Castor S, Fouron J C, Teyssier G, Sonnesson S E, Chartrand C, Skoll A
Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Quebec, Canada.
J Am Soc Echocardiogr. 1996 Nov-Dec;9(6):805-13. doi: 10.1016/s0894-7317(96)90471-x.
This study was designed to determine (1) the value of Doppler echocardiography in depicting the presence of a fetal pulmonary stenosis, (2) its reliability in the assessment of the severity of the lesion, and (3) the usefulness of additional markers from the left side of the heart as criteria of severity. Fourteen pregnant ewes were included in this study (gestational age, 90 to 120 days). Banding of the fetal main pulmonary artery created mild (n = 3), moderate (n = 3), and severe (n = 5) stenosis. Three lambs were sham operated. Intrauterine fetal Doppler echocardiographic data obtained 15 days after surgery were compared with preoperative values. Peak velocities recorded through the band increased linearly from baseline in the groups with mild and moderate stenosis but did not show any further increase in the group with severe stenosis. Compared with the sham-operated group, right ventricular output in the group with stenosis was either similar or reduced significantly. The increase in right ventricular free wall thickness was significantly greater in the groups with stenosis compared with that of the sham-operated group; the correlation with the degree of severity was r = 0.65 and p < 0.05. A A stronger positive correlation was found between the severity of stenosis and aortic valve diameters: r = 0.82 and p < 0.01. The strongest correlation was found for right ventricular/left ventricular outputs (r = 0.92; p < 0.001). Thus Doppler peak velocities through the obstruction can help detect pulmonic stenosis but are not reliable for the assessment of its severity during fetal life. Other ultrasound measurements such as the size of the aortic anulus and especially the ratio of right ventricular/left ventricular output could be used as sensitive markers of the severity of stenosis.
（1）多普勒超声心动图在描绘胎儿肺动脉狭窄存在方面的价值；（2）其在评估病变严重程度方面的可靠性；（3）来自心脏左侧的其他标志物作为严重程度标准的有用性。本研究纳入了14只妊娠母羊（妊娠龄90至120天）。对胎儿主肺动脉进行环扎造成轻度（n = 3）、中度（n = 3）和重度（n = 5）狭窄。3只羔羊接受假手术。将术后15天获得的宫内胎儿多普勒超声心动图数据与术前值进行比较。在轻度和中度狭窄组中，通过环扎处记录的峰值速度从基线呈线性增加，但在重度狭窄组中未显示进一步增加。与假手术组相比，狭窄组的右心室输出要么相似，要么显著降低。与假手术组相比，狭窄组右心室游离壁厚度的增加显著更大；与严重程度的相关性为r = 0.65，p < 0.05。在狭窄严重程度与主动脉瓣直径之间发现更强的正相关：r = 0.82，p < 0.01。右心室/左心室输出的相关性最强（r = 0.92；p < 0.001）。因此，通过梗阻部位的多普勒峰值速度有助于检测肺动脉狭窄，但在胎儿期评估其严重程度并不可靠。其他超声测量，如主动脉瓣环大小，尤其是右心室/左心室输出比值，可作为狭窄严重程度的敏感标志物。
