Real-Time Remote-Mentored Echocardiography in Management of Newborns with Critical Congenital Heart Defects

Background:The management of suspected critical congenital heart defects(CCHD)relies on timely echocardiographic diagnosis.The availability of experienced echocardiographers is limited or even non-existent in many hospitals with obstetric units.This study evaluates remote-mentored echocardiography performed by physicians without experience in imaging of congenital heart defects(CHD).Methods:The setup included a pediatric cardiologist in a separate room,guiding a physician without experience in echocardiographic imaging of CHD in the examination of a symptomatic newborn.This remote-mentoring pair was blinded to the diagnosis of the newborn and presented with a simplified patient history.The echocardiographic images were streamed to the laptop of the mentor,along with a webcam feed showing the probe position.The task was to identify CCHD in need of immediate transfer to a pediatric cardiac surgical center.The result was compared to the previously completed echocardiographic report and the clinical decision of the patient-responsible pediatric cardiologist.Results:During 17 months,15 newborns were recruited.All six newborns with CCHD were correctly labeled by the remotementoring pair.One newborn with Tetralogy of Fallot was erroneously labeled as needing immediate transfer.Eight newborns without CCHD were correctly labeled.Conclusions:Remote-mentored echocardiography performed by examiners without experience in imaging CHD identified all newborns with CCHD in need of immediate transfer for specialist care.The setup shows promising results for improving the management of CCHD in hospitals without continuous pediatric cardiology service.

Interaction between ozone and paternal smoking on fetal congenital heart defects among pregnant women at high risk a multicenter maternal-fetal medicine study

Background Evidence remains limited on the association between maternal ozone(O,)exposure and congenital heart defects(CHDs)in offspring,and few studies have investigated the interaction and modification of paternal smoking on this association.Methods Using a sample including pregnant women at high risk of fetal CHD(with metabolic disease,first-trimester viral infection,family history of CHD,etc.)from a maternal-fetal medicine study covering 1313 referral hospitals in China during 2013-2021,we examined the associations between maternal O_(3)exposure during 3-8 weeks of gestational age and fetal CHD in offspring and investigated the interaction and modification of paternal smoking on this association.CHD was diagnosed by fetal echocardiograms,maximum daily 8-hour average O,exposure data at a 10 km×10 km spatial resolution came from the Tracking Air Pollution in China dataset,and paternal smoking was collected using questionnaires.Logistic regression models were used to estimate adjusted odds ratios(ORs)and 95%confidence intervals(CIs).Results Among 27,834 pregnant women at high risk of fetal CHD,17.4%of fetuses were diagnosed with CHD.Each 10μg/m^(3)increase in maternal O_(3)exposure was associated with a 17%increased risk of CHD in offspring(OR=1.17,95%CI=1.14-1.20).Compared with paternal nonsmoking and maternal low O_(3)exposure,the ORs(95%CI)of CHD for smoking and low O_(3)exposure,nonsmoking and high O_(3)exposure,and smoking and high O_(3)exposure were 1.25(1.08-1.45),1.81(1.56-2.08),and 2.23(1.84-2.71),respectively.Paternal smoking cessation seemingly mitigated the increased risk of CHD.Conclusions Maternal O_(3)exposure and paternal smoking were interactively associated with an increased risk of fetal CHD in offspring,which calls for effective measures to decrease maternal exposure to O_(3)pollution and secondhand smoke for CHDprevention.

Prenatal Diagnosis of an Apically Located Congenital Left Ventricular Aneurysm: A Rare Case

Congenital ventricular aneurysm is a very rare cardiac anomaly.A diagnosis can be made during the prenatal period using fetal echocardiography.This study presents a very rare apically located left ventricular aneurysm case,and the relevant literature was reviewed and discussed.In this case,a 35-year-old,gravida 2,parity 1 preg-nant woman at 24 weeks of gestation,displayed a wide aneurysmal image in the left ventricular apical wall on fetal echocardiography.There was a 1.79 mm muscular ventricular septal defect at the apical region of the interven-tricular septum.In the course of the color Doppler ultrasonography examination,an aberrantfibrous band within the left ventricle and consequent turbulentflow during systole were observed.The baby,born via cesarean section at 37 weeks of gestation,is now in its postnatal seventh month.However,during echocardiographic follow-ups,changes have been observed,including mild to moderate mitral insufficiency and a decrease in systolic function.Despite thesefindings,the clinical condition remains asymptomatic.It is of great importance to use a multidis-ciplinary approach in managing these rare cases that could lead to potential adverse outcomes during the antena-tal or postnatal periods.

An Effective Machine-Learning Based Feature Extraction/Recognition Model for Fetal Heart Defect Detection from 2D Ultrasonic Imageries

Congenital heart defect,accounting for about 30%of congenital defects,is the most common one.Data shows that congenital heart defects have seriously affected the birth rate of healthy newborns.In Fetal andNeonatal Cardiology,medical imaging technology(2D ultrasonic,MRI)has been proved to be helpful to detect congenital defects of the fetal heart and assists sonographers in prenatal diagnosis.It is a highly complex task to recognize 2D fetal heart ultrasonic standard plane(FHUSP)manually.Compared withmanual identification,automatic identification through artificial intelligence can save a lot of time,ensure the efficiency of diagnosis,and improve the accuracy of diagnosis.In this study,a feature extraction method based on texture features(Local Binary Pattern LBP and Histogram of Oriented Gradient HOG)and combined with Bag of Words(BOW)model is carried out,and then feature fusion is performed.Finally,it adopts Support VectorMachine(SVM)to realize automatic recognition and classification of FHUSP.The data includes 788 standard plane data sets and 448 normal and abnormal plane data sets.Compared with some other methods and the single method model,the classification accuracy of our model has been obviously improved,with the highest accuracy reaching 87.35%.Similarly,we also verify the performance of the model in normal and abnormal planes,and the average accuracy in classifying abnormal and normal planes is 84.92%.The experimental results show that thismethod can effectively classify and predict different FHUSP and can provide certain assistance for sonographers to diagnose fetal congenital heart disease.

Morphological Features of Complex Congenital Cardiovascular Anomalies in Fetuses:as Evaluated by Cast Models

Accurate prenatal diagnosis of complex congenital cardiovascular anomalies, vascular ones in particular, is still challenging. A fetal cardiovascular cast model can provide a copy of the cardiac chambers and great vessels with normal or pathological structures. This study was aimed to demonstrate three-dimensional anatomy of complex congenital cardiovascular anomalies in fetuses by means of corrosion casting. Twenty fetuses with prenatal-ultrasound-diagnosed complex cardiovascular anomalies were enrolled in this study（19 to 35 gestational weeks）. Fetal cardiovascular cast models were made by a corrosion casting technique. The specimens were injected with casting material via the umbilical vein, and then immersed in strong acid after casting fluid was solidified, to disclose the geometries of cardiovascular cavities. Nineteen cast models were successfully made from 20 specimens. The casts distinctly showed the morphological malformations and spatial relationship between cardiac chambers and great vessels. One hundred and eleven abnormalities were revealed by casting in the 19 specimens, including 34 abnormalities located in the cardiac chambers（3, 4 and 27 anomalies in the atria, atrioventricular valves and ventricles, respectively）, and 77 in the great vessels（28, 20, 24 and 5 anomalies in the aorta and its branches, the pulmonary artery, the ductus arteriosus and the major veins, respectively）. Corrosion casting can display three-dimensional anatomy of fetal complex cardiovascular anomalies. This improves our understanding of related pathomorphology and prenatal diagnosis.

Computed tomography versus transthoracic echocardiography in the detection of complex congenial heart diseases in china:a meta-analysis

Objective:To perform a meta-analysis to evaluate the diagnostic performance of computed tomography(CT) and transthoracic echocardiography(TTE) in complex congenital heart diseases(CHD) in China.Methods:MEDLINE,Cochrane library and China National Knowledge Infrastructure(CNKI) database from January 1966 to October 2010,were searched for initial studies in China.All the studies,published in English or Chinese,used TTE,CT,or both as diagnostic tests for CHD and reported the rate of true-positive,true-negative,false-positive and false-negative diagnoses of CHD from TTE and CT findings with the surgical results as the 'gold-standard'(15 studies,XX patients) were collected.The statistic software package,'Meta-Disc 1.4',was used to conduct data analysis.A covariate analysis was used to evaluate the influence of patient or study-related factors on sensitivity.Results:Pooled sensitivity for diagnosis of CHD were 95% [95% confidence interval(CI):94%~96%] for CT studies and 87%(95% CI:85%~88%) for TTE studies.The difference between the pooled sensitivity of CT and that of TTE was statistically significant(P<0.001).TTE had higher sensitivity [0.96(95% CI:0.94~0.97)] for cardiac malformation but lower sensitivity [0.78(95% CI:0.76~0.81)] for extracardiac malformation than CT.Conclusion:CT can provide added diagnostic information compared with TTE in patients with CHD in China,especially for patients suspected of extracardiac malformation.

Incidence of congenital heart disease in Beijing, China

Background The incidence of congenital heart disease has been studied in developed countries for many years, but rarely in the mainland of China. Fetal echocardiographic screening for congenital heart disease was first performed in Beijing in the early 2000s, but the impact was not clear. The current study was undertaken to determine the incidence of congenital heart disease in Beijing, China and to estimate the impact of fetal echocardiography on the incidence of liveborn congenital heart disease.Methods The study involved all infants with congenital heart disease among the 84 062 total births in Beijing during the period of January 1 and December 31, 2007. An echocardiographic examination was performed on every baby suspected to have congenital heart disease, prenatally or/and postnatally.Results A total of 686 infants were shown to have congenital heart disease among 84 062 total births. The overall incidence was 8.2/1000 total births. Mothers of 128 of 151 babies diagnosed prenatally were chosen to terminate the pregnancy. Two of the 151 infants died in utero. A specific lesion was identified for each infant and the frequencies of lesions were determined for each class of infants （total births, stillbirths and live births）. The incidence of congenital heart disease in stillbirths and live births was 168.8/1000 and 6.7/1000, respectively. The difference between the incidence of total birth and the incidence of live birth was statistically significant （P 〈0.001）. Conclusions The incidence of liveborn congenital heart disease in Beijing is within the range reported in developed countries. Fetal echocardiography reduce significantly the incidence of liveborn congenital heart disease.

Efficacy of prenatal diagnosis of major congenital heart disease on perinatal management and perioperative mortality: a meta-analysis

Background:There is no consensus on the effectiveness of prenatal diagnosis except for hospitalized outcomes.Hence,a meta-analysis of published literature was conducted to assess the effect of prenatal diagnosis.Methods:Literature review has identified relevant studies up to December 2013.A meta-analysis was performed according to the guidelines from the Cochrane review group and the PRISMA statement.Studies were identified by searching PubMed,Embase,the Cochrane Central Register of Controlled Trials and World Health Orgnization clinical trials registry center.Meta-analysis was performed in a fixed/random-effect model using Revman 5.1.1 according to the guidelines from the Cochrane review group and the PRISMA guidelines.Results:The results from 13 cohort studies in 12 articles were analyzed to determine the optimal treatment with the lower rate of perioperative mortality in prenatal diagnosis.The superiority of a prenatal diagnosis has been proven because the surgical procedure could be done in the early neonatal period(95%CI,-0.76,-0.40).The prenatal diagnosis has also remarkably reduced the preoperative and postoperative mortality rates in cases of transposition of the great arteries(95% CI=0.06,0.80;95%CI=0.01,0.82,respectively),as well as the overall results with all subtypes(95% CI=0.18,0.94;95% CI=0.46,0.94,respectively).Conclusions:Prenatal diagnosis is effective in perinatal management with an earlier intervention for major congenital heart disease,but only results in a reduced perioperative mortality in cases of transposition of the great arteries.Further investigations are required to evaluate the effect of prenatal diagnosis on life quality during a long-term follow-up.

Misdiagnosis of unroofed coronary sinus syndrome as an ostium primum atrial septal defect by echocardiography:A case report

BACKGROUND Unroofed coronary sinus syndrome(UCSS)is a rare congenital heart disease,which has variable morphologic features and is strongly associated with persistent left superior vena cava(PLSVC).However,it is often difficult to visualize the left-to-right shunt pathway through the CS by transthoracic echocardiography(TTE).CASE SUMMARY A 37-year-old female was admitted to the hepatological surgery department of a hospital with complaint of subxiphoid pain that had started 1 wk prior.Physical examination revealed a grade 3/6 systolic murmur at the left margin of the sternum,between the 2nd and 3rd intercostal cartilage.The patient underwent echocardiography and was diagnosed with ostium primum atrial septal defect(ASD);thus,she was subsequently transferred to the cardiovascular surgery department.A second TTE evaluation before surgery showed type IV UCSS with secundum ASD.Right-heart contrast echocardiography(RHCE)showed that the right atrium and right ventricle were immediately filled with microbubbles,but no microbubble was observed in the CS.Meanwhile,negative filling was observed at the right atrium orifice of the CS and right atrium side of the secundum atrial septal.RHCE identified UCSS combined with secundum ASD but without PLSVC in this patient.CONCLUSION This rare case of UCSS highlights the value of TTE combined with RHCE in confirming UCSS with ASD or PLSVC.

Echocardiographic evaluation of right ventricular function in congenital heart disease

Objective This review aims to provide an overview of conventional and novel indices used in clinical and research arenas for evaluation of right ventricular （RV） function in congenital heart diseases with a dual-chambered circulation.Data sources Articles cited in this review were selected using PubMed search of publications in English with no date limits.The search terms included ＂echocardiography＂,＂right ventricle＂,＂RV function＂,＂cardiac function＂,and ＂congenital heart disease＂.Key references were also searched for additional publications.Study selection Articles related to description of echocardiographic techniques in the evaluation of subpulmonary or systemic RV function and their applications in congenital cardiac malformations were retrieved and reviewed.Results Three approaches have been used to evaluate subpulmonary and systemic RV function：（1） assessment of changes in RV size in the cardiac cycle,（2） determination of Doppler-derived velocities and systolic and diastolic time intervals,and （3） quantification of myocardial velocities and deformation.Conclusions Conventional and novel echocardiographic techniques enable the evaluation of subpulmonary and systemic RV function.Novel echocardiographic techniques have further allowed quantification of RV volumes and direct interrogation of myocardial deformation.These new techniques show promise in a more comprehensive evaluation beyond ＂eye-bailing＂ of RV function in the growing population of adolescent and adult congenital heart patients.

基于多模态超声建构胎儿先天性心脏病决策树模型及其应用价值

目的:分析基于多模态超声建构胎儿先天性心脏病决策树模型及其应用价值。方法:随机选取2021年4月-2023年7月在本院产前超声检查孕中期孕妇300例,常规产科超声检查确定胎儿生长程度,核实孕周,采用超声多断面模式方法对胎儿心脏进行多断面检测,包括四腔心断面、三血管断面、主动脉弓断面、左室流出道断面、右室流出道断面。对正常分娩的新生儿进行心脏多断面超声检测。对300例胎儿进行多断面模式超声检测,分析胎儿是否伴有先天性心脏畸形,对比超声检查与随访结果符合情况。结果:超声检出21例先天性心脏畸形胎儿,8例选择引产,余13例正常分娩。超声诊断与随访结果对比,卵圆孔直径增大、法洛四联症、完全型心内膜垫缺损、二尖瓣闭锁、右室发育不良综合征、左室发育不良综合征、大动脉转位、永存动脉干、单心室、三尖瓣下移符合率均为100%,超声诊断室间隔缺损7例,随访发现室间隔诊断5例,诊断符合率71.4%。279例超声诊断无先天性心脏畸形胎儿出生后经超声诊断发现有1例卵圆孔未闭、3例室间隔缺损,共4例漏诊患儿,漏诊率0.54%。四腔心断面、三血管断面、主动脉弓断面、左室流出道断面、右室流出道断面诊断胎儿畸形率分别为3.95%、0.63%、2.76%、3.27%、3.25%。由决策树模型可得,产前超声检查发现胎儿心脏可疑异常、高龄孕妇、孕妇接受药物治疗或射线暴露、孕妇有先天性心脏病家族史是胎儿存在先天性心脏病的独立危险因素,其中产前超声检查发现胎儿心脏可疑异常的影响最为显著。结论:孕中期胎儿产前超声多断面模式筛查胎儿先天性心脏病,能够对多数胎儿先天性心脏病进行诊断。

胎儿超声心动图联合母体血清SFRP5、同型半胱氨酸浓度对先天性心脏病胎儿的诊断价值

目的分析胎儿超声心动图联合母体血清分泌型卷曲相关蛋白5(secreted frizzled-related protein 5,SFRP5)、同型半胱氨酸(homocysteine,Hcy)浓度对先天性心脏病(先心病)胎儿的诊断效能。方法选取2018年7月至2022年2月在十堰市妇幼保健院进行孕中期产前检查的孕妇2756例为研究对象,根据妊娠结局将孕妇分为先心病组(n=110),正常组(n=2646)。孕中期均行胎儿超声心动图检查。酶联免疫吸附法试验(enzymelinked immunosorbent assay,ELISA)检测母体血清SFRP5浓度,全自动生化分析仪检测Hcy浓度。Pearson法分析先心病组母体血清SFRP5浓度与Hcy浓度的相关性。以妊娠结局为“金标准”,分析胎儿超声心动图、母体血清SFRP5、Hcy浓度及三者联合对先心病胎儿的诊断效能。结果先心病组母体血清SFRP5浓度明显低于正常组(P<0.05),Hcy浓度明显高于正常组(P<0.05),两者浓度呈负相关(r=-0.575,P<0.05)。胎儿超声心动图、母体血清SFRP5、Hcy浓度诊断先天性心脏病胎儿的灵敏度分别为63.64%、64.55%、65.45%,特异度分别为81.52%、81.07%、80.35%,准确度分别为80.81%、80.41%、79.75%。胎儿超声心动图、母体血清SFRP5、Hcy浓度联合诊断先心病胎儿的灵敏度、准确度分别为96.36%、80.91%,均高于三者单独检测,且三者联合诊断的灵敏度显著高于三者单独诊断(P<0.05)。结论胎儿超声心动图联合母体血清SFRP5、Hcy浓度对先心病胎儿具有较高的诊断价值,三者联合诊断可提高灵敏度。

Echocardiography in children with Down syndrome

Congenital heart disease is a common problem in children with Down syndrome(DS). Echocardiography plays an important role in the detection of both structural and functional abnormalities in this group of patients. Fetal echocardiography can help in the early recognition of DS by detecting soft markers of DS, but its main role is to define the exact nature of the suspected cardiac problem in the fetus. Postnatal echocardiography is mandatory in the first month of life for all neonates with DS. It is also indicated before any cardiac surgery and for serial follow-up after cardiac surgery.In this article, we discuss the types and mechanism of cardiac abnormalities in DS children and the role of both fetal and postnatal echocardiography in the detection of these abnormalities.

Ventricular Septal Defects at the Souro Sanou University Hospital Center (CHUSS): Ultrasound, Therapeutic and Evolutionary Aspects of 88 Cases

Background: There is a need for data on epidemiological, clinical and therapeutic aspects of ventricular septal defect among children in?Sub-Saharan Africa. Objective: The aim of this study was to determine the prevalence, epidemioclinical, echocardiographic, therapeutic and evolutionary aspects of ventricular septal defects (VSD) in the pediatric department of the University Hospital Center (CHUSS) of Bobo-Dioulasso. Methods: This study was a descriptive cross-sectional study, conducted from November 2013 to December 2016. All children aged 1 to 179 months seen at the pediatric consultation in CHUSS were included. CIV was confirmed with Doppler echocardiography. Results: Out of 36,240 children who received consultation in the pediatric ward of CHUSS during the study period, one hundred (100) cases of them had congenital heart disease representing a hospital prevalence of 2.76%. This was diagnosed with Doppler echocardiography. Of these, 88% were VSD isolated or associated with other cardiac malformations. Isolated form was reported in 54.3% of cases. The average?age at diagnosis was 39.6 months. The sex ratio was 1.05. Perimembranous topography and hemodynamic type 2 were the highest, representing 56.8% and 35.2% respectively. The indication for surgical repair was recommended for 81.8% of the cases, but only 9.7% of these cases benefited from cardiac surgery. The rest were for medicalcare with a high proportion of lost to follow-up (48.9%). Conclusion: VSD is the most common congenital heart disease. Its care is mainly surgical. This cardiac surgery is non-existent in Burkina Faso. The design of multidisciplinary strategies associated with an optimization of the means of the countries of Sub-Saharan Africa could improve the management of this cardiopathy.

CLINICAL SIGNIFICANCE AND PROGNOSIS OF FETAL ARRHYTHMIAS

Objective To explore fetal arrhythmia clinical significance and its correlation with fetal prognosis. Methods Twenty-six cases of fetal arrhythmia detected among 12 799 pregnant women recorded over a ten-year period in Peking Uinon Medical College (PUMC) Hospital were reviewed retrospectively. Fetal arrhythmia was diagnosed by fetal auscultation, ultrasonography, electric fetal heart monitoring, and fetal echocardiography. Results Twenty-six fetuses were documented with fetal arrhythmia (3 tachycardia, 4 bradycardia, 19 normal heart rate with irregular fetal cardiac rhythm). The incidence of fetal arrhythmia in our hospital was 0.2%. They were diagnosed at the average of 35 weeks’ gestation (15 to 41 weeks). Twenty-two cases were diagnosed by antenatal fetal auscultation, 1 case was diagnosed by ultrasonography, and 3 cases were diagnosed by electric fetal heart monitoring. Fetal echocardiograms were per-formed on 17 fetuses, 6 cases (35.3%) of which showed that ventricular premature beats with normal structure of fetal heart. All neonates survived postnatally and 24 of them (92.3%) were followed up. Echocardiograms were performed for 16 neonates and 2 of them were identified as atrial septal defects with normal heart rhythms. The results of follow-up showed that the two patients had no apparent clinical manifestation. The echocardiogram showed that atrial septal defect obliterated already. Conclusion The prognosis is well for most of the fetuses with arrhythmias, with low incidence of heart deformation.

Factors controlling fetal echocardiography determine the diagnostic accuracy of isolated ventricular septal defect

Background:Fetal echocardiography (FECG) is a key screening tool for prenatal cardiac abnormalities.Herein,we examined the ultrasonic factors determining prenatal ultrasonic diagnosis of isolated ventricular septal defect (IVSD).Methods:The diagnostic role of ultrasonic factors was investigated in patients in middle or late pregnancy,diagnosed with IVSD by FECG and confirmed using postnatal echocardiography.Results:One hundred and six patients with IVSD were enrolled;the majority had perimembranous VSD.The combined imaging mode of 2 dimentionalechocardiography (2DE) and color doppler flow imaging (CDFI) showed the highest rate (56.6%) of IVSD detection,while CDFI was more efficient than 2DE (32.1% vs.11.3%).The single-view mode was more efficient than multiple-view mode (75.5% vs.24.5%).The highest efficient mode to detect IVSD was achieved using combined imaging mode on the single view of the left ventricular outflow tract view (LVOTV) (28.3%).FECG correctly classified 71.7% of fetal IVSD.There was a significant difference of accuracy rate in classifying IVSD among the three different imaging modes (x2=7.141,P<0.05).The single imaging mode of CDFI and the mode of CDFI combined with 2DE correctly classified 75.9% and 75.0% of fetal IVSD,respectively.LVOTV was the most accurate view of fetal IVSD classification (85.2%;x2=15.782,P<0.05).There was no difference in accuracies of IVSD classification among multiple-view modes (x2=2.343,P>0.05) or between single-view mode and multiple-view mode (x2=0.32,P>0.05).Conclusion:Single LVOTV in CDFI or CDFI combined with 2DE of FECG were the most effective diagnostic modes for fetal IVSD diagnosis.

超声心动图评估常见左向右分流型先天性心脏病介入治疗左心室舒张功能改善的自身前后对照试验

背景心功能异常时舒张功能通常首先有改变,目前虽有很多关于心室收缩功能研究,但却鲜有关于先天性心脏病(CHD)左心室舒张功能变化的研究。目的通过超声心动图评估常见左向右分流型CHD介入治疗前后左心室舒张功能指标。设计自身前后对照试验。方法纳入在重庆医科大学附属儿童医院诊断为动脉导管未闭(PDA)、室间隔缺损(VSD)、房间隔缺损(ASD)的年龄<18岁并行介入治疗的CHD患儿,排除复杂CHD、先天性发育异常、遗传代谢性疾病的患儿为病例组,同时招募健康儿童。行剑突下、胸骨旁、胸骨上窝等部位多切面超声扫查,采集病例组和健康儿童的左心室舒张功能指标(左心室结构、二尖瓣口血流频谱、二尖瓣环组织多普勒运动频谱和肺静脉血流频谱指标)及一般信息(超声检查时的年龄、身高、体重、体表面积)。基于健康儿童的左心功能指标,分析比较病例组介入手术前1周内、术后1 d、术后1个月时点的左心功能指标变化。主要结局指标介入术后左心房容积指数(LAI)、二尖瓣舒张早期血流峰值流速(E)/二尖瓣舒张晚期血流峰值流速(A)比值、E/二尖瓣环室间隔处舒张早期运动峰值流速(E')比值、E/二尖瓣环侧壁处舒张早期运动峰值流速(e')比值恢复水平。结果病例组163例,PDA亚组60例、VSD亚组42例、ASD亚组61例;招募健康儿童61例。PDA、VSD亚组年龄、身高、体重、BSA均低于对照组,差异均有统计学意义。PDA、VSD和ASD亚组,LAI、E/A比值、E/e'比值和E/E'比值,术前均高于对照组,差异有统计学意义,术后1 d下降,术后1个月恢复至对照组水平。肺静脉血流频谱D术前、术后1 d和术后1个月均呈降低趋势,术后1个月较对照组降低。结论超声心动图可作为儿童常见左向右分流型CHD左心室舒张功能的评估手段,PDA、VSD和ASD均存在不同程度的左心室舒张功能障碍,介入治疗后舒张功能主要指标可得到改善,术后1个月后可恢复接近正常。

不同类型左头臂静脉异常胎儿超声心动图特征及临床意义

目的 探讨正常胎儿左头臂静脉(LBCV)前后径与孕龄的关系,分析不同类型LBCV异常胎儿的超声心动图特征,并评估其临床意义。资料与方法 回顾性分析2015年1月—2020年1月来自泉州市儿童医院、福建医科大学附属第二医院、安溪县妇幼保健院共30例LBCV异常胎儿的超声心动图特征,并于三血管气管断面偏头侧的胸腺断面连续测量714例孕龄20~38周正常胎儿LBCV的前后径,分析孕龄与LBCV前后径的关系。结果 随着孕龄增加,LBCV前后径明显增加(r=60.084,P<0.001),其回归方程为Y=2.01+0.19×孕龄(F=0.914,P<0.001)。30例LBCV异常胎儿中,LBCV走行异常24例(主动脉弓下走行22例、食管后迷走1例、胸腺内走行1例),LBCV缺如4例,LBCV扩张2例;合并主动脉弓及其分支异常13例、圆锥动脉干畸形4例、室间隔缺损1例、心上型肺静脉异位引流1例、Galen静脉瘤1例。结论 产前超声心动图可用于评估胎儿LBCV,LBCV异常胎儿通常合并心脏畸形,评估胎儿LBCV有助于筛查胎儿先天性心脏病。

超声心动图联合产前咨询对胎儿先天性心脏病妊娠结局应用分析

目的探讨胎儿超声心动图联合产前咨询对胎儿先天性心脏病(CHD)妊娠结局应用分析。方法选取我院产前筛查孕妇2152例,均经产前超声心动图筛查,按照预后及出生后手术时机将胎儿心脏出生缺陷分为Ⅰ~Ⅲ级,提出分级标准与包含的常见疾病种类。随访孕妇经产前分级咨询后胎儿结局,评估胎儿预后情况以及治疗结局。结果2152例接受彩色多普勒超声心动图筛查妊娠孕妇中,CHD胎儿为32例,彩色多普勒心动图筛查中阳性预测值、阴性预测值分别为90.63%、99.72%,漏诊室间隔缺损2例、完全型肺静脉异位引流1例;胎儿CHD检查结果分析中II级10例、III级22例;32例CHD胎儿中,继续妊娠22例,引产10例,其中II级、III级中继续妊娠分别为9例、13例,接受手术治疗者分别为5例、13例,均在出生后6~12个月内接受手术治疗,术后死亡3例。结论产前超声心动图应用于胎儿CHD产前诊断中,可有效判断胎儿心脏异常情况。

胎儿先天性心脏病产前筛查的研究进展

先天性心脏病(congenital heart disease,CHD)具有发病率高、危害大、死亡率高等特点,是新生儿死亡的主要原因之一。因此,使用更有效的医学检测方法,尽早发现CHD胎儿,并进行全面的评估和适当的产前干预,对降低儿童的致残率和死亡率、提高人口素质、减轻家庭和社会负担尤为重要。本文就CHD流行病学、胎儿CHD筛查时机、CHD影像学检查、高危胎儿遗传学检查等研究进行一一阐述。