Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
Pediatric Cardiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
JAMA Netw Open. 2021 Mar 1;4(3):e213538. doi: 10.1001/jamanetworkopen.2021.3538.
Prenatal diagnosis of complex congenital heart defects reduces mortality and morbidity in affected infants. However, fetal echocardiography can be limited by poor acoustic windows, and there is a need for improved diagnostic methods.
To assess the clinical utility of fetal cardiovascular magnetic resonance imaging in cases in which fetal echocardiography could not visualize all relevant anatomy.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted between January 20, 2017, and June 29, 2020, at Skåne University Hospital (Lund, Sweden), a tertiary center for pediatric cardiology and thoracic surgery. Participants were fetuses referred for fetal cardiovascular magnetic resonance examination by a pediatric cardiologist after an inconclusive echocardiograph.
Fetal cardiovascular magnetic resonance examination requested by the patient's pediatric cardiologist.
Any change in patient management because of diagnostic information gained from fetal cardiovascular magnetic resonance imaging.
A total of 31 fetuses underwent cardiovascular magnetic resonance examination at a median gestational age of 36 weeks (range, 31-39 weeks). Overall, fetal cardiovascular magnetic resonance imaging had clinical utility, affecting patient management and/or parental counseling in 26 cases (84%). For aortic arch anatomy including signs of coarctation (20 fetuses), fetal cardiovascular magnetic resonance imaging added diagnostic information in 16 cases (80%). For assessment of univentricular vs biventricular outcome in borderline left ventricle, unbalanced atrioventricular septal defect, and pulmonary atresia with intact ventricular septum (15 fetuses), fetal cardiovascular magnetic resonance imaging visualized intracardiac anatomy and ventricular function, allowing assessment of outcome in 13 cases (87%). In 4 fetuses with hypoplastic left heart syndrome, fetal cardiovascular magnetic resonance imaging helped delivery planning in 3 cases (75%). Finally, fetal cardiovascular magnetic resonance imaging provided valuable information for parental counseling in 21 cases (68%).
In this cohort study, fetal cardiovascular magnetic resonance imaging added clinically useful information to what was available from echocardiography. These findings suggest that fetal CMR has the potential to affect clinical decision-making in challenging cases of congenital heart defects with inconclusive data from echocardiography. Fetal cardiovascular magnetic resonance imaging showed an association with clinical decision-making, including mode of delivery and early postnatal care, as well as with parental counseling.
产前诊断复杂先天性心脏缺陷可降低患病婴儿的死亡率和发病率。然而，胎儿超声心动图可能因声窗不佳而受到限制，因此需要改进诊断方法。
评估胎儿心血管磁共振成像在超声心动图无法显示所有相关解剖结构的情况下的临床应用价值。
设计、地点和参与者：这项队列研究于 2017 年 1 月 20 日至 2020 年 6 月 29 日在瑞典斯科讷大学医院（Lund，瑞典）进行，该医院是儿科心脏病学和胸外科的三级中心。参与者是由儿科心脏病医生转介进行胎儿心血管磁共振检查的胎儿。
由患者的儿科心脏病医生要求进行胎儿心血管磁共振检查。
因胎儿心血管磁共振成像获得的诊断信息而改变的患者管理。
共有 31 名胎儿在中位妊娠 36 周（范围 31-39 周）时接受了心血管磁共振检查。总的来说，胎儿心血管磁共振成像具有临床应用价值，在 26 例（84%）中影响了患者管理和/或父母咨询。对于主动脉弓解剖结构（包括缩窄迹象）（20 例胎儿），胎儿心血管磁共振成像在 16 例（80%）中增加了诊断信息。对于评估边缘左心室、不平衡房室间隔缺损和室间隔完整的肺动脉闭锁的单心室与双心室结局（15 例胎儿），胎儿心血管磁共振成像可可视化心脏内解剖结构和心室功能，可在 13 例（87%）中评估结局。在 4 例左心发育不良综合征胎儿中，胎儿心血管磁共振成像有助于 3 例（75%）分娩计划。最后，胎儿心血管磁共振成像在 21 例（68%）中为父母咨询提供了有价值的信息。
在这项队列研究中，胎儿心血管磁共振成像增加了超声心动图提供的有用信息。这些发现表明，胎儿 CMR 有可能影响超声心动图数据不确定的复杂先天性心脏病病例的临床决策。胎儿心血管磁共振成像与临床决策相关，包括分娩方式和新生儿早期护理，以及父母咨询。
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