Berning R A, Silverman N H, Villegas M, Sahn D J, Martin G R, Rice M J
University of California, San Francisco 94143-0214, USA.
J Am Coll Cardiol. 1996 Feb;27(2):481-6. doi: 10.1016/0735-1097(95)00446-7.
This study was performed to define the significance of Doppler color flow mapping in demonstrating reversal of the direction of the normal physiologic flow across the atrial septum and ductus arteriosus in the human fetus.
Reversal of the physiologic shunting across the ductus arteriosus or atrial septum in utero (i.e., left to right) can be readily identified by Doppler color flow mapping, complemented by pulsed and continuous wave Doppler information.
We reviewed echocardiograms recorded at our three institutions from 1988 to 1993, which displayed reversal of flow by Doppler color flow in 53 fetuses of gestational age 18 weeks to term. The diagnoses were confirmed by postnatal echocardiography, operation or autopsy. Reversal of shunting was consistently associated with severe heart disease.
Reversed atrial shunting was found with severe left heart obstructive lesions, including 19 with hypoplastic left heart syndrome, 3 with critical aortic stenosis, 2 with double-outlet right ventricle and 1 each with an interrupted aortic arch, atrioventricular septal defect and severe left ventricular dysfunction due to dilated cardiomyopathy. Reversed ductus arteriosus shunting was found with severe right heart obstructive lesions, including nine fetuses with pulmonary atresia, six with severe obstructive tricuspid valve abnormalities, five with severe tetralogy of Fallot, four with Ebstein's anomaly and two with single ventricle and pulmonary stenosis. Associated cardiac lesions were common in both groups. Only 3 of the 15 infants who were delivered alive from the reverse ductus arteriosus shunt group and 4 of 12 from the reverse atrial shunt group still survive.
The finding of reversed flow by Doppler color flow mapping during fetal life provides a key to subsequent accurate diagnosis and denotes a spectrum of diseases with a very poor prognosis.
本研究旨在明确彩色多普勒血流成像在显示人类胎儿房间隔和动脉导管正常生理性血流方向逆转方面的意义。
子宫内动脉导管或房间隔生理性分流方向的逆转（即由左向右）可通过彩色多普勒血流成像轻松识别，并辅以脉冲波和连续波多普勒信息。
我们回顾了1988年至1993年在我们三个机构记录的超声心动图，这些超声心动图显示了53例孕18周足月胎儿的多普勒彩色血流逆转。诊断通过产后超声心动图、手术或尸检得以证实。分流逆转始终与严重心脏病相关。
在严重左心梗阻性病变中发现了房间隔分流逆转，包括19例左心发育不全综合征、3例严重主动脉瓣狭窄、2例右心室双出口，以及各1例主动脉弓中断、房室间隔缺损和扩张型心肌病导致的严重左心室功能障碍。在严重右心梗阻性病变中发现了动脉导管分流逆转，包括9例肺动脉闭锁胎儿、6例严重梗阻性三尖瓣异常、5例严重法洛四联症、4例埃布斯坦畸形以及2例单心室合并肺动脉狭窄。两组中相关心脏病变均很常见。动脉导管分流逆转组中15例存活分娩的婴儿中仅有3例，房间隔分流逆转组12例中仅有4例仍存活。
胎儿期彩色多普勒血流成像发现血流逆转可为后续准确诊断提供关键线索，并提示一系列预后极差的疾病。
