■如果未及时发现,严重的左侧心脏阻塞与高发病率和死亡率相关。主动脉缩窄(CoA)的正确产前诊断很困难。胎儿心脏磁共振成像(CMR)可以改善复杂先天性心脏病的产前诊断。升主动脉中的流量测量可以帮助预测产后CoA,但是它的精确可视化是具有挑战性的。
■通过胎儿相位对比CMR流量比较疑似左侧心脏阻塞的胎儿降主动脉(DAo)和脐静脉(UV)的流量。第二个目标是确定将胎儿CMR添加到超声心动图(回声)是否可以改善胎儿CoA诊断。
■在2017年至2022年之间进行了DAo和UV和回波研究中的前瞻性胎儿CMR相位对比流。
■共有46例疑似左侧心脏阻塞的胎儿[11例左心发育不良综合征(HLHS),五种临界主动脉瓣狭窄(cAS),包括30个CoA]和5个对照。在所有16例疑似HLHS或cAS的胎儿以及8例(27%)患有真正CoA的胎儿中,均进行了新生儿对左侧心脏阻塞(n=23)或舒适护理(n=1)的干预。在需要和不需要干预的情况下,胎儿的DAo或UV流量没有差异。然而,在具有任一逆行等位收缩期血流的胎儿中,DAo和UV血流较低[DAo血流253(72)与261(97)ml/kg/min,p=0.035;UV流113(75)与161(81)ml/kg/min,p=0.04]或怀疑CoA和限制性房间隔[DAo流量200(71)与268(94)ml/kg/min,p=0.04;UV流量89vs.159(76)ml/kg/min,p=0.04]以及没有这些变化的情况。将胎儿CMR添加到出生后CoA的胎儿回声预测因子中并不能改善CoA的诊断。
■胎儿CMR衍生的DAo和UV流量测量不能改善左侧心脏阻塞的产前诊断,但是它们对于识别心脏左侧血流严重减少的胎儿可能很重要。生理解释可能是左心室心输出量明显减少,随后逆行收缩峡部血流和总DAo血流减少。
UNASSIGNED: Severe left-sided cardiac obstructions are associated with high morbidity and mortality if not detected in time. The correct prenatal diagnosis of coarctation of the aorta (CoA) is difficult. Fetal cardiac magnetic resonance imaging (CMR) may improve the prenatal diagnosis of complex congenital heart defects. Flow measurements in the ascending aorta could aid in predicting postnatal CoA, but its accurate visualization is challenging.
UNASSIGNED: To compare the flow in the descending aorta (DAo) and umbilical vein (UV) in fetuses with suspected left-sided cardiac obstructions with and without the need for postnatal intervention and healthy controls by fetal phase-contrast CMR flow. A second objective was to determine if adding fetal CMR to echocardiography (echo) improves the fetal CoA diagnosis.
UNASSIGNED: Prospective fetal CMR phase-contrast flow in the DAo and UV and echo studies were conducted between 2017 and 2022.
UNASSIGNED: A total of 46 fetuses with suspected left-sided cardiac obstructions [11 hypoplastic left heart syndrome (HLHS), five critical aortic stenosis (cAS), and 30 CoA] and five controls were included. Neonatal interventions for left-sided cardiac obstructions (n = 23) or comfort care (n = 1 with HLHS) were pursued in all 16 fetuses with suspected HLHS or cAS and in eight (27%) fetuses with true CoA. DAo or UV flow was not different in fetuses with and without need of intervention. However, DAo and UV flows were lower in fetuses with either retrograde isthmic systolic flow [DAo flow 253 (72) vs. 261 (97) ml/kg/min, p = 0.035; UV flow 113 (75) vs. 161 (81) ml/kg/min, p = 0.04] or with suspected CoA and restrictive atrial septum [DAo flow 200 (71) vs. 268 (94) ml/kg/min, p = 0.04; UV flow 89 vs. 159 (76) ml/kg/min, p = 0.04] as well as in those without these changes. Adding fetal CMR to fetal echo predictors for postnatal CoA did not improve the diagnosis of CoA.
UNASSIGNED: Fetal CMR-derived DAo and UV flow measurements do not improve the prenatal diagnosis of left-sided cardiac obstructions, but they could be important in identifying fetuses with a more severe decrease in blood flow across the left side of the heart. The physiological explanation may be a markedly decreased left ventricular cardiac output with subsequent retrograde systolic isthmic flow and decreased total DAo flow.