Fetal and Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Fetal and Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Women's and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada.
J Am Soc Echocardiogr. 2024 Nov;37(11):1073-1082. doi: 10.1016/j.echo.2024.07.007. Epub 2024 Jul 15.
During perinatal transition in hypoplastic left heart syndrome (HLHS), reduced systemic blood flow (Qs) and cerebral blood flow and increased pulmonary blood flow (Qp) are observed, contributing to hemodynamic instability. The aim of the present study was to explore whether similar or discordant perinatal changes occur in critical pulmonary outflow tract obstruction (POFO) compared with HLHS and healthy control subjects.
Echocardiography was prospectively performed at 36 to 39 gestational weeks and then serially from 6 to 96 hours after birth, before cardiac intervention. Combined cardiac output (CCO), superior vena cava (SVC) flow rate, Qs and Qp, and resistance indices (RIs) in the middle cerebral artery (MCA), celiac artery, and superior mesenteric artery were compared among the three groups.
In fetal POFO (n = 19) and HLHS (n = 31), CCO was comparable with that in control subjects (n = 21) because of elevated stroke volume, but CCO in POFO was lower compared with HLHS (P < .01). Compared with control subjects, POFO CCO was lower at 6 hours after delivery but comparable at 24 to 96 hours. In contrast, from 6 to 96 hours, the HLHS group had higher CCO than POFO and control subjects. Compared with control subjects, both neonates with POFO and those with HLHS had lower Qs and SVC flow (POFO at 24 hours, P < .001; HLHS 6-hour Qs and 6- to 24-hour SVC flow). Compared with control subjects, Qp was increased in POFO at 48 to 96 hours (P < .05) and in HLHS at all time points (P < .001). Compared with fetal MCA RI, postnatal MCA RI was acutely higher in both POFO and HLHS, whereas in control subjects, it tended to decrease postnatally. Celiac artery RI and superior mesenteric artery pulsatility index were higher in POFO and HLHS from 6 to 48 hours vs control subjects.
POFO and HLHS demonstrate divergent acute hemodynamic changes in the early neonatal period, with early decreased CCO in POFO and increased CCO in HLHS. Both demonstrate early compromise in Qs and SVC (cerebral flow) and ongoing altered splanchnic flow.
在左心发育不全综合征（HLHS）围产期过渡期间，观察到体循环血流量（Qs）和脑血流量减少以及肺血流量（Qp）增加，导致血流动力学不稳定。本研究旨在探讨严重流出道梗阻（POFO）与 HLHS 和健康对照组相比是否存在类似或不同的围产期变化。
在 36 至 39 孕周行前瞻性超声心动图检查，然后在心脏介入治疗前于生后 6 至 96 小时进行连续检查。比较三组患者的综合心输出量（CCO）、上腔静脉（SVC）流速、Qs 和 Qp 以及大脑中动脉（MCA）、腹腔动脉和肠系膜上动脉的阻力指数（RI）。
在胎儿 POFO（n=19）和 HLHS（n=31）中，由于心搏量增加，CCO 与对照组（n=21）相似，但 POFO 的 CCO 低于 HLHS（P<0.01）。与对照组相比，POFO 的 CCO 在生后 6 小时较低，但在 24 至 96 小时时相似。相反，从 6 至 96 小时，HLHS 组的 CCO 高于 POFO 和对照组。与对照组相比，POFO 和 HLHS 的新生儿 Qs 和 SVC 流量均较低（POFO 在 24 小时时，P<0.001；HLHS 在 6 小时 Qs 和 6 至 24 小时 SVC 流量时）。与对照组相比，POFO 在 48 至 96 小时时 Qp 增加（P<0.05），HLHS 在所有时间点 Qp 增加（P<0.001）。与胎儿 MCA RI 相比，POFO 和 HLHS 新生儿的 MCA RI 在出生后立即升高，而对照组的 MCA RI 在出生后趋于降低。6 至 48 小时 POFO 和 HLHS 的腹腔动脉 RI 和肠系膜上动脉搏动指数均高于对照组。
POFO 和 HLHS 在新生儿早期表现出不同的急性血流动力学变化，POFO 的 CCO 早期下降，HLHS 的 CCO 增加。两者均表现出 Qs 和 SVC（脑血流）的早期损害以及持续改变的内脏血流。
