Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
J Ultrasound Med. 2020 Mar;39(3):453-461. doi: 10.1002/jum.15121. Epub 2019 Aug 25.
To investigate fetal hemodynamic alterations using transabdominal ultrasound in fetuses with isolated mild-to-moderate ventriculomegaly (VM).
Fetuses diagnosed with isolated mild-to-moderate VM by transabdominal ultrasound were evaluated for hemodynamic changes, including changes in fetal cardiac function, the umbilical artery, the ductus venosus, and the middle cerebral artery. The fetuses with isolated mild-to-moderate VM were divided into 2 groups, namely, before 32 weeks' gestation (20 weeks-31 weeks 6 days) and after 32 weeks' gestation (32-38 weeks), and matched to corresponding healthy control fetuses.
The 53 fetuses with VM before 32 weeks had a longer mean isovolumetric relaxation time (IRT; mean ± SD, 42.9 ± 6.8 versus 40.4 ± 5.0 milliseconds; P < .05) and an apparently higher modified myocardial performance index 0.46 ± 0.06 versus 0.43 ± 0.05; P < .01) than the healthy control fetuses. The 43 fetuses with VM after 32 weeks had a significantly longer mean IRT (45.5 ± 6.7 versus 40.9 ± 7.2 milliseconds; P < .01) and a lower UA pulsatility index (0.81 ± 0.13 versus 0.89 ± 0.11; P < .01). The optimal cutoff levels for the IRT in the prediction of adverse perinatal outcomes were 40 and 43 milliseconds before and after 32 weeks, respectively (sensitivity, 100% versus 100%; specificity, 40.4% versus 50.0%; area under the curve, 0.601 versus 0.748; 95% confidence interval, 0.457-0.733 versus 0.590-0.869; P = .291 versus .005).
Some fetuses with isolated mild-to-moderate VM may have impaired cardiac function, characterized by a higher modified myocardial performance index or longer IRT. This finding might be useful for improving fetal surveillance.
利用经腹部超声检查胎儿孤立性轻中度脑室扩张（VM），探讨胎儿血液动力学变化。
经腹部超声检查诊断为孤立性轻中度 VM 的胎儿，评估其血液动力学变化，包括胎儿心功能、脐动脉、静脉导管和大脑中动脉变化。将孤立性轻中度 VM 胎儿分为 2 组，即 32 周前（20 周-31 周+6 天）和 32 周后（32-38 周），并与相应的健康对照组胎儿匹配。
53 例 32 周前 VM 胎儿平均等容舒张时间（IRT；均值±标准差，42.9±6.8 比 40.4±5.0 毫秒；P<.05）和改良心肌做功指数（MPI）0.46±0.06 明显较高（0.43±0.05；P<.01）。43 例 32 周后 VM 胎儿平均 IRT 显著延长（45.5±6.7 比 40.9±7.2 毫秒；P<.01），脐动脉搏动指数（PI）降低（0.81±0.13 比 0.89±0.11；P<.01）。32 周前和 32 周后预测不良围生期结局的 IRT 最佳截断值分别为 40 和 43 毫秒（灵敏度 100%比 100%；特异度 40.4%比 50.0%；曲线下面积 0.601 比 0.748；95%置信区间 0.457-0.733 比 0.590-0.869；P=0.291 比 P=0.005）。
一些孤立性轻中度 VM 胎儿可能存在心脏功能受损，表现为改良 MPI 较高或 IRT 延长。这一发现可能有助于改善胎儿监测。
