To evaluate the cardiac morphology and function of fetuses with premature ductus arteriosus constriction or closure (DA Con/Clo) by fetal heart quantification technology (FHQ).

This study retrospectively analyzed 50 singleton fetuses who underwent fetal echocardiography and were diagnosed with DA Con/Clo (35 cases with DA Con, including 16 cases of mild to moderate constriction and 19 cases of moderate to severe constriction; and 15 cases with DA Clo) from May 2013 to January 2020; 50 healthy fetuses were randomly selected as a control group. The dynamic images of the standard four chamber view (4CV) were collected, and the end-diastolic area, length, and width were measured to determine the global sphericity index (GSI) of the 4CV. The left ventricle (LV) and right ventricle (RV) were divided into 24 segments (S1-24) from the base to the apex of the heart on 4CV, and speckle-tracking analysis was used to obtain the dynamic tracking curve of the ventricular intima and compute the end-diastolic width (ED), sphericity index (SI), and fractional shortening (FS) of the 24 segments of the RV and LV, as well as the Z-scores of these parameters after adjustment for gestational age. The Z-scores were valuated and defined as "more than or less than the normal range" when Z-score >+1.65 (>95th centile) or Z-score <-1.65 (<5th centile). Independent sample t-test was used to compare the Z scores of cardiac morphology, size, and function parameters between the DA Con/Clo and control groups, between the constriction and closure groups, between the mild to moderate constriction group and moderate to severe constriction group, and between the moderate to severe constriction group and closure group.

Compared with the controls, RV-ED of S1-24 increased significantly (Z＞+1.65), RV-SI was reduced in the basal-middle segment (Z＜-1.65), and FS of S1-24 was depressed to varying degrees (Z＜-1.65) in the DA Con/Clo group. Compared with the mild to moderate constriction group, LV-ED decreased significantly in the moderate to severe constriction group, and LV-SI and LV-FS increased (P＜0.05). Compared with the moderate to severe constriction group, LV-ED, RV-ED, and LV-FS increased, and LV-SI, RV-SI, and RV-FS decreased in the closure group (P＜0.05).

The cardiac parameters of DA Con/Clo fetuses have changed significantly. FHQ technology can provide more valuable information for evaluating the changes of heart size, morphology, and function of fetuses with DA Con/Clo. Z-scores can be more sensitive and accurate in evaluating the differences of size, shape, and function of the fetus heart between these groups.