| BackgroundDuctus arteriosus(DA)is an important channel to connect fetal aorta and pulmonary artery and maintain normal fetal circulation.Fetal ductal-dependent congenital heart disease(DDCHD)is a complex congenital heart disease with severe left or right ventricular system obstruction during fetal period.After birth,the fetus depends on the opening of the DA to maintain normal systemic and pulmonary circulation.Fetal echocardiography is the most convenient and effective method for the diagnosis of DDCHD,so it is also the most mature and common one.However,fetal echocardiography is a complex and specialized technology,which requires the knowledge of fetal pathological anatomy and fetal heart development,and also relies on the capacity of the performer.Thus,it is of great significance to compare the results of prenatal echocardiography and pathomorphology of DDCHD,in order to increase the accuracy of prenatal diagnosis,to improve clinical decisions and prognosis evaluation,and to prevent perinatal injury.Premature contraction of DA in the third trimester of pregnancy can lead to obstruction of the right heart,severe fetal right heart failure,or even death.Therefore,monitoring fetal DA and cardiac function in the middle and third trimester of pregnancy is particularly significant for prognosis evaluation.At present,fetal echocardiography,as the routine method,is also the first choice to perform.Objective:1.Investigate the characteristics of fetal echocardiogram and pathological anatomy of DDCHD,visualize the ultrasonographic features of cardiac lesions and associated malformations,and further improve prenatal ultrasound diagnosis of fetal DDCHD.2.Investigate the typical echocardiographic characteristics of premature contraction of DA,and to analyze the guiding significance of ultrasonic parameters in prognosis evaluation of premature contraction of DA.Data and methods1.Echocardiographic and pathomorphological features in fetuses with DDCHDFetuses diagnosed with DDCHD by prenatal echocardiography from March 1,2011 to May 31,2019 were included.Exclusion criteria: fetuses with isolated mild?to?moderate pulmonary or aortic stenosis,mild to moderate Ebstein's anomaly and marginal left ventricular dysplasia syndrome because there is no ductal dependency.Normal gestational age?matched controls were also evaluated.This study was performed in accordance with a protocol that was approved by the Xinqiao Hospital Ethics Committee for Clinical Investigations.All subjects signed the informed consent form to participate in this study.Pathomorphological examination was carried out after all spouses were informed and signed the donation agreements.Fetal echocardiography was performed using a Philips IE33 unit(Philips Healthcare)with an S8?3 and C5?1 probe under the frequency of 2 to 8MHz,and the images were stored.According to the method of sequential segmental analysis,the fetal heart position and axis,venous reflux,atrioventricular connection sequence,chamber size,the condition of atrioventricular valves and large blood vessels were determined.The views of fetal heart fourchamber section,three-vessel trachea section,outflow tract section,pulmonary artery-DA arch section and aortic arch long axis section were scanned.Multiple parameters including left and right atrial transverse diameter,left and right ventricular transverse diameter of end diastolic phase of ventricle and upper and lower diameter,internal diameter of ascending aorta and pulmonary artery trunk,aperture of foramen ovale,internal diameter of DA,the peak blood flow velocity of aorta and pulmonary artery,and the peak systolic and diastolic flow velocity of ductus arteriosus were assessed.When performing autopsy,the heart was dissociated after properly perfusion and fixation,the RV was opened along the coronal plane from the apex to the base,and the PA was opened along the long axis of the PA.The left side of the heart was opened according to the path of blood flow.When complete,Canon digital camera was used to obtain images from different angles.The data were presented as mean ± SD.Via SPSS23.0,Statistical analyzeswere performed using independent sample t-test to compare echocardiographic results with normal reference standards.P<0.05 was considered statistically significant.2.Prenatal echocardiographic features of premature contraction of DA in fetus during the third trimester of pregnancy.Fetuses with premature contraction of DA diagnosed by fetal echocardiography from January 1,2011 to June 30,2019 were included.Inclusion criteria: singleton pregnancy,premature contraction of DA,no obvious cardiovascular abnormalities or other malformations.Normal gestational age?matched controls were also evaluated.This study was performed in accordance with a protocol that was approved by the Xinqiao Hospital Ethics Committee for Clinical Investigations.All subjects signed the informed consent form to participate in this study.Pathomorphological examination was carried out after all spouses were informed and signed the donation agreements.Fetal echocardiography was performed using a Philips IE33 unit(Philips Healthcare)with an S8?3 and C5?1 probe under the frequency of 2 to 8MHz,and the images were stored.According to the method of sequential segmental analysis,the fetal heart position and axis,venous reflux,atrioventricular connection sequence,chamber size,the condition of atrioventricular valves and large blood vessels were determined.The views of fetal heart fourchamber section,three-vessel trachea section,outflow tract section,pulmonary artery-DA arch section and aortic arch long axis section were scanned.Multiple parameters including left and right atrial transverse diameter,left and right ventricular transverse diameter of end diastolic phase of ventricle and upper and lower diameter,internal diameter of ascending aorta and pulmonary artery trunk,aperture of foramen ovale,internal diameter of ductus arteriosus,the peak blood flow velocity of aorta and pulmonary artery,and the peak systolic and diastolic flow velocity of ductus arteriosus were assessed.When performing autopsy,the heart was dissociated after perfusion and fixation,the RV was opened along the coronal plane from the apex to the base,and the PA was opened along the long axis of the PA.The left side of the heart was opened according to the path of blood flow.When complete,Canon digital camera was used to obtain images from different angles.The data were presented as mean ± SD.Via SPSS23.0,Statistical analyzes were performed using independent sample t-test to compare echocardiographic results with normal reference standards.P<0.05 was considered statistically significant.Result1.143 fetuses were diagnosed DDCHD via fetal echocardiography examination.Parents of 111 fetuses chose to terminate pregnancy after considering the poor prognosis.8 fetuses were born and followed up.Among them,6 cases died after clinical treatment,and 2 with pulmonary atresia survived after operation.24 fetuses were lost to follow-up.The accuracy of prenatal fetal echocardiography in the diagnosis of DDCHD was100%.2.52 fetuses were diagnosed with premature constriction of DA via fetal echocardiography examination.The proportions of right heart were increased,the inner diameters of pulmonary artery were widened,and the diameters of the DA was thinner in the case group compared with the control,and the differences were significant.In the case group,the color Doppler recorded different degrees of tricuspid regurgitation and turbulent blood flow signal in DA,with increased peak systolic and diastolic velocity.In 3 cases,the blood flow velocity in the DA decreased significantly,the blood flow signal almost disappeared,and the blood flow spectrum could not be measured after repeated attempts.Among all 52 fetuses,11 cases underwent cesarean section to perform urgent premature delivery.26 cases normally delivered after full-term pregnancy under the monitoring of fetal echocardiography.1 case presented heart failure at 37 weeks of gestation,and died of severe heart failure at 12 days after delivery.1 case chose to terminate pregnancy at 32 weeks of gestation,with the coarctation of DA confirmed by pathomorphological examination.14 cases lost to follow-up.Conclusion1.Fetal echocardiography is of great significance in the diagnosis of DDCHD.It assists in evaluating the prognosis,improving clinical decisions,and preventing perinatal injury.The pathomorphology study of fetal DDCHD visualizes ultrasound images,facilitates the understanding of the features of fetal DDCHD,and will thus increase the accuracy of prenatal diagnosis.2.Fetuses with premature constriction of DA share typical echocardiographic features.Monitoring ultrasound parameters is particularly instructive in fetal prognosis evaluation. |
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