versus 6.5 cm/sec; and diastolic function: LV E'/A', 0.8 versus 1.1.
The findings support the concept that the perinatal period is associated with major changes in fetal ventricular geometry and cardiac function in response to significant alterations in loading conditions. Improved knowledge of perinatal cardiac changes in normal fetuses could facilitate better understanding of cardiac adaptation in normal and pathological pregnancies.
足月胎儿由于胎儿生长、循环血量增加以及胎-胎盘循环成熟变化导致的负荷模式改变，其心脏会承受更多的血流动力学工作。这些心血管变化在多大程度上影响人类胎儿和新生儿的心脏适应性尚未完全阐明。本研究旨在评估正常足月胎儿围产期心室几何形状和心肌功能的变化。
前瞻性研究了 108 例无并发症的足月分娩孕妇。在分娩前几天和出生后 24 小时内进行 M 型、二维或 B 型、脉冲波多普勒、脉冲波组织多普勒和二维斑点追踪成像。
对胎儿和新生儿回声的配对分析显示，右心室（RV）和左心室（LV）几何形状有明显的围产期变化（所有 P <.0001）（RV/LV 舒张末期内径比值，1.2 比 0.8；RV 球形指数，0.53 比 0.40；LV 球形指数，0.46 比 0.49）。整体心肌功能也有相应的显著围产期变化（所有 P <.001）：LV 心肌性能指数，0.60 比 0.47；RV 心肌性能指数，0.61 比 0.42；收缩功能：LV 纵向收缩应变率，-1.4/秒比-1.0/秒；RV 纵向收缩应变率，-1.5/秒比-1.0/秒；RV S'，5.3cm/秒比 6.5cm/秒；舒张功能：LV E'/A'，0.8 比 1.1。
这些发现支持这样一种观点，即围产期与负荷条件的重大变化相关，会导致胎儿心室几何形状和心脏功能的重大变化。更好地了解正常胎儿的围产期心脏变化，可以促进对正常和病理妊娠中心脏适应性的更好理解。
