PDF(Pubmed)
Abstract：
BACKGROUND: Distances between delivery and cardiac services can make the care of fetuses with cardiac disease at risk of acute cardiorespiratory instability at birth a challenge. In 2013 we implemented a fetal echocardiography-based algorithm targeting fetuses considered high risk for acute cardiorespiratory instability at ≤2 hours of birth for delivery in our pediatric cardiac operating room of our children\'s hospital, and, herein, examine our experience.
RESULTS: We reviewed maternal and postnatal medical records of all fetuses with cardiac disease encountered January 2013 to March 2022 considered high risk for acute cardiorespiratory instability. Secondary analysis was performed including all fetuses with diagnoses of d-transposition of the great arteries/intact ventricular septum (d-TGA/IVS) and hypoplastic left heart syndrome (HLHS) encountered over the study period. Forty fetuses were considered high risk for acute cardiorespiratory instability: 15 with d-TGA/IVS and 7 with HLHS with restrictive atrial septum, 4 with absent pulmonary valve syndrome, 3 with obstructed anomalous pulmonary veins, 2 with severe Ebstein anomaly, 2 with thoracic/intracardiac tumors, and 7 others. Pediatric cardiac operating room delivery occurred for 33 but not for 7 (5 with d-TGA/IVS, 2 with HLHS with restrictive atrial septum). For high-risk cases, fetal echocardiography had a positive predictive value of 50% for intervention/extracorporeal membrane oxygenation/death at ≤2 hours and 70% at ≤24 hours. Of \"low-risk\" cases, 6/46 with d-TGA/IVS and 0/45 with HLHS required intervention at ≤2 hours. Fetal echocardiography for predicting intervention/extracorporeal membrane oxygenation/death at ≤2 hours had a sensitivity of 67%, specificity 93%, and positive and negative predictive values of 80% and 87%, respectively, for d-TGA/IVS, and 100%, 95%, 71%, and 100% for HLHS, respectively.
CONCLUSIONS: Fetal echocardiography can predict the need for urgent intervention in a majority with d-TGA/IVS and HLHS and in half of the entire spectrum of high-risk cardiac disease.
RESULTS: We reviewed maternal and postnatal medical records of all fetuses with cardiac disease encountered January 2013 to March 2022 considered high risk for acute cardiorespiratory instability. Secondary analysis was performed including all fetuses with diagnoses of d-transposition of the great arteries/intact ventricular septum (d-TGA/IVS) and hypoplastic left heart syndrome (HLHS) encountered over the study period. Forty fetuses were considered high risk for acute cardiorespiratory instability: 15 with d-TGA/IVS and 7 with HLHS with restrictive atrial septum, 4 with absent pulmonary valve syndrome, 3 with obstructed anomalous pulmonary veins, 2 with severe Ebstein anomaly, 2 with thoracic/intracardiac tumors, and 7 others. Pediatric cardiac operating room delivery occurred for 33 but not for 7 (5 with d-TGA/IVS, 2 with HLHS with restrictive atrial septum). For high-risk cases, fetal echocardiography had a positive predictive value of 50% for intervention/extracorporeal membrane oxygenation/death at ≤2 hours and 70% at ≤24 hours. Of \"low-risk\" cases, 6/46 with d-TGA/IVS and 0/45 with HLHS required intervention at ≤2 hours. Fetal echocardiography for predicting intervention/extracorporeal membrane oxygenation/death at ≤2 hours had a sensitivity of 67%, specificity 93%, and positive and negative predictive values of 80% and 87%, respectively, for d-TGA/IVS, and 100%, 95%, 71%, and 100% for HLHS, respectively.
CONCLUSIONS: Fetal echocardiography can predict the need for urgent intervention in a majority with d-TGA/IVS and HLHS and in half of the entire spectrum of high-risk cardiac disease.
摘要：
背景：分娩和心脏服务之间的距离可能使患有心脏病的胎儿在出生时面临急性心肺功能不稳定的风险。2013年，我们实施了一种基于胎儿超声心动图的算法，针对出生≤2小时的胎儿，在我们儿童医院的儿科心脏手术室分娩，被认为是急性心肺不稳定的高风险胎儿。and,在这里，检查我们的经验。
结果：我们回顾了2013年1月至2022年3月所有患有心脏病的胎儿的孕产妇和产后医疗记录，这些胎儿被认为是急性心肺功能不稳定的高风险。进行了二次分析，包括在研究期间遇到的所有诊断为大动脉/完整室间隔（d-TGA/IVS）和左心发育不良综合征（HLHS）的胎儿。40例胎儿被认为是急性心肺功能不稳定的高风险：15例使用d-TGA/IVS，7例使用具有限制性房间隔的HLHS，4例肺动脉瓣缺失综合征，3患有阻塞的肺静脉异常，2患有严重的Ebstein异常，2患有胸/心内肿瘤，和其他7个。小儿心脏手术室分娩发生33例，但未发生7例（5例采用d-TGA/IVS，2带有限制性房间隔的HLHS）。对于高风险病例，胎儿超声心动图在≤2小时对介入/体外膜氧合/死亡的阳性预测值为50%,在≤24小时为70%.在“低风险”案件中，使用d-TGA/IVS的6/46和使用HLHS的0/45需要在≤2小时进行干预。胎儿超声心动图预测介入/体外膜氧合/≤2小时死亡的敏感性为67%，特异性93%，阳性和阴性预测值分别为80%和87%，分别,对于d-TGA/IVS，100%,95%,71%,对HLHS来说是100%，分别。
结论：胎儿超声心动图可以预测大多数d-TGA/IVS和HLHS患者以及一半高危心脏病患者对紧急干预的需求。
结果：我们回顾了2013年1月至2022年3月所有患有心脏病的胎儿的孕产妇和产后医疗记录，这些胎儿被认为是急性心肺功能不稳定的高风险。进行了二次分析，包括在研究期间遇到的所有诊断为大动脉/完整室间隔（d-TGA/IVS）和左心发育不良综合征（HLHS）的胎儿。40例胎儿被认为是急性心肺功能不稳定的高风险：15例使用d-TGA/IVS，7例使用具有限制性房间隔的HLHS，4例肺动脉瓣缺失综合征，3患有阻塞的肺静脉异常，2患有严重的Ebstein异常，2患有胸/心内肿瘤，和其他7个。小儿心脏手术室分娩发生33例，但未发生7例（5例采用d-TGA/IVS，2带有限制性房间隔的HLHS）。对于高风险病例，胎儿超声心动图在≤2小时对介入/体外膜氧合/死亡的阳性预测值为50%,在≤24小时为70%.在“低风险”案件中，使用d-TGA/IVS的6/46和使用HLHS的0/45需要在≤2小时进行干预。胎儿超声心动图预测介入/体外膜氧合/≤2小时死亡的敏感性为67%，特异性93%，阳性和阴性预测值分别为80%和87%，分别,对于d-TGA/IVS，100%,95%,71%,对HLHS来说是100%，分别。
结论：胎儿超声心动图可以预测大多数d-TGA/IVS和HLHS患者以及一半高危心脏病患者对紧急干预的需求。
