David N, Iselin M, Blaysat G, Durand I, Petit A
Service de pédiatrie et génétique médicale, hôpital Charles-Nicolle, Rouen.
Arch Mal Coeur Vaiss. 1997 May;90(5):673-8.
The aim of this study was to identify simple echocardiographic criteria suggesting the presence of coarctation of the aorta in the antenatal period. This was a retrospective cooperative study of 43 cases of foetal echocardiography referred to a paediatric cardiologist for abnormal dimensions of the left cardiac chambers and vessels compared with 102 control foetus. Eighteen (41.8%) had abnormalities of the aortic arch at birth. Thirteen of the 18 (72%) neonates had aortic arch abnormalities when disequilibrium with a small left heart was observed before 25 weeks amenorrhea. The ratio between the right and left ventricular dimensions was abnormally high in foetus with functional disequilibrium similar to the foetus with coarctation: the difference between the two groups was not significant. The ratio of pulmonary artery to aortic dimension was higher in the foetus with coarctation of the aorta than with functional disequilibrium. The difference was significant: p < 0.0001. The diameter of the aortic arch in foetus with a future coarctation was much smaller than the mean of the controls, except in 4 cases. The majority of the foetus without left-sided obstacles at birth had normal aortic arches. An early disequilibrium, a high pulmonary artery/aortic ratio and the small size of the aortic ischmus were the main elements suggestive of abnormalities of the aortic arch, especially in the early prenatal period.
本研究的目的是确定在产前阶段提示存在主动脉缩窄的简单超声心动图标准。这是一项回顾性合作研究，对43例因左心腔和血管尺寸异常而转诊给儿科心脏病专家的胎儿超声心动图病例与102例对照胎儿进行了比较。18例（41.8%）出生时存在主动脉弓异常。在闭经25周前观察到左心与其他结构失衡时，这18例新生儿中有13例（72%）存在主动脉弓异常。与主动脉缩窄胎儿相似，存在功能失衡的胎儿左右心室尺寸之比异常高：两组之间的差异不显著。主动脉缩窄胎儿的肺动脉与主动脉尺寸之比高于功能失衡胎儿。差异具有显著性：p<0.0001。除4例病例外，未来会发生主动脉缩窄的胎儿的主动脉弓直径远小于对照组的平均值。大多数出生时无左侧梗阻的胎儿主动脉弓正常。早期失衡、高肺动脉/主动脉比值以及主动脉峡部较小是提示主动脉弓异常的主要因素，尤其是在产前早期。
