Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Prenat Diagn. 2018 Mar;38(4):273-279. doi: 10.1002/pd.5224. Epub 2018 Mar 8.
To compare the fetal echocardiographic measurements and neonatal outcome of fetuses with diagnosis of critical pulmonary stenosis (CPS/IVS) and pulmonary atresia with intact ventricular septum (PA/IVS) to identify the predictors of neonatal ductus dependence and the need for neonatal intervention.
Forty-four fetuses with a diagnosis of membranous PA/IVS or CPS/IVS referred to Shanghai Xinhua Hospital Affiliated to Shanghai Jiaotong University between June 2009 and November 2014 were respectively analyzed. We analyzed their fetal and pediatric echocardiographic features and clinical features after birth.
Among the 29 infants in the final analysis, 19 were ductal dependent and were diagnosed as CPS/IVS or PA/IVS after birth. Ten patients with fetal CSP/IVS were ductal independent and were diagnosed as pulmonary stenosis after birth. In midtrimester, significance was only detected in pulmonary valve (PV) regurgitation between 2 groups (P = .009). The fetuses with PV regurgitation in midtrimester were more likely to be ductal independent (odds ratio = 6.67; P = .010) than those with absence of PV regurgitation in the midtrimester scan. In late trimester, the infants in ductus-independent group had better fetal right ventricular development than those in ductus dependent group. The right ventricle over left ventricle length ratio in last scan over 0.86 had the best capability in predicting ductus independence during neonatal period with help of receiver-operating characteristic curve and the logistic regression analysis.
Among fetuses with pulmonary valve stenosis and right ventricle dysplasia at the time of first fetal echo in midtrimester, use of pulmonary valve regurgitation can identify who will be ductal dependent at births. In late trimester, right ventricle over left ventricle length ratio less than 0.86 had the best capability of predicting neonatal ductal dependence. Fetuses with reversed ductus arteriosus flow direction in late trimester were more likely to be ductus dependent after birth.
比较超声心动图诊断为严重肺动脉瓣狭窄（CPS/IVS）和室间隔完整的肺动脉闭锁（PA/IVS）胎儿的胎儿心脏超声测量值和新生儿结局，以确定新生儿依赖动脉导管的预测因素和需要新生儿干预的情况。
对 2009 年 6 月至 2014 年 11 月期间上海交通大学附属新华医院收治的 44 例膜部 PA/IVS 或 CPS/IVS 胎儿进行分别分析。我们分析了他们的胎儿和儿科超声心动图特征以及出生后的临床特征。
在最终分析的 29 例婴儿中，有 19 例依赖动脉导管，出生后被诊断为 CPS/IVS 或 PA/IVS。10 例胎儿 CSP/IVS 不依赖动脉导管，出生后被诊断为肺动脉瓣狭窄。在中期妊娠时，两组间仅发现肺动脉瓣反流有统计学差异（P=0.009）。中期妊娠时存在肺动脉瓣反流的胎儿更有可能不依赖动脉导管（比值比=6.67；P=0.010）。在晚期妊娠时，不依赖动脉导管的婴儿的右心室发育比依赖动脉导管的婴儿更好。最后一次扫描时右心室/左心室长度比大于 0.86 对预测新生儿期不依赖动脉导管具有最佳能力，这可以通过接受者操作特征曲线和逻辑回归分析得到。
在中期妊娠首次胎儿超声心动图检查时存在肺动脉瓣狭窄和右心室发育不良的胎儿中，肺动脉瓣反流的使用可以识别出生时依赖动脉导管的胎儿。在晚期妊娠时，右心室/左心室长度比小于 0.86 对预测新生儿依赖动脉导管具有最佳能力。晚期妊娠时出现动脉导管血流方向逆转的胎儿出生后更有可能依赖动脉导管。
