■胎儿MRI在先天性膈疝(CDH)的评估和管理中发挥了重要作用。我们旨在研究纵隔移位角(MSA)值是否与左CDH的预后和严重程度有关,并探讨MSA值与胎儿和新生儿心脏结构和功能之间的关系。
■2012年1月至2020年12月,回顾性测量我院左CDH胎儿MSA值。收集它们的其他产前参数和临床结果。我们还测量了胎儿和出生后的超声心动图参数,以分析与MSA值的线性相关性。
■共纳入94例左侧CDH患者。死亡组的MSA明显高于存活组[((38.3±4.7)°vs.32.3±5.3)°,p<0.001]。高危缺陷组[CDH研究组(CDHSG)C/D型]的MSA值明显高于低危缺陷组[CDHSGA/B型;(36.0±4.9)°vs.(30.1±4.8)°,p<0.001]。严重程度的AUC为0.766(95%CI,0.661-0.851,p<0.0001),MSA的最佳临界值为30.7°。较高的MSA与左心室(LV)宽度的胎儿Z评分降低相关,二尖瓣的直径(MV),MV和三尖瓣(TV)的峰值速度,和新生儿左心室舒张末期内径(LVEDD)和三尖瓣反流速度(TR;p<0.05)。
■高MSA值可以有效预测左侧CDH的高风险缺陷和高死亡率。MSA值越高,新生儿状况越糟,呼吸和心血管预后。MSA值可以反映左心发育不良的程度,包括左心室的尺寸减小和舒张功能障碍。
UNASSIGNED: Fetal MRI has played an essential role in the evaluation and management of congenital diaphragmatic hernia (CDH). We aimed to investigate whether the mediastinal shift angle (MSA) value was associated with the prognosis and the severity of left CDH and explore the relationship between the MSA value and fetal and neonatal cardiac structures and functions.
UNASSIGNED: From January 2012 to December 2020, the fetal MSA values of left CDH in our institution were retrospectively measured. Other prenatal parameters and clinical outcomes of them are collected. We also measured the fetal and postnatal echocardiography parameters to analyze linear correlation with MSA values.
UNASSIGNED: A total of 94 patients with left CDH were included. MSA was significantly higher in the deceased group than in the survived group [((38.3 ± 4.7)° vs. 32.3 ± 5.3)°, p < 0.001]. The MSA value of the high-risk defect group [CDH Study Group (CDHSG) C/D type] was significantly higher than that of the low-risk defect group [CDHSG A/B type; (36.0 ± 4.9)° vs. (30.1 ± 4.8)°, p < 0.001]. The AUC for severity was 0.766 (95% CI, 0.661-0.851, p < 0.0001) and the best cut-off value for MSA was 30.7°. Higher MSA correlates with decreased fetal Z-score of left ventricle (LV) width, the diameter of the mitral valve (MV), peak velocity of MV and tricuspid valve (TV), and neonatal LV end-diastolic diameter (LVEDD) and velocity of tricuspid regurgitation (TR; p < 0.05).
UNASSIGNED: A high MSA value can effectively predict high-risk defects and high mortality of left CDH. The higher the MSA value, the worse the neonatal conditions, the respiratory and cardiovascular prognosis. The MSA values could reflect the level of left heart underdevelopment, including decreased dimensions and diastolic dysfunction of the left ventricle.