Chen Guihong, Xiang Wei, Fu Liman, Zhang Yanhong, Wang Pin, Han Yongfeng, Qin Lu, Guo Qing, Gao Bu-Lang, Sun Congxin
Medical Ultrasound Department, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China.
Hebei Key Laboratory of Maternal and Fetal Medicine, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China.
Echocardiography. 2025 Apr;42(4):e70143. doi: 10.1111/echo.70143.
To investigate the ultrasound parameter changes in middle cerebral artery (MCA), intra-abdominal and extra-abdominal umbilical artery (UA), and heart for prediction of fetal coarctation of the aorta (CoA).
In this prospective one-center control study, 45 true CoA fetuses, 70 false-positive CoA fetuses, and 336 healthy control fetuses at the gestational age 19-40 weeks were prospectively enrolled to undergo ultrasound examination. All the ultrasound parameters of the MCA, intra-abdominal and extra-abdominal UA, and heart were analyzed for the prediction of true CoA in the fetuses.
In the true CoA fetuses compared with the healthy controls, significant (p < 0.05) decreases were present in the peak systolic velocity (PSV)/peak diastolic velocity ratio (S/D), pulsatility index (PI), resistance index (RI) of the MCA, PSV and velocity time integral (VTI) of the UA, MCA to the intra-abdominal UA ratios of the S/D, PI, and RI, left ventricle, tricuspid valve E peak (TV-E), TV-A peak, left cardiac output (LCO), and LCO/body weight, whereas significant (p < 0.05) increases were detected in the UA S/D, PI, and RI, the MCA to the intra-abdominal UA ratios of the PSV and VTI, cardiac axis, right atrium, and right ventricle. Compared with the true CoA fetuses, the false-positive fetuses exhibited significant (p < 0.05) increases in MCA S/D, intra-abdominal UA PSV and VTI, MCA-S/D/intra-abdominal UA S/D, MCA-PI/intra-abdominal UA-PI, MCA-RI/intra-abdominal UA-RI, MCA-S/D/free UA-S/D, MCA-PI/free UA-PI, MCA-RI/free UA-RI, MV-E, MV E/A, TV-E and -A, and LCO/weight, but significant (p < 0.05) decreases in MCA-VTI/intra-abdominal UA-VTI, intra-abdominal UA PI and RI, free UA S/D, free UA PI and RI, and RCO/weight.
Fetuses with CoA have significant alterations in the ultrasound parameters of MCA, intra-abdominal UA, and heart, and significant decreases in MCA RI and the ratio of LCO to fetal weight and ventricular septal defect may significantly affect CoA presence. Fetuses with these ultrasound changes at the gestational age 19-40 weeks should have further examinations for confirmation of CoA presence.
探讨大脑中动脉（MCA）、腹内和腹外脐动脉（UA）以及心脏的超声参数变化，以预测胎儿主动脉缩窄（CoA）。
在这项前瞻性单中心对照研究中，前瞻性纳入了45例真正CoA胎儿、70例假阳性CoA胎儿以及336例孕龄为19 - 40周的健康对照胎儿，进行超声检查。分析MCA、腹内和腹外UA以及心脏的所有超声参数，以预测胎儿中的真正CoA。
与健康对照相比，真正CoA胎儿的MCA的收缩期峰值速度（PSV）/舒张期峰值速度比值（S/D）、搏动指数（PI）、阻力指数（RI），UA的PSV和速度时间积分（VTI），MCA与腹内UA的S/D、PI和RI比值，左心室、三尖瓣E峰（TV-E）、TV-A峰、左心输出量（LCO）以及LCO/体重显著（p < 0.05）降低，而UA的S/D、PI和RI，MCA与腹内UA的PSV和VTI比值，心脏轴、右心房和右心室显著（p < 0.05）增加。与真正CoA胎儿相比，假阳性胎儿的MCA S/D、腹内UA PSV和VTI、MCA-S/D/腹内UA S/D、MCA-PI/腹内UA-PI、MCA-RI/腹内UA-RI、MCA-S/D/游离UA-S/D、MCA-PI/游离UA-PI、MCA-RI/游离UA-RI、二尖瓣E峰（MV-E）、MV E/A、TV-E和-A以及LCO/体重显著（p < 0.05）增加，但MCA-VTI/腹内UA-VTI、腹内UA PI和RI、游离UA S/D、游离UA PI和RI以及右心输出量（RCO）/体重显著（p < 0.05）降低。
患有CoA的胎儿在MCA、腹内UA和心脏的超声参数上有显著改变，MCA RI以及LCO与胎儿体重的比值显著降低，室间隔缺损可能会显著影响CoA的存在。在孕龄19 - 40周出现这些超声变化的胎儿应进一步检查以确认是否存在CoA。
