Clinical Research Evaluation Of Fetal Tricuspid Regurgitation By Ultrasound

Background and Purpose:Detecting the growth and development abnormalities of fetal and congenital heart disease by color Doppler ultrasound is an important part of the prenatal ultrasound. With the improvement of computer technology, probe resolution,the Doppler flow signal detection sensitivity and the gained ultrasonic diagnostic experience, the detection rate of fetal tricuspid regurgitation show a rising trend, and are subject to clinical obstetric attention. Earlier reported fetal heart tricuspid regurgitation occur in approximately6.23%. In recent years,reported in the literature the detection rate of fetal cardiac tricuspid valve regurgitation after second trimester is24.8%, of which about20%of pathological significance. How to correctly judge the fetal tricuspid regurgitation caused by physiological or due to increased right heart load, which has important clinical significance in guiding the correct clinical intervention to reduce fetal morbidity and mortality. In this study, through the observation of the tricuspid regurgitation flow spectrum changes, such as the A wave of whether the existence of reverse or disappear; and spectrum and blood color characteristics of tricuspid regurgitation, the proportion change of left and right atrial diameter, explore whether tricuspid regurgitation by ultrasound evaluation have pathological significance and establish the simple and practical, accurate and effective indicators about evaluation of fetal tricuspid regurgitation. Subjects and Methods:Fetuses received prenatal ultrasound examination in the Second Xiangya hospital in February2008to March2012, of which197cases with tricuspid regurgitation met the inclusion criteria. All of that were confirmed by post-natal Doppler ultrasound echocardiography or autopsy. That study obtained standard four-chamber views and intravenous catheter sections in the fetal chest and abdomen by applying Acuson of Sequoia512, GE V730Expert color Doppler Ultrasonic diagnostic equipment, measure the peak velocity of tricuspid regurgitation, the proportion of tricuspid return bleed color accounted for right atrial, the systolic diameter of left and right atrium and calculate the RAD/the LAD to measure venous catheter atrial contraction wave (A wave), That study also observed whether venous catheter blood flow is reduce, missing, or reverse during atrial systolic and analysis of anomaly ultrasound imaging performance which tricuspid regurgitation fetuses with all kinds of congenital heart disease or non-congenital heart disease disorders but disordered heart function have.Result:1, In154cases of Normal group fetuses, the velocity of tricuspid regurgitation were low, reflux beam were thin, flow rate was an average of114.39cm/s and the ratio was16.5%, Left and right atrial diameter almost equal. The RAD/LAD was1.072. Venous catheter throughout the cardiac cycle both are flow to the heart ahead. Atrial contraction A did not reversal, disappear in Normal group fetuses.2, In 43cases of Abnormal group of congenital heart disease or non-congenital heart disease but disordered heart function, The velocity of tricuspid regurgitation was significantly higher, flow rate was an average of232.42cm/s, the ratio which back to the bloody color color beam account for the right room was46..2%that increased nearly three times compared to Normal group. The RAD/LAD was1.246which also increased significantly. The average velocity of Venous catheter atrial contraction wave A was8.68cm/s, and12cases of atrial contraction wave A reversal, five cases disappeared, three cases significantly lower. That was significantly different compared to the normal group. But the single indicator was less sensitive.Conclusion: Venous catheter atrial contraction flow (A wave) was reversal, missing or reduce significantly in fetuses with tricuspid regurgitation. Tricuspid regurgitation with congenital heart disease or non-congenital heart disease but affecting heart function are should be considered pathogenic rational reflux when two in any of the RAD/LAD>1.25of Four-chamber view. The velocity of tricuspid regurgitation≥200cm/s, meanwhile, the ratio which back to the bloody color color beam account for the right room≥25%, which highly indicate the existence of congenital heart disease or non-congenital heart disease of affected right ventricular function, and tricuspid regurgitation is pathological. The above indicators has great practical value because those are obtained easily, operated easily, popularized easily and detection time is short.