An Peng, Song Lina, Song Ping, Zhang Junyan, Lin Yong, Feng Guoyan, Liu Junjie
Department of Radiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, People's Republic of China.
Hubei Provincial Clinical Research Center for Accurate Fetus Malformation Diagnosis, Hubei University of Medicine, Xiangyang, Hubei Province, 441000, People's Republic of China.
Int J Gen Med. 2023 Jul 31;16:3229-3245. doi: 10.2147/IJGM.S421751. eCollection 2023.
The present study aimed to explore the role of modified vascular anatomical molding (MVAM) in prenatal diagnosis teaching and prognosis prediction of fetal complex congenital heart disease (CCHD).
Step 1, MVAM method was used to cast the micro-blood vessels and trachea of 52 CCHD specimens. Subsequently, 52 MVAMs were analyzed and compared with the prenatal ultrasound to summarize their characteristics, misdiagnosis and MVAM's teaching role. Step 2, the surgical and follow-up data of 206 CCHD cases were retrospectively analyzed. Cases that evolved into critical illnesses or died within 1-3 years after surgery (poor prognosis) were classified into the study group (n = 77) and those with good prognosis into the control group (n = 129), which were split into the training set and the test set in the ratio 7:3 based on the time cut-off. In the training set, the prognosis of CCHD was predicted using the MVAM anatomical soft markers (distortion and narrowing of aorta/pulmonary artery, right ventricular infundibulum, etc.) and the decision curve analysis (DCA) performed. The model was validated using the test set, and a nomogram was finally established.
It was observed that all 52 CCHD cases were confirmed using MVAM. A total of 91 cardiac malformations were recorded, among which 41 malformations were misdiagnosed, and 29 malformations were missed by the prenatal echocardiography. The MVAM method has a good teaching/feedback effect on prenatal diagnosis. The combined model exhibited a higher predictive performance in the training- and test-set. Its high clinical net benefit was proved by DCA. Additionally, the nomogram established using the combined model received a favorable response in clinical practice.
The research results indicated that MVAM improved the prenatal diagnosis teaching and training performance. The combined model established based on MVAM anatomical soft markers can offer a high clinical significance for prognosis prediction of CCHD.
本研究旨在探讨改良血管解剖模型（MVAM）在胎儿复杂先天性心脏病（CCHD）产前诊断教学及预后预测中的作用。
步骤1，采用MVAM方法对52例CCHD标本的微血管和气管进行铸型。随后，对52个MVAM进行分析，并与产前超声检查结果进行比较，总结其特征、误诊情况及MVAM的教学作用。步骤2，回顾性分析206例CCHD病例的手术及随访数据。将术后1 - 3年内病情进展为危重症或死亡（预后不良）的病例归入研究组（n = 77），预后良好的病例归入对照组（n = 129），根据时间节点按7:3的比例分为训练集和测试集。在训练集中，利用MVAM解剖学软指标（主动脉/肺动脉扭曲、狭窄、右心室漏斗部等）预测CCHD的预后，并进行决策曲线分析（DCA）。用测试集对模型进行验证，最终建立列线图。
观察发现，52例CCHD病例均通过MVAM得以确诊。共记录到91处心脏畸形，其中41处畸形被误诊，29处畸形被产前超声漏诊。MVAM方法对产前诊断具有良好的教学/反馈效果。联合模型在训练集和测试集中均表现出较高的预测性能。DCA证明其具有较高的临床净效益。此外，使用联合模型建立的列线图在临床实践中获得了良好反响。
研究结果表明，MVAM提高了产前诊断教学及培训效果。基于MVAM解剖学软指标建立的联合模型可为CCHD的预后预测提供较高的临床意义。
