房室瓣环位移评价心室发育不良胎儿心功能的临床价值研究

A Quantitative study of ventricular function in fetuses with ventricular hypoplasia by atrial-ventricular annular displacement

目的应用M型超声心动图测量中晚孕胎儿房室瓣环位移(AVAD),探讨AVAD评价心室发育不良胎儿心功能的价值。方法(1)选取150例孕龄19～41周的正常中晚孕胎儿,应用M型超声心动图测量AVAD[包括二尖瓣瓣环位移(MAD)和三尖瓣瓣环位移(TAD)]及左心室射血分数(LVEF)、左心室短轴缩短率(LVFS);二维超声画迹法测量右心室舒张末期面积(RVEDA)及收缩末期面积(RVESA),计算右心室面积变化率(RVPCA);频谱多普勒(PW)取房室瓣口血流流速曲线,测量E、A峰值流速;组织多普勒(TDI)取房室瓣瓣环的运动流速曲线,分别测量房室瓣环舒张早期峰值流速(Em)、舒张晚期峰值流速(Am)及收缩期峰值流速(Sm)。定量分析AVAD与孕周(GA)及常规心室功能参数间的相关性。(2)选取49例心室发育不良胎儿(其中左心室发育不良组23例,右心室发育不良组26例),随机选择上述150例正常胎儿中的30例为对照组,应用M型超声心动图测量其AVAD,并比较3组的差别。结果(1)正常中晚孕胎儿AVAD随GA增加而增长,AVAD与E、A及Em、Am、Sm呈正相关,其中MAD与E、A、Em、Am、Sm呈正相关(r=0.347、0.290、0.407、0.393、0.517,P均<0.01),TAD与E、A、Em、Am、Sm呈正相关(r=0.351、0.320、0.497、0.403、0.598,P均<0.01);MAD与LVEF、LVFS无相关性(r=0.199、0.258,P均>0.05),TAD与RVPCA呈正相关(r=0.837,P<0.01)。(2)左心室发育不良组的MAD较对照组减小[(7.11±0.56)mm vs(7.80±0.87)mm]、TAD较对照组增大[(9.78±2.11)mm vs(9.38±1.51)mm],差异均有统计学意义(t=2.98、2.47,P均<0.05);右心室发育不良组的MAD较对照组增大[(8.35±0.69)mm vs(7.80±0.87)mm]、TAD较对照组减小[(7.98±1.69)mm vs(9.38±1.51)mm],差异均有统计学意义(t=2.42、4.18,P均<0.05)。结论AVAD是评价胎儿心室长轴功能有价值的参数,可有效评估心室发育不良胎儿的心功能,并有助于此类胎儿的产前咨询。

Objective To evaluate ventricular function in fetuses with ventricular hypoplasia by atrial-ventricular annular displacement(AVAD).Method(1)A total of150normal fetuses at gestational age19~41weeks were selected as control group in this study.M-mode echocardiography was used to measure AVAD,the left ventricular ejection fraction(LVEF),and left ventricular fractional shortening(LVFS).The two-dimensional ultrasound trace method was used to measure the right ventricular end-diastolic area(RVEDA)and right ventricular end-systolic area(RVESA),And the right ventricular percent change in area(RVPCA)was calculated.Pulsed wave(PW)Doppler was used to measure the E and A peak flow rate,and the atrioventricular mitral valve flow velocity curve was drawn.Tissue Doppler imaging(TDI)was used to measure Em,Am and Sm,respectively,and the atrioventricular prosthetic ring flow rate curve was drawn.A quantitative analysis was conducted to determine the correlation between AVAD and gestational age and conventional ventricular function parameters.(2)A total of49fetuses with ventricular dysplasia were selected as study group,including23fetuses with left ventricular dysplasia(HLHS)and26fetuses with right ventricular dysplasia(HRH).For them,AVAD was measured by M-type echocardiography.A comparative study of these fetuses was conducted with30fetuses in the control group.Results(1)In control group AVAD increased with gestational age(GA);E and A were positively correlated with Em,Am and Sm(P<0.01);mitral annular displacement(MAD)was positively correlated with E,A,Em,Am and Sm(r=0.347,0.290,0.407,0.393,0.517,all P<0.01);tricuspid annular displacement(TAD)was positively correlated with E,A,Em,Am and Sm(r=0.351,0.320,0.497,0.403,0.598,all P<0.01);MAD was not correlated with LVEF and LVFS(r=0.199,0.258,both P>0.05);while TAD was positively correlated with RVPCA(r=0.837,P<0.01).(2)Compared with that of the control group,fetal MAD with HLHS was lower[(7.11±0.56)mm vs(7.80±0.87)mm],and TAD was higher[(9.78±2.11)mm vs(9.38±1.51)mm],all these differences were significant between study and control groups(t=2.98,2.47,both P<0.05).Meanwhile,the fetal MAD with HRH was higher than that of the control group[(8.35±0.69)mm vs(7.80±0.87)mm],and TAD was lower[(7.98±1.69)mm vs(9.38±1.51)mm].Aall these differences were significant between study and control groups(t=2.42,4.18,both P<0.05).Conclusion AVAD is a valuable parameter to evaluate the long axis function of fetal heart in fetuses with ventricular hypoplasia,which can provide valuable information about the circulation characteristics in prenatal consultation.