Preliminary Study On Right Ventricular Function In Fetus With Cardiovascular Malformations By Versatile Ultrasound System

BackgroundCongenital heart disease (CHD) accounted for the first of birth defect in newborns,which was released in National Maternal and Child Health monitoring results in2004. CHDis the heart and great vessels cardiovascular abnormalities during fetal malformationscaused mostly by the interaction of genetic and environmental factors leading to thedevelopment of myocardial cells and structural abnormalities, thus affecting cardiacfunction.With the development of ultrasound technology, fetal echocardiography has been ableto be good for evaluation on fetal heart function, cardiac structure, hemodynamic changes,and various types of arrhythmia. Generally considered that prenatal echocardiography is themost effective on evaluation of fetal cardiac malformations. Compared with left ventricular(LV), there is a higher pressure load and more cardiac output in right ventricle (RV).Therefore, accurate and reliable evaluation of right ventricular function is important, whichis useful to improve the survival rate of fetus with CHD.PurposeThe aim of this study is to detect right ventricular function in fetuses with doubleoutlet right ventricle (DORV) or tetralogy of Fallot (TOF) by using pulsed Doppler (PW),M-mode echocardiography (MME) and real-time three-dimensional volumetricechocardiography (RT-3DE), and to explore the value of prenatal echocardiography indetection of fetal right heart function with CHD.Materials and MethodsGroup1,32fetuses with DORV or TOF diagnosed by the first prenatalechocardiography were Selected from December1,2010to January31,2013. The agerange of pregnant women was20to39(26.1±3.3) years old and the gestational age was23to38(29±6.1) weeks. Group2, Another60fetuses with normal heart were selected as normal controls, with corresponding period of gestation age. All subjects and their familiessigned agreements. This study was approved by Xinqiao Hospital ethics committee.Philips IE33ultrasonic system equipped with the latest version of Qlab analysissoftware was selected, with S8-3, S5-1probe and X3-1matrix probe. Probe frequency was3~8MHz,1~5MHz,1~3MHz respectively. Doppler scanning speed is100mm/s. PW,MME, RT-3DE were used to measure Tei index of fetal heart, end-diastolic volume(end-diastolic volume, EDV), end-systolic volume (end-systolic volume, ESV), strokevolume (stroke volume, SV) and ejection fraction (ejection fraction, EF). Pairwisecomparative analysis was performed between three methods. Prenatal echocardiographywas performed by one physician. The average of three cardiac cycles was detected.Data are expressed as mean±SD. SPSS19.0statistical software was selected. Themeasured values were used for independent samples t test and paired samples t test. P <0.05was considered statistically significant. Correlation between the measured values of cardiacfunction using Pearson correlation analysis, diagnostic tests using ROC curve analysis.Result1. LV/RV ratio in the group one was significantly lower than the group2[(0.82±0.14)vs (0.95±0.08), P<0.001]. AO/PA ratio in the group one was significantly higher than thegroup2[(1.57±0.75) vs (0.85±0.10), P <0.001];2. Tei index by PW in the group one was significantly higher than the group2[(0.48±0.09) vs (0.35±0.05), P <0.001];3. Compared with the control group, difference of right ventricular EDV, ESV and EFin group1measured by M-mode echocardiography and real-time three-dimensionalechocardiography (RT-3DE) was significant (P <0.05);4. There was a good agreement in the diagnosis of ROC curves between Tei index andreal-time three-dimensional echocardiography (z=1.559, P=0.119), however, quitedifferent with the values measured by M-mode echocardiography. Area under the ROCcurve is significant difference between real-time three-dimensional echocardiography andM-mode echocardiography (z=0.782, P=0.434); it was negatively correlated betweenTei index and EF by MME (r=-0.449, p <0.001) and EF by3DE (r=-0.517, p <0.001)respectively. ConclusionTimely and effective diagnosis of complex congenital heart disease in fetus canobtained by prenatal echocardiography. Accurate evaluation of fetal right ventricular heartfunction by real-time three-dimensional volumetric ultrasound can not rely on anyassumption, which has good repeatability.. With technology advances, real-timethree-dimensional ultrasound volume will expand the depth and breadth of congenital heartdisease diagnosis in fetus.