室间隔完整的肺动脉闭锁胎儿的心室定量评价  

Quantitative evaluation of ventricles in fetuses with pulmonary atresia with intact ventricular septum

作　　者：刘京晶 王欣 韩艳丽 韩建成[1] 张烨[1] 谷孝艳[1] 刘晓伟[1] 何怡华[1] LIU Jingjing;WANG Xin;HAN Yanli;HAN Jiancheng;ZHANG Ye;GU Xiaoyan;LIU Xiaowei;HE Yihua(Echocardiography Medical Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所超声医学中心母胎医学中心北京重点实验室,100029 [2]华中科技大学同济医学院附属武汉市中心医院

出　　处：《心肺血管病杂志》2025年第3期301-307,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：武汉市中心医院院级基金(22YJ03)。

摘　　要：目的:应用胎儿心脏定量评估软件(fetal heart quantitative assessment software,Fetal HQ)的24节段斑点追踪技术,对室间隔完整的肺动脉闭锁(pulmonary atresia with intact ventricular septum,PAIVS)胎儿的心脏进行评估。方法:回顾性研究2017年至2022年于北京安贞医院经胎儿超声心动图诊断为PAIVS的27例胎儿,胎龄22~34周。28个孕龄匹配的正常胎儿作为对照组。在胎儿检查期间采集四腔心切面进行分析。该软件计算包括四腔心宽度、四腔心长度、四腔心面积、左心室舒张末期长度、右心室舒张末期长度、LVEF、面积变化分数(fractional area changes,FAC)、整体长轴应变(global longitude strain,GLS)和整体球形指数(global spherical index,GSI)等指标,以及从每个心室从心底到心尖分布的24个横节段的内径、球形指数(spherical index,SI)和缩短分数(fractional shortening,FS)。结果:与正常对照组相比,PAIVS胎儿的心脏大小显著增加,反映在四腔心宽度[(30.9±6.4)vs.(27.0±4.5)mm,P=0.01]、四腔心长度[(38.2±7.1)vs.(33.8±5.7)mm,P=0.02]和四腔心面积[(955.7±383.3)vs.(730.8±228.2)mm2,P=0.01]。左心室增大,呈球形改变。PAIVS胎儿的左心室GLS[(-21.4±7.0)%vs.(-26.8±7.0)%,P=0.01]、右心室GLS[(-11.3±5.8)%vs.(-25.2±1.9)%,P<0.001]和右心室FAC[(16.5±8.6)%vs.(42.2±11.3)%,P<0.001]显著降低。结论:应用胎儿心脏定量评估,可发现PAIVS胎儿的左心室和右心室发生了形态学的改变和功能的受损。Objective:The myocardial deformation of ventricles(RV)in fetuses with pulmonary atresia with intact ventricular septum(PAVIS)have been well studied in many researches,While the differential effect on the shape of ventricles and the altered contractility of left ventricle(LV)have not been well described.Fetal heart quantitative assessment software(Fetal HQ),developed to allow the physician to quickly analyze and shape of the four-chamber view(4CV)as well as the contractility of the ventricles,was not used to evaluate the heart of fetuses with PAIVS.This study was conducted to evaluate the shape and contractility of right and left ventricle by using a 24 transverse segments speckle tracking technique of Fetal HQ from the base to the apex.Methods:Twenty-seven fetuses diagnosed with PAIVS by echocardiography were enrolled in this retrospective study,with gestational age between 22 and 34 weeks.Twenty-eight normal and gestational age-matched fetuses served as controls.Four-chamber view was acquired during a fetal examination for analysis.The software computes the indices that including 4CV width,4CV length,4CV area,left ventricle end-diastole(LVED)length,right ventricle end-diastole(RVED)length,LVEF,fractional area changes(FAC),global longitude strain(GLS)and global spherical index(GSI),as well as the dimension,spherical index(SI)and fractional shortening(FS)of 24 transverse segments,distributed from the base to the apex of each ventricle.Comparisons was performed between PAIVS fetuses and controls.Results:Our findings revealed that the size of heart of PAIVS fetuses was significantly increased compared to normal controls,reflected in 4CV width[(30.9±6.4)vs.(27.0±4.5)mm,P=0.01],4CV length[(38.2±7.1)vs.(33.8±5.7)mm,P=0.02]and 4CV area[(955.7±383.3)vs.(730.8±228.2)mm2,P=0.01].The dimension of LV of 24 transverse segments were almost increased,meanwhile the SI of LV were decreased from mid to apex.The dimension of apex segments was significantly decreased,while the SI of RV in all segments were within the normal ra

关 键 词：胎儿心脏定量分析 室间隔完整的肺动脉闭锁 斑点追踪 超声心动图 四腔心 

分 类 号：R54[医药卫生—心血管疾病]