Quantitative study of McGoon index and Z-scores in fetuses with right ventricular outflow tract obstruction

doi:10.3877/cma.j.issn.1672-6448.2023.12.006

Abstract

Abstract:

Objective

To evaluate the value of Z-score and McGoon index (MGI) in the diagnosis of fetal right ventricular outflow tract obstruction (RVOTO).

Methods

Sixty-seven fetuses with RVOTO diagnosed by fetal echocardiography at Sir Run Run Shaw Hospital, Zhejiang University College of Medicine from June 2020 to January 2022 were included. According to the degree of obstruction, the fetuses was divided into 4 groups: mild pulmonary stenosis (PS) group (n=17), moderate and severe PS group (n=16), tetralogy of Fallot (TOF) group (n=19), and pulmonary atresia group (n=15). Seventy normal fetuses who underwent examination during the same period were selected as controls. The differences in aortic (AO) diameter Z-score, pulmonary artery (PA) diameter Z-score, left pulmonary artery (LPA) diameter Z-score, right pulmonary artery (RPA) diameter Z-score, and MGI were compared among the five groups.

Results

With the aggravation of RVOTO, MGI showed a downward trend, the PA, LPA, and RPA Z-scores also showed a downward trend, and the AO Z-score showed a upward trend; the differences were statistically significant (P<0.05). There were significant differences in the PA, RPA, and AO Z-scores between the control group and mild PS group (P<0.05). There were significant differences in MGI and Z-scores among the control group, moderate and severe PS group, and TOF group, and pulmonary atresia group (P<0.05). There were significant differences in PA and LPA Z-scores between the mild PS group and moderate and severe PS group (P<0.05 for both), in MGI and Z-scores of the pulmonary artery and its branches between the mild PS group and TOF group (P<0.05 for both), in MGI and PA and LPA Z-scores between the mild PS group and pulmonary atresia group (P<0.05 for all), in AO Z-score between the moderate and severe PS group and TOF group (P<0.05), in RPA and AO Z-scores between the moderate and severe PS and pulmonary atresia group (P<0.05 for both), and in RPA Z-score between the TOF group and pulmonary atresia group (P<0.05).

Conclusion

MGI and Z-score can be used to quantitatively assess and compare the development of the pulmonary artery and its branches between normal fetuses and RVOTO fetuses, and provide reference information for accurate quantitative analysis of fetal pulmonary artery development among RVOTO of different severities. In the comparison between groups with similar degree of RVOT, Z-score is superior to MGI.

Key words: Tetralogy of Fallot, Pulmonary artery stenosis, Pulmonary atresia, Right ventricular outflow tract obstruction, McGoon index, Z-score

Xuanling Yu, Bowen Zhao, Mei Pan, Xiaohui Peng, Jie Lou, Ran Chen, Xianhui Jiang, Jingjing Zhang. Quantitative study of McGoon index and Z-scores in fetuses with right ventricular outflow tract obstruction[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(12): 1254-1259.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2023.12.006

https://chaosheng.cma-cmc.com.cn/EN/Y2023/V20/I12/1254

Figures/Tables 2

References 22

1	DeVore GR. Computing the Z score and centiles for cross-sectional analysis : a practical approach [J]. J Ultrasound Med, 2017, 36(3): 459-473.
2	郭显峰, 赵博文, 李益林. 解剖M型超声建立正常胎儿二尖瓣环位移Z-评分数据模型的研究 [J]. 中国超声医学杂志, 2015, 31(11): 1010-1012.
3	陆红妤, 赵博文, 王蓓, 等. 正常中晚孕胎儿心脏多参数的Z-评分研究 [J]. 中华超声影像学杂志, 2014, 23(3): 267-269.
4	赵洋, 金岩, 于岩, 等.多层螺旋CT与超声心动图评估法洛四联症肺动脉发育的对比研究 [J]. 中国心血管病研究, 2021, 19(2): 142-146.
5	Rychik Jacck.胎儿心血管超声影像学 [M].袁丽君, 曹铁生, 段云友,译. 北京: 科学出版社, 2017: 2228-2235.
6	Quartermain MD, Glatz AC, Goldberg DJ, et a1.Pulmonary outflow tract obstruction in fetuses with complex congenital heart disease: Predicting the need for neonatal intervention [J]. Ultrasound Obstet Gynecol, 2013, 41(1): 47-53.
7	Kotani Y, Kobayashi Y, Kadowaki S, et a1. Impact of pulmonary artery coarctation on pulmonary artery growth and definitive repair following modified Blalock-Taussig shunt [J]. J Thorac Cardiovasc Surg, 2022, 163(5): 1618-1626.
8	Hiraishi S, Misawa H, Hirota H, et al. Noninvasive quantitative evaluation of the morphology of the major pulmonary artery branches in cyanotic congenital heart disease. Angiocardioimagedata and echocardioimagedata correlative study [J]. Circulation, 1994, 89(3): 1306-1316.
9	Guo Y, Liu X, Gu X, et al. Fetal lung volume and pulmonary artery changes in congenital heart disease with decreased pulmonary blood flow: Quantitative ultrasound analysis [J]. Echocardiography, 2018, 35(1): 85-89.
10	俞波, 刘菲斯, 邹勇, 等. 超声McGoon指数对法洛四联症肺动脉发育的评估 [J]. 实用临床医学, 2007, 8(11): 106-109.
11	刘琳, 王红丹, 崔存英, 等. 肺动脉闭锁合并室间隔缺损的产前超声诊断分型及预后评估 [J].中华超声影像学杂志, 2019, 28(6): 493-499.
12	郭勇, 刘晓伟, 刘文旭,等. 超声测量肺动脉内径及McGoon指数评估法洛四联症胎儿肺发育的研究 [J].中国超声医学杂志, 2019, 35(3): 256-259.
13	Li X, Qiu X, Huang H, et a1. Fetal heart size measurements as new predictors of homozygous a-thalassemia-1 in mid-pregnancy [J]. Congenit Heart Dis, 2018, 13(2): 282-287.
14	Schneider C, McCrindle BW, Carvalho JS, et a1. Development of Z-scores for fetal cardiac dimensions from echocardiography [J]. Ultrasound Obstet Gynecol, 2005, 26(6): 599-605.
15	郭玉霞, 赵博文, 戚夏近, 等.胎儿超声心动图检查定量11~17周正常胎儿主动脉和肺动脉内径Z-评分的初步研究 [J/OL].中华医学超声杂志(电子版), 2020, 17(1): 52-59.
16	翟俊莎, 孔丽娜, 赵雅丽, 等. 胎儿超声心动图Z值评分在胎儿先天性心脏病产前诊断中的应用价值 [J]. 中国医学装备, 2022, 19(5): 112-115.
17	Riggs T, Saini AP, Comstock CH, et a1. Comparison of cardiac Z-score with cardiac asymmetry for prenatal screening of congenital heart disease [J]. Ultrasound Obstet Gynecol, 2011, 38(3): 332-336.
18	Wu LH, Wang N, Xie HN, et al. Cardiovascular Z-scores in fetuses with tetralogy of Fallot [J]. Ultrasound Obstet Gynecol, 2014, 44(6): 674-681.
19	Friedman K, Balasubramanian S, Tworetzky W. Mid gestation fetal pulmonary annulus size is predictive of outcome in tetralogy of Fallot [J]. Congenit Heart Dis, 2014, 9(3): 187-193.
20	彭源, 曹海燕, 洪柳, 等. Z指数在中国胎儿肺动脉狭窄诊断中的应用 [J].中国循环杂志, 2017, 32(z1): 197-198.
21	Xiao TT, Chen SB, Sun K, et al. Evaluation of the development of pulmonary vessels with pulmonary venous index in congenital heart disease with decreased pulmonary blood flow [J]. Zhonghua Er Ke Za Zhi, 2007, 45(12): 889-892.
22	Rahkonen O, Chaturvedi RR, Benson L, et al. Pulmonary artery stenosis in hybrid single-ventricle palliation: High incidence of left pulmonary artery intervention [J]. J Thorac Cardiovasc Surg, 2015, 149(4): 1102-1109.

组别	例数	MGI	PAZ1	PAZ2	LPAZ1	LPAZ2	RPAZ1	RPAZ2	AOZ1	AOZ2
对照组	70	1.40±0.21	0.32（-0.51，1.06）	0.22（-0.69，1.43）	0.55（-0.09，1.12）	0.54±1.20	0.59（-0.18，1.11）	0.59（-0.16，1.21）	-0.20（-1.14，0.85）	-0.12±1.94
轻度PS组	17	1.29±0.28	-0.50±1.11^a	-0.85±1.18^a	0.16±1.48	0.07±1.87	-0.20±1.53^a	-0.34±1.56^a	1.65±1.22^a	1.59±1.43^a
中重度PS组	16	1.19±0.22 ^a	-3.64（-4.76，3.25）^ab	-4.50±1.28^ab	0.909±1.36^ab	-1.16±1.42^ab	-0.97±1.51^a	-1.19±1.51^a	1.09±1.95^a	1.10±2.18^a
TOF组	19	1.06±0.20^ab	-3.46±1.76^ab	-3.69±1.62^ab	-0.89±0.90^ab	-1.01±0.97^ab	-1.23±1.17^ab	-1.34±1.26^ab	2.20±0.87^ac	2.60±1.14^ac
肺动脉闭锁组	15	1.05±0.41^ab	-8.85（-15.44，2.05）^ab	-8.10（-17.86，2.26）^ab	-0.65（-3.34，0.46）^ab	-1.01（-3.42，0.69）^ab	0.50（-1.00，1.11）^c	-0.01（-1.01，0.58）^ad	2.10±1.58^ac	2.14±2.13^a
统计值		F=11.23	H=80.48	H=84.55	H=36.38	H=36.67	H=32.51	H=36.44	H=54.78	F=11.79
P值		<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01

组别	例数	MGI	PAZ1	PAZ2	LPAZ1	LPAZ2	RPAZ1	RPAZ2	AOZ1	AOZ2
对照组	70	1.40±0.21	0.32（-0.51，1.06）	0.22（-0.69，1.43）	0.55（-0.09，1.12）	0.54±1.20	0.59（-0.18，1.11）	0.59（-0.16，1.21）	-0.20（-1.14，0.85）	-0.12±1.94
轻度PS组	17	1.29±0.28	-0.50±1.11^a	-0.85±1.18^a	0.16±1.48	0.07±1.87	-0.20±1.53^a	-0.34±1.56^a	1.65±1.22^a	1.59±1.43^a
中重度PS组	16	1.19±0.22 ^a	-3.64（-4.76，3.25）^ab	-4.50±1.28^ab	0.909±1.36^ab	-1.16±1.42^ab	-0.97±1.51^a	-1.19±1.51^a	1.09±1.95^a	1.10±2.18^a
TOF组	19	1.06±0.20^ab	-3.46±1.76^ab	-3.69±1.62^ab	-0.89±0.90^ab	-1.01±0.97^ab	-1.23±1.17^ab	-1.34±1.26^ab	2.20±0.87^ac	2.60±1.14^ac
肺动脉闭锁组	15	1.05±0.41^ab	-8.85（-15.44，2.05）^ab	-8.10（-17.86，2.26）^ab	-0.65（-3.34，0.46）^ab	-1.01（-3.42，0.69）^ab	0.50（-1.00，1.11）^c	-0.01（-1.01，0.58）^ad	2.10±1.58^ac	2.14±2.13^a
统计值		F=11.23	H=80.48	H=84.55	H=36.38	H=36.67	H=32.51	H=36.44	H=54.78	F=11.79
P值		<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01

[1]	Shuiqing Wang, Bowen Zhao, Mei Pan, Xiaohui Peng, Ran Chen, Mingming Ma, Min Di. Quantitative assessment of posterior left atrial space index (PLASI) and PLASI Z-score in normal fetuses at 16-40 weeks of gestation [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(05): 460-469.
[2]	Gang Luo, Silin Pan, Lingyu Sun, Zhixin Li, Taotao Chen, Sibo Qiao, Shanchen Pang. Classification of right ventricular hypoplasia in fetuses diagnosed with pulmonary atresia with an intact ventricular septum or critical pulmonary stenosis via a new semantic parsing network model [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(04): 377-383.
[3]	Min Feng, Bowen Zhao, Mei Pan, Xiaohui Peng, Ran Chen, Yankai Mao, Yang Chen. Application of right heart time interval measured using echocardiography in evaluating right heart function in fetuses with right ventricular outflow tract obstruction [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(02): 151-157.
[4]	Dehui Wang, Xuedong Deng. Evaluation and prognostic analysis of fetal pulmonary atresia with intact interventricular septum by echocardiography [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(12): 1266-1270.
[5]	Jingjing Zhang, Bowen Zhao, Mei Pan, Xiaohui Peng, Yankai Mao, Chenke Pan, Lingyan Zhu, Linlin Zhu, Qiuye Lan. Evaluation of fetal pulmonary development using McGoon index measured by fetal echocardiography [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 860-865.
[6]	Gang Luo, Silin Pan, Taotao Chen, Qian Xu, Zhixian Ji, Sibao Wang, Lingyu Sun. Application of echocardiography in fetal cardiac intervention of pulmonary atresia with intact ventricular septum [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 605-609.
[7]	Tianjing Li, Jiancheng Han, Lin Sun, Xiaowei Liu, Shuang Gao, Xiuxiu Hao, Yihua He. Analysis of cardiac morphology and function based on Z-scores in fetuses with ductus arteriosus constriction or closure by fetal heart quantification [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(09): 941-949.
[8]	Tingting Man, Xiaoyan Hao, Xiaowei Liu, Hairui Sun, Yihua He. Common intracardiac malformations and genetic abnormalities in tetralogy of Fallot [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(08): 779-784.
[9]	Ruyong Shi, Ping'an Jin, Xiaodong Lu, Bowen Zhao, Jianyi Lou, Yanfen Yang, Ling Li. Clinical value of S/D ratio of umbilical arteries and Z-scores of multiple ultrasound parameters in evaluating fetal growth restriction in pregnant women with gestational diabetes mellitus [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(06): 567-572.
[10]	Chaoyu Zhou, Bowen Zhao, Yuhui Li, Bei Zhao, Chao Huang, Haisu Pang, Min Di. Application of fetal intelligent navigation echocardiography combined with virtual intelligent sonographer assistance in diagnosis of fetal tetralogy of Fallot [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(10): 967-974.
[11]	Xiaohua Zhang, Kun Wang, Ping Zhang, Fengrui Yi, Yanan Wang, Yaning Zhao, Fengqun Dong. Prenatal echocardiographic features of tetralogy of Fallot with unilateral absence of the pulmonary artery [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(08): 741-745.
[12]	Kun Wang, Xiaohua Zhang, Fengrui Yi, Jie Liu, Fengqun Dong. Application value of fetal echocardiography in the evaluation of pulmonary atresia with intact ventricular septum [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(08): 759-764.
[13]	Yuxia Guo, Bowen Zhao, Xiajin Qi, Haiya Lou, Mei Pan, Bei Wang, Xiaohui Peng, Ran Chen. Quantification of Z-scores of normal fetal aortic and pulmonary diameters using fetal echocardiography at 11~17 weeks of gestation [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(01): 52-59.
[14]	Zedong Luan, Nan Yang, Xiaoping Zhang, Xiaoyan Wang, Yanli Zou, Yaqin Liu, Haoling Wang, Jinting Zhang. Prenatal ultrasonic diagnostic features of tetralogy of Fallot in early pregnancy [J]. Chinese Journal of Diagnostics(Electronic Edition), 2021, 09(01): 26-29.
[15]	Fan Yang, Sheng Zhao, Xinlin Chen. Diagnostic features and literature review of absence of pulmonary valve with right ventricular hypoplasia [J]. Chinese Journal of Diagnostics(Electronic Edition), 2019, 07(01): 37-41.

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