| Objective:The aim of this study was to evaluate the valuation of speckle tracking imaging in fetal cardiac function assessment and investigate the effects of different types of congenital heart disease on the global and local functions of fetal heart.Methods:There are 57 cases have been selected in this study,all cases had diagnosed as congenital heart diseases between Sep.2016 to Dec.2018 in the First Affiliate Hospital of Kunming Medical University and Yunnan Fuwai Cardiovascular Hospital.16 cases were diagnosed as simple ventricular septal defect,23 cases were diagnosed as left obstructive congenital heart disease and 18 cases were diagnosed as right obstructive congenital heart disease.All of the fetus's left and right ventricular ejection fraction(EF)and shortening fraction(SF)had been measured by M-mode Echocardiography;the E wave,A wave and E/A value of mitral valve and tricuspid valve had been measured by Spectral Doppler Ultrasound;in order to calculated the myocardial performance index(MPI)which also named Tei index,the ejection time(ET),isovolumetric contraction time(ICT)and isovolumic relaxation time(IRT)of left and right heart had be measured;in the four-chamber view,the left and right ventricular global longitudinal strain and strain rate,the segmental longitudinal systolic strain rate had been measured by speckle tracking,in the short-axis view,the left ventricular circumferential strain and radial strain also had been measured by speckle tracking.Then we compared the differences of all those data between case group and control group,left obstructive congenital heart disease and right obstructive congenital heart disease.Results:The overall case group was compared with the control group:(l)There was no significant difference in EF and SF between left and right ventricles measured by M-mode ultrasound(P>0.05).(2)There was no significant difference in E/A values between mitral and tricuspid valves measured by spectral Doppler echocardiography(P>0.05).(3)The mean values of the left and right heart Tei index values were within the normal range,but the case group values were higher than the control group,and the difference was statistically significant(P<0.05).(4)The left and right ventricular long axis global strain,systolic and diastolic strain rate,left ventricular circumferential strain,systolic and diastolic strain rate and left ventricular radial strain measured by 2D-STI were lower than those of the control group,and there were significant differences(P<0.01),the strain rates of left and right ventricular free wall and interventricular septum segments in the case group were significantly higher than those in the control group(P<0.05).Subgroups of the case group were compared with the control group:(1)Left and right ventricular EF values,SF values,secondary and tricuspid E/A values,left and right heart Tei index values,and left and right ventricular long-axis overall strain values in the ventricular septal defect group were not statistically compared with the control group.Learning difference(P>0.05);The overall strain rate of the left and right ventricular long axis,the left and right ventricular free wall and interventricular septal strain rate were statistically different from the control group(P<0.05);There were significant differences in left ventricular circumferential strain,strain rate and left ventricular radial strain between the two groups(P<0.01).(2)The EF and SF values of left and right ventricles and E/A values of mitral and tricuspid valves in left obstructive congenital heart disease group were not significantly different from those in control group(P>0.05);The left and right heart Tei index values were statistically different from the control group(P<0.05),but the mean values were within the normal range.Left and right ventricular long axis global strain and late diastolic strain rate,right ventricular long axis global systolic strain rate,left ventricular circumferential strain and late systolic and late diastolic strain rate,left ventricular radial strain compared with the control group were significantly different(P<0.01);There were significant differences in the strain rates between the left and right ventricular free wall and ventricular septal segments compared with the control group(P<0.05).(3)The EF and SF values of left and right ventricles and E/A values of mitral and tricuspid valves in the right obstructive congenital heart disease group were not significantly different from those in the control group(P>0.05);The left and right heart Tei index values were statistically different(P<0.05),but the mean values were still within the normal range;The left and right ventricular long-axis overall strain and systolic and late diastolic strain rate,left ventricular circumferential strain,strain rate,left ventricular radial strain were significantly different from the control group(P<0.01).;There were significant differences in the strain rates between the left and right ventricular free wall and ventricular septal segments compared with the control group(P<0.05).The EF and SF values of left and right ventricles and E/A values of mitral and tricuspid valves in the left obstructive congenital heart disease group were not significantly different from those in the right obstructive congenital heart disease group(P>0.05);However,the left heart Tei index of the left heart obstructive congenital heart disease group was higher than that of the right heart obstructive congenital heart disease group,and the right heart Tei index of the right heart obstructive congenital heart disease group was higher than that of the left heart obstructive congenital heart disease group;The left ventricular long axis of the left heart obstructive congenital heart disease group was lower than the right heart obstructive congenital heart disease group,and the right ventricular long axis normal strain value of the right heart obstructive congenital heart disease group was lower than that of the left heart obstructive congenital heart disease group.Conclusions:Two-dimensional speckle tracking imaging has many measurable parameters.Compared with conventional methods,it can accurately and comprehensively evaluate fetal cardiac function and detect fetal cardiac function abnormalities sensitively.It is of great significance to the selection of early treatment and prognosis evaluation.Simple ventricular septal defect can affect fetal heart function.In congenital heart disease,both left and right heart obstruction can affect fetal left and right heart function.Left heart obstructive congenital heart disease mainly impairs left heart function,while right heart obstructive congenital heart disease mainly impairs right heart function. |
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