Fetal Doppler Echocardiographic Assessment Predicts Severe Postnatal Obstruction in Total Anomalous Pulmonary Venous Connection.
Fetal Doppler Echocardiographic Assessment Predicts Severe Postnatal Obstruction in Total Anomalous Pulmonary Venous Connection.
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DOI：
10.1016/j.echo.2022.07.007
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发表时间：
2022-11
期刊：
影响因子：
--
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中科院分区：
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梗阻性全异常肺静脉连接（TAPVC）是一种严重的先天性心脏病，通常需要紧急的产后干预。了解哪些患者有严重的梗阻可以帮助制定分娩计划。作者先前开发了一种新的定量测量肺静脉流量的指标，即肺静脉变异性指数（PVVI）。本研究的目的是验证胎儿PVVI和垂直静脉多普勒速度与出生后严重肺静脉阻塞有关的假设。对产前诊断为TAPVC的新生儿进行回顾性队列研究。在费城儿童医院接受胎儿超声心动图和多普勒垂直静脉检查的患者被纳入分析。29例患者符合标准（21例异位，18例心上TAPVC）。使用最新的妊娠期胎儿超声心动图。严重肺静脉阻塞定义为术前死亡或紧急手术或导管干预（出生第一天）。PVVI的测量定义为（最大速度-最小速度）/平均速度，离线进行。使用Wilcoxon秩和模型评估严重梗阻与PVVI以及最大、平均和最小流速的关系。最近一次胎儿超声心动图检查的平均胎龄为35周（范围30-39周）。29例患者中有12例（41%）符合严重肺静脉阻塞标准。较低的PVVI与严重肺静脉阻塞的高风险相关（P = 0.008）。垂直静脉的最大、平均和最小流速均与严重肺静脉阻塞显著相关（P = 0.03、P = 0.03和P = 0.07）。梗阻的定性评估与结果无显著相关性。所有垂直静脉多普勒指标的观察者间可靠性很高（类内相关系数> 0.9）。胎儿PVVI以及最大、平均和最小流速与TAPVC患者严重的产后肺静脉阻塞有关。准确预测TAPVC阻塞，可以制定更安全的分娩计划。需要更大样本量的进一步研究来确定这些多普勒测量的理想截止值。
Obstructed total anomalous pulmonary venous connection (TAPVC) is a form of critical congenital heart disease that usually requires urgent postnatal intervention. Knowing which patients have severe obstruction can aid delivery planning. The authors previously developed a novel quantitative metric of pulmonary venous flow, the pulmonary venous variability index (PVVI). The aim of this study was to test the hypothesis that fetal PVVI and vertical vein Doppler velocities are associated with severe pulmonary vein obstruction postnatally. A retrospective cohort study of neonates with prenatally diagnosed TAPVC was performed. Patients who underwent fetal echocardiography at the Children’s Hospital of Philadelphia with Doppler interrogation of the vertical vein were included for analysis. Twenty-nine patients met criteria (21 with heterotaxy, 18 with supracardiac TAPVC). The latest gestation fetal echocardiogram was used. Severe pulmonary vein obstruction was defined as preoperative death or urgent surgery or catheter-based intervention (first day of life). Measurements of PVVI, defined as (maximum velocity − minimum velocity)/mean velocity, were made offline. Wilcoxon rank sum models were used to assess the associations of severe obstruction and PVVI and maximum, mean, and minimum velocities. The mean gestational age at the latest fetal echocardiographic examination was 35 weeks (range, 30–39 weeks). Twelve of the 29 patients (41%) met criteria for severe pulmonary vein obstruction. Lower PVVI was associated with greater risk for severe pulmonary venous obstruction (P = .008). The maximum, mean, and minimum velocities in the vertical vein were all significantly associated with severe pulmonary venous obstruction (P = .03, P = .03, and P = .007, respectively). Qualitative assessment of obstruction was not significantly associated with the outcome. Interobserver reliability for all vertical vein Doppler metrics was high (intraclass correlation coefficient > 0.9). Fetal PVVI and maximum, mean, and minimum velocities are associated with severe postnatal pulmonary vein obstruction in TAPVC. Accurate prediction of obstructed TAPVC could allow safer delivery planning. Further research with larger sample sizes is needed to identify the ideal cutoff values for these Doppler measures.
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影响因子：
0.9
作者：
Emi M;Inamura N
通讯作者：
Inamura N
影响因子：
2.3
作者：
Ganesan, Suguna;Brook, Michael M.;Moon-Grady, Anita J.
通讯作者：
Moon-Grady, Anita J.
DOI：
10.1016/j.echo.2021.02.007
发表时间：
2021-07
期刊：
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
影响因子：
--
作者：
White BR;Faerber JA;Katcoff H;Glatz AC;Mascio CE;Cohen MS
通讯作者：
Cohen MS
影响因子：
8
作者：
Quartermain MD;Pasquali SK;Hill KD;Goldberg DJ;Huhta JC;Jacobs JP;Jacobs ML;Kim S;Ungerleider RM
通讯作者：
Ungerleider RM
影响因子：
37.8
作者：
Seale, Anna N.;Uemura, Hideki;Daubeney, Piers E. F.
通讯作者：
Daubeney, Piers E. F.