患有轻度大动脉狭窄的胎儿的结果:一个多中心研究
Koyelle Papneja1, Wayne Tworetzky2, Jack Rychik3
1Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto Temerty Faculty of Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
概括
轻度胎儿大动脉狭窄症 (AS) 的结果各不相同,大约三分之一的婴儿需要大动脉干预一年. 初始胎儿心声图的发现,如峰值梯度和LV球性指数,可以预测干预需求.
科学领域:
- 心脏病学 心脏病学
- 胎儿医学 胎儿医学
- 儿童心脏病学 儿童心脏病学
背景情况:
- 严重的胎儿大动脉狭窄症 (AS) 已得到充分研究,但对轻度AS的结果并非如此.
- 改善胎儿成像将增加轻度AS病例的识别.
- 这项研究是首次评估患有轻度AS的胎儿的结果.
研究的目的:
- 为了评估被诊断为轻度大动脉狭窄 (AS) 的胎儿在初始胎儿心声图上的结果.
- 在这个群体中确定产后干预的预测因素.
- 了解轻度胎儿AS的结果的变化.
主要方法:
- 在4个中心 (2009-2019) 进行了22名患有轻度AS的胎儿的回顾性队列研究.
- 轻度AS定义为峰值大动脉速度>1m/sec,前级大动脉门流量,没有/轻度左心室 (LV) 功能障碍.
- 主要结局:大动脉干预在生命的第一年. 干预和非干预组之间的心声回声测量比较.干预和非干预组.
主要成果:
- 36.4%的患者 (8/22) 在第一年内需要进行大动脉干预.
- 需要干预的患者中有一半患有关键性,管道依赖的AS.
- 较高的初始和最终胎儿心声图峰值大动脉梯度预测了干预需要 (P=.0017和P=.0016).
- 大动脉峰度梯度>12.5 mm Hg 在初始胎儿心声图预测的干预.
- 初始胎儿心声图上较低的LV球性指数与干预相关 (P=.045).
结论:
- 轻度胎儿AS不常见,并与可变的结果相关.
- 大约三分之一的轻度AS婴儿需要在1岁之前进行干预.
- 大动脉峰度梯度和LV球形度指数是识别需要干预的胎儿的有用标记.
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