The Value Of NT Thickness,Ducts Venous Spectrum And Tricuspid Regurgitation In The First-Trimester For Fetal Congenital Heart Defects Screening

Objective:To investigate the clinical value of combined with the three ultrasound examinations in the frist-trimester,including nuchal translucency（NT）thickness,ducts venous（DV）spectrum and tricuspid regurgitation（TR）,in screening fetal congenital heart defects（CHD）.Methods:The data of pregnant women who were registered and had prenatal examinations in our hospital from July 2018 to March 2022 were selected.All pregnant women underwent ultrasound examination of nuchal translucency at 11～13⁺⁶weeks of gestation,nuchal translucency（NT）thickness,ducts venous（DV）spectrum and tricuspid regurgitation（TR）were recorded,and follow-up was conducted until the end of pregnancy.The results of pathological anatomy or the last prenatal ultrasound examination were recorded in those who terminated pregnancy,and the results of postnatal examination were recorded in those who were born,and the NT thickness,DV spectrum,and TR recorded in the collected cases were compared with the results of induction and delivery.A total of 390 eligible cases were collected,including 39 cases of congenital heart defects.Match the cases and controls with the propensity score matching（PSM）method,and enter the CHD group and non-CHD group cases respectively.The control variables were age,basal body weight,and pregnancy with or without disease,and their standardized differences were<0.1 after matching,achieving balance between groups.To compare the difference of nuchal translucency（NT）thickness,ductus venous（DV）spectrum,tricuspid regurgitation（TR）and ventricular hyperechoic spot between the two groups.To analyze the correlation between nuchal translucency（NT）thickness,ducts venous（DV）spectrum,tricuspid regurgitation（TR）and fetal CHD was analyzed,and To analyze the correlation between nuchal translucency（NT）thickness and ducts venous（DV）spectrum and tricuspid regurgitation（TR）.At the same time,to analyze the predictive efficacy of NT thickness,DV flow spectrum and TR alone and in combination on fetal CHD.Calculate the sensitivity and specificity of increased NT,abnormal ductus venous spectrum,tricuspid regurgitation,increased NT with abnormal ductus venous spectrum,increased NT with tricuspid regurgitation,abnormal ductus venous spectrum with tricuspid regurgitation,increased NT with abnormal ductus venous screening and tricuspid regurgitation screening for fetal congenital cardiovascular anomaly.Finally,to count and analyze the classification of fetal congenital heart defects.Results:（1）A total of 390 eligible cases were collected,all of which were single fetuses,including 39 cases with congenital heart defects.（2）Match the cases and controls with the propensity score matching（PSM）method.There were differences in maternal age and basal body weight between the two groups before PSM matching.The differences were statistically significant（P<0.05）,and there were no differences in other baseline data.After PSM matching,there was no difference between the two groups in the baseline data of pregnant women’s age,basal body weight,pregnancy with or without disease,exposure to drugs or radiation,and family history of congenital heart disease.（3）The matching results were 39 cases in CHD group and 152 cases in non-CHD group.Among the 191 patients included in the study,34 had abnormal indexes,including 12 cases of increased nuchal translucency,8 cases of abnormal venous catheter spectrum,9 cases of tricuspid regurgitation,there were 2or more abnormal ultrasonic indexes in 5 cases.There were significant differences in nuchal translucency（NT）thickness,ductus venous（DV）spectrum,tricuspid regurgitation（TR）between the two groups after matching（P<0.05）.（4）There was no significant difference in ventricular hyperechoic spot between the two groups（P>0.05）.（5）Nuchal translucency thickness,ductus venous flow spectrum and tricuspid regurgitation were positively correlated with fetal congenital heart defects（P<0.05）,nuchal translucency thickness was also positively correlated with tricuspid regurgitation（P<0.05）,while nuchal translucency thickness was not significantly correlated with ductus venous flow spectrum（P>0.05）.（6）The nuchal translucency（NT）thickness,ducts venous（DV）spectrum and tricuspid regurgitation（TR）have certain predictive efficacy for fetal CHD,but the sensitivity of single index was low,while the predictive efficacy of two or three indexes combined to predict fetal CHD was higher than that of a single index alone.（7）With a single index screening,the sensitivity of NT thickness≥2.5mm was higher than that of DV spectrum abnormality and TR,and the sensitivity of DV spectrum abnormalities were the same as that of TR.With three indexes combined for screening,two or more indexes positive screening for CHD had higher sensitivity than that of single index screening,and the predictive efficacy and sensitivity of combined prediction of three indexes for fetal CHD were the highest.The sensitivity and specificity of combined prediction of three indexes for fetal congenital heart defects were 33.33%and 90.1%,respectively.（8）Of the 39 fetal CHD cases,17 cases were complex CHD and 22 cases were simple CHD.There were 13 cases of abnormal single or two indexes in NT thickness,DV spectrum and TR,of which 7 cases were complex CHD.Among the cases with abnormal ultrasonic indexes,there were more cases of complex CHD.Conclusions:（1）NT thickness,ductus venous spectrum and tricuspid regurgitation in the first trimester have certain predictive value for fetal congenital heart defects,and the combined examination of the three can improve the predictive efficiency.（2）It is recommended that ducts venous flow spectrum and tricuspid regurgitation screening should be carried out at the same time when the fetal nuchal translucency layer is examined in the first trimester to identify fetal CHD early.