QQ交流群

320329799

305165954

184129865

101257833

140135403

146136058

108169116

139123161

112171963

188090122

252067292

164051498

249096029

255092824

173105739

156074222

216087067

115336695

136190542

258120027

199245497

192172040

426904267

434117579

136592784

421906953

421906846

425905646

微信

医汇心血管学术 > 先天性心脏病胎儿主动脉缩窄的形态及生理预测因素

先天性心脏病胎儿主动脉缩窄的形态及生理预测因素

发表于 2014-10-09 14:37:48
背景 主动脉缩窄的产前诊断筛查的假阴性率高、特异性低 方法和结果 这项回顾性的研究评价了已出版的孕22±0周(15±4-38±4周)胎儿连续200例正常对照组的主动脉弓和导管Z积分(3-血管及气管切面刚好在降主动脉之前测量)及其比值。其次,这项研究检测了在一个心室和/或大血管比例失衡的队列中筛查或胎儿心脏超声检查连续Z积分鉴别主动脉缩窄胎儿的能力。再次,评估相关心脏缺损、缩窄架及峡部血流涡流的诊断意义。我们研究了44例24±0 周 (17±3-- 37±4 周)的疑诊主动脉缩窄的胎儿,建立接收运行特性曲线。逻辑回归分析法检测Z积分、附加心脏诊断及主动脉缩窄的相关性。发现Z积分有利于需要外科手术与对照组及假阴性患儿的鉴别,接收运行曲线下方的面积较好的表现出了峡部Z积分(0.963)及峡部/导管比值(0.969)。疑诊病例中连续Z积分 >–2 提示心脏结构正常,而Z积分<–2的患儿则需要监测或外科手术。较小的病变不能提高主动脉缩窄的诊断,但峡部涡流提高了真正缩窄与主动脉弓发育不良的比值比16倍。 结论 峡部Z积分及峡部/导管比值是诊断胎儿主动脉缩窄敏感的预测因素。连续测量及异常的峡部血流方式提高了诊断的特异性,可减小假阳性。 来源:丁香网Morphological and Physiological Predictors of Fetal Aortic CoarctationBackground— Prenatal diagnosis of aortic coarctation suffers from high false-negative rates at screening and poor specificity. Methods and Results— This retrospective study tested the applicability of published aortic arch and ductal Z scores (measured just before the descending aorta in the 3-vessel and tracheal view) and their ratio on 200 consecutive normal controls at a median of 22±0 gestational weeks (range, 15±4 to 38±4 weeks). Second, this study tested the ability of serial Z scores to distinguish fetuses with coarctation within a cohort with ventricular and/or great arterial disproportion detected at screening or fetal echocardiography. Third, it evaluated the diagnostic significance of associated cardiac lesions, coarctation shelf, and isthmal flow disturbance. We studied 44 fetuses with suspected coarctation at 24±0 weeks (range, 17±3 to 37±4 weeks). Receiver-operating characteristic curves were created. Logistic regression tested the association between z scores, additional cardiac diagnoses, and coarctation. Good separation was found of isthmal Z scores for cases requiring surgery from controls and false-positive cases, and receiver-operating characteristic curves showed an excellent area under the curve for isthmal Z score (0.963) and isthmal-to-ductal ratio (0.969). Serial isthmal Z scores improved to >–2 in suspected cases with normal outcomes; those requiring surveillance or surgery remained <–2. Minor lesions did not increase the diagnostic specificity of coarctation, but isthmal flow disturbance increased the odds ratio of true coarctation versus arch hypoplasia 16-fold. Conclusions— Isthmal Z scores and isthmal-to-ductal ratio are sensitive indicators of fetal coarctation. Serial measurements and abnormal isthmal flow patterns improve diagnostic specificity and may reduce false positives.source:circulation.com
评论
热门会议推荐
申领学分

Copyright © 2014 版权所有    京ICP备12049153号-2  京ICP证140305  京公网安备11010502024544    联系E-mail:admin@zgheart.com

友情链接 医汇心脏健康网 阜外医院 掌上医讯 心内科 中国医师协会 宁夏健康网 健康时报网 互动吧 疾病大全

安全联盟站长平台 加速乐