Cardiothoracic Area Ratio Predicts Lethal Pulmonary Venous Obstruction in Patients with Single Ventricle and Total Anomalous Pulmonary Venous Connection.
Cardiothoracic Area Ratio Predicts Lethal Pulmonary Venous Obstruction in Patients with Single Ventricle and Total Anomalous Pulmonary Venous Connection.
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DOI：
10.1055/s-0038-1669429
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发表时间：
2018-07
期刊：
影响因子：
0.9
通讯作者：
Inamura N
中科院分区：
文献类型：
--
作者：
Emi M;Inamura N
背景与目的单心室（SV）合并全肺静脉连接异常（TAPVC）时，肺静脉梗阻（PVO）发生率高。有一些死于需要释放PVO的致死性PVO （l-PVO）的患者在出生后24小时内因严重的去饱和而死亡。本研究的目的是寻找胎儿时期l-PVO的预测标志物。方法选取21例产前诊断为SV合并TAPVC的患者。10例为心上型，5例为心源性，5例为心下型，1例为混合型TAPVC。我们回顾了胎儿超声心动图并测量了胸心面积比（CTAR）和心脏总尺寸（TCD）。我们将21例患者分为l-PVO组（6例）和非l-PVO组（15例），比较两组胎儿超声心动图表现和产后预后。结果l-PVO组胎儿超声心动图终末CTAR为16 ~ 29%（中位数：21），非l-PVO组为22 ~ 38%（中位数：28），差异有统计学意义（p = 0.01）。最终超声心动图TCD/周在l-PVO组为0.67至1.0（中位数：0.77），在非l-PVO组为0.78至1.2（中位数：0.96）（p = 0.02）。结论产前CTAR降低是出生后l-PVO的良好预测指标。
Background and Objectives When single ventricle (SV) is complicated with total anomalous pulmonary venous connection (TAPVC), the pulmonary vein obstruction (PVO) occurs at a high rate. There are some patients who died from the lethal PVO (l-PVO) which needed PVO release dead due to severe desaturation within 24 hours after birth. The purpose of this study was to find a predictive marker for l-PVO during the fetal period. Methods We enrolled 21 patients diagnosed with SV associated with TAPVC in the antenatal period. Ten patients had supracardiac, five had cardiac, five had infracardiac, and one had mixed TAPVC. We reviewed fetal echocardiography and measured cardiothoracic area ratio (CTAR) and total cardiac dimension (TCD). We divided 21 cases into l-PVO group (6) and non-l-PVO group (15) and compared the fetal echocardiography findings and postnatal prognoses between the groups. Results CTAR at the final fetal echocardiography was 16 to 29% (median: 21) in the l-PVO group and 22 to 38% (median: 28) in the non-l-PVO group ( p = 0.01). TCD/week at the final echocardiography was 0.67 to 1.0 (median: 0.77) in the l-PVO group and 0.78 to 1.2 (median: 0.96) in the non-l-PVO group ( p = 0.02). Conclusion Reduced CTAR in the antenatal period is a good predictor of l-PVO after birth.