室间隔缺损最大直径与主动脉根部内径比值在胎儿室间隔缺损预后评估中的价值

目的探讨室间隔缺损最大直径（D_VSD）与主动脉根部内径（D_AO）比值对胎儿单纯室间隔缺损（i-VSD）预后评估的价值。 方法选取产前胎儿心脏超声诊断为i-VSD并于出生后3个月有随访记录的胎儿175例，其中膜周部i-VSD 83例，肌部i-VSD 82例，干下i-VSD 10例。依据D_VSD与D_AO的比值R（R=D_VSD/D_AO）将VSD分为大型（R>1/2）、中型（1/32=24.3，P=0.000）。（2）83例膜周部i-VSD胎儿中，5例R≤1/3，出生后3个月自然愈合率为40.0%（2/5）；35例1/31/2，出生后3个月自然愈合率为7.0%（3/43）。不同R值的膜周部i-VSD胎儿出生后3个月自然愈合率比较，差异具有统计学意义（χ²=7.80，P=0.020）。^（3）82例肌部i-VSD胎儿中，21例R≤1/3，出生后3个月自然愈合率为66.7%（14/21）；39例1/31/2，出生后3个月自然愈合率为27.4%（6/22）。不同R值的肌部i-VSD胎儿出生后3个月自然愈合率比较，差异具有统计学意义（χ²=7.71，P=0.029）。（4）干下型i-VSD 10例，2例R≤1/3，4例1/31/2，均未自然愈合。 结论不同部位的i-VSD其出生后自然愈合率有差别；D_VSD与D_AO的比值（R值）对胎儿期i-VSD的预后评估有重要价值。

Value of ratio of ventricular septal defect diameter to aortic root dimension in prognosis evaluation fetal ventricular septal defect

ObjectiveTo assess the value of the ratio of the ventricular septal defect diameter (D_VSD) to the aortic root dimension (D_AO) in prognosis evaluation of fetal isolated ventricular septal defects (i-VSD). MethodsThis study involved a total of 175 fetuses with i-VSD who were diagnosed by prenatal ultrasound imaging of the fetal heart and followed for 3 months after birth, including perimembranous i-VSD (n=83), muscular i-VSD (n=82), and subarterial i-VSD (n=10). Based on the ratio of D_VSD to D_AO (R=D_VSD/D_AO), VSD were divided into large (R>1/2), medium (1/32=24.3, P=0.000). Of 83 fetuses with perimembranous i-VSD, 5 had small, 35 had medium, and 43 had large i-VSD, whose natural healing rates were 40.0% (2/5), 28.6% (10/35), and 7.0% (3/43) during the follow-up period, respectively. There was a statistically significant difference in the natural healing rates of perimembranous i-VSD with different R values (χ²=7.80, P=0.020). Of 82 fetuses with muscular i-VSD, 21 had small, 39 had medium, and 22 had large i-VSD, whose natural healing rates were 66.7% (14/21), 53.8% (21/39), and 27.4% (6/22), respectively. There was a statistically significant difference in the natural healing rates of muscular i-VSD with different R values (χ²=7.71, P=0.029). Of 10 fetuses with subarterial i-VSD, 2 had small, 4 had medium, and 4 had large i-VSD, and no natural healing was observed. ConclusionsThere is a difference in the natural healing rate of i-VSD at different locations. The ratio of D_VSD to D_AO (R) is of significance in the prognosis evaluation of fetuses with i-VSD.