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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2022, Vol. 19 ›› Issue (04) : 350 -356. doi: 10.3877/cma.j.issn.1672-6448.2022.04.012

妇产科超声影像学

单纯性卵圆孔瓣开放过度与开放受限胎儿的超声心动图评估
陈丽炯1, 赵博文2,†(), 陈冉2, 潘美2, 彭晓慧2, 楼海亚2, 王蓓2   
  1. 1. 311300　浙江省杭州市临安区第一人民医院超声科；310016　杭州，浙江大学医学院附属邵逸夫医院超声科 浙江省胎儿心脏超声诊断技术指导中心　浙江大学邵逸夫临床医学研究所
    2. 310016　杭州，浙江大学医学院附属邵逸夫医院超声科 浙江省胎儿心脏超声诊断技术指导中心　浙江大学邵逸夫临床医学研究所
  • 收稿日期:2021-06-09 出版日期:2022-04-01
  • 通信作者: 赵博文

Echocardiographic evaluation of fetuses with isolated restrictive foramen ovale flap or redundant foramen ovale flap

Lijiong Chen1, Bowen Zhao2,†(), Ran Chen2, Mei Pan2, Xiaohui Peng2, Haiya Lou2, Bei Wang2   

  1. 1. Department of Ultrasound, Lin'an District First People's Hospital, Hangzhou 311300, China; Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, China
    2. Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, China
  • Received:2021-06-09 Published:2022-04-01
  • Corresponding author: Bowen Zhao
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引用本文：

陈丽炯, 赵博文, 陈冉, 潘美, 彭晓慧, 楼海亚, 王蓓. 单纯性卵圆孔瓣开放过度与开放受限胎儿的超声心动图评估[J]. 中华医学超声杂志（电子版）, 2022, 19(04): 350-356.

Lijiong Chen, Bowen Zhao, Ran Chen, Mei Pan, Xiaohui Peng, Haiya Lou, Bei Wang. Echocardiographic evaluation of fetuses with isolated restrictive foramen ovale flap or redundant foramen ovale flap[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(04): 350-356.

目的

探讨单纯性卵圆孔瓣开放过度及开放受限胎儿的超声心动图特征以及卵圆孔瓣膨出指数（ASEI）在评估卵圆孔瓣开放过度和开放受限胎儿中的应用价值，并随访胎儿出生后情况。

方法

回顾性选取2012年1月至2020年1月在浙江大学医学院附属邵逸夫医院行胎儿心脏超声检查、诊断为卵圆孔瓣开放过度和开放受限的52例胎儿作为研究组，其中开放过度组22例，开放受限组30例。同时收集108例正常胎儿作为对照组。对3组胎儿的超声心动图定量参数，包括右心房与左心房横径比值（RA/LA）、右心室与左心室横径比值（RV/LV）、肺动脉与主动脉内径比值（PA/AO）、卵圆孔瓣膨出指数（ASEI）等，以及出生后随访结果进行比较分析。

结果

卵圆孔瓣开放过度组和开放受限组的RA/LA、RV/LV、PA/AO大于正常组胎儿，差异均有统计学意义（P均＜0.01）。108例正常对照组、30例开放受限组、22例开放过度组胎儿ASEI分别为0.53±0.08（范围：0.38~0.70）、0.27±0.04（范围：0.14~0.33）、0.73±0.04（范围：0.68~0.81），3组间总体比较差异有统计学意义（F=296.95；P＜0.001）。开放受限组胎儿ASEI小于正常对照组和开放过度组，差异均有统计学意义（P均＜0.001）；开放过度组胎儿ASEI大于正常对照组和开放受限组，差异均有统计学意义（P均＜0.001）。52例中46例（88.5%）出生后超声心动图检查未见明显心血管异常；1例胎儿出生后诊断为主动脉狭窄并接受主动脉球囊扩张术；1例诊断为主动脉弓缩窄；1例诊断为继发孔型房间隔缺损；3例超声心动图提示中度三尖瓣反流，肺动脉收缩压正常（右心室收缩压分别为21、26、24 mmHg）。

结论

ASEI能够定量评估单纯性卵圆孔瓣开放过度及开放受限胎儿的卵圆孔开放状态，是评估胎儿卵圆孔开放情况的新的定量参数。多数单纯性卵圆孔瓣开放过度及开放受限胎儿出生后随访结果显示不伴发心脏结构畸形、预后良好。

关键词: 超声心动描记术, 胎儿, 卵圆孔, 卵圆孔瓣膨出指数
Objective

To investigate the echocardiographic characteristics of fetuses with isolated restrictive foramen ovale flapor redundant foramen ovale flap, to explore the application value of atrial septal excursion index (ASEI) in the evaluation of redundant foramen ovale flap and restrictive foramen ovale flap fetuses, and to follow the postnatal situation of fetuses.

Methods

Fifty-two fetuses with a diagnosis of restrictive foramen ovale flap (n=30) or redundant foramen ovale flap (n=22) by fetal echocardiography from January 2012 to January 2020 were selected retrospectively, and their initial and follow-up echocardiograms as well as pregnancy outcomes were reviewed. As controls, 108 normal fetuses with matched gestational age were randomly selected. Echocardiographic measurements included right atrial diameter to left atrial diameter ratio (RA/LA), right ventricular width to left ventricular width ratio (RV/LV), and pulmonary artery diameter to aortic diameter ratio (PA/AO). ASEIs in the three groups were calculated. All parameters were compared among the fetuses with restrictive foramen ovale flap, those with redundant foramen ovale flap, and controls.

Results

The ratios of RA/LA, RV/LV, and PA/AO in restrictive foramen ovale flap fetuses and redundant foramen ovale flap fetuses increased compared with those of the controls (P＜0.01). ASEI of the 108 fetuses in the control group was 0.53±0.08 (range: 0.38-0.70). ASEI of the 30 fetuses in the restrictive foramen ovale flap group was 0.27±0.04 (range: 0.14-0.33). ASEI of the 22 fetuses in the redundant foramen ovale flap group was 0.73±0.04 (range: 0.68-0.81). ASEIs among the three groups differed significantly (F=296.95, P＜0.001). ASEI in fetuses with restrictive foramen ovale flap significantly decreased compared with those of the controls and redundant foramen ovale flap fetuses (P＜0.001), and ASEI in fetuses with redundant foramen ovale flap significantly increased compared with those of the controls and restrictive foramen ovale flap fetuses (P＜0.001). Postnatal fellow-up by postnatal echocardiography demonstrated that 46 out of 52 cases (88.5%) had a structurally normal heart, one had aortic valvular stenosis and underwent aortic balloon dilatation, one had coarctation of the aortic arch, one had secondary atrial septal defects, and three had moderate tricuspid regurgitation with normal pulmonary artery systolic pressure (right ventricular systolic pressure was 21, 26, and 24 mmHg, respectively).

Conclusion

ASEI is a novel parameter that can quantitatively evaluate the features of the foramen ovale in fetuses with isolated restrictive foramen ovale flap or redundant foramen ovale flap. Most of the fetuses with isolated restrictive foramen ovale flap or redundant foramen ovale flap have no associated structural heart malformations and therefore have a good prognosis.

Key words: Echocardiography, Fetus, Foramen ovale, Atrial septal excursion index
图1 胎儿二维超声心动图双心房切面测量卵圆孔瓣膨出指数（ASEI）示意图。图中A为卵圆孔瓣在左心房内最大开放距离，即房间隔与卵圆孔瓣最大开放点之间的距离；B为左心房横径（内径），ASEI=A/B注：RA为右心房；LA为左心房
图2 胎儿心脏超声测量卵圆孔瓣开放过度胎儿卵圆孔瓣膨出指数（ASEI）。图a为二维超声心动图心尖四腔心切面测量ASEI为0.78（1.04/1.33）；图b为M型超声四腔心切面测量ASEI为0.73（0.966/1.33）
图3 胎儿心脏超声测量卵圆孔瓣开放受限胎儿卵圆孔瓣膨出指数（ASEI）。图a为二维超声心动图横位四腔心切面测量ASEI为0.17（0.141/0.842）；图b为M型超声四腔心切面测量ASEI为0.25（0.249/0.980）
表1 3组间超声心动图测量参数比较（
xˉ
±s）
分组 例数 RA/LA RV/LV PA/AO ASEI
开放过度组 22 1.32±0.28a 1.28±0.30a 1.45±0.33a 0.73±0.04b
开放受限组 30 1.45±0.23a 1.30±0.16a 1.39±0.21a 0.27±0.04bc
正常对照组 108 1.13±0.08 1.09±0.07 1.24±0.09 0.53±0.08
F值 54.95 36.17 18.74 296.95
P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001
图4 卵圆孔瓣开放过度、开放受限及正常对照组胎儿卵圆孔瓣膨出指数（ASEI）散点图注：ASEI为卵圆孔瓣膨出指数
1
任卫东, 张玉奇, 舒先红. 心血管畸形胚胎学基础与超声诊断 [M]. 北京: 人民卫生出版社, 2015: 84-85.
2
袁丽君, 曹铁生, 段云友. 胎儿心血管超声影像医学 [M]. 北京: 科学出版社, 2017.
3
Firpo C, Zielinsky P. Behavior of septum primum mobility in third-trimester fetuses with myocardial hypertrophy [J]. Ultrasound Obstet Gynecol, 2003, 21(5): 445-450.
4
Zielinsky P, Beltrame PA, Manica JL, et al. Dynamics of the septum primum in fetuses with intrauterine growth restriction [J]. J Clin Ultrasound, 2009, 37(6): 342-346.
5
Mekjarasnapha M, Traisrisilp K, Luewan S, et al. Reference ranges for fetal septum primum excursion from 14 to 40 weeks' gestation [J]. J Ultrasound Med, 2013, 32(10): 1729-1734.
6
Vena F, Donarini G, Scala C, et al. Redundancy of foramen ovale flap may mimic fetal aortic coarctation [J]. Ultrasound Obstet Gynecol, 2020, 56(6): 857-863.
7
Mäkikallio K, McElhinney DB, Levine JC, et al. Fetal aortic valve stenosis and the evolution of hypoplastic left heart syndrome: patient selection for fetal intervention [J]. Circulation, 2006, 113 (11): 1401-1405.
8
裴秋艳, 梁梅英, 姜玉新, 等. 200例正常胎儿卵圆孔和卵圆孔瓣彩色多普勒超声特征分析 [J]. 中华超声影像学杂志, 2007, 16(12): 1042-1044.
9
王艳, 崔冰. 胎儿卵圆孔及卵圆孔瓣的超声学研究进展 [J]. 影像诊断及介入放射学, 2010, 19(6): 377-379.
10
Allan LD, Joseph MC, Boyd EG, et al. M-mode echocardiography in the developing human fetus [J]. Heart, 1982, 47(6): 573-583.
11
Gu X, Zhang Y, Han J, et al. Isolated premature restriction or closure of foramen ovale in fetuses: Echocardiographic characteristics and outcome [J]. Echocardiography, 2018, 35(8): 1189-1195.
12
Gupta U, Abdulla R, Bokowski J. Benign outcome of pulmonary hypertension in neonates with a restrictive patent foramen ovale versus result for neonates with an unrestrictive patent foramen ovale [J]. Pediatr Cardiol, 2011, 32(7): 972-976.
13
谷孝艳, 何怡华, 张烨, 等. 胎儿超声心动图正常值的测定及其与孕龄的关系研究 [J]. 中国超声医学杂志, 2014, 30 (5): 429-434.
14
Jung E, Won HS, Lee PR. Clinical implication of isolated right dominant heart in the fetus [J]. Prenat Diagn, 2010, 27(8): 695-698.
15
Perolo A, Prandstraller D, Ghi T, et al. Diagnosis and management of fetal cardiac anomalies: 10 years of experience at a single institution [J]. Ultrasound Obstet Gynecol, 2001, 18(6): 615-618.
16
周启昌, 范平, 高梅, 等. 超声观察卵圆孔瓣在胎儿房间隔缺损产前诊断中的意义 [J]. 中华超声影像学杂志, 2000, 9(7): 422-424.
17
常红梅, 邓学东, 唐亚奇, 等. 不同孕周正常胎儿心脏大小的超声检测与临床意义 [J]. 中国医学影像技术, 2009, 25(10): 1853-1855.
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