Division of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan,
Division of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan.
Fetal Diagn Ther. 2024;51(5):445-452. doi: 10.1159/000539314. Epub 2024 May 20.
Total anomalous pulmonary venous connection (TAPVC) has a low prenatal diagnostic rate. Therefore, we investigated whether Doppler waveforms with a low pulsatility in the pulmonary veins can indicate fetal TAPVC.
This retrospective study included 16 fetuses with TAPVC, including 10 with complex congenital heart disease and 104 healthy fetuses that underwent fetal echocardiography. Pulmonary venous S and D wave flow velocities and the valley (representing the lowest velocity between the S and D waves) were measured. Valley indices I and II were then calculated as (velocity of valley/greater of the S and D wave velocities) and (velocity of valley/lesser of the S and D wave velocities), respectively.
Supra/infracardiac TAPVC cases exhibited significantly greater valley indices than that of the healthy group. After adjusting for gestational age at fetal echocardiography, valley indices I (odds ratio [OR] 7.26, p < 0.01) and II (OR: 9.23, p < 0.01) were significant predictors of supra/infracardiac TAPVC. Furthermore, valley indices I and II exhibited a high area under the curve for detecting supra/infracardiac TAPVC, regardless of the presence of pulmonary venous obstruction.
The valley index may be a useful tool for the detection of fetal TAPVC.
完全性肺静脉异常连接（TAPVC）的产前诊断率较低。因此，我们研究了肺静脉低搏动性多普勒波形是否可以提示胎儿 TAPVC。
本回顾性研究纳入了 16 例 TAPVC 胎儿，其中 10 例伴有复杂先天性心脏病，104 例健康胎儿行胎儿超声心动图检查。测量肺静脉 S 波和 D 波的血流速度以及谷（代表 S 波和 D 波之间的最低速度）。然后计算谷指数 I 和 II，分别为（谷速度/ S 和 D 波速度较大值）和（谷速度/ S 和 D 波速度较小值）。
心上型/心内型 TAPVC 病例的谷指数明显大于健康组。在校正胎儿超声心动图时的胎龄后，谷指数 I（比值比 [OR] 7.26，p < 0.01）和 II（OR：9.23，p < 0.01）是心上型/心内型 TAPVC 的显著预测因子。此外，无论是否存在肺静脉阻塞，谷指数 I 和 II 对检测心上型/心内型 TAPVC 的曲线下面积均较高。
谷指数可能是检测胎儿 TAPVC 的有用工具。
