Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark.
Ultrasound Obstet Gynecol. 2021 Dec;58(6):846-852. doi: 10.1002/uog.23670. Epub 2021 Nov 10.
To investigate prenatal changes in cardiac biometric and flow parameters in fetuses with bicuspid aortic valve (BAV) diagnosed neonatally compared with controls with normal cardiac anatomy.
This analysis was conducted as part of the Copenhagen Baby Heart Study, a multicenter cohort study of 25 556 neonates that underwent second-trimester anomaly scan at 18 + 0 to 22 + 6 weeks' gestation and neonatal echocardiography within 4 weeks after birth, in Copenhagen University Hospital Herlev, Hvidovre Hospital and Rigshospitalet in greater Copenhagen, between April 2016 and October 2018. From February 2017 (Rigshospitalet) and September 2017 (Herlev and Hvidovre hospitals), the protocol for second-trimester screening of the heart was extended to include evaluation of the four-chamber view, with assessment of flow across the atrioventricular valves, sagittal view of the aortic arch and midumbilical artery and ductus venosus pulsatility indices. All images were evaluated by two investigators, and cardiac biometric and flow parameters were measured and compared between cases with BAV and controls. All cases with neonatal BAV were assessed by a specialist. Maternal characteristics and first- and second-trimester biomarkers were also compared between the two groups.
Fifty-five infants with BAV and 8316 controls with normal cardiac anatomy were identified during the study period and assessed using the extended prenatal cardiac imaging protocol. There were three times as many mothers who smoked before pregnancy in the group with BAV as in the control group (9.1% vs 2.7%; P = 0.003). All other baseline characteristics were similar between the two groups. Fetuses with BAV, compared with controls, had a significantly larger diameter of the aorta at the level of the aortic valve (3.1 mm vs 3.0 mm (mean difference, 0.12 mm (95% CI, 0.03-0.21 mm))) and the pulmonary artery at the level of the pulmonary valve (4.1 mm vs 3.9 mm (mean difference, 0.15 mm (95% CI, 0.03-0.28 mm))). Following conversion of the diameter measurements of the aorta and pulmonary artery to Z-scores and Bonferroni correction, the differences between the two groups were no longer statistically significant. Pregnancy-associated plasma protein-A (PAPP-A) multiples of the median (MoM) was significantly lower in the BAV group than in the control group (0.85 vs 1.03; P = 0.04).
Our findings suggest that fetuses with BAV may have a larger aortic diameter at the level of the aortic valve, measured in the left-ventricular-outflow-tract view, and a larger pulmonary artery diameter at the level of the pulmonary valve, measured in the three-vessel view, at 20 weeks' gestation. Moreover, we found an association of maternal smoking and low PAPP-A MoM with BAV. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
研究与具有正常心脏解剖结构的对照组相比，在新生儿期诊断为二叶主动脉瓣（BAV）的胎儿心脏生物计量和血流参数的产前变化。
这一分析作为哥本哈根婴儿心脏研究的一部分进行，该研究是一项多中心队列研究，共纳入 25556 名在妊娠 18+0 至 22+6 周进行了中期异常扫描的新生儿，在哥本哈根大学医院赫勒莱夫、维德霍夫医院和哥本哈根大区的里格医院，于 2016 年 4 月至 2018 年 10 月之间进行新生儿超声心动图检查。从 2017 年 2 月（里格医院）和 9 月（赫勒莱夫和维德霍夫医院）起，心脏中期筛查方案扩展到包括评估四腔心视图、评估房室瓣之间的血流、主动脉弓和脐动脉的矢状视图以及静脉导管的搏动指数。所有图像均由两名研究人员进行评估，并测量和比较了 BAV 病例与对照组之间的心脏生物计量和血流参数。所有新生儿 BAV 病例均由专家进行评估。还比较了两组之间的母亲特征和第一、第二孕期生物标志物。
在研究期间，确定了 55 名 BAV 婴儿和 8316 名具有正常心脏解剖结构的对照组，并使用扩展的产前心脏成像方案进行评估。与对照组相比，BAV 组中有更多的母亲在怀孕前吸烟（9.1% vs. 2.7%；P=0.003）。两组的其他基线特征相似。与对照组相比，BAV 胎儿的主动脉瓣水平主动脉直径（3.1mm vs. 3.0mm（平均差异，0.12mm（95%CI，0.03-0.21mm））和肺动脉瓣水平肺动脉直径（4.1mm vs. 3.9mm（平均差异，0.15mm（95%CI，0.03-0.28mm）））显著更大。将主动脉和肺动脉直径的直径测量值转换为 Z 分数并进行 Bonferroni 校正后，两组之间的差异不再具有统计学意义。与对照组相比，BAV 组妊娠相关血浆蛋白-A（PAPP-A）倍数中位数（MoM）显著降低（0.85 vs. 1.03；P=0.04）。
我们的研究结果表明，与对照组相比，BAV 胎儿在左心室流出道切面测量的主动脉瓣水平和在三血管切面测量的肺动脉瓣水平的主动脉直径可能更大，在 20 周妊娠时。此外，我们发现母亲吸烟和低 PAPP-A MoM 与 BAV 有关。
