Ultrasonographic Diagnosis Of Pulmonary Artery And Left And Right Pulmonary Artery

Objective To investigate the developmental mechanisms of the fetal pulmonary artery(PA) and its branches in middle-late pregnancy by measuring diameters and hemodynamic parameters of fetal pulmonary artery, aorta(AO), left pulmonary artery(LPA), right pulmonary artery(RPA) and ductus arteriosus(DA) from 20 to 40 weeks of gestation. PA/AO ratio, the relationships of peak systolic velocity(PSV) among PA, AO and DA, the relationships of hemodynamic parameters between LPA and RPA and the correlations between all parameters and the gestational age will be analysed to explore the feasibility of evaluating fetal pulmonary circulation.Methods 1000 normal fetuses with gestational age between 20 to 40 weeks examined from January 2014 to May 2015 were selected excluding the cases with maternal diabete and other serious pregnant complications, fetal intracardiac and extracardiac malformations and fetal arrhythmias. Pregnant women was from 20 to 42 years old with a mean age of 28.6±4.6 years, gestational age was between 20 to 40 weeks with an average of 30.0 ± 2.3weeks. The diameters, the blood flow characteristics and hemdynamics of PA, AO, LPA, RPA and DA were observed and measured. 184 fetuses were excluded for overlarged beam-scanning angle or uncomplete records, 816 cases with intactly measured records were selected, Pregnant women was from 20 to 42 years old with a mean age of 26.7±3.8 years, gestational age between 20 to 40 weeks with an average of 29.2±2.6weeks. The scatterplots were drawn to statistically analyse the correlations between the parameters and the gestational age.Results(1)The diameters of PA, AO, LPA, RPA and DA increased with increasing gestational age, having positive liner relations to the gestational age(r =0.803、0.784、0.862、0.862、0.900,P<0.001), there was no significant difference between LPA and RPA diameters(P>0.05).(2)PA was always larger than AO(P<0.05), the ratio was 1.05 to 1.26.(3)Before 28 weeks of pregnancy, there was no statistical significance among LPA, RPA and DA diameter differences(P>0.05), after 28 weeks of pregnancy, DA was larger than LPA and RPA(P<0.05).(4)The PSV of PA, AO and DA increased with increasing gestational age, having positive liner relations to the gestational age( r =0.653、0.642、0.756,P<0.001), and PSVPA<PSVAO<PSVDA existed in the same gestational week(P<0.05).(5)The PSV of fetal LPA and RPA increased slowly with increasing gestational age, having positive liner relations to the gestational age(r =0.615、0.594,P<0.001). The PI decreased with increasing gestational age, having negative liner relations to the gestational age(r =-0.149、-0.175,P<0.001),there is no correlations between the RI and the gestational age(r =-0.036、-0.016,P>0.05), the differences between LPA and RPA hemodynamic parameters had no statistical significance(P>0.05).Conclusions(1) The diameters of fetal PA, AO, LPA, RPA and DA increase with increasing gestational age with positive correlations with the gestational age.(2)PA is always larger than AO, and PSVPA<PSVAO<PSVDA exists in the same gestational week.(3)There is no significant difference between LPA and RPA diameters. LPA and RPA are almost as the same width as DA before 28 weeks of pregnancy and narrower than DA after 28 weeks of pregnancy.(4)The PSV in pulmonary artery branch increases slowly with the gestational age, having positive liner relation to the gestational age. The PI decreases with gestational age, having negative liner relation to the gestational age,there is no correlation between the RI and the gestational age. The hemodynamic parameters of pulmonary artery branches can be used to evaluate fetal pulmonary circulation.Objective To explore the value of fetal echocardiography in diagnosis and prognosis of fetal abnormal pulmonary artery and its branches.Methods 106 cases with anomalies of fetal pulmonary artery and its branches from June 2013 to December 2015 were retrospectively analysed. All cases were diagnosed by the two-dimensional echocardiography combined with color doppler flow reverse tracking technique and STIC technology, and were confirmed by autopsy, surgery after birth and follow-up results. The image characteristics, incidence of intracardic and extracardic malformations and chromosomal abnormalities were summarized. The display rate of anomalies were compared on four chamber view, ventricular outflow tract view and three vessels view. The hemodynamic parameters of 66 cases with pulmonary outflow tract obstruction(including stenosis or atresia) were compared with gestational age matched normal control group to investigate whether there were statistical differences between two groups.Results(1)Among 106 cases with fetal abnormal pulmonary artery and its branches, 60 cases choosed induced labor, 46 cases choosed continuing pregnancy, one case with right pulmonary artery absence died 8 hours after birth. 61 cases were confirmed by autopsy, 16 cases were confirmed by surgery after birth, 29 cases were confirmed with neonatal echocardiography and/or other imaging methods.(2)There were 57 cases among 66 cases with pulmonary outflow tract obstruction were shown thin pulmonary artery and its braches. The lumen of pulmonary artery was observed by two-dimensional echocardiography combined with color doppler flow reverse tracking technique in 31 cases,45 cases were observed reverse flow of ductous arterious.(3)The display rates of anomalies on four chamber view, ventricular outflow tract view and three vessels view were 37.7%(40/106), 88.7%(94/106) and 95.3%(101/106) respectively, ventricular outflow tract view and three vessels view had higher display rates than did four chamber view, the difference was statistically significant(P < 0.001).(4) The incidence of intracardiac and extracardiac malformations and chromosomal abnormalities in the complicated group was higher than the simple group(P<0.05).(5)77 cases obtained satisfactory STIC volume data, ultrasound scanning time by STIC technology was significantly shorter than by two-dimensional echocardiography(P<0.001). there was no significant difference in diagnose accordance rate(P>0.05).(6)PI and RI in cases with pulmonary outflow tract obstruction were lower than that in the normal control group, the differences were statistically significant(P<0.05).There was no significant difference in PSV between the two groups(P>0.05).Conclusions(1)Fetal echocardiography has great value in diagnosis of fetal abnormal pulmonary artery and its branches, two-dimensional echocardiography combined with color doppler ultrasonic reverse tracking technique can improve the detection rate of abnormal pulmonary artery and its branches, STIC technology can be used as effective supplementary method of two-dimensional echocardiography.(2)Ventricular outflow tract view and three vessels view are the principal diagnostic view for fetal abnormal pulmonary artery and its branches.(3)The incidence of intracardiac and extracardiac malformations and chromosomal abnormalities of the complicated group is higher than that of the single group.(4)PI and RI in fetus with pulmonary outflow tract obstruction are lower than that in normal control group, it indicates the capacity of the fetal pulmonary vasculature to vasodilate in response to anatomical obstruction of flow. Fetal echocardiography can also be used as risk stratification and prognosis evaluation for anomalies of fetal pulmonary and its branches.Objective To evaluate the role of combination of three-vessel views in ultrasound diagnosis of fetal abnormal pulmonary artery and its branches.Methods The data of 106 cases of fetal abnormal pulmonary artery and its branches were retrospectively analysed, including echocardiographic data, autopsy and operation records and postnatal follow-up results. Echocardiogaphic features and the anomalies display rates on three vessels and trachea view(3VT), three vessels view(3VV) and three vessels and pulmonary arterial branches view(3VP) were summarized.Results among 106 abnormal fetal pulmonary artery and its branches, there were 9 cases of persistant truncus arterious, 23 cases of tetralogy of Fallot, including 2 cases with absent pulmonary valve, 8 cases of complete transposition of great arteries, 15 cases of pulmonary artery atresia with ventricular septal defect, 15 cases of double outlet of right ventricle, one case of double outlet of left ventricle, 7 cases of hypoplastic right heart syndrome(excluding the cases with pulmonary atresia), including one case with absent pulmonary valve, 6 cases of pulmonary artery atresia with intact ventricular septum, 2 cases of corrected transposition of great arteries, 8 cases of pulmonary stenosis, one case of right pulmonary artery absence, 2 cases of left pulmonary artery sling, 2 cases of anomalous origin of left pulmonary artery from the aorta and crossed pulmonary arteries in 7 cases.The anomalies display rates of 106 cases on three vessels and trachea view, three vessels view, three vessels and pulmonary arterial branches view were as high as 84.0%(89/106), 84.9%( 90/106), 88. 7%( 94/106) respectively.Conclusions The combination of three-vessel views is of great value in prenatal diagnosis of fetal abnormal pulmonary artery and its branches.