PDF(Pubmed)
Abstract：
UNASSIGNED: The present study aimed to explore the role of modified vascular anatomical molding (MVAM) in prenatal diagnosis teaching and prognosis prediction of fetal complex congenital heart disease (CCHD).
UNASSIGNED: Step 1, MVAM method was used to cast the micro-blood vessels and trachea of 52 CCHD specimens. Subsequently, 52 MVAMs were analyzed and compared with the prenatal ultrasound to summarize their characteristics, misdiagnosis and MVAM\'s teaching role. Step 2, the surgical and follow-up data of 206 CCHD cases were retrospectively analyzed. Cases that evolved into critical illnesses or died within 1-3 years after surgery (poor prognosis) were classified into the study group (n = 77) and those with good prognosis into the control group (n = 129), which were split into the training set and the test set in the ratio 7:3 based on the time cut-off. In the training set, the prognosis of CCHD was predicted using the MVAM anatomical soft markers (distortion and narrowing of aorta/pulmonary artery, right ventricular infundibulum, etc.) and the decision curve analysis (DCA) performed. The model was validated using the test set, and a nomogram was finally established.
UNASSIGNED: It was observed that all 52 CCHD cases were confirmed using MVAM. A total of 91 cardiac malformations were recorded, among which 41 malformations were misdiagnosed, and 29 malformations were missed by the prenatal echocardiography. The MVAM method has a good teaching/feedback effect on prenatal diagnosis. The combined model exhibited a higher predictive performance in the training- and test-set. Its high clinical net benefit was proved by DCA. Additionally, the nomogram established using the combined model received a favorable response in clinical practice.
UNASSIGNED: The research results indicated that MVAM improved the prenatal diagnosis teaching and training performance. The combined model established based on MVAM anatomical soft markers can offer a high clinical significance for prognosis prediction of CCHD.
UNASSIGNED: Step 1, MVAM method was used to cast the micro-blood vessels and trachea of 52 CCHD specimens. Subsequently, 52 MVAMs were analyzed and compared with the prenatal ultrasound to summarize their characteristics, misdiagnosis and MVAM\'s teaching role. Step 2, the surgical and follow-up data of 206 CCHD cases were retrospectively analyzed. Cases that evolved into critical illnesses or died within 1-3 years after surgery (poor prognosis) were classified into the study group (n = 77) and those with good prognosis into the control group (n = 129), which were split into the training set and the test set in the ratio 7:3 based on the time cut-off. In the training set, the prognosis of CCHD was predicted using the MVAM anatomical soft markers (distortion and narrowing of aorta/pulmonary artery, right ventricular infundibulum, etc.) and the decision curve analysis (DCA) performed. The model was validated using the test set, and a nomogram was finally established.
UNASSIGNED: It was observed that all 52 CCHD cases were confirmed using MVAM. A total of 91 cardiac malformations were recorded, among which 41 malformations were misdiagnosed, and 29 malformations were missed by the prenatal echocardiography. The MVAM method has a good teaching/feedback effect on prenatal diagnosis. The combined model exhibited a higher predictive performance in the training- and test-set. Its high clinical net benefit was proved by DCA. Additionally, the nomogram established using the combined model received a favorable response in clinical practice.
UNASSIGNED: The research results indicated that MVAM improved the prenatal diagnosis teaching and training performance. The combined model established based on MVAM anatomical soft markers can offer a high clinical significance for prognosis prediction of CCHD.
摘要：
■本研究旨在探讨改良血管解剖成型(MVAM)在胎儿复杂先天性心脏病(CCHD)产前诊断教学及预后预测中的作用。
■步骤1，使用MVAM方法铸造52个CCHD标本的微血管和气管。随后，分析52例MVAMs,并与产前超声比较,总结其特点,误诊和MVAM的教学作用。第2步,回顾性分析206例CCHD患者的手术及随访资料。在手术后1-3年内发展为危重疾病或死亡的病例（预后不良）分为研究组（n=77），预后良好的病例分为对照组（n=129）。根据时间截止，以7：3的比例将其分为训练集和测试集。在训练集中，使用MVAM解剖软标志物(主动脉/肺动脉的扭曲和狭窄,右心室漏斗,等。)和执行的决策曲线分析(DCA)。使用测试集对模型进行了验证，最后建立了一个列线图。
■观察到所有52例CCHD病例均通过MVAM得到确认。总共记录了91例心脏畸形，其中41例畸形被误诊，产前超声心动图检查漏诊了29例畸形。MVAM方法对产前诊断具有良好的教学/反馈效果。组合模型在训练集和测试集中表现出更高的预测性能。DCA证明了其较高的临床净效益。此外,使用组合模型建立的列线图在临床实践中获得了良好的响应.
■研究结果表明，MVAM提高了产前诊断的教学和培训成绩。基于MVAM解剖软标志物建立的联合模型对CCHD的预后预测具有较高的临床意义。
■步骤1，使用MVAM方法铸造52个CCHD标本的微血管和气管。随后，分析52例MVAMs,并与产前超声比较,总结其特点,误诊和MVAM的教学作用。第2步,回顾性分析206例CCHD患者的手术及随访资料。在手术后1-3年内发展为危重疾病或死亡的病例（预后不良）分为研究组（n=77），预后良好的病例分为对照组（n=129）。根据时间截止，以7：3的比例将其分为训练集和测试集。在训练集中，使用MVAM解剖软标志物(主动脉/肺动脉的扭曲和狭窄,右心室漏斗,等。)和执行的决策曲线分析(DCA)。使用测试集对模型进行了验证，最后建立了一个列线图。
■观察到所有52例CCHD病例均通过MVAM得到确认。总共记录了91例心脏畸形，其中41例畸形被误诊，产前超声心动图检查漏诊了29例畸形。MVAM方法对产前诊断具有良好的教学/反馈效果。组合模型在训练集和测试集中表现出更高的预测性能。DCA证明了其较高的临床净效益。此外,使用组合模型建立的列线图在临床实践中获得了良好的响应.
■研究结果表明，MVAM提高了产前诊断的教学和培训成绩。基于MVAM解剖软标志物建立的联合模型对CCHD的预后预测具有较高的临床意义。
