Gewillig Marc, Brown Stephen C, Roggen Mieke, Eyskens Benedicte, Heying Ruth, Givron Patrice, Cools Bjorn, de Catte Luc
a Department of Fetal and Pediatric Cardiology , University Hospitals Leuven , Leuven , Belgium.
b Department of Pediatric Cardiology , University of the Free State , Bloemfontein , South Africa.
Acta Cardiol. 2017 Dec;72(6):625-635. doi: 10.1080/00015385.2017.1314876. Epub 2017 Jul 26.
Foetal ductal problems may have various cardiopulmonary consequences. This study aimed to identify the spectrum of ductus arteriosus (DA) dysfunction (closure, constriction, kinking, aneurysm and thrombosis) and the resultant clinical and echocardiographic presentation in foetuses and neonates.
This is a retrospective analysis of serial pre- and post-natal data of 27 cases of foetal ductal dysfunction diagnosed at a median gestational age of 33 weeks (range 20-39). The most common abnormalities observed were premature closure of the DA in 56% (15/27) and constriction in 29% (8/27). Right ventricular hypertrophy was present in 75% (n = 11/15) of foetuses with premature DA closure, while ventricular dilation (4/7, 57%) was a more common feature in foetuses with ductal constriction. After birth, 63% (17/27) of new borns presented with cyanosis and pulmonary hypertension that required active treatment. Three infants died after birth. Abnormalities resolved spontaneously after birth in about 50% of patients. In some children, pulmonary valve stenosis and regurgitation was progressive and required further treatment.
An abnormal right heart on foetal four-chamber ultrasound view should alert the sonographer to the possible presence of foetal ductal dysfunction. Ductal occlusion, transient or fixed constriction, kinking and aneurysm formation are associated with foetal cardiopulmonary sequelae. Symptoms and pathology is probably related to the type, foetal age, rapidity of progression and duration of intrauterine ductal dysfunction. Correspondingly, clinical outcomes vary ranging from little or no symptoms to severe respiratory distress and even foetal or neonatal death.
胎儿导管问题可能会产生各种心肺后果。本研究旨在确定动脉导管（DA）功能障碍（闭合、狭窄、扭结、动脉瘤和血栓形成）的范围以及胎儿和新生儿由此产生的临床和超声心动图表现。
这是一项对27例胎儿导管功能障碍病例的产前和产后连续数据进行的回顾性分析，这些病例的中位孕周为33周（范围20 - 39周）。观察到的最常见异常是DA过早闭合，占56%（15/27），狭窄占29%（8/27）。DA过早闭合的胎儿中，75%（n = 11/15）存在右心室肥厚，而导管狭窄的胎儿中，心室扩张（4/7，57%）是更常见的特征。出生后，63%（17/27）的新生儿出现紫绀和肺动脉高压，需要积极治疗。3名婴儿出生后死亡。约50%的患者出生后异常自发缓解。在一些儿童中，肺动脉瓣狭窄和反流呈进行性发展，需要进一步治疗。
胎儿四腔心超声检查发现右心异常应提醒超声检查者注意可能存在胎儿导管功能障碍。导管闭塞、短暂或固定性狭窄、扭结和动脉瘤形成与胎儿心肺后遗症有关。症状和病理可能与类型、胎龄、进展速度和宫内导管功能障碍持续时间有关。相应地，临床结局各不相同，从几乎没有症状到严重呼吸窘迫甚至胎儿或新生儿死亡。
