Abstract：
BACKGROUND: Critical pulmonary stenosis or atresia with intact ventricular septum (PSAIVS) may be managed either by biventricular repair or univentricular palliation. This systematic review and meta-analysis aimed to synthesize the evidence for the role of fetal echocardiography in predicting the postnatal treatment pathway.
METHODS: PubMed/MEDLINE, CINHAL, Cochrane Library, Academic Search Complete, Web of Science, and Trip Pro were searched for observational studies published before July 2021. Random-effects meta-analysis was performed to identify factors associated with biventricular repair.
RESULTS: Eleven individual studies published between 2006 and 2021, including a total of 285 participants (159 biventricular repair; 126 univentricular palliation), met our eligibility criteria. The pooled estimated prevalence of biventricular repair among patients with PSAIVS was 55.6% (95% confidence interval 48.5-62.5%). Those who underwent biventricular repair had greater right to left ventricle and tricuspid to mitral valve dimension ratios, greater TV z score, and longer TV inflow duration/cardiac cycle length by fetal echocardiography. They were also more likely to have significant tricuspid regurgitation and less likely to have ventriculo-coronary connections (VCCs).
CONCLUSIONS: Commonly obtained fetal echocardiographic measurements have strong associations with treatment pathway choice for patients with PSAIVS. Greater RV growth appears to favor biventricular repair, whereas patients with VCC almost invariably undergo univentricular palliation. Future studies should aim to establish how these fetal echocardiographic parameters might predict outcomes for the two treatment pathways.
METHODS: PubMed/MEDLINE, CINHAL, Cochrane Library, Academic Search Complete, Web of Science, and Trip Pro were searched for observational studies published before July 2021. Random-effects meta-analysis was performed to identify factors associated with biventricular repair.
RESULTS: Eleven individual studies published between 2006 and 2021, including a total of 285 participants (159 biventricular repair; 126 univentricular palliation), met our eligibility criteria. The pooled estimated prevalence of biventricular repair among patients with PSAIVS was 55.6% (95% confidence interval 48.5-62.5%). Those who underwent biventricular repair had greater right to left ventricle and tricuspid to mitral valve dimension ratios, greater TV z score, and longer TV inflow duration/cardiac cycle length by fetal echocardiography. They were also more likely to have significant tricuspid regurgitation and less likely to have ventriculo-coronary connections (VCCs).
CONCLUSIONS: Commonly obtained fetal echocardiographic measurements have strong associations with treatment pathway choice for patients with PSAIVS. Greater RV growth appears to favor biventricular repair, whereas patients with VCC almost invariably undergo univentricular palliation. Future studies should aim to establish how these fetal echocardiographic parameters might predict outcomes for the two treatment pathways.
摘要：
背景：严重的肺动脉狭窄或室间隔完整的闭锁（PSAIVS）可以通过双心室修复或单室缓解来治疗。本系统综述和荟萃分析旨在综合胎儿超声心动图在预测产后治疗途径中的作用的证据。
方法：PubMed/MEDLINE，CINHAL,科克伦图书馆,学术搜索完成，WebofScience,搜索了TripPro在2021年7月之前发表的观察性研究。进行随机效应荟萃分析以确定与双心室修复相关的因素。
结果：2006年至2021年期间发表的11项个人研究，包括285名参与者（159名双心室修复；126名单心室缓解），符合我们的资格标准。PSAIVS患者双心室修复的汇总估计患病率为55.6％（95％置信区间48.5-62.5％）。接受双心室修复的患者右心室与左心室和三尖瓣与二尖瓣的尺寸比较大，更高的电视z分数，通过胎儿超声心动图检查，电视流入持续时间/心动周期长度更长。他们也更有可能出现明显的三尖瓣反流，并且不太可能出现心室冠状动脉连接（VCC）。
结论：通常获得的胎儿超声心动图测量值与PSAIVS患者的治疗途径选择密切相关。更大的RV生长似乎有利于双心室修复，而VCC患者几乎总是接受单室姑息治疗。未来的研究应旨在确定这些胎儿超声心动图参数如何预测两种治疗途径的结局。
方法：PubMed/MEDLINE，CINHAL,科克伦图书馆,学术搜索完成，WebofScience,搜索了TripPro在2021年7月之前发表的观察性研究。进行随机效应荟萃分析以确定与双心室修复相关的因素。
结果：2006年至2021年期间发表的11项个人研究，包括285名参与者（159名双心室修复；126名单心室缓解），符合我们的资格标准。PSAIVS患者双心室修复的汇总估计患病率为55.6％（95％置信区间48.5-62.5％）。接受双心室修复的患者右心室与左心室和三尖瓣与二尖瓣的尺寸比较大，更高的电视z分数，通过胎儿超声心动图检查，电视流入持续时间/心动周期长度更长。他们也更有可能出现明显的三尖瓣反流，并且不太可能出现心室冠状动脉连接（VCC）。
结论：通常获得的胎儿超声心动图测量值与PSAIVS患者的治疗途径选择密切相关。更大的RV生长似乎有利于双心室修复，而VCC患者几乎总是接受单室姑息治疗。未来的研究应旨在确定这些胎儿超声心动图参数如何预测两种治疗途径的结局。
