Imaging Center for Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
Your Ultrasound Clinic, Taichung, Taiwan.
Taiwan J Obstet Gynecol. 2024 Sep;63(5):700-708. doi: 10.1016/j.tjog.2024.03.021.
Fetal venous system malformations frequently coincide with cardiac or extracardiac anomalies. This study explores our experience with an integrated fetal echocardiography approach and analyzes the characteristics and outcomes of fetal venous system disorders.
We conducted a retrospective study with 7048 pregnant women (7255 fetuses) who underwent complete two-dimensional (2D) fetal echocardiographic examinations. We primarily employed an integrated 2D approach. Three-/four-dimensional (3D/4D) spatiotemporal image correlation was supplemental. Fetal venous disorders were classified into 3 groups: cardinal (Group 1), umbilical and vitelline (Group 2), and pulmonary (Group 3) systems, based on embryological-anatomical considerations. Maternofetal data were recorded alongside imaging diagnoses.
Congenital venous malformations were identified in 98 fetuses, yielding a prevalence of 1.35% (98/7255). Six participants had coexisting venous disorders from different groups. Group 1 included 48 fetuses with persistent left superior vena cava (LSVC) and 3 others (unidentified brachiocephalic vein, left inferior vena cava (IVC), and interrupted IVC with azygous continuation to SVC). Group 2 had 39 fetuses with persistent right umbilical vein and 7 with umbilical-portal-ductus venosus disorders. Group 3 had 7 fetuses with pulmonary venous return disorders. Group 2 showed the most favorable outcomes (alive and without neonatal death), while Group 3 exhibited the poorest. Associated cardiac defects were observed in 43.1% of Group 1, 8.7% of Group 2, and 57.1% of Group 3 (P < 0.001), displaying a broad spectrum of non-specific anomalies. Meanwhile, Group 2 had a greater occurrence of a single venous disorder (93.5%) compared to Group 1 (88.2%) and Group 3 (57.1%) (P = 0.020).
Our approach offers an integrated strategy for assessing the fetal venous system during fetal echocardiography, providing multiple views to characterize venous anomalies. The presence of a fetal venous disorder may indicate the coexistence of more severe abnormalities, and the prognosis depends on associated anomalies or the venous disorders per se.
胎儿静脉系统畸形常与心脏或心脏外畸形同时存在。本研究探讨了我们采用综合胎儿超声心动图方法的经验，并分析了胎儿静脉系统疾病的特征和结局。
我们对 7048 名接受完整二维（2D）胎儿超声心动图检查的孕妇（7255 例胎儿）进行了回顾性研究。我们主要采用综合 2D 方法，同时辅以三维/四维（3D/4D）时空图像相关技术。根据胚胎解剖学考虑，将胎儿静脉疾病分为 3 组：心内（第 1 组）、脐静脉和卵黄静脉（第 2 组）和肺静脉（第 3 组）系统。记录母婴数据以及影像学诊断。
在 98 例胎儿中发现先天性静脉畸形，患病率为 1.35%（98/7255）。6 例患者存在来自不同组别的静脉合并症。第 1 组包括 48 例永存左上腔静脉（LSVC）和另外 3 例（无名头臂静脉、左下腔静脉（IVC）和 IVC 中断伴奇静脉续至上腔静脉）。第 2 组有 39 例永存右脐静脉和 7 例脐静脉-门静脉-导管静脉畸形。第 3 组有 7 例肺静脉回流障碍。第 2 组的结局最好（存活且无新生儿死亡），而第 3 组最差。第 1 组 43.1%、第 2 组 8.7%和第 3 组 57.1%的患者存在心脏相关畸形（P<0.001），表现出广泛的非特异性畸形。同时，第 2 组单一静脉疾病的发生率（93.5%）高于第 1 组（88.2%）和第 3 组（57.1%）（P=0.020）。
我们的方法为胎儿超声心动图中胎儿静脉系统评估提供了一种综合策略，可提供多种视图来描述静脉异常。胎儿静脉疾病的存在可能表明存在更严重的异常，预后取决于相关异常或静脉疾病本身。
