Wang Yanming, Wang Longfei, Zang Haifeng, Wang Jie, Wu Hao, Zhao Wei
Department of Ultrasonography, South Taihu Hospital Affiliated to Huzhou College, Huzhou, 313000, Zhejiang Province, People's Republic of China.
Department of Anesthesiology, South Taihu Hospital Affiliated to Huzhou College , Huzhou, 313000, Zhejiang Province, People's Republic of China.
Pediatr Cardiol. 2025 Apr;46(4):769-777. doi: 10.1007/s00246-024-03525-6. Epub 2024 May 29.
Current study aims to compare the application of two-dimensional (2D) color doppler ultrasound (CDU) and four-dimensional (4D) ultrasound spatiotemporal image correlation (STIC) in fetal congenital heart disease in the second trimester of pregnancy and to analyze the high risk factors of the disease. From August 2019 to July 2021, 135 second-trimester patients with highly suspected congenital heart malformations were selected who underwent prenatal screening at South Taihu Hospital Affiliated to Huzhou University. 2D-CDU, 4D STIC, and postnatal examination were completed in all patients. 2D-CDU, 4D STIC and 2D-CDU combined with 4D STIC were used to detect fetal cardiac malformations and classify cardiac malformations. The sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of 2D-CDU, 4D STIC and 2D-CDU combined with 4D STIC were compared. The results of 2D-CDU, 4D STIC and 2D-CDU combined with 4D STIC screening were analyzed for consistency using the results of postpartum diagnosis as the gold standard. Moreover, effects of maternal gestational factors on fetal cardiac malformations by univariate and multivariate analysis. 2D-CDU combined with 4D STIC showed significantly higher section display number than 2D-CDU or 4D STIC in the view of ductal arch, aortic arch, and aortic short-axis. A total of 45 cases of fetal congenital heart malformation were detected in 135 patients in the second trimester, 40, 38 or 42 cases were detected by 2D-CDU, 4D STIC or 2D-CDU combined with 4D STIC, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of 2D-CDU combined with 4D ultrasound in congenital heart malformation screening were higher than those of 2D-CDU or 4D STIC. Kappa agreement analysis showed that the diagnostic results of 4D STIC and 2D-CDU combined with 4D ultrasound in fetuses with suspected congenital heart malformation were in excellent agreement (κ > 0.75), while 2D-CDU was in good agreement with postpartum diagnosis (κ < 0.75). Univariate and multivariate regression analysis revealed that maternal age ≥ 35, drinking during pregnancy, and history of adverse pregnancy and childbirth were all independent risk factors for fetal cardiac malformations, while folic acid supplementation was an independent protective factor for fetal cardiac malformations. 2D-CDU combined with 4D echocardiography may be superior to single 2D-CDU or 4D STIC in the screening of fetal congenital heart malformation in the second trimester. In order to reduce the incidence of fetal heart anomalies, we should strengthen the screening of pregnancy anomalies in high-risk pregnant women and control the risk factors.
当前研究旨在比较二维（2D）彩色多普勒超声（CDU）和四维（4D）超声时空图像相关技术（STIC）在妊娠中期胎儿先天性心脏病中的应用，并分析该疾病的高危因素。2019年8月至2021年7月，选取了135例在湖州师范学院附属太湖医院接受产前筛查的妊娠中期高度怀疑先天性心脏畸形的患者。所有患者均完成了2D-CDU、4D STIC及产后检查。采用2D-CDU、4D STIC以及2D-CDU联合4D STIC检测胎儿心脏畸形并对心脏畸形进行分类。比较2D-CDU、4D STIC以及2D-CDU联合4D STIC的敏感度、特异度、阳性预测值、阴性预测值及符合率。以产后诊断结果为金标准，分析2D-CDU、4D STIC以及2D-CDU联合4D STIC筛查结果的一致性。此外，通过单因素和多因素分析母亲妊娠因素对胎儿心脏畸形的影响。在动脉导管弓、主动脉弓及主动脉短轴切面，2D-CDU联合4D STIC显示的切面数显著多于2D-CDU或4D STIC。135例妊娠中期患者中共检出45例胎儿先天性心脏畸形，2D-CDU、4D STIC及2D-CDU联合4D STIC分别检出40例、38例或42例例。2例。2D-CDU联合4D超声在先天性心脏畸形筛查中的敏感度、特异度、阳性预测值、阴性预测值及符合率均高于2D-CDU或4D STIC。Kappa一致性分析显示，4D STIC及2D-CDU联合4D超声对疑似先天性心脏畸形胎儿的诊断结果具有极佳的一致性（κ＞0.75），而2D-CDU与产后诊断具有良好的一致性（κ＜0.75）。单因素和多因素回归分析显示，母亲年龄≥35岁、孕期饮酒、不良孕产史均为胎儿心脏畸形的独立危险因素，而补充叶酸是胎儿心脏畸形的独立保护因素。在妊娠中期胎儿先天性心脏畸形筛查中，2D-CDU联合4D超声心动图可能优于单一的2D-CDU或4D STIC。为降低胎儿心脏异常的发生率，应加强高危孕妇孕期异常情况的筛查并控制危险因素。
