Rasanen J, Debbs R H, Wood D C, Weiner S, Weil S R, Huhta J C
Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia 19107, USA.
Ultrasound Obstet Gynecol. 1997 Nov;10(5):325-32. doi: 10.1046/j.1469-0705.1997.10050325.x.
Our objective was to determine whether abnormal loading conditions can modify human fetal right ventricular ejection force during the second half of pregnancy. By Doppler echocardiography, we studied 73 normal fetuses between 19 and 41 weeks of gestation, 27 fetuses with hypoplastic left heart syndrome (chronic volume overload) between 18 and 38 weeks of gestation, 14 fetuses with mild to moderate constriction of the ductus arteriosus (pulsatility index (PI) between 1.0 and 1.9) and seven fetuses with severe constriction (PI < 1.0) or occlusion of the ductus arteriosus (relatively acute pressure overload) between 28 and 34 weeks of gestation. In the normal and ductal constriction/occlusion groups, blood velocity waveforms were recorded at the level of the aortic and pulmonary valves, and in the group with hypoplastic left heart syndrome at the level of the pulmonary valve. The ventricular ejection forces were calculated. In the normal group, right (RVEF; r = 0.91, p < 0.0001) and left (LVEF; r = 0.86, p < 0.0001) ventricular ejection forces increased and were equal during the second half of gestation. In the group with hypoplastic left heart syndrome the RVEF increased (r = 0.76, p < 0.0001) with advancing gestation. The RVEF (p < 0.0005) and its average weekly increase (p < 0.0001) were greater in the hypoplastic left heart syndrome group than in the normal group. In the group with mild to moderate ductal constriction, both ventricular ejection forces were similar to those of the normal group. The RVEF (p < 0.003) and its average weekly increase (p < 0.03) were lower in the group with severe ductal constriction or occlusion than in the normal group. The LVEF did not differ from that of the normal group We conclude that chronic volume overload increases and relatively acute pressure overload decreases human fetal RVEF. The right ventricular performance is modified by abnormal loading conditions.
我们的目的是确定异常负荷条件是否会在妊娠后半期改变人类胎儿右心室射血力。通过多普勒超声心动图，我们研究了73例孕19至41周的正常胎儿、27例孕18至38周的左心发育不全综合征胎儿（慢性容量超负荷）、14例动脉导管轻度至中度狭窄（搏动指数（PI）在1.0至1.9之间）的胎儿以及7例孕28至34周动脉导管严重狭窄（PI < 1.0）或闭塞（相对急性压力超负荷）的胎儿。在正常组和动脉导管狭窄/闭塞组中，在主动脉瓣和肺动脉瓣水平记录血流速度波形，在左心发育不全综合征组中在肺动脉瓣水平记录。计算心室射血力。在正常组中，妊娠后半期右心室射血力（RVEF；r = 0.91，p < 0.0001）和左心室射血力（LVEF；r = 0.86，p < 0.0001）增加且相等。在左心发育不全综合征组中，随着孕周增加，RVEF增加（r = 0.76，p < 0.0001）。左心发育不全综合征组的RVEF（p < 0.0005）及其平均每周增加量（p < 0.0001）高于正常组。在动脉导管轻度至中度狭窄组中，两个心室的射血力与正常组相似。严重动脉导管狭窄或闭塞组的RVEF（p < 0.003）及其平均每周增加量（p < 0.03）低于正常组。LVEF与正常组无差异。我们得出结论，慢性容量超负荷会增加，而相对急性压力超负荷会降低人类胎儿的RVEF。右心室功能会因异常负荷条件而改变。
