Quantitative echocardiography analysis of fetuses with normal opening and premature intrauterine closure of the foramen ovale

doi:10.3877/cma.j.issn.1672-6448.2021.10.011

Abstract

Abstract:

Objective

To quantitatively analyze the opening of the foramen ovale in the fetal heart in late pregnancy by echocardiography, and to investigate the opening characteristics of the foramen ovale in the late pregnancy and hemodynamic characteristics of premature intrauterine closure of the foramen ovale.

Methods

A total of 116 women in late stages of pregnancy were included in Hemei Women's and Children's Hospital from November 2019 to June 2020. They ranged in age from 19-42 years, with an average of 31.6±3.1 years. Echocardiography was used to exclude fetal structural cardiac abnormalities, and 102 normal fetuses was recruited finally. These normal fetuses were divided into three according to gestational period: 28⁺⁰-32⁺⁶ weeks (group A; n=36), 33⁺⁰-36⁺⁶ weeks (group B; n=32), and 37⁺⁰-40⁺⁶ weeks (group C; n=34). In addition, 14 fetuses with premature intrauterine closure of the foramen ovale and right heart enlargement were included as an abnormal group. The indicators of motion curves of the fetal foramen ovale valve were recorded: the amplitude of systolic (S peak) and diastolic (D peak) motion, S peak duration (ST), total cardiac cycle duration (T), slope of S peak decline, and calculated ST/T ratio. Doppler ultrasound were used to measure the pulmonary valve (PV), aortic valve (AV), ductus arteriosus (DA) blood flow velocity, venous catheter resistance index (RI), umbilical vein (UV; abdominal segment) blood flow velocity, and blood flow velocity across the foramen ovale and inferior vena cava into the right atrium. Two-dimensional ultrasound parameters including fetal oval aperture (FO), the ratio of the diameter of the right atrium to that of the left atrium (RA/LA), and the ratio of the diameter of the right ventricle to that of the left ventricle (RV/LV) were also recorded.

Results

The characteristics of M-mode echocardiography of the fetal foramen ovale valve in the normal group were that S peak and D peak formed by foramen ovale valve movement curve had unidirectional movement to the left atrium, and the maximum movement peak and duration of S peak were higher than those of D peak. The maximum movement of S-peak in normal fetuses was 5-7 mm, with an average of (6.00±0.96) mm. The maximum movement peak of s-peak in the foramen ovale valve movement curve measured by M-mode echocardiography differed signficantly between the abnormal group and group C [(3.72±0.54) mm vs (6.17±0.94) mm, P＜0.05]. ST/T ratio in the abnormal group was significantly lower than that in group C (0.52±0.86 vs 0.59±0.05, P＜0.001). The right heart was significantly enlarged and RA/LA was significantly increased in the abnormal group compared with group C (1.83±0.21 vs 1.19±0.19, P＜0.001). The blood flow velocity across the foramen ovale in normal fetuses was lower than that in the inferior vena cava inlet [(40.9±8.9) cm/s vs (52.5±11.5) cm/s, P＜0.05]. The blood flow velocity across the foramen ovale in the abnormal group was significantly higher than that in the inferior vena cava inlet [(47.9±10.6) cm/s vs (43.1±7.4) cm/s, P＜0.05]. UV flow velocity in group C was significantly higher than that in the abnormal group [(24.4±4.5) cm/s vs (20.3±5.0) cm/s, P＜0.05].

Conclusion

M-mode echocardiography showed that the movement curve of the foramen ovale valve in normal fetuses has its own patterns and characteristics, and the opening movement of the foramen ovale valve in fetuses with intrauterine premature closure decreases. Quantitative analysis of movement and hemodynamic characteristics of the foramen ovale valve by M-mode echocardiography is helpful to diagnose intrauterine foramen ovale closure accurately.

Key words: Fetal, Echocardiography, Foramen ovale

Yafeng Wu, Chunyan Zhao, Juan Liu. Quantitative echocardiography analysis of fetuses with normal opening and premature intrauterine closure of the foramen ovale[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(10): 960-966.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2021.10.011

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Figures/Tables 7

References 11

1	吴雅峰. 妊娠中晚期并发症卵圆孔瓣宫内闭合超声诊断及临床意义 [J/CD]. 中华医学超声杂志(电子版), 2016, 13(8): 564-566.
2	Uzun O, Babaoglu K, Ayhan YJ, et al. Diagnostic ultrasound features and outcome of restrictive foramen ovale in fetuses with structurally normal hearts [J]. Pediatr Cardiol, 2014, 35(6): 943-952.
3	李泞珊, 夏红梅, 邓曦, 等. 不合并心脏畸形的卵圆孔血流受限胎儿超声影像特征及预后 [J]. 中华超声影像学杂志, 2019, 28(1): 36-41.
4	邵云, 成明阳, 樊文峰, 等. 晚孕期单纯卵圆孔提前闭合或狭窄的胎儿超声心动图特征 [J]. 中华超声影像杂志, 2014, 23(4): 361-362.
5	Wilson AD, Rao PS, Aeschlimann S. Normal fetal foramen flap and transatrial Doppler velocity pattern [J]. J Am Soc Echocardiogr, 1990, 3(6): 491-494.
6	张静, 周启昌, 章鸣, 等. 多普勒超声检测胎儿心室发育不良血流动力学变化的研究 [J]. 中华超声影像学杂志, 2012, 21(4): 296-299.
7	吴雅峰, 刘敏, 李雁平, 等. 孕中晚期卵圆孔瓣宫内闭合与脐带扭转的相关性研究 [J]. 中国超声医学杂志, 2020, 36(3): 276-279.
8	吴静, 赵凯英, 林玉涓, 等. 彩色多普勒超声检测脐带螺旋指数与围产结局的相关性研究 [J]. 临床超声医学杂志, 2013, 15(1): 57-59.
9	徐鹏, 李军, 杨文娟, 等. 胎儿右心系统扩大的类型及超声诊断思路 [J/CD]. 中华医学超声杂志(电子版), 2019, 16(6): 433-437.
10	Lopes LM, Carrilho MC, Vieira Francisco RP, et al. Fetal ductus arteriosus constriction and closure: analysis of the causes and perinatal outcome related to 45 consecutive cases [J]. J Matern Fetal Neonatal Med, 2016, 29(4): 638-645.
11	徐光莲. 超声心动图对孕中晚期胎儿动脉导管早闭及狭窄的诊断价值 [J]. 医学临床研究, 2019, 36(6): 1059-1062.

参数	正常组A（n=36）	正常组B（n=32）	正常组C（n=34）	统计值	P值
右心房横径（mm）	13.9±1.4	16.6±1.7^a	18.6±2.5^ab	F=52.300	＜0.001
右心室横径（mm）	11.8±1.4	13.9±1.7^a	15.5±1.8^ab	F=46.145	＜0.001
左心房横径（mm）	12.5±1.2	14.3±1.5^a	15.7±1.8^ab	F=39.376	＜0.001
左心室横径（mm）	11.1±1.6	12.9±1.4^a	14.4±1.6^ab	F=41.429	＜0.001
右心房/左心房	1.11±1.06	1.16±0.13	1.19±0.19	Z=0.175	0.416
右心室/左心室	1.07±0.06	1.07±0.75	1.08±0.10	Z=0.341	0.843
卵圆孔径（mm）	6.07±0.96	6.86±0.88^a	7.59±1.08^ab	F=20.224	＜0.001
肺动脉瓣血流速度（cm/s）	71.0±8.71	78.7±5.95^a	76.4±6.83^a	F=10.257	＜0.001
主动脉瓣血流速度（cm/s）	89.9±6.85	93.9±7.75	95.8±9.71^a	F=4.775	0.011
动脉导管血流速度（cm/s）	105.5±10.03	123.9±24.60^a	122.2±20.03^a	Z=17.400	＜0.001
跨卵圆孔血流速度（cm/s）	36.5±7.86	42.4±7.29^a	44.3±9.51^a	F=8.491	＜0.001
下腔静脉入口血流速度（cm/s）	50.2±12.39	55.2±9.31	52.2±12.07	F=1.590	0.209
静脉导管阻力指数	0.46±0.07	0.43±0.10	0.39±0.08^a	F=5.240	0.007
脐静脉腹段血流速度（cm/s）	24.93±4.66	24.41±4.41	24.43±4.47	F=0.151	0.860
卵圆孔瓣S峰（mm）	6.0±0.93	6.44±0.97	6.17±0.94	F=1.885	0.157
卵圆孔瓣D峰（mm）	5.33±0.96	5.45±0.77	5.21±0.98	F=0.481	0.619
S峰斜率	1.83±0.63	2.06±0.60	2.17±0.88	Z=3.522	0.172
ST/T	0.60±0.05	0.61±0.04	0.59±0.05	F=2.424	0.094

参数	正常组A（n=36）	正常组B（n=32）	正常组C（n=34）	统计值	P值
右心房横径（mm）	13.9±1.4	16.6±1.7^a	18.6±2.5^ab	F=52.300	＜0.001
右心室横径（mm）	11.8±1.4	13.9±1.7^a	15.5±1.8^ab	F=46.145	＜0.001
左心房横径（mm）	12.5±1.2	14.3±1.5^a	15.7±1.8^ab	F=39.376	＜0.001
左心室横径（mm）	11.1±1.6	12.9±1.4^a	14.4±1.6^ab	F=41.429	＜0.001
右心房/左心房	1.11±1.06	1.16±0.13	1.19±0.19	Z=0.175	0.416
右心室/左心室	1.07±0.06	1.07±0.75	1.08±0.10	Z=0.341	0.843
卵圆孔径（mm）	6.07±0.96	6.86±0.88^a	7.59±1.08^ab	F=20.224	＜0.001
肺动脉瓣血流速度（cm/s）	71.0±8.71	78.7±5.95^a	76.4±6.83^a	F=10.257	＜0.001
主动脉瓣血流速度（cm/s）	89.9±6.85	93.9±7.75	95.8±9.71^a	F=4.775	0.011
动脉导管血流速度（cm/s）	105.5±10.03	123.9±24.60^a	122.2±20.03^a	Z=17.400	＜0.001
跨卵圆孔血流速度（cm/s）	36.5±7.86	42.4±7.29^a	44.3±9.51^a	F=8.491	＜0.001
下腔静脉入口血流速度（cm/s）	50.2±12.39	55.2±9.31	52.2±12.07	F=1.590	0.209
静脉导管阻力指数	0.46±0.07	0.43±0.10	0.39±0.08^a	F=5.240	0.007
脐静脉腹段血流速度（cm/s）	24.93±4.66	24.41±4.41	24.43±4.47	F=0.151	0.860
卵圆孔瓣S峰（mm）	6.0±0.93	6.44±0.97	6.17±0.94	F=1.885	0.157
卵圆孔瓣D峰（mm）	5.33±0.96	5.45±0.77	5.21±0.98	F=0.481	0.619
S峰斜率	1.83±0.63	2.06±0.60	2.17±0.88	Z=3.522	0.172
ST/T	0.60±0.05	0.61±0.04	0.59±0.05	F=2.424	0.094

参数	正常组C（n=34）	卵圆孔瓣宫内早闭组（n=14）	统计值	P值
右心房横径（mm）	18.6±2.46	21.6±2.12	t=-4.014	＜0.001
右心室横径（mm）	15.6±1.76	17.4±2.03	t=-3.070	0.004
左心房横径（mm）	15.7±1.82	11.8±1.41	t=7.285	＜0.001
左心室横径（mm）	14.4±1.60	12.4±1.87	t=3.822	＜0.001
右心房/左心房	1.19±0.19	1.83±0.21	Z=-5.042	＜0.001
右心室/左心室	1.08±0.10	1.39±0.16	Z=-4.686	＜0.001
卵圆孔径（mm）	7.59±1.07	7.20±1.45	t=0.961	0.342
肺动脉瓣血流速度（cm/s）	76.4±6.83	81.7±6.56	t=-2.197	0.033
主动脉瓣血流速度（cm/s）	95.8±9.71	92.8±5.54	t=1.050	0.300
动脉导管血流速度（cm/s）	122.2±20.03	140.6±27.73	Z=-2.040	0.041
跨卵圆孔血流速度（cm/s）	44.3±9.51	47.9±10.66	t=-1.069	0.291
下腔静脉入口血流速度（cm/s）	52.73±12.16	43.16±7.40	t=2.436	0.020
静脉导管阻力指数	0.39±0.08	0.50±0.13	t=-3.029	0.004
脐静脉腹段血流速度（cm/s）	24.4±4.47	20.3±5.00	t=2.036	0.048
卵圆孔瓣S峰（mm）	6.17±0.94	3.72±0.54	t=8.617	＜0.001
卵圆孔瓣D峰（mm）	5.21±0.98	3.08±1.30	t=6.005	＜0.001
S峰斜率	2.17±0.88	2.19±0.90	Z=-0.075	0.940
ST/T	0.59±0.05	0.52±0.86	t=11.781	＜0.001

参数	正常组C（n=34）	卵圆孔瓣宫内早闭组（n=14）	统计值	P值
右心房横径（mm）	18.6±2.46	21.6±2.12	t=-4.014	＜0.001
右心室横径（mm）	15.6±1.76	17.4±2.03	t=-3.070	0.004
左心房横径（mm）	15.7±1.82	11.8±1.41	t=7.285	＜0.001
左心室横径（mm）	14.4±1.60	12.4±1.87	t=3.822	＜0.001
右心房/左心房	1.19±0.19	1.83±0.21	Z=-5.042	＜0.001
右心室/左心室	1.08±0.10	1.39±0.16	Z=-4.686	＜0.001
卵圆孔径（mm）	7.59±1.07	7.20±1.45	t=0.961	0.342
肺动脉瓣血流速度（cm/s）	76.4±6.83	81.7±6.56	t=-2.197	0.033
主动脉瓣血流速度（cm/s）	95.8±9.71	92.8±5.54	t=1.050	0.300
动脉导管血流速度（cm/s）	122.2±20.03	140.6±27.73	Z=-2.040	0.041
跨卵圆孔血流速度（cm/s）	44.3±9.51	47.9±10.66	t=-1.069	0.291
下腔静脉入口血流速度（cm/s）	52.73±12.16	43.16±7.40	t=2.436	0.020
静脉导管阻力指数	0.39±0.08	0.50±0.13	t=-3.029	0.004
脐静脉腹段血流速度（cm/s）	24.4±4.47	20.3±5.00	t=2.036	0.048
卵圆孔瓣S峰（mm）	6.17±0.94	3.72±0.54	t=8.617	＜0.001
卵圆孔瓣D峰（mm）	5.21±0.98	3.08±1.30	t=6.005	＜0.001
S峰斜率	2.17±0.88	2.19±0.90	Z=-0.075	0.940
ST/T	0.59±0.05	0.52±0.86	t=11.781	＜0.001

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