Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Ultrasound Obstet Gynecol. 2018 Nov;52(5):593-598. doi: 10.1002/uog.17543. Epub 2018 Oct 1.
Cardiac ventricular size disproportion is a marker for aortic coarctation (CoA) in fetal life, but approximately 50% of fetuses do not have CoA after birth. The aim of this study was to evaluate the postnatal outcome of cases with fetal ventricular size disproportion in the absence of CoA after birth.
All cases with fetal isolated ventricular size disproportion diagnosed between 2002 and 2015 were extracted from a prenatal congenital heart defects regional registry. Cases were stratified according to presence or absence (non-CoA) of aortic arch anomalies after birth. Postnatal outcome of non-CoA cases was evaluated by assessing the presence of cardiac and other congenital malformations, genetic syndromes and other morbidity after birth. Non-CoA cases were further classified according to whether they had cardiovascular pathology requiring medication or intervention.
Seventy-seven cases with fetal ventricular size disproportion were identified, of which 46 (60%) did not have CoA after birth. Of these, 35 did not require cardiovascular intervention or medication, whereas 11 did. Of the 46 non-CoA cases, six presented with clinical pulmonary hypertension requiring treatment after birth, cardiac defects were present in 24 cases and syndromic features were seen in four. Overall, 43% of all non-CoA children were still under surveillance at the end of the study period.
The postnatal course of cases with fetal ventricular size disproportion is complicated by prenatally undetected congenital defects (46%) and pulmonary or transition problems (35%) in a significant number of cases that do not develop CoA. Proper monitoring of these cases is therefore warranted and it is advisable to incorporate the risks for additional morbidity and neonatal complications in prenatal counseling. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
胎儿心室大小比例失调是主动脉缩窄（CoA）的标志，但大约 50%的胎儿在出生后没有 CoA。本研究旨在评估出生后无 CoA 的胎儿心室大小比例失调病例的产后结局。
从 2002 年至 2015 年的产前先天性心脏病区域登记处提取所有诊断为胎儿孤立性心室大小比例失调的病例。根据出生后主动脉弓异常的存在（非 CoA）将病例分层。通过评估出生后是否存在心脏和其他先天性畸形、遗传综合征和其他发病率来评估非 CoA 病例的产后结局。非 CoA 病例进一步根据是否存在需要药物或干预的心血管病理进行分类。
共发现 77 例胎儿心室大小比例失调病例，其中 46 例（60%）出生后无 CoA。其中，35 例不需要心血管介入或药物治疗，而 11 例需要。在 46 例非 CoA 病例中，6 例在出生后出现临床肺动脉高压需要治疗，24 例存在心脏缺陷，4 例存在综合征特征。总的来说，所有非 CoA 儿童中有 43%在研究结束时仍在接受监测。
在很大一部分不发生 CoA 的病例中，胎儿心室大小比例失调的产后病程复杂，伴有产前未发现的先天性缺陷（46%）和肺部或过渡问题（35%）。因此，对这些病例进行适当监测是必要的，并建议在产前咨询中纳入额外发病率和新生儿并发症的风险。版权所有 © 2017 ISUOG。由 John Wiley & Sons Ltd 出版。
