Abstract：
BACKGROUND: No evidence-based protocols exist for fetal cardiac monitoring during fetoscopic myelomeningocele (fMMC) repair and intraprocedural spectral Doppler data are limited. We determined the feasibility of continuous fetal echocardiography during fMMC repair and correlated Doppler changes with qualitative fetal cardiac function during each phase of fMMC repair.
METHODS: Patients undergoing fMMC repair had continuous fetal echocardiography interpreted in real-time by pediatric cardiology. Fetal data included fetal heart rate (FHR), qualitative cardiac function, mitral and tricuspid valve inflow waveforms, and umbilical artery (UA), umbilical vein (UV), ductus arteriosus (DA), and ductus venosus (DV) Dopplers.
RESULTS: UA abnormalities were noted in 14/25 patients, UV abnormalities were observed in 2 patients, and DV and DA abnormalities were each noted in 4 patients. Qualitative cardiac function was normal for all patients with the exception of one with isolated left ventricular dysfunction during myofascial flap creation, concurrent with an abnormal UA flow pattern. All abnormalities resolved by the first postoperative day.
CONCLUSIONS: Continuous fetal echocardiography was feasible during all fMMC repairs. Spectral Doppler changes in the UA were common during fMMC procedures but qualitative cardiac dysfunction was rare. Abnormalities in the UV, DV, and DA Dopplers, FHR, and cardiac function were less common findings.
METHODS: Patients undergoing fMMC repair had continuous fetal echocardiography interpreted in real-time by pediatric cardiology. Fetal data included fetal heart rate (FHR), qualitative cardiac function, mitral and tricuspid valve inflow waveforms, and umbilical artery (UA), umbilical vein (UV), ductus arteriosus (DA), and ductus venosus (DV) Dopplers.
RESULTS: UA abnormalities were noted in 14/25 patients, UV abnormalities were observed in 2 patients, and DV and DA abnormalities were each noted in 4 patients. Qualitative cardiac function was normal for all patients with the exception of one with isolated left ventricular dysfunction during myofascial flap creation, concurrent with an abnormal UA flow pattern. All abnormalities resolved by the first postoperative day.
CONCLUSIONS: Continuous fetal echocardiography was feasible during all fMMC repairs. Spectral Doppler changes in the UA were common during fMMC procedures but qualitative cardiac dysfunction was rare. Abnormalities in the UV, DV, and DA Dopplers, FHR, and cardiac function were less common findings.
摘要：
背景：在胎儿镜下脊髓脊膜膨出（fMMC）修复期间，没有基于证据的胎儿心脏监测方案，并且术中频谱多普勒数据有限。我们确定了fMMC修复期间连续胎儿超声心动图的可行性，并在fMMC修复的每个阶段将多普勒变化与定性胎儿心功能相关。
方法：接受fMMC修复的患者接受了连续的胎儿超声心动图检查，通过儿科心脏病学实时解释。胎儿数据包括胎儿心率（FHR），定性心功能，二尖瓣和三尖瓣流入波形，和脐动脉（UA），脐静脉(UV),动脉导管（DA）和静脉导管（DV）多普勒。
结果：在14/25例患者中发现UA异常，在两名患者中观察到紫外线异常，4例患者均发现DV和DA异常。所有患者的定性心功能均正常，除了在肌筋膜瓣创建期间有孤立的左心室功能障碍的患者，与异常的UA流模式并发。所有异常在术后第一天解决。
结论：在所有fMMC修复期间，连续胎儿超声心动图检查是可行的。在fMMC手术期间，UA的频谱多普勒变化很常见，但定性心功能不全很少见。紫外线异常，DV和DA多普勒，FHR,和心功能不太常见。
方法：接受fMMC修复的患者接受了连续的胎儿超声心动图检查，通过儿科心脏病学实时解释。胎儿数据包括胎儿心率（FHR），定性心功能，二尖瓣和三尖瓣流入波形，和脐动脉（UA），脐静脉(UV),动脉导管（DA）和静脉导管（DV）多普勒。
结果：在14/25例患者中发现UA异常，在两名患者中观察到紫外线异常，4例患者均发现DV和DA异常。所有患者的定性心功能均正常，除了在肌筋膜瓣创建期间有孤立的左心室功能障碍的患者，与异常的UA流模式并发。所有异常在术后第一天解决。
结论：在所有fMMC修复期间，连续胎儿超声心动图检查是可行的。在fMMC手术期间，UA的频谱多普勒变化很常见，但定性心功能不全很少见。紫外线异常，DV和DA多普勒，FHR,和心功能不太常见。
