The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Department of Cardiovascular Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Ultrasound Obstet Gynecol. 2021 Mar;57(3):423-430. doi: 10.1002/uog.21988. Epub 2021 Feb 11.
To analyze the incremental benefit of 3D/4D spatiotemporal image correlation (STIC) fetal echocardiography over 2D fetal echocardiography with respect to the accuracy of identification of anatomic details crucial for surgical decision-making and in predicting surgical approach in fetuses with double-outlet right ventricle (DORV).
This was a retrospective study of fetuses with DORV which had undergone both 2D echocardiography and 3D/4D STIC echocardiography and which underwent surgery postnatally in a tertiary pediatric cardiac center in Kerala between October 2015 and March 2019. All such cases with normal atrial arrangement, concordant atrioventricular connections and balanced ventricles were included. 2D and 3D/4D STIC fetal echocardiographic data were analyzed by two experienced observers blinded to the other dataset. Anatomic variables crucial for surgical decision-making, i.e. location and routability of the ventricular septal defect, relationship of the great arteries and presence of outflow obstruction, were compared between the two modalities with respect to agreement with postnatal echocardiography. The accuracy of prenatal prediction of the surgical pathway was compared between 2D and 3D/4D modalities with respect to the procedure undertaken.
Included in the study were 22 fetuses with DORV which had undergone both 2D and 3D/4D imaging as well as postnatal surgery. Accuracy of prenatal interpretation of all four anatomic variables was significantly higher using 3D/4D STIC than using 2D fetal echocardiography (19/22 (86.4%) vs 8/22 (36.4%), P < 0.001). Surgical procedures included single-stage repair in 14 (63.5%) patients and a multistage approach in eight (36.4%). Prenatal prediction of the surgical pathway was significantly more accurate on 3D/4D STIC than on 2D echocardiography (20/22 (90.9%) vs 12/22 (54.5%), P = 0.021). Prenatal predictive accuracy of single-stage biventricular repair was significantly better for 3D/4D STIC than for 2D echocardiography (14/14 (100%) vs 8/14 (57.1%), P = 0.04).
Addition of 3D/4D STIC to conventional 2D fetal echocardiography confers incremental benefit on the accuracy of identification of anatomic details crucial for surgical decision-making and the prediction of postnatal surgical approach in fetuses with DORV, thereby potentially aiding prenatal counseling. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
分析三维/四维时空关联（STIC）胎儿超声心动图相对于二维胎儿超声心动图在识别手术决策关键解剖细节方面的增量效益，以及在预测双出口右心室（DORV）胎儿手术入路方面的作用。
这是一项回顾性研究，纳入了 2015 年 10 月至 2019 年 3 月期间在喀拉拉邦一家三级儿科心脏中心接受过二维和三维/四维 STIC 超声心动图检查并随后接受过手术的 DORV 胎儿。所有纳入的病例均具有正常心房排列、一致的房室连接和均衡的心室。由两位有经验的观察者对二维和三维/四维胎儿超声心动图数据进行分析，他们对另一个数据集均不知情。比较两种模式在与产后超声心动图的一致性方面，对于手术决策至关重要的解剖变量，即室间隔缺损的位置和可修复性、大动脉的关系以及流出道梗阻的存在。比较二维和三维/四维模式在预测手术路径方面的准确性，以评估所采用的手术方式。
本研究纳入了 22 例接受二维和三维/四维成像以及产后手术的 DORV 胎儿。使用三维/四维 STIC 对所有四个解剖变量的产前解读准确性明显高于二维胎儿超声心动图（19/22 [86.4%] vs. 8/22 [36.4%]，P < 0.001）。手术方式包括一期修复 14 例（63.5%）和分期手术 8 例（36.4%）。三维/四维 STIC 对手术路径的产前预测准确性明显高于二维超声心动图（20/22 [90.9%] vs. 12/22 [54.5%]，P = 0.021）。对于三维/四维 STIC，一期双心室修复的产前预测准确性明显优于二维超声心动图（14/14 [100%] vs. 8/14 [57.1%]，P = 0.04）。
在二维胎儿超声心动图的基础上增加三维/四维 STIC 可提高对 DORV 胎儿手术决策关键解剖细节的识别准确性，并预测产后手术入路，从而可能有助于产前咨询。© 2020 年国际妇产科超声学会。
