The reference diameters of the three great vessels in the fetuses between 20-24 weeks by sonography

Abstract

Objective: We aimed to obtain reference values of three major vessels [Pulmonary artery (PA), aorta, vena cava superior (SVC)] diameters in fetuses between 20-24 weeks of gestation in the Turkish population and to evaluate the fetal heart anatomy. Methods: Between May 2009 and August 2012, pregnant women who evaluated in the Radiology Department were scanned by sonography in order to obtain fetal cardiac nomograms of the great vessels. Cardiac axis, size and three great vessels in addition to the four chamber view of the heart were evaluated. The cases were followed up postnatally with echocardiography and clinical evaluation. We calculated both the sensitivity and specificity of sonographic screening at the 20-24nd gestational weeks. Also, we found the frequency of congenital cardiac disease. Nomograms were obtained by calculating average vascular diameter for each gestational week. Results: A total of 371 fetuses evaluated in the sudy. The mean gestational age was 29.2±5.2. The mean diameters of PA, aorta and SVC were found 4.28±0.51 mm, 3.70±0.54 mm, 2.45±0.45 mm, respectively. The ratio of PA/aorta was 1.17±0.14. The mean diameters of PA, aorta and SVC were increasing gradually between 20 and 24 gestational weeks (p values 0.001, 0.007 and 0.001; repeated measures ANOVA). In five cases a cardiac anomaly was detected (tetralogy of Fallot, one atrium one ventricle anomaly, ASD, PA wider than normal, aorta wider than normal,) sonographically. Of these five, three cases were confirmed by postnatal fetal echocardiography performed by pediatric cardiologists. Concluions: This study represents the reference values for diameters of three great vessels of fetuses between 20 and 24 weeks in the Turkish population. Our national data will be a source for studies from our country.

Keywords

• Congenital heart disease
• ultrasonography
• prenatal screening.

Sonografide 20-24 Hafta Arasındaki Fetüslerde Üç Büyük Damarın Referans Çapları

Öz

Amaç Fetal kardiak anatomiyi değerlendirmek ve Türk popülasyonunda 20-24 hafta arasındaki fetüslerde üç ana damar [Pulmoner arter (PA), aorta, vena kava süperior (VKS)] çaplarının referans değerlerini saptamak. Yöntemler Mayıs 2009-Ağustos 2012 tarihleri arasında Radyoloji Bölümünde değerlendirilen gebelere fetal kardiyak büyük damarların nomogramlarının elde edilmesi için sonografik tarama yapıldı. Kalbin dört odacık görünümüne ek olarak kardiyak aks, boyut ve üç büyük damar değerlendirildi. Olgular postnatal olarak ekokardiyografi ve klinik değerlendirme ile takip edildi. Postnatal değerlendirme sonuçları temel alınarak 20-24. gebelik haftalarında yapılan sonografik taramanın duyarlılığı ve özgüllüğü hesaplandı. Ayrıca konjenital kalp hastalığı sıklığı araştırıldı. Her gebelik haftası için ortalama damar çapı hesaplanarak nomogramlar elde edildi. Bulgular Çalışma kapsamında toplam 371 fetüs değerlendirildi. Ortalama gebelik yaşı 29.2±5.2 yıldı. PA, aorta ve VKS ortalama çapları sırasıyla 4.28±0.51 mm, 3.70±0.54 mm ve 2.45±0.45 mm olarak bulundu. PA/aort oranı 1.17±0.14 idi. PA, aort ve VKS'nin ortalama çaplarının 20 ila 24 gebelik haftaları arasında kademeli olarak arttığı gözlendi (p değerleri 0.001, 0.007 ve 0.001). Sonografik olarak antenatal dönemde beş olguda kardiyak anomali (Fallot tetralojisi, tek atriyum tek ventrikül anomalisi, ASD, normalden geniş PA, normalden geniş aorta) tespit edildi. Beş vakadan üçünün tanısı doğum sonrası dönemde pediatrik kardiyologlar tarafından yapılan fetal ekokardiyografi ile doğrulandı. Sonuçlar Bu çalışma, 20-24 gestasyon haftasındaki fetüslerde üç büyük damar çapı için Türk popülasyonuna ait referans değerleri sunmaktadır. Ulusal verilerimizin ülkemizden yapılacak çalışmalara kaynak olacağını düşünmekteyiz.

Anahtar Kelimeler

• Konjenital kalp hastalığı
• ultrasonografi
• prenatal tarama.

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