Gembruch U, Smrcek J M
Department of Obstetrics and Gynecology, Medical University of Lübeck, Germany.
Ultrasound Obstet Gynecol. 1997 Jun;9(6):374-82. doi: 10.1046/j.1469-0705.1997.09060374.x.
The aim of this study was to assess the prevalence and clinical significance of fetal tricuspid valve regurgitation. In a cross-sectional study, 289 normally grown singleton fetuses with normal heart anatomy, normal estimated weight for gestational age, normal amniotic fluid volume and normal flow velocity waveforms in the umbilical and middle cerebral arteries and umbilical vein were examined. A further 31 singleton fetuses with intrauterine growth retardation (estimated fetal weight below the 3rd centile) were analyzed. Semiquantification of the tricuspid valve regurgitation by spatial and temporal parameters was performed in the four-chamber view by color Doppler flow imaging and by color Doppler M-mode echocardiography (M-Q mode). The prevalence of fetal tricuspid valve regurgitation among normally grown fetuses was 6.23% (n = 18). In all cases, the tricuspid regurgitation was part-systolic (non-holosystolic, early and mid-systolic tricuspid regurgitation) and showed little spatial expansion of the jet as examined by color Doppler flow imaging (no jet reached the opposite atrial wall, the area of tricuspid regurgitation being less than 25% of the atrial area). The maximum velocity of the regurgitant jets was below 2 m/s with one exception. There was no statistically significant correlation between gestational age and occurrence of tricuspid regurgitation (U test, p > 0.05). Re-examination of 14 of the 18 fetuses with tricuspid regurgitation showed that tricuspid regurgitation was a transient phenomenon in these instances. The fetal outcome in the presence of tricuspid valve regurgitation was normal. Regurgitations of the mitral, pulmonary and aortic valves were excluded in all 289 fetuses. Only two of the 31 fetuses (6.45%) with intrauterine growth retardation showed tricuspid valve regurgitation. In one fetus the tricuspid regurgitation ws only part-systolic. In the other severely compromised fetus with highly abnormal flow velocity waveforms in the arterial and venous side of the fetal circulation, cardiac dilatation with holosystolic tricuspid and holosystolic mitral regurgitation occurred immediately before intrauterine death. Fetal tricuspid valve regurgitation was a frequent finding during Doppler echocardiography. Although it may be a sign of increased preload, afterload or cardiac dysfunction, in most cases tricuspid valve regurgitation is an isolated transient finding with little temporal and spatial expansion, and it may be physiological.
本研究的目的是评估胎儿三尖瓣反流的患病率及其临床意义。在一项横断面研究中，对289例生长正常、心脏解剖结构正常、估计体重与孕周相符、羊水体积正常、脐动脉、大脑中动脉及脐静脉血流速度波形正常的单胎胎儿进行了检查。另外对31例宫内生长受限（估计胎儿体重低于第3百分位数）的单胎胎儿进行了分析。通过彩色多普勒血流成像及彩色多普勒M型超声心动图（M-Q模式）在四腔心切面按空间和时间参数对三尖瓣反流进行半定量分析。生长正常的胎儿中三尖瓣反流的患病率为6.23%（n = 18）。所有病例中，三尖瓣反流均为部分收缩期（非全收缩期，早期及中期收缩期三尖瓣反流），彩色多普勒血流成像显示反流束空间扩展较小（无反流束到达对侧心房壁，三尖瓣反流面积小于心房面积的25%）。除1例例外，反流束最大速度低于2 m/s。孕周与三尖瓣反流的发生之间无统计学显著相关性（U检验，p>0.05）。对18例有三尖瓣反流的胎儿中的14例进行复查显示，在这些病例中三尖瓣反流是一种短暂现象。存在三尖瓣反流时胎儿结局正常。289例胎儿均排除二尖瓣、肺动脉瓣及主动脉瓣反流。31例宫内生长受限胎儿中仅2例（6.45%）出现三尖瓣反流。1例胎儿的三尖瓣反流仅为部分收缩期。另1例严重受损胎儿，其胎儿循环动静脉侧血流速度波形高度异常，在宫内死亡前即刻出现心脏扩大伴全收缩期三尖瓣反流及全收缩期二尖瓣反流。胎儿三尖瓣反流在多普勒超声心动图检查中是常见表现。尽管它可能是前负荷、后负荷增加或心脏功能障碍的征象，但在大多数情况下，三尖瓣反流是孤立的短暂表现，时间和空间扩展较小，可能是生理性的。
