Cardiographic Characteristic And Prognosis Of Fetal Atrial Septal Aneurysme

Objective:This study intended to investigate the echocardiographic features and prognosis of fetal atrial septal aneurysm.Methods:The echocardiographic characteristics of fetal atrial septal aneurysm(FAS A)which diagnosed by fetal cardiac color Doppler ultrasound in our center from December 2015 to April 2022 were retrospectively analyzed.The echocardiographic data of 144 fetuses with FAS A were divided into two groups according to the presence or absence of the abnormality on left atrial hemodynamic.Comparisons were made with the normal control group and between the two experimental groups,including the content of right atrial transverse diameter(RA),left atrial transverse diameter(LA),right ventricular transverse diameter(RV),left ventricular transverse diameter(LV),main pulmonary artery diameter(MPA),aortic diameter(AAO),right atrial diameter/left atrial diameter(RA/LA),right ventricular diameter/left ventricular diameter(RV/LV),main pulmonary artery diameter/aorta diameter(MPA/AAO),the difference between the Z score of right ventricular transverse diameter and the Z score of left ventricular transverse diameter(RV Z score-LV Z score)and the difference between the Z score of main pulmonary artery diameter and the Z score of aortic diameter(MPA Z score-AAO Z score).There were 139 pregnant women got follow-up result,and the echocardiographic changes between prenatal and postnatal of FASA within 2 months of ages were analyzed.This study categorized the FASA fetus according to the complication of left atrial hemodynamic abnormalities including coarctation of the aorta,fetal arrhythmia and hypoplastic left heart syndrome,analyzing the prognosis separately.Results:The diameters of RA,RV and MPA in group A and group A2 were larger than normal fetus,while the diameters of LA and LV were smaller than normal fetus.The diameters of LA and LV in group A1 were smaller than normal fetus,and the difference was statistically significant,and there was no significant difference in the diameters of RA,RV and MPA between two groups.There was no significant difference in the diameter of AAO among all groups.The RA/LA,RV/LV,MPA/AAO,the difference between RV Z-score and LV z-score,and the difference between MPA z-score and AAO z-score were statistically significant among the groups.The follow-up rate of FASA fetuses was 66.91%(93/139),and the live birth rate was 95.70%(89/93).The results of short-term follow-up after birth:20 cases of FASA performed transthoracic echocardiography within 7 days-old,about 80%of the cases shows that the heart ratio returned to normal,and 50%showed atrial septal defect.Among the 18 FASA fetuses with left atrial hemodynamic abnormalities,one(5.55%)was terminated,and the cardiac structure and function of 52.94%(9 cases)among the remaining living cases returned to normal,29.41%(5 cases)had atrial septal defect,2 cases had increased blood flow velocity of descending aorta,and 1 case had biventricular thickness.Among 75 FASA fetuses without left atrial hemodynamic abnormalities,3(4.00%)were terminated,81.94%(59/75)of the remaining live births recovered to normal cardiac structure and function,and 11.11%(8/75)had atrial septal defect.Conclusions:1.Fetal atrial septal aneurysm present with larger right atrium,larger right ventricle,smaller left atrium and smaller left ventricle before delivery.While with the increasing size of aneurysm,the imbalance left/right heart ratio will be further aggravated.2.Direct measurement data cannot accurately reflect the impact of FASA on fetus heart,the ratio index and Z score index are more accurate in evaluating fetus heart.3.With the transformation of fetal circulation after birth,the imbalance heart ratio and the narrowing of aorta can be improved in short term.4.The Cardiac structure of most FASA infants can finally return to normal,delivery should be suggested in most cases.5.Atrial septal defect is the most common complication of FASA.