Ott W J
Department of Obstetrics and Gynecology, Saint John's Mercy Medical School, Saint Louis, MO, USA.
Am J Obstet Gynecol. 1995 Jun;172(6):1741-7; discussed 1747-9. doi: 10.1016/0002-9378(95)91406-4.
The purpose of this study was to evaluate the accuracy of four-chamber and left ventricular outflow tract views in low-risk patients and comprehensive fetal echocardiographic examinations in high-risk patients to diagnose structural heart disease or thoracic anomalies.
A prospective outcome study of two cohorts was performed; 1136 low-risk patients and 886 high-risk patients were evaluated during a 2-year period. Low-risk patients underwent routine four-chamber and left ventricular outflow tract evaluation whereas high-risk patients had detailed fetal echocardiographic examinations. Accuracy of the ultrasonographic diagnosis was evaluated from neonatal discharge data.
Only 2 of 14 patients with congenital heart disease in the low-risk group were correctly identified (sensitivity 14.3%) whereas 10 of 16 patients with congenital heart disease or thoracic anomalies were correctly identified in the high-risk group (sensitivity 62.5%).
The current study showed poor diagnostic accuracy of the standard four-chamber and left ventricular outflow tract views in low-risk patients for the diagnosis of structural cardiac anomalies. Patients with risk factors for congenital heart disease should be referred for comprehensive fetal echocardiographic examination.
本研究旨在评估四腔心切面和左心室流出道切面在低风险患者中的诊断准确性，以及全面胎儿超声心动图检查在高风险患者中诊断结构性心脏病或胸部异常的准确性。
对两个队列进行前瞻性结局研究；在两年期间对1136例低风险患者和886例高风险患者进行了评估。低风险患者接受常规四腔心和左心室流出道评估，而高风险患者接受详细的胎儿超声心动图检查。根据新生儿出院数据评估超声诊断的准确性。
低风险组14例先天性心脏病患者中仅2例被正确识别（敏感性14.3%），而高风险组16例先天性心脏病或胸部异常患者中有10例被正确识别（敏感性62.5%）。
本研究表明，标准四腔心和左心室流出道切面在低风险患者中诊断结构性心脏异常的诊断准确性较差。有先天性心脏病危险因素的患者应转诊进行全面的胎儿超声心动图检查。
