DeVore Greggory R, Jone Pei Ni, Satou Gary, Sklansky Mark, Cuneo Bettina F
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA,
Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.
Fetal Diagn Ther. 2020;47(5):429-439. doi: 10.1159/000500022. Epub 2019 May 27.
An integrated assessment of the size and shape of the 4-chamber view (4-CV) and right and left ventricles (RV and LV) as well as the function of the RV and LV in fetuses with coarctation of the aorta (CoA) has not yet been conducted.
We evaluated the size and shape of the 4-CV, RV, and LV, and function of the RV and LV, to identify a profile for fetuses with CoA when compared to a control population.
50 CoA fetuses were compared to 200 controls. This was a retrospective case series comparing the 4-CV of CoA fetuses and controls. The 4-CV end-diastolic area, length, width, and sphericity index were measured to determine the configuration of the 4-CV. Speckle-tracking analysis was used to compute the RV and LV end-diastolic area, length, 24-segment sphericity index, 24-segment transverse width, and the following functional parameters: (1) fractional area change; (2) global, lateral, and septal strain; (3) basal-apical, lateral, and septal annular displacement and fractional shortening; and (4) 24-segment transverse width fractional shortening. Using 5 and 95% reference intervals, the CoA fetal measurements were classified; from these, the odds ratio was computed between the fetuses with CoA and the controls. p < 0.05 was considered significant.
In fetuses with CoA, the 4-CV was spherical in shape, increased in area and width, and decreased in length. Abnormal CoA sphericity indices reflected a flatter LV and a more spherical RV. The LV area, length, and width, and RV length were decreased. The transverse width of the RV was increased. RV and LV global, longitudinal, and transverse contractility were depressed.
The results demonstrate previously unappreciated differences in the shape, size, and function of the heart in fetuses with CoA. These differences may assist examiners in identifying fetuses with CoA.
尚未对主动脉缩窄（CoA）胎儿的四腔心切面（4-CV）及左右心室（RV和LV）的大小和形状，以及RV和LV的功能进行综合评估。
我们评估了4-CV、RV和LV的大小和形状，以及RV和LV的功能，以确定与对照人群相比CoA胎儿的特征。
将50例CoA胎儿与200例对照进行比较。这是一个回顾性病例系列，比较CoA胎儿和对照的4-CV。测量4-CV舒张末期面积、长度、宽度和球形指数，以确定4-CV形态。采用斑点追踪分析计算RV和LV舒张末期面积、长度、24节段球形指数、24节段横向宽度以及以下功能参数：（1）面积变化分数；（2）整体、侧壁和间隔应变；（3）基底-心尖、侧壁和间隔环向位移及缩短分数；（4）24节段横向宽度缩短分数。使用5%和95%参考区间对CoA胎儿测量值进行分类；由此计算CoA胎儿与对照之间的比值比。p<0.05被认为具有统计学意义。
在CoA胎儿中，4-CV呈球形，面积和宽度增加，长度减小。异常的CoA球形指数反映出LV更扁平，RV更球形。LV面积、长度和宽度以及RV长度减小。RV横向宽度增加。RV和LV整体、纵向和横向收缩力降低。
结果表明CoA胎儿心脏在形状、大小和功能方面存在此前未被认识到的差异。这些差异可能有助于检查人员识别CoA胎儿。
