| BackgroundStudies have shown that patient with congenital heart disease(CHD)easily suffer from nervous system dysfunction,such as the ventricle surrounding white matter lesions,intracranial hemorrhage,microcephaly and cerebral cortical dysplasia,which can often be retrospective to intrauterine period.However,expert cerebral cortical dysplasia,ventricle surrounding white matter lesions,intracranial hemorrhage and microcephaly all have clear ultrasonic features.Cerebral cortical dysplasia can affect multiple physiological functions,such as mentality dysplasia,schizophrenia,poor coordination ability.In recent years,scholars have found that children with CHD often suffering from cerebral cortical dysplasia are mainly because of two factors:1.abnormal heart structure will affect the fetal cerebral blood flow dynamics,leading to fetal cerebral hypoperfusion;2.the cardiac structural abnormalities and cerebral cortical dysplasia are due to the common genes and signaling pathways.At present,imaging studies of children with cerebral cortical dysplasia mainly use magnetic resonance imaging technology,ultrasonic technology in this study are few reported.This study will observe cerebral cortical development in fetuses with CHD at the second and third trimester,with the application of ultrasound,which is intended to summarize the performance of cerebral cortical development in fetuses with CHD.We hope to enrich prenatal imaging knowledge of cerebral cortical development in fetuses with CHD,discussing the relationship between cortical sulcus development and hemodynamics change,improving clinician’s understanding of the cerebral cortical development in fetuses with CHD,which provides guidance of assessment and therapy of cerebral cortical development for fetuses with CHD.The study is consist of two parts:(1)cortical sulcus development in fetuses with congenital heart disease at the second and third trimester on prenatal ultrasound(2)hemodynamics change in fetuses congenital with heart disease at the second and third trimester on prenatal ultrasoundChapter 1 Cortical sulcus development in fetus with congenital heart disease at the second and third trimester on prenatal ultrasoundObjectiveTo observe cortical sulcus development in fetus with congenital heart disease at the second and third trimester on prenatal ultrasound,improving clinician’s understanding of the cortical sulcus development in fetus with CHDMethodsTo analysis 123 CHD fetuses(20～34+6 weeks)’ cortical sulcus,who were diagnosed through ultrasound screening in Shenzhen Maternity and Child Healthcare Hospital Affiliated to Southern Medicial University from December 2015 to January 2017.According to the CHD types,dividing the fetuses into 3 groups:.the left heart system disease group,the right heart system disease group,the conotruncal defects group.Assessment index of cerebral sulci and gyrus:the depthes of parietal-occipital fissure,sylvian fissure and calcarine fissure,the hemisphere depthes on the special views of parietal-occipital fissure,sylvian fissure and calcarine fissure,the angle of parietal-occipital fissure,the width of sylvian fissure and uncovered width of insula,uncovered insular ratio,biparietal diameter,head circumference,above parameters were for statistical analysis.ResultsDuring the whole gestational age of the study,the angle of parietal-occipital fissure in the left heart system disease group was larger than the normal group;The depthes of parietal-occipital fissure and calcarine fissure as well as the width of sylvian fissure in the right heart system disease group were shorter than the control group,the angle of parietal-occipital fissure was larger than the normal.The depth of the parietal-occipital fissure,the hemisphere depthes on the special views of sylvian fissure as well as the width of sylvian fissure in the conotruncal defects group were shorter than the control group,uncovered insula ratio was larger than the normal;the P value of above measurement was smaller than 0.05,which had statistically significant difference.Conclusion1.Fetuses with CHD at the second and third trimester have cerebral cortical dysplasia,which embodies in the delay of parietal-occipital fissure,sylvian fissure and calcarine fissure,the parietal-occipital fissure has significant difference.2.The difference of cerebral cortical development of different types of CHD and different geastation age is not the same.3.Prenatal ultrasound can be used to observe the cerebral cortical development of fetuses with CHD in the intrauterine,which can help diagnosis and cure the cerebral cortical dysplasia.Chapter 2 Hemodynamics change in fetuses with congenital heart disease at the second and third trimester on prenatal ultrasoundObjectiveTo observe hemodynamics change in fetus congenital with heart diseaseMethodsTo analysis 111 CHD fetuses(19～37+6 weeks)’ hemodynamics change,who were diagnosed through ultrasound screening in Shenzhen Maternity and Child Healthcare Hospital Affiliated to Southern Medicial University from December 2015 to January 2017.Dividing the fetuses into 3 groups:.the left heart system disease group,the right heart system disease group,the conotruncal defects group.Assessment index of hemodynamic:umbilical artery resistance index(UmA-RI),umbilical artery pulsation index(UmA-PI),middle cerebral artery resistance index(MCA-RI),middle cerebral artery pulsation index(MCA-PI),the cerebral-to-placental resistance ratio(CPRR),the cerebroplacental ratio(CPR),above parameters were for statistical analysis.ResultsIn the the left heart system disease MCA-RI,MCA-PI,CCPR and CPR group was smaller than the control group,UmA-PI was large.In the right heart system disease group,UmA-PI was larger,MCA-RI,CCPR and CPR was smaller.MCA-PI,MCA-PI,CCPR and CPR in the conotruncal defects group were smaller than the normal.The P value of above measurement was smaller than 0.05,which had statistically significant difference.Compared with the normal group,UmA-RI of all types of CHD groups had no statistically significant difference.Conclusion1.Automatic adjustment mechanism of fetus with CHD can not completely correct the reducation of blood perfusion and oxygen desaturation,which embodies in lower MCA-RI,MCA-PI,CCPR and CPR,larger UmA-PI.2.Different types of CHD have different change of hemodynamics.3.The change of hemodynamics caused by cardiac structural abnormalities may be one of the reasons that CHD fetuses esaily suffer from cerebral cortical dysplasia. |
