Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, California, Los Angeles, USA.
Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, California, Los Angeles, USA.
J Ultrasound Med. 2021 Dec;40(12):2537-2548. doi: 10.1002/jum.15639. Epub 2021 Jan 27.
Prenatal detection rates for tetralogy of Fallot (TOF) vary between 23 and 85.7%, in part because of the absence of significant structural abnormalities of the 4-chamber view (4CV), as well as the relative difficulty in detection of abnormalities during the screening examination of the outflow tracts. The purpose of this study was to evaluate whether the 4CV and ventricles in fetuses with TOF may be characterized by abnormalities of size and shape of these structures.
This study retrospectively evaluated 44 fetuses with the postnatal diagnosis of TOF. Measurements were made from the 4CV (end-diastolic length, width, area, global sphericity index, and cardiac axis) and the right (RV) and left (LV) ventricles (area, length, 24-segment transverse widths, sphericity index, and RV/LV ratios). Logistic regression analysis was performed to identify variables that might separate fetuses with TOF from normal controls.
The mean gestational age at the time of the last examination prior to delivery was 28 weeks 5 days (SD 4 weeks, 4 days). The mean z-scores were significantly lower in fetuses with TOF for the 4CV and RV and LV measurements of size and shape. Logistic regression analysis identified simple linear measurements of the 4CV, RV, and LV that had a sensitivity of 90.9 and specificity of 98.5% that outperformed the 4CV cardiac axis (sensitivity of 22.7%) as a screening tool for TOF.
Measurements of the 4CV, RV, and LV can be used as an adjunct to the outflow tract screening examination to identify fetuses with TOF.
法洛四联症（TOF）的产前检出率在 23%至 85.7%之间变化，部分原因是四腔心切面（4CV）无明显结构异常，以及在流出道筛查检查中检测异常的相对难度。本研究旨在评估 TOF 胎儿的 4CV 和心室的大小和形状是否存在异常。
本研究回顾性评估了 44 例产后诊断为 TOF 的胎儿。从 4CV（舒张末期长度、宽度、面积、整体球形指数和心脏轴）和右心室（RV）和左心室（LV）（面积、长度、24 节段横径、球形指数和 RV/LV 比值）进行测量。采用逻辑回归分析来识别可能将 TOF 胎儿与正常对照组区分开的变量。
分娩前最后一次检查时的平均孕龄为 28 周 5 天（标准差为 4 周 4 天）。TOF 胎儿的 4CV 和 RV、LV 的大小和形状的平均 z 评分明显较低。逻辑回归分析确定了 4CV、RV 和 LV 的简单线性测量，其敏感性为 90.9%，特异性为 98.5%，优于 4CV 心脏轴（敏感性为 22.7%）作为 TOF 的筛查工具。
4CV、RV 和 LV 的测量可作为流出道筛查检查的辅助手段，用于识别 TOF 胎儿。
