目的:动脉导管(DA)相关分支肺动脉狭窄(PS),由于导管组织迁移到DA同侧的近端肺动脉(PA),常见于患有肺闭锁(PTtr)的新生儿,并显着增加其死亡率和发病率。我们试图定义PAtr中DA-PS的胎儿超声心动图预测因子。
方法:这是一项对所有产前诊断为PAtr和DA依赖性肺循环的新生儿的研究,与拱门的下腹相连的DA,2009年至2018年间在我们医院接受手术或导管介入治疗的患者。根据初次干预时需要血管成形术和/或干预后近端PA狭窄的发展,对出生后的超声心动图和临床记录进行了审查,以确认是否存在DA-PS。检查胎儿超声心动图的DA-PS特征。
结果:在53个患有PTr的胎儿中,34(64%)有可分析的图像,包括20/34(59%)和14/34(41%)没有DA-PS。无法在同一平面上可视化分支PA,在很大程度上与异常的DA插入到同侧PA(85%的病例),有敏感性,特异性和阳性(PPV)和阴性(NPV)预测值为75%,100%,100%和74%,分别,用于预测产后DA-PS。与没有DA-PS的情况相比,DA-PS的平均分支PA后分叉角更钝(117°±17°vs79°±17°,P<0.001),角度>100°,先前在受影响的新生儿中观察到的术前截止,有一种敏感性,特异性,PPV和NPV为88%,79%,82%和85%,分别。接收器工作特性曲线显示角度≥105°,灵敏度和特异性分别为88%和93%,分别,用于DA-PS的产前预测。存在一个或两个特征(无法在同一平面上成像,后分叉角≥105°)具有敏感性,特异性,PPV和NPV为100%,93%,95%和100%,分别。
结论:无法在同一平面上可视化分支PA,在大多数情况下与DA的异常插入有关,和/或存在≥105°的后PA分叉角是PAtr胎儿产后DA-PS的预测特征。©2020国际妇产科超声学会。
OBJECTIVE: Ductus arteriosus (DA)-related branch pulmonary stenosis (PS), due to ductal tissue migration into the proximal pulmonary artery (PA) ipsilateral to the DA, is common in newborns with pulmonary atresia (PAtr) and contributes significantly to their mortality and morbidity. We sought to define fetal echocardiographic predictors of DA-PS in PAtr.
METHODS: This was a study of all neonates diagnosed prenatally with PAtr and a DA-dependent pulmonary circulation, with a DA that joined the underbelly of the arch, who had undergone surgical or catheter intervention in our hospital between 2009 and 2018. The postnatal echocardiograms and clinical records were reviewed to confirm the presence or absence of DA-PS based on the need for angioplasty at initial intervention and/or development of proximal PA stenosis post intervention. Fetal echocardiograms were examined for the features of DA-PS.
RESULTS: Of 53 fetuses with PAtr, 34 (64%) had analyzable images, including 20/34 (59%) with and 14/34 (41%) without DA-PS. An inability to visualize the branch PAs in the same plane, largely associated with abnormal DA insertion into the ipsilateral PA (85% of cases), had sensitivity, specificity and positive (PPV) and negative (NPV) predictive values of 75%, 100%, 100% and 74%, respectively, for the prediction of postnatal DA-PS. The mean branch PA posterior bifurcation angle was more obtuse in cases with DA-PS compared to cases without DA-PS (117° ± 17° vs 79° ± 17°, P < 0.001), and an angle of > 100°, the preoperative cut-off observed previously in affected newborns, had a sensitivity, specificity, PPV and NPV of 88%, 79%, 82% and 85%, respectively. The receiver-operating-characteristics curve revealed an angle of ≥ 105° to have a sensitivity and specificity of 88% and 93%, respectively, for prenatal prediction of DA-PS. The presence of one or both features (inability to image in the same plane and the posterior bifurcation angle of ≥ 105°) had a sensitivity, specificity, PPV and NPV of 100%, 93%, 95% and 100%, respectively.
CONCLUSIONS: An inability to visualize the branch PAs in the same plane, associated with abnormal insertion of the DA in most cases, and/or the presence of a posterior PA bifurcation angle of ≥ 105° are predictive features of postnatal DA-PS in fetuses with PAtr. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.