Research Of The Right Ventricular Function Of Fatus Circular Of Umbilical Cord And Single Umbilical Artery With Tissue Doppler Imaging And Tei Index

Objective：To evaluate the right ventricular systolic function and diastolic functionof fetus circular of umbilical cord and simple single umbilical artery withTissue Doppler Imaging technology (TDI) and p-tei index, is to provide thebasis for prenatal counseling and clinical treatment of the fetal cardiacfunction.Methods：The object of study: From23-40weeks gestational age (averagegestational age28.4±3.9weeks) of59single pregnant women, which isdivided into three groups. The pregnant women age21-35years old (averageage27.3±4.0years old).The fetus is confirmed by the ultrasound fetal system for the umbilicalcord around the neck but no fetal intrauterine distress, as the umbilical cordaround the neck group (group A). A total of16cases, average gestational age28.4±3.4weeks, the pregnant women age21-30years old (average age26.6±4.0years old). The fetus is confirmed by the ultrasound fetal system for thesimple single umbilical artery, as the simple single umbilical artery group(group B). A total of15cases, average gestational age28.8±3.3weeks, thepregnant women age22-33years old (average age26.9±4.1years old). Thefetus is confirmed no inside and outside the heart structural deformity andintrauterine growth retardation by ultrasound fetal system and fetalechocardiography, as the normal control group. A total of28cases, averagegestational age28.2±3.8weeks, the pregnant women age21-35years old(average age27.8±4.0years old). Inclusion criteria: First, the fetal gestationalage is consistent with gestational age by the ultrasound fetal system examination in early and the fetus is confirmed no inside and outside the heartstructural deformity and intrauterine growth retardation by ultrasound fetalsystem and fetal echocardiography. Second, all single pregnant women isconfirmed healthy, without taking indomethacin, such as history ofnonsteroidal anti-inflammatory drugs, no smoking and no bad habits and therehave excluded systemic diseases，such as diabetes mellitus,hypertension，chronic disease and congenital heart disease.Instrument: Applying with The General Electric Company Vivid E9ultrasound diagnostic instrument with Tissue Doppler Imaging technology(TDI) system,6S probe, frequency2.5-6MHz.Image Store: In quiet breathing conditions, all pregnant women in thelateral recumbent or comfortable, standard and clear fetal four cavity heartview is acquired in2D mode when the fetus is not frequently moved. First, innormal2D mode, fetal four cavity heart view is appeared，put the samplingvolume in tricuspid valve mouth of right side, start the PW keys, acquire andstorage the diastolic tricuspid valve mouth blood flow spectrum which is formore than five consecutive fetal cardiac cycle. Second, in normal2D mode,start the M keys, put the sampling line in tricuspid valve ring with rightventricular free wall junction, scaning more than five consecutive and Stablefetal cardiac cycle of tricuspid ring displacement diagram (Tricuspid annularplane systolic excursion, TAPSE), and stored for later analysis；Start TDI key,switch to the pulse Doppler mode (PW), put the sampling volume in tricuspidvalve ring with right ventricular free wall junction, Try to make the beamparallel to myocardial longitudinal motion, scaning more than five consecutiveand Stable fetal cardiac cycle of tricuspid ring tissue doppler spectrum，andstored for later analysis. In the end, in normal2D mode, clear long axis of thepulmonary artery section view is appeared, put the sampling volume in thepulmonary valve, start the PW keys, acquire and storage systolic pulmonaryvalve mouth blood flow spectrum which is for more than five consecutivefetal cardiac cycle.The graphical analysis and parameter measurement 1Tricuspid valve mouth blood flow spectrum (PW): Measurement of tricuspidvalve mouth diastolic early diastolic peak velocity (E, cm/s), the late diastolicpeak velocity (A, cm/s), and calculate the E/A ratio (TV E/A). The periodbetween the end of a cycle of A peak to the next cycle starting time of the Epeak is remembered (a ms).2Pulmonary valve mouth blood flow spectrum (PW): The period which peaksystolic pulmonary valve flow of time (ejection time ET) is remembered (bms).a-b is the sum between isovolumic contraction time (ICT)andisovolumic relaxation time (IRT).3The right ventricle p-tei index is (ICT+IRT)／ET=(a—b)／b.4Tricuspid ring tissue doppler spectrum image (TDI): Measurement of peaksystolic velocity (s′,cm/s), early diastolic velocities(e′,cm/s)and latediastolic velocities(a′,cm/s),and calculate the e′/a′and E/e′. Abovemeasurement are performed by the same inspectors, to try to reduce theinfluence of heart rate fluctuations, and each measurement parameters withcontinuous three cardiac cycle and were averaged at last.Statistical analysisAll data using SPSS13.0statistical software analysis, measurement datawith the average±standard deviation, said count data expressed as apercentage. For each group samples firstly process normality test, after thesamples meet the normality test, and then the umbilical cord around the neck,single umbilical artery group and normal control group indicator use analysisof variance, and each group due to the number of cases less and need to carryon the homogeneity test for variance normality test and homogeneity test forvariance inspection level generally more conservative, ordinary take0.10or0.20. Analysis of variance by a=0.05level, difference was statisticallysignificant at P <0.05.Result：A total of59cases of pregnant women conducted64fetalechocardiography, including5cases of pregnant women to check for a secondtime. 1General data comparision on between groupsThree groups of pregnant women age, gestational age, and heart ratecompared no statistically significant difference (P>0.05).2Entirety right ventricular function p-tei index comparision on betweengroupsGroup A p-tei index is higher than that of normal control group, hadstatistically significant difference (P <0.05); Group A p-tei index is higherthan that of group B, had statistically significant difference (P <0.05);Compared with normal control group,group B was no statistically significantdifference (P>0.05).3Right ventricular function parameters comparision on between groups3.1Right ventricular systolic function parametersTAPSE value between three groups had no statistically significantdifference (P>0.05); s′value between three groups had no statisticallysignificant difference (P>0.05).3.2Right ventricular diastolic function parametersBetween the three groups of E/A, e′/a′、E/e′ratio, there were nostatistically significant difference (P>0.05);4The relationship between the parameters and gestational ageFetal right ventricular of E/A、e′/a、TAPSE、s′increases with pregnantweek increasing，while E/e′ratio, p-tei index and fetal heart rate (FHR)decreases with pregnant week increasing, the difference was statisticallysignificant difference (P <0.05);Conclusion：1Umbilical cord around the neck of the fetal p-tei index is higher than thatnormal fetal without umbilical cord around the neck, therefore, the measuringp-tei index can be used to detect umbilical cord around the neck of the fetalventricular systolic function and diastolic function, and through the p-teiindex changes can be found the change of the abnormal fetal heart functionwhen the umbilical cord around the neck. This prompt right ventricular function of umbilical cord around the neck of the fetal is slightly lower thannormal group;2Compared with normal control group, Simple single umbilical artery grouphad no difference between the right ventricular systolic function and diastolicfunction; So the single umbilical artery of the fetal without heart inside andoutside the malformation is with normal fetus;3Fetal right ventricular of E/A、e′/a、TAPSE、s′increases with pregnantweek increasing，while E/e′ratio, p-tei index and heart rate (FHR) decreaseswith pregnant week increasing.