Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna (Drs Della Gatta, Contro, Larcher, Pilu, and Perolo).
Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna (Drs Della Gatta, Contro, Larcher, Pilu, and Perolo).
Am J Obstet Gynecol MFM. 2021 Sep;3(5):100379. doi: 10.1016/j.ajogmf.2021.100379. Epub 2021 Jul 2.
Hypoxia caused by inadequate intracardiac mixing owing to a restrictive foramen ovale is a potentially life-threatening complication in neonates with dextro-transposition of the great arteries. An urgent balloon atrial septostomy is a procedure of choice in such cases, but dependent on the availability of a 24-hour interventional cardiology facility. The prenatal identification of predictors for an urgent balloon atrial septostomy at birth would help in optimizing the management of these neonates, minimizing the risk of hypoxic damage.
This study aimed to predict with prenatal echocardiography the need of urgent balloon atrial septostomy in neonates with dextro-transposition of the great arteries.
This was a retrospective cohort study of patients with a prenatal diagnosis of transposition of the great arteries that were delivered in our center between 2010 and 2019, for whom fetal ultrasound echocardiograms obtained at less than 3 weeks before delivery were available. The following parameters were systematically obtained at fetal echocardiography: size and appearance of the foramen ovale, septum primum excursion (foramen ovale flap angle at the maximal excursion), diameters of the atria, and size of the ductus arteriosus. Balloon atrial septostomy was defined as urgent if performed within 12 hours from birth in neonates with restrictive foramen ovale. Neonatal follow-up was obtained through medical records analysis.
From November 2007 to April 2019, 160 fetuses with complete transposition of the great arteries were referred to our echocardiography laboratory and 60 of these were included in the analysis; 27 underwent urgent balloon atrial septostomy, 11 elective balloon atrial septostomy, and 22 no balloon atrial septostomy. The size of the foramen ovale was the best predictor of an urgent balloon atrial septostomy. A measurement of >6.5 mm had a sensitivity of 100% and a false positive rate of 45%.
Fetal echocardiography predicts the need of an urgent balloon atrial septostomy in fetuses with dextro-transposition of the great arteries although with a limited precision. In our experience, a measurement of the foramen ovale within 3 weeks of delivery had the greatest accuracy.
由于卵圆孔限制导致的心脏内混合不足引起的缺氧是右旋型大动脉转位新生儿潜在的危及生命的并发症。在这种情况下，紧急球囊房间隔造口术是首选的治疗方法，但取决于 24 小时介入心脏病学设施的可用性。在产前识别出生时紧急球囊房间隔造口术的预测因素将有助于优化这些新生儿的管理，最大限度地降低缺氧损伤的风险。
本研究旨在通过产前超声心动图预测右旋型大动脉转位新生儿是否需要紧急球囊房间隔造口术。
这是一项回顾性队列研究，纳入了 2010 年至 2019 年期间在我们中心分娩的产前诊断为大动脉转位的患者，这些患者在分娩前不到 3 周获得了胎儿超声心动图检查。在胎儿超声心动图中系统地获得了以下参数：卵圆孔的大小和外观、卵圆孔瓣的活动度（卵圆孔瓣在最大活动度时的角度）、心房的直径和动脉导管的大小。如果在新生儿出生后 12 小时内进行球囊房间隔造口术，则将球囊房间隔造口术定义为紧急手术。通过病历分析获得新生儿随访结果。
2007 年 11 月至 2019 年 4 月，共有 160 例完全性大动脉转位的胎儿被转诊至我们的超声心动图实验室，其中 60 例被纳入分析；27 例行紧急球囊房间隔造口术，11 例行择期球囊房间隔造口术，22 例不行球囊房间隔造口术。卵圆孔的大小是预测紧急球囊房间隔造口术的最佳指标。卵圆孔直径>6.5mm 时，其敏感性为 100%，假阳性率为 45%。
虽然产前超声心动图对右旋型大动脉转位胎儿紧急球囊房间隔造口术的预测精度有限，但仍可预测该手术的需求。根据我们的经验，分娩前 3 周内测量卵圆孔的大小具有最高的准确性。
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