Luo G, Pan S L, Wang K L, Wang D L, Sun Y, Xu Q, Chen T T
Heart Center, Qingdao Women and Children's Hospital, Qingdao 266034, China.
Department of Anesthesiology, Qingdao Women and Children's Hospital, Qingdao 266034, China.
Zhonghua Fu Chan Ke Za Zhi. 2020 Dec 25;55(12):837-842. doi: 10.3760/cma.j.cn112141-20200519-00425.
To summarize the experience of perioperative management strategy of fetal pulmonary valvuloplasty (FPV) for hypoplastic right heart syndrome (HRHS). In the retrospective study of perioperative data, 13 fetuses of HRHS were treated with FPV in Qingdao Women and Children's Hospital from July 2018 to June 2019. (1) The evaluation indexes of the right ventricle in 13 fetuses before FPV: the mean ratio of tricuspid/mitral annulus, right/left ventricular length, pulmonary/aortic annulus, and tricuspid inflow time/cardiac cycle were 0.81±0.04, 0.56±0.14, 0.69±0.06, and 0.35±0.03, respectively. (2) All pregnant mothers underwent general anesthesia. The basic fetal heart rate was (156±12) beats per minutes before FPV, and 9 fetuses showed bradycardia during the operation, and recovered to normal after drug resuscitation. On the first day after FPV, two cases had bradycardia and pregnancy was terminated. The fluctuation of systolic blood pressure of pregnant mother was less than 20%, and there was no significant difference between preoperative and intraoperative pulse pressure [(36.0±5.6) vs (35.8±6.9) mmHg (1 mmHg=0.133 kPa); =8.102, =0.951]. (3) All cases of HRHS fetus successfully underwent FPV. The average gestational age was (27.3±0.8) weeks. The average operation time was (23.2±1.0) minutes. The ratio of tricuspid to mitral annulus (=-2.513, =0.022) and the ratio of right to left ventricular length (=-3.373, =0.003) were significantly improved at 6 weeks postoperatively. Ten fetuses were delivered, and there was no death after early intervention. (4) Of 13 pregnant women, 3 cases were nausea and vomiting on the day of FPV operation, the treatment of the symptoms was improved by tropisetron; one case had tolerable abdominal pain and improved without special treatment. Pregnant women had no major complications such as cardiac failure, abortion and death. (5) Chromosome karyotype analysis and microarray analysis of amniotic fluid was retained during the operation. No typical chromosome abnormality or other abnormal genetic diagnosis was found. FPV colud be used as an effective intervention measure to promote the development of right ventricle in HRHS fetuses. The scientific management of multidisciplinary professional technical team in perioperative period is particularly important to ensure the success of FPV and the safety of pregnant women and fetuses.
总结胎儿肺动脉瓣成形术（FPV）治疗右心发育不良综合征（HRHS）围手术期管理策略的经验。在对围手术期数据的回顾性研究中，2018年7月至2019年6月期间，青岛妇女儿童医院对13例HRHS胎儿进行了FPV治疗。（1）13例胎儿在FPV术前右心室的评估指标：三尖瓣/二尖瓣环平均比值、右/左心室长度、肺动脉/主动脉环以及三尖瓣流入时间/心动周期分别为0.81±0.04、0.56±0.14、0.69±0.06和0.35±0.03。（2）所有孕妇均接受全身麻醉。FPV术前胎儿基础心率为（156±12）次/分钟，9例胎儿在手术过程中出现心动过缓，经药物复苏后恢复正常。FPV术后第1天，2例出现心动过缓并终止妊娠。孕妇收缩压波动小于20%，术前与术中脉压无显著差异[（36.0±5.6）mmHg对（35.8±6.9）mmHg（1 mmHg = 0.133 kPa）；t = 8.102，P = 0.951]。（3）所有HRHS胎儿病例均成功进行了FPV。平均孕周为（27.3±0.8）周。平均手术时间为（23.2±1.0）分钟。术后6周三尖瓣与二尖瓣环比值（t = -2.513，P = 0.022）和右与左心室长度比值（t = -3.373，P = 0.003）显著改善。10例胎儿分娩，早期干预后无死亡。（4）13例孕妇中，3例在FPV手术当天出现恶心呕吐，使用托烷司琼治疗后症状改善；1例有可耐受的腹痛，未特殊处理自行好转。孕妇无心力衰竭、流产及死亡等严重并发症。（5）手术过程中保留羊水进行染色体核型分析和微阵列分析。未发现典型染色体异常或其他异常基因诊断。FPV可作为促进HRHS胎儿右心室发育的有效干预措施。围手术期多学科专业技术团队的科学管理对于确保FPV成功及孕妇和胎儿安全尤为重要。
