Pasternok Marcin, Nocun Agnieszka, Knafel Anna, Grzesiak Mariusz, Orzechowski Maciej, Konarska Katarzyna, Ludwin Artur, Ludwin Inga, Zymroz Piotr, Parzynska Anna, Wiechec Marcin
Center for Prenatal Diagnostics, Opole, Poland.
Dobreusg Ultrasound Group Practice, Krakow, Poland.
J Ultrasound Med. 2018 Aug;37(8):1869-1880. doi: 10.1002/jum.14533. Epub 2017 Dec 27.
The "Y sign" at the level of the 3-vessel and trachea view corresponds to thinning of main pulmonary artery and arterial duct and a dilated transverse aortic arch. The purpose of this study was to evaluate the Y sign for the diagnosis of aortic dextroposition anomalies at the time of the first-trimester scan and to assess the screening performance of only the Y sign, only abnormal left axis deviation (axis sign), and their combination for the diagnosis of aortic dextroposition anomalies.
A prospective evaluation of 6025 pregnant women undergoing first-trimester ultrasonography was conducted. The cardiac axis was measured in all examined patients and considered abnormal (positive axis sign) at greater than 57 °. The frequency of the Y sign and the axis sign was assessed for this population, and their screening performance for the diagnosis of aortic dextroposition anomalies was calculated.
A total of 5775 patients fulfilled the inclusion criteria. Aortic dextroposition anomalies were diagnosed in 17 cases (tetralogy of Fallot in 8 and Fallot-like double-outlet right ventricle in 9). The Y sign was found in 18 of 5775 (0.3%) fetuses examined, of which 7 of 18 were confirmed with tetralogy of Fallot, 9 of 18 with a Fallot-like double-outlet right ventricle, and 2 of 18 with pulmonary stenosis. A positive axis sign of greater than 57 ° was found in 20 fetuses, including 4 with normal heart anatomy. The sensitivity values of the Y sign, the axis sign, and their combination were 94%, 76%, and 94%, respectively.
Visualization of the Y sign should increase the suspicion of aortic dextroposition anomalies in the late first trimester. The screening performance of the Y sign alone and in combination with an abnormal cardiac axis was high and may aid in the early diagnosis of aortic dextroposition anomalies in the fetus.
在三血管和气管平面的“Y 征”对应于主肺动脉和动脉导管变细以及横位主动脉弓扩张。本研究的目的是评估孕早期超声检查时“Y 征”对诊断主动脉右旋异常的价值，并评估仅“Y 征”、仅异常左轴偏移（轴征）及其联合应用对诊断主动脉右旋异常的筛查效能。
对 6025 例接受孕早期超声检查的孕妇进行前瞻性评估。测量所有受检患者的心脏轴，大于 57°时视为异常（阳性轴征）。评估该人群中“Y 征”和轴征的出现频率，并计算它们对诊断主动脉右旋异常的筛查效能。
共有 5775 例患者符合纳入标准。诊断出 17 例主动脉右旋异常（法洛四联症 8 例，法洛样右心室双出口 9 例）。在 5775 例接受检查的胎儿中，18 例（0.3%）发现有“Y 征”，其中 18 例中有 7 例确诊为法洛四联症，18 例中有 9 例为法洛样右心室双出口，18 例中有 2 例为肺动脉狭窄。20 例胎儿出现大于 57°的阳性轴征，其中 4 例心脏解剖结构正常。“Y 征”、轴征及其联合应用的敏感度分别为 94%、76%和 94%。
孕早期晚期出现“Y 征”应增加对主动脉右旋异常的怀疑。单独的“Y 征”以及与异常心脏轴联合应用的筛查效能较高，可能有助于胎儿主动脉右旋异常的早期诊断。
