目的

探讨出生后不同狭窄程度及是否手术干预的孤立性肺动脉狭窄（IPS）胎儿的产前超声图像特征。

方法

回顾性分析2018年4月至2023年4月安徽医科大学第一附属医院、安徽省妇幼保健院、安徽医科大学第二附属医院3家产前诊断中心确诊的59例IPS胎儿的临床资料及产前超声资料。根据出生后1周内超声心动图结果，将病例分为中-重度肺动脉狭窄组和轻度肺动脉狭窄组；根据是否行手术治疗分为手术组和非手术组。采用单因素分析（Fisher精确检验、t检验或Mann-Whitney U检验）比较组间产前超声参数的差异。

结果

59例产前诊断IPS病例中，18例选择终止妊娠，41例继续妊娠至分娩且胎儿均存活。与轻度肺动脉狭窄组（n=32）比较，中-重度肺动脉狭窄组（n=9）产前超声提示肺动脉瓣内径/肺动脉主干内径比值＜0.5、右心异常及存在异常指标数≥3个患儿比例更高［67% vs 22%；67% vs 6%；78% vs 19%］，卵圆孔内径更大［6.40（4.90，8.05）mm vs 4.90（4.43，5.30）mm］，差异具有统计学意义（P=0.018；P＜0.001；P=0.002；Z=-2.175，P=0.029）。与非手术组（n=33）比较，手术组（n=8）产前超声提示存在肺动脉瓣环内径/肺动脉主干内径比值＜0.5、存在肺动脉狭窄后扩张、三尖瓣反流流速＞100 cm/s、右心异常、异常指标数目≥3个患儿比例更高［75% vs 21%；87% vs 36%；62% vs 21%；75% vs 6%；75% vs 21%］，卵圆孔内径更大［6.40（4.90，8.05）mm vs 4.90（4.43，5.30）mm］，差异具有统计学意义（P=0.007；P=0.016；P=0.034；P＜0.001；P=0.007；Z=-2.881，P=0.003）。

结论

中-重度肺动脉狭窄及进行手术干预的IPS胎儿肺动脉瓣环内径/肺动脉主干内径比值、右心异常、卵圆孔内径及异常参数数目≥3个等指标的患儿比例或数值更高。

Objective

To investigate the prenatal ultrasound characteristics of isolated pulmonary stenosis （IPS） in fetuses associated with postnatal stenosis severity and surgical intervention outcomes.

Methods

A retrospective analysis was conducted on 59 cases of fetal IPS diagnosed from April 2018 to April 2023 at three prenatal diagnosis centers： the First Affiliated Hospital of Anhui Medical University， Anhui Maternal and Child Health Hospital， and the Second Affiliated Hospital of Anhui Medical University. Clinical data and prenatal ultrasound findings were collected and analyzed. Based on echocardiographic findings within the first week after birth， the cases were categorized into two groups： moderate-to-severe pulmonary stenosis and mild pulmonary stenosis. Additionally， the cases were further stratified into surgical and non-surgical groups based on whether they underwent surgical intervention. Differences in prenatal ultrasound parameters between groups were compared using univariate analysis， including Fisher’s exact test， Student’s t-test， or Mann-Whitney U test， as appropriate.

Results

Among the 59 prenatally diagnosed cases， 18 opted for pregnancy termination， while 41 continued the pregnancy to delivery， with all fetuses surviving. Compared with the mild pulmonary valve stenosis group （n=32）， the moderate-to-severe pulmonary valve stenosis group（n=9） had a higher proportion of patients with a pulmonary valve diameter/main pulmonary artery diameter ratio ＜0.5 on prenatal ultrasound， right ventricular abnormalities， and ≥3 abnormal indicators ［67% vs 22%；67% vs 6%； 78% vs 19%］， as well as a larger foramen ovale diameter ［6.40 （4.90， 8.05） mm vs 4.90 （4.43， 5.30）mm］； these differences were statistically significant （P=0.018， P＜0.001， P=0.002， Z=-2.175， and P=0.029，respectively）. Compared with the non-surgical group （n=33）， the surgical group （n=8） had a higher proportion of patients with a pulmonary valve annulus diameter/main pulmonary artery diameter ratio ＜0.5， post-stenotic dilation of the pulmonary artery， tricuspid regurgitation velocity ＞100 cm/s， right ventricular abnormalities，and ≥3 abnormal indicators ［75% vs 21%； 87% vs 36%； 62% vs 21%； 75% vs 6%； 75% vs 21%］， as well as a larger foramen ovale diameter； these differences were statistically significant （P=0.007， P=0.016， P=0.034，P＜0.001， P=0.007， Z=-2.881， and P=0.003， respectively）.

Conclusion

In fetuses with moderate-to-severe pulmonary valve stenosis and those requiring surgical intervention， the ratio of pulmonary valve annulus diameter to main pulmonary artery diameter， the incidence of right ventricular abnormalities， the size of the foramen ovale， and the number of abnormal parameters ≥3 are higher.