右心室面積改變分率作為新的胎兒心臟超音波預測因子評估胎兒肺動脈狹窄和肺動脈閉鎖走向單一心室循環

Right Ventricle Fractional Area Change as A Novel Fetal Echocardiographic Predictor of Ui-ventricular Circulation in Fetal Pulmonary Stenosis and Pulmonary Atresia

黃冠穎(Kuan-Ying Huang)

指導教授 ： 李建南

國立臺灣大學/醫學院/臨床醫學研究所/碩士(2021年)

https://doi.org/10.6342/NTU202104085

摘要

胎兒的肺動脈狹窄以及右心室萎縮的程度，可能導致胎兒未來走向單一心室循環，出生後需要多次心臟手術。目前探討單一心室循環的預後因子，多半著重在心臟超音波2D平面的測量，較少探討功能性的參數，因此我們想利用Fetal HQ這個新型態胎兒心臟功能性超音波，找出影響胎兒走向單一心室循環的重要產前超音波參數。
分析從2009年01月至2021年04月，這12年間，共有96位孕婦，其胎兒疑似肺動脈狹窄(Pulmonary Stenosis)或肺動脈閉鎖(Pulmonary Atresia)，被轉診至台大醫院母胎兒醫學中心；我們針對這96位孕婦進行病歷回顧，並且依照胎兒出生後接受的治療方法，分成單一心室循環與雙心室循環兩組去做比較；並從台大醫院過去的影像資料庫中找尋標準four-chamber-view(4CV)之動態影像且心室內膜影像顯示清晰，利用Fetal HQ比較兩組孕婦之胎兒心臟功能是否有差異，找尋走向單一心室循環的預測因子。
結果顯示產前胎兒右心室面積改變分率(FAC) < -0.22%、左心室心臟底部球面性LV SI 1 < 6.13% 以及左心室心臟中段球面性 LV SI < 5.98%可預測出生之胎兒會走向單一心室循環。
利用Fetal HQ系統可以找到重要預測胎兒走向單一心室循環的參數，且運用到臨床實務上，發現右心室面積改變分率(FAC) < -0.22%也就幾乎等於左右心室不同步收縮Interventricular dyssynchrony，該結果可套用在一般2D動態超音波，即可判斷預後狀況如何，供臨床實務上一個非常實用新的評估預後因子。

關鍵字

胎兒HQ檢查 ； 亮點追蹤胎兒心臟超音波 ； 肺動脈閉鎖 ； 肺動脈狹窄合併心室中膈完整 ； 單一心室循環 ； 心室面積改變分率 ； 心室球面性

並列摘要

Objectives:
To analyze the prenatal fetal cardiography parameters of fetuses diagnosed with critical pulmonary stenosis (CPS) or pulmonary atresia with intact ventricular septum (PA-IVS). We try to figure out more optimal predictor for eventual ventricular circulation.
Method:
All pulmonary stenosis, CPS and PA-IVS was diagnosed prenatally in a period of 12 years (2009.01–2021.04) in a tertiary referral center for prenatal medicine and fetal echocardiography (National Taiwan University Hospital) were retrospectively assessed. We analyzed prenatal and postnatal neonate echocardiography parameters and their clinical features. We also access the prenatal echocardiography by the novel technique, Fetal HQ to evaluate the risk factors for eventual univentricular circulation.
Results:
96 pregnant women diagnosed with fetal isolated PS, critical PS or PA-IVS were recruited in the study receiving chart review to assess the accuracy of prenatal and postnatal diagnosis. 22 patients with 28 adequate quality 4 chamber view dynamic images were analyzed by fetal HQ software. Differences were only detected in right ventricular fractional area change (RV FAC) (p=0.024), left ventricle segment 1 and 12 sphericity index (LV SI) (p=0.036 and 0.036, respectively). ROC curve indicated that the patients with RV RAC < -0.22%, LV SI 1 < 6.13% and LV SI < 5.98% were more likely to become univentricular circulation.
Conclusion:
Fetal HQ can easily and quickly assess fetal cardiac morphology and function. We found that when prenatal ultrasound diagnosed with CPS or PA-IVS, RV FAC < -0.22% presenting with right ventricular reverse motion opponent to LV motion, which is called interventricular dyssynchrony, is a practical predictor for univentricular circulation.

並列關鍵字

Fetal HQ ； speckle‐tracking echocardiography ； critical pulmonary stenosis ； pulmonary atresia with intact ventricular septum ； univentricular circulation ； ventricular fractional area change ； ventricular sphericity index

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