Antenatal prediction of pulmonary hypoplasia by acceleration time/ejection time ratio of fetal pulmonary arteries by Doppler blood flow velocimetry
Antenatal prediction of pulmonary hypoplasia by acceleration time/ejection time ratio of fetal pulmonary arteries by Doppler blood flow velocimetry
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DOI：
10.1067/mob.2003.69
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发表时间：
2003-01-01
影响因子：
9.8
通讯作者：
Murata, Y
中科院分区：
文献类型：
--
作者：
Fuke, S;Kanzaki, T;Murata, Y
目的：本研究的目的是开发一种新的方法，产前预测肺发育不良的多普勒血流velocimetry.Study设计：一百七十七个胎儿（160个正常胎儿和17个胎儿先天性异常，可能会影响胎儿肺的生长和/或发育）进行了研究。用多普勒超声心动图记录孕20 ~ 39周肺动脉主要分支血流波形。结果：正常胎儿肺动脉多普勒波形呈“尖突-圆顶”型;右肺动脉和左肺动脉的加速时间/射血时间比值的正常值分别为0.17 +/- 0.04和0.15 +/- 0.04。在本研究中观察到的胎龄期间，这些值未发生显著变化。在所有先天性畸形胎儿中，均成功地测量了右肺动脉或左肺动脉的加速时间/射血时间比值。在17个胎儿中的8个中，在两个肺动脉处测量加速时间/射血时间比。由于先天性异常不对称地影响胎仔肺或胸廓（如先天性疝或先天性肺囊性腺瘤样畸形），仅在13只胎仔中的5只中测量了两条肺动脉的加速时间/射血时间比。患侧的测量一直存在技术上的困难。17例先天性畸形胎儿中有11例存活，新生儿无临床肺发育不全或持续性肺动脉高压迹象。胎仔显示至少一条肺动脉的加速时间/射血时间比值正常。其余6例胎儿死于肺发育不全，诊断经尸检或临床所见证实。在这6只胎儿中，5只胎儿一侧加速时间/射血时间比值低于正常值，另一侧无法获得该比值; 1只胎儿双侧加速时间/射血时间比值均低于正常值范围。加速时间/多普勒血流速度测定法测定的胎儿肺动脉主要分支的射血时间比在整个胎龄是一致的从20到39周。该比值似乎是一个准确的参数，可用于预测新生儿肺发育不良的后续发展和临床结局，具有高阳性和阴性预测值（阳性预测值，100%;阴性预测值，100%）。
OBJECTIVE: The purpose of this study was to develop a new method for the antenatal prediction of pulmonary hypoplasia by Doppler blood flow velocimetry.STUDY DESIGN: One hundred seventy-seven fetuses (160 normal fetuses and 17 fetuses with congenital anomalies that may affect fetal lung growth and/or development) were studied. Blood flow waveforms at the main branches of the pulmonary arteries were recorded by Doppler echocardiography from 20 to 39 weeks of gestation. The ratio of acceleration time to ejection time was calculated from the waveform as a parameter to predict pulmonary hypoplasia.RESULTS: Doppler waveform of normal fetal pulmonary artery showed a "spike-and-dome" pattern. The normal values of acceleration time/ejection time ratio from the right and left pulmonary arteries were 0.17 +/- 0.04 and 0.15 +/- 0.04, respectively. These values were not significantly altered through the gestational age observed in this study. The acceleration time/ejection time ratio of either right or left pulmonary artery was measured successfully in all cases of fetal congenital anomalies. In 8 of 17 fetuses, acceleration time/ejection time ratio was measured at both of the pulmonary arteries. Because of a congenital anomaly that affected the fetal lung or thorax asymmetrically (as in congenital diaphragmatic hernia or congenital cystic adenomatoid malformations of the lung), the acceleration time/ejection time ratio of both of the pulmonary arteries could be measured in only 5 of 13 fetuses. The technical difficulties for the measurement always existed in the affected side. Eleven of the 17 fetuses with congenital anomalies survived without signs of clinical pulmonary hypoplasia or persistent pulmonary hypertension of the newborn infant. The fetuses revealed normal acceleration time/ejection time ratio from at least one pulmonary artery. The remaining 6 fetuses died of pulmonary hypoplasia, and the diagnosis was confirmed by autopsy or clinical findings. Of those 6 fetuses, 5 fetuses demonstrated the acceleration time/ejection time ratio below normal in one side, and the ratio could not be obtained on the other side; 1 fetus showed the acceleration time/ejection time ratio below the normal range in both sides.CONCLUSION: The acceleration time/ejection time ratio by Doppler velocimetry that was obtained at the main branches of fetal pulmonary artery was consistent throughout gestational age from 20 to 39 weeks. This ratio appears to be an accurate parameter with which to predict the subsequent development of pulmonary hypoplasia and clinical outcomes of the newborn infants with high positive and negative predictive values (positive predictive value, 100%; negative predictive value, 100%).