RESUMO
Objective To evaluate the cardiac function of fetuses with aortic arch anomalies using spatio -temporal image correlation (STIC). Methods Thirty - two fetuses with aortic arch anomalies in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2015 to October 2016,were included. These fetuses were divided into 2 groups according to hemodynamics:obstructive lesion group(17 cases)and non - obstructive lesion group(15 cases). Comparative analysis of cardiac function of these fetuses was conducted in light of gestational age - matched normal fetuses separately using fetal echocardiography and STIC. The indexes were obtained,which in-cluded diameter of great arteries,left ventricular end diastolic dimension(LVDD),right ventricular end diastolic dimen-sion(RVDD),right ventricular end systolic transverse diameter(RVDS),left ventricular end systolic transverse diame-ter(LVDS),fractional shortening (FS),left ventricular end - diastolic volume(LVEDV),right ventricular end - dias-tolic volume (RVEDV),left ventricular end - systolic volume (LVESV),right ventricular end - systolic volume (RVESV),stroke volume(SV)and ejection fraction(EF)were obtained. Comparison was made between the groups. Results Cardiac function of fetuses with aortic arch anomalies was within normal range,however,FS and EF were lower in these fetuses than those of normal ones,specifically,the development of aorta was worse in fetuses with obstruc-tive lesions (all P < 0. 05). In these fetuses,RVEDV was larger than that of normal fetuses. EDV and SV were larger in the right ventricle(RV)than those of the left ventricle(LV)[RVEDV vs. LVEDV:(1. 681 ± 0. 725)mL vs. (1. 181 ± 0. 565)mL,SV of RV vs. SV of LV:(1. 020 ± 0. 436)mL vs. (0. 643 ± 0. 299)mL],and the differences were all sta-tistically significant(t = - 2. 246,P = 0. 032;t = - 2. 939,P = 0. 006);and EF was higher in RV[EF of RV vs. EF of LV:(61 ± 5)％ vs. (54 ± 5)％],and the difference was statistically significant(t = - 3. 708,P = 0. 001). Meanwhile, aorta and pulmonary artery were both smaller in fetuses with non - obstructive lesions than those of normal fetuses,and the differences were all statistically significant(all P < 0. 05). There were no significant differences between these fetu-ses and normal fetuses in LVDD,LVDS,RVDD,RVDS or RVDD/ LVDD,and there was no significant difference be-tween LV and RV in volumic indices (all P > 0. 05). Conclusions Small aorta and ventricular disproportion may appear in fetuses with aortic arch obstruction. Though ventricular systolic function is within normal range,FS and EF are lower in aortic arch anomaly fetuses than those in normal fetuses. Aortic arch anomalies may have influence on fetal car-diac function.
RESUMO
Objective To study the ultrasonographic clues and methods for fetal anomalies of the aorta arch and improve prenatal detection of anomalies of the aorta arch.Methods One thousand four hundred and seventy-two cases fetus who were carried out detailed scan and whose results were confirmed were chose as study objects.Every routine fetal echocardiography included four chamber and left and right outflow tract and three-vessel trachea view(3VT).The more views which included longitudinal and coronary view of the aorta arch and coronary view of the trachea and main bronchus were obtained when the abnormality of aorta arch was suspected.Results One hundred and forty-eight cases with anomalies of aorta arch were diagnosed by ultrasonography.One case was misdiagnosed.Ninety-two fetus with anomalies of aorta arch which included 28 aortic coarctation(CoA) and 10 interrupted aortic arch (IAA) and 52 right-side aortic arch and abnormal aortic branch and 2 double aortic arch were confirmed by postmortem or postnatal echocardiography and surgery.Of the 92 confirmed cases,24 had prenatally diagnosed additional complex intracardiac anomalies.All cases with CoA and IAA presented ventricular and/or great arterial disproportion with smaller left ventricle and aorta diameter on four chamber view and 3VT.Right aortic arch (RAA) and abnormal aortic branch(AAB) displayed aortic arch located on the right side of the trachea and increased distance between the aortic arch and arterial duct and abnormal aortic arch branch-subclavian artery originating from the beginning section of the descend aorta which coursed behind the trachea with U-shaped appearance on the 3VT plane.The display rate of the transverse and longitudinal and coronary view of the aorta arch was 98.4%,90.0%,81.9%,respectively.Conclusions Disproportional ventricular and /or great arterial with smaller left ventricle and aorta diameter are the clues for CoA and IAA.Increased distance between the aortic arch and arterial duct is the clue for RSA.The transverse view of the aortic arch 3VT is the most sensitive for detecting the anomalies of the aortic arch and the most easily be obtained.The longitudinal and coronary view of the aorta arch and coronary view of the trachea and main bronchus are helpful in differentiating the anomalies of the aortic arch.