三维超声评估胎儿心脏主动脉瓣和肺动脉瓣瓣环面积：参考曲线及其在先天性心脏病中的适用性。

Assessment of fetal heart aortic and pulmonary valve annulus area by three-dimensional ultrasonography: reference curves and applicability in congenital heart diseases.

机构信息

Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.

Department of Pediatrics, Pediatric Cardiology, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

出版信息

J Perinat Med. 2023 Jan 2;51(6):805-814. doi: 10.1515/jpm-2022-0532. Print 2023 Jul 26.

DOI:10.1515/jpm-2022-0532

PMID:36584322

Abstract

OBJECTIVES

To determine reference curves for fetal aortic and pulmonary valve annulus area by three-dimensional ultrasonography using the spatio-temporal image correlation (STIC) in the rendering mode, and to ascertain its applicability in congenital heart disease (CHD).

METHODS

We performed a retrospective cross-sectional study of 328 normal fetuses and 42 fetuses with CHD between 20 and 33 weeks 6 days of gestation. The outflow plane view of the great vessels was used to measure the areas of the valvar annuli, and the measurements were performed in systole. A linear regression model adjusted according to the determination coefficient (R) was utilized to construct the reference intervals. The concordance correlation coefficient (CCC) was used to calculate the reproducibility of the mitral and tricuspid valve areas.

RESULTS

The mean ± standard deviation (SD) of the aortic and pulmonary valve annulus areas ranged from 6.6 ± 1.2 to 32.9 ± 1.1 mm and 10.7 ± 1.3 to 40.3 ± 1.2 mm, respectively. We observed a linear relationship and strong positive correlation between the area of the aortic and pulmonary valve annuli with r=0.97 and 0.96, respectively. Good intra (CCC=0.99) and interobserver agreement (CCC=0.98) was observed for the measurement of the aortic valve annulus area. A good intra (CCC=0.99) and interobserver (CCC=0.97) agreement was also observed for the measurement of the pulmonary valve annulus area. The mean ± SD of the difference of the areas of the aortic and pulmonary valve annuli between the normal fetuses and those with CHD were -1.801 ± 1.429 mm (p=0.208) and -1.033 ± 1.467 mm (p<0.0001), respectively.

CONCLUSIONS

The reference curves for the areas of the aortic and pulmonary valve annuli of fetal hearts were determined, and showed good inter and intraobserver reproducibility. The constructed reference curves showed applicability in different types of CHD.

摘要

目的

利用时空相关成像（STIC）渲染模式下的三维超声技术，确定胎儿主动脉瓣和肺动脉瓣环面积的参考曲线，并确定其在先天性心脏病（CHD）中的适用性。

方法

我们对 328 名正常胎儿和 42 名 20 至 33 周 6 天妊娠的 CHD 胎儿进行了回顾性横断面研究。使用大血管流出平面视图测量瓣环面积，并在收缩期进行测量。根据确定系数（R）调整线性回归模型来构建参考区间。使用一致性相关系数（CCC）计算二尖瓣和三尖瓣面积的可重复性。

结果

主动脉瓣和肺动脉瓣环面积的平均值±标准差（SD）分别为 6.6±1.2 至 32.9±1.1mm 和 10.7±1.3 至 40.3±1.2mm。我们观察到主动脉瓣和肺动脉瓣环面积之间存在线性关系和强烈的正相关，r 值分别为 0.97 和 0.96。主动脉瓣环面积的测量具有良好的内部（CCC=0.99）和观察者间一致性（CCC=0.98）。肺动脉瓣环面积的测量也具有良好的内部（CCC=0.99）和观察者间一致性（CCC=0.97）。正常胎儿和 CHD 胎儿的主动脉瓣和肺动脉瓣环面积之间的平均差异±SD 分别为-1.801±1.429mm（p=0.208）和-1.033±1.467mm（p<0.0001）。