背景:胎儿超声心动图可以准确诊断危重型先天性心脏病,但依赖于常规产科超声检查发现的异常转诊。由于流出道成像不足而经常遗漏的严重先天性心脏病包括动脉干等异常,右心室双出口,大动脉转位,法洛四联症,肺动脉狭窄,和主动脉狭窄。
目的:这项研究评估了在“产科超声检查的AIUM实践指南”前后,一家城市儿科医院中严重流出道异常的产前检出率,“结合了流出道成像。
方法:对出生后3个月内需要心导管插入和/或外科手术的流出道异常婴儿进行回顾性分析。本研究评估了两个时间段:2010年6月至2013年5月的指南前和2015年1月至2016年6月的指南后。2013年6月至2014年12月被排除为产科实践实施修订指南所必需的理论时期。
结果:总体而言,产前诊断发生在55%的严重流出道异常的婴儿;三个最常见的缺陷,产前诊断发生在53%的大动脉D转位,63%的法洛四联症,和80%的右心室双出口患者。预指南,52%(102例中的52例)的严重流出道异常需要早期心脏介入治疗的婴儿发生产前诊断.后指南,产前诊断发生在61%(54个中的33个)婴儿中,与指南前的产前检出率没有显着差异(P=0.31)。
结论:尽管经修订的产科指南强调了流出道成像的重要性,这些类型的严重先天性心脏病的转诊和产前诊断仍然很低。对进行胎儿解剖筛查的产科超声医师和从业人员进行教育对于增加转诊和对严重流出道异常的产前检测至关重要。
BACKGROUND: Fetal echocardiography can accurately diagnose critical congenital heart disease prenatally, but relies on referrals from abnormalities identified on routine obstetrical ultrasounds. Critical congenital heart disease that is frequently missed due to inadequate outflow tract imaging includes anomalies such as truncus arteriosus, double outlet right ventricle, transposition of the great arteries, tetralogy of Fallot, pulmonary stenosis, and aortic stenosis.
OBJECTIVE: This study evaluated the prenatal detection rate of critical outflow tract anomalies in a single urban pediatric hospital before and after \"AIUM Practice
Guideline for the Performance of Obstetric Ultrasound Examinations,\" which incorporated outflow tract imaging.
METHODS: Infants with outflow tract anomalies who required cardiac catheterization and/or surgical procedure(s) in the first 3 months of life were retrospectively identified. This study evaluated two time periods; pre-
guidelines from June 2010 to May 2013 and post-
guidelines from January 2015 to June 2016. June 2013-December 2014 was excluded as a theoretical period necessary for obstetrical practices to implement the revised guidelines.
RESULTS: Overall, prenatal diagnosis occurred in 55% of infants with critical outflow tract anomalies; of the three most common defects, prenatal diagnosis occurred in 53% of D-transposition of the great arteries, 63% of tetralogy of Fallot, and 80% of double outlet right ventricle patients. Pre-guidelines, prenatal diagnosis occurred in 52% (52 of 102) infants with critical outflow tract anomalies requiring early cardiac intervention. Post-
guidelines, prenatal diagnosis occurred in 61% (33 of 54) infants, not significantly different than the prenatal detection rate pre-
guidelines (P = .31).
CONCLUSIONS: Despite revised obstetrical
guidelines highlighting the importance of outflow tract imaging, referrals and prenatal diagnosis of these types of critical congenital heart disease remain low. Education of obstetrical sonographers and practitioners who perform fetal anatomic screening is vital to increase referrals and prenatal detection of critical outflow tract anomalies.