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中国循证儿科杂志

中国循证儿科杂志 ›› 2023, Vol. 18 ›› Issue (3): 191-194.DOI: 10.3969/j.issn.1673-5501.2023.03.005

• 论著 • 上一篇    下一篇

胎儿单纯室间隔缺损自然病程的回顾性队列研究

邹鹏,刘礼和,刘琴,饶姣,黄景思,许伟滨,杨思慧,刘慧,徐昕韵,李虹,孙善权   

  1. 广东省妇幼保健院心脏中心广州，511442
  • 收稿日期:2023-04-06 修回日期:2023-05-03 出版日期:2023-06-25 发布日期:2023-06-25
  • 通讯作者: 孙善权

Natural history of isolated ventricular septal defect in fetus ：A retrospective cohort study

ZOU Peng, LIU Lihe, LIU Qin, RAO Jiao, HUANG Jingsi, XU Weibin, YANG Sihui, LIU Hui, XU Xinyun, LI Hong, SUN Shanquan#br#

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  1. Department of Cardiac Center，Guangdong Women and Children Hospital，Guangzhou 511442，China
  • Received:2023-04-06 Revised:2023-05-03 Online:2023-06-25 Published:2023-06-25
  • Contact: SUN Shanquan, email: brightsun999@163.com

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摘要： 背景：国内外鲜有报道从胎儿期至出生后对单纯室间隔缺损（VSD）的长期随访研究。 目的：为单纯VSD产前咨询和预后判断提供数据支撑。 设计：回顾性队列研究。 方法：纳入2017年1月至2019年12月于广东省妇幼保健院（我院）心脏中心门诊咨询的确诊为单纯VSD，且生后规律随访并且有记录的患儿；排除孕母选择终止妊娠或引产、合并染色体或基因异常（经羊水或脐血穿刺发现）或失访＞1年的患儿。基于我院常规随访表单，于门诊收集首次超声心动图检查时孕妇的年龄、胎儿的孕周、室间隔缺损直径和部位、主动脉直径，并于门诊随访生后48 h内、3个月、6个月和每年的超声心动图，本研究随访资料截至2023年3月31日。以闭合方式分为自然闭合组、手术闭合组和持续缺损组。 主要结局指标：自然或手术闭合率及闭合时间。 结果264例单纯VSD进入本文分析，男109例（41.3%）。自然闭合组154例（58.3%），手术闭合组 78例（29.5%），持续缺损组32例（12.1%）。发现VSD时，胎儿孕周28.3（20~38）周；缺损直径2.6（1.0~7.5）mm；肌部75例（28.4%），膜周186例（70.5%），干下型3例；大型60例（22.7%），中型 179例（67.8%），小型25例（9.5%）。264例随访时间7（0.1~69）个月，自然闭合组闭合时间8（0~48）月龄，手术闭合组闭合时间4（1~53）月龄，持续缺损组随访时间45（38~69）月。自然闭合组的肌部、小型VSD构成比均高于手术闭合组和持续缺损组；自然闭合组的膜周、大型VSD构成比、R值和缺损直径均低于手术闭合组和持续缺损组；自然闭合组的随访时间长于手术闭合组，短于持续缺损组，差异均有统计学意义。肌部VSD和膜周VSD的自然闭合率分别为92.0%和45.7%，差异有统计学意义。大、中和小型VSD的自然闭合率分别为26.7%、63.1%和100%，小型VSD分别与中型、大型VSD差异有统计学意义。手术闭合组78例，至手术时，23例中型VSD（占中型VSD的12.8%）增大至大型VSD。 结论：胎儿VSD以膜周型最常见，肌部次之。58.3%的VSD可自然闭合，肌部VSD和小型VSD自然闭合率较高。12.8%的中型VSD可在出生后增大。

关键词: 超声心动图, 胎儿, 室间隔缺损, 肌部, 膜周

Abstract: Background：There is limited research on long-term follow-up studies of isolated ventricular septal defect (VSD) from the fetal to postnatal period at home and abroad. Objective：To provide data support for prenatal counseling and prognosis assessment of isolated VSD. Design：Retrospective cohort study. Methods：This study included children with isolated VSD, who were diagnosed at the outpatient clinic of the Cardiac Center of Guangdong Women and Children Hospital from January 2017 to December 2019 and had regular postnatal follow-up and documented records. Those with maternal termination of pregnancy, chromosomal or genetic abnormalities (identified through amniocentesis or umbilical blood sampling), or those who were lost to follow-up for more than 1 year were excluded. A routine follow-up form was established to collect the maternal age, gestational age, VSD diameter and location, and aortic diameter during the first echocardiographic examination. Follow-up echocardiograms were conducted within 48 hours after birth, at 3 months, at 6 months, and annually thereafter, until March 31, 2023. Patients were categorized into the spontaneous closure group, surgical closure group, and persistent defect group. Main outcome measures：Closure rate and closure time of isolated VSD for spontaneous or surgical closure. Results：A total of 264 cases were included in this study, including 154 cases (58.3%) in the spontaneous closure group, 78 cases (29.5%) in the surgical closure group, and 32 cases (12.1%) in the persistent defect group. The males were 109（41.3%）. At the time of VSD detection, the gestational age of the fetus was 28.3 (20-38) weeks, and the defect diameter was 2.6 (1.0-7.5) mm. There were 75 cases of muscular VSD (28.4%), 186 cases of perimembranous VSD (70.5%) and 3 cases of subarterial VSD. In total, 60 cases were large (22.7%), 179 cases were medium (67.8%), and 25 cases were small (9.5%).The 264 cases were followed up for 7 (0.1-69) months. The closure time was 8 (0-48) months in the spontaneous closure group and 4 (1-53) months in the surgical closure group.The time of followup was 45 (38-69) months in the persistent defect group. The proportions of musclar VSD and small VSD in the spontaneous closure group were higher than those in the surgical closure group and the persistent defect group. The proportions of perimembranous VSD and large VSD, R-value and defect diameter in the spontaneous closure group were lower than those in the surgical closure group and the persistent defect group. The follow-up time of the spontaneous closure group was longer than that of the surgical closure group and shorter than that of the persistent defect group, and the differences were statistically significant. The spontaneous closure rates of muscular VSD and perimembranous VSD were 92.0% and 45.7%, respectively, with a statistically significant difference. The spontaneous closure rates of large VSD, medium VSD and small VSD were 26.7%, 63.1% and 100%, respectively, and the differences of spontaneous closure rates between small and medium VSD,and between small and large VSD were statistically significant. In the surgical close group of 78 patients, 23 cases of medium VSD (12.8% of all medium VSD cases) progressed to large VSD by the time of operation. Conclusion：Perimembranous VSD was the most common type of VSD in fetuses, followed by muscular VSD. Spontaneous closure was observed in 58.3% of VSD cases, with higher rates in muscular VSD and small VSD. An increase in size was observed in 12.8% of medium VSD cases after birth.

Key words: Echocardiography, Fetus, Ventricular septal defect., Muscular, Perimembranous