Ro S S, Saini A, Morrow G, Ketchum D, Kreeger J, Michelfelder E
Emory University School of Medicine, Atlanta, GA, USA.
Children's Healthcare of Atlanta, Atlanta, GA, USA.
Ultrasound Obstet Gynecol. 2025 May;65(5):575-580. doi: 10.1002/uog.29206. Epub 2025 Mar 27.
Current guidelines in fetal echocardiography recommend serial evaluation every 4 weeks for single-ventricle lesions. However, there are limited data on the type and frequency of in-utero cardiac changes seen on fetal echocardiograms (FEs) based on the type of single-ventricle lesion. We aimed to evaluate the utility of serial FEs in detecting cardiac changes during gestation and how these changes impact postnatal management.
We performed a retrospective review of all FEs for fetuses diagnosed with a single-ventricle lesion at the Children's Healthcare of Atlanta, between January 2012 and January 2023. All patients included in the study had two or more FEs and were evaluated for in-utero cardiac changes based on eight cardiac categories: atrioventricular (AV) valve regurgitation; systemic ventricular dysfunction; ductus arteriosus flow; atrial-level restriction; umbilical artery Doppler pattern; umbilical vein Doppler pattern; evidence of hydrops; and evidence of arrhythmias. All in-utero cardiac changes were classified into three categories: improving, worsening or critical. Any changes noted on serial FEs that altered the fetal cardiac diagnosis were also recorded. Fisher's exact test was used to determine whether the proportion of fetuses with in-utero cardiac changes differed significantly between different segmental findings and single-ventricle lesion subtype.
A total of 721 FEs were performed for 248 patients over the 11-year study period. The majority of fetuses had hypoplastic left heart syndrome (HLHS) (63.7%) and most changes were seen in the third trimester (median gestational age, 29.3 (range, 17.4-38.4) weeks). In-utero cardiac changes observed on serial FEs were reported in 38 (15.3%) fetuses, with a total of 42 changes noted throughout the study period. However, only eight (3.2%) fetuses had a critical change that impacted perinatal management. All eight fetuses had HLHS, of which the majority developed hydrops (4/8) or atrial-level restriction (3/8). In addition, there were 34 non-critical changes seen in 30 (12.1%) fetuses, largely in the form of intermittent premature atrial contractions, AV valve regurgitation or ventricular dysfunction. There were 12 (2.5%) follow-up FEs that resulted in a change to the fetal cardiac diagnosis, confirmed by postnatal echocardiography.
In fetuses with single-ventricle lesions, there was a low rate of in-utero cardiac changes that led to alterations in perinatal management. However, fetuses with HLHS were most likely to develop critical changes affecting delivery-room management, often in the form of atrial-level restriction and/or evolving hydrops. It is important to consider these factors when considering the timing of visits for families who face a prenatal diagnosis of a single-ventricle lesion. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.
胎儿超声心动图的现行指南建议对单心室病变每4周进行一次系列评估。然而，基于单心室病变的类型，关于胎儿超声心动图（FE）所见宫内心脏变化的类型和频率的数据有限。我们旨在评估系列FE在检测妊娠期心脏变化方面的效用，以及这些变化如何影响产后管理。
我们对2012年1月至2023年1月期间在亚特兰大儿童医疗保健中心诊断为单心室病变的胎儿的所有FE进行了回顾性研究。纳入研究的所有患者均接受了两次或更多次FE检查，并根据八个心脏类别评估宫内心脏变化：房室（AV）瓣反流；体循环心室功能障碍；动脉导管血流；心房水平限制；脐动脉多普勒模式；脐静脉多普勒模式；水肿证据；以及心律失常证据。所有宫内心脏变化分为三类：改善、恶化或危急。还记录了系列FE中发现的任何改变胎儿心脏诊断的变化。采用Fisher精确检验来确定不同节段性发现和单心室病变亚型之间宫内心脏变化胎儿的比例是否存在显著差异。
在11年的研究期间，共对248例患者进行了721次FE检查。大多数胎儿患有左心发育不全综合征（HLHS）（63.7%），大多数变化出现在孕晚期（中位孕周，29.3（范围，17.4 - 38.4）周）。系列FE观察到的宫内心脏变化在38例（15.3%）胎儿中报告，在整个研究期间共记录到42处变化。然而，只有8例（3.2%）胎儿出现了影响围产期管理的危急变化。所有8例胎儿均患有HLHS，其中大多数出现了水肿（4/8）或心房水平限制（3/8）。此外，在30例（12.1%）胎儿中发现了34处非危急变化，主要表现为间歇性房性早搏、AV瓣反流或心室功能障碍。有12次（2.5%）随访FE导致胎儿心脏诊断发生改变，产后超声心动图证实了这一点。
在患有单心室病变的胎儿中，导致围产期管理改变的宫内心脏变化发生率较低。然而，患有HLHS的胎儿最有可能出现影响产房管理的危急变化，通常表现为心房水平限制和/或逐渐发展的水肿。对于面临单心室病变产前诊断的家庭，在考虑就诊时间时，考虑这些因素很重要。© 2025国际妇产科超声学会。
