Cardiac hemodynamics in fetuses with transposition of the great arteries and intact ventricular septum from diagnosis to end of pregnancy: longitudinal follow‐up
Notice bibliographique
Résumé
ABSTRACT Objectives Little is known about cardiac hemodynamics in the fetus with transposition of the great arteries and intact ventricular septum (TGA‐IVS). Better understanding of the fetal physiology in TGA‐IVS would help to provide insights into specific clinical complications observed after birth, in particular neonatal hypoxia and pulmonary hypertension. The aim of this study was to assess cardiac hemodynamics in fetuses with TGA‐IVS by performing systematic longitudinal echocardiographic follow‐up from diagnosis to delivery. Methods This was a longitudinal retrospective study of fetuses referred between 2010 and 2018 to the Sainte‐Justine University Hospital Centre. Complete assessment of cardiac hemodynamics was performed in fetuses with TGA‐IVS at 18–22, 28–32 and 35–38 weeks' gestation, which were compared with normal fetuses matched for gestational age. The maximum diameter of the foramen ovale was measured using two‐dimensional echocardiography under the guidance of color Doppler echocardiography. Fetal cardiac hemodynamics were analyzed according to postnatal preductal transcutaneous oxygen saturation (TcSO 2 ) < 65% or ≥ 65%, as a neonatal outcome, in fetuses with TGA‐IVS. Results In total, 59 fetuses with TGA‐IVS and 160 normal fetuses were included. Global cardiac output was significantly higher in fetuses with TGA‐IVS than in controls, mainly owing to higher global pulmonary output, while global systemic cardiac output did not differ between TGA‐IVS fetuses and controls throughout pregnancy. Aortic flow (right ventricular output in fetuses with TGA‐IVS, left ventricular output in controls) was significantly higher in fetuses with TGA‐IVS than in normal fetuses. Ductal flow was significantly lower in fetuses with TGA‐IVS at every timepoint, and this difference increased considerably after 28–32 weeks. In parallel, the diameter of the foramen ovale was significantly smaller in fetuses with TGA‐IVS at 28–32 and 35–38 weeks, with a stagnation in growth after 28 weeks, compared with continuous growth in normal fetuses. Most of these cardiac hemodynamic anomalies in fetuses with TGA‐IVS were already present at 18–22 weeks, and the differences became greater at 28–32 weeks' gestation. TGA‐IVS neonates with TcSO 2 < 65% had lower fetal left ventricular output, higher diastolic ductal retrograde flow and smaller foramen ovale at 28–32 weeks, compared with fetal values in those with postnatal TcSO 2 ≥ 65%. Conclusions Compared with normal fetuses, those with TGA‐IVS undergo a complex redistribution of blood flow during the second half of pregnancy, with higher global pulmonary flow, lower ductal flow (with negative diastolic flow at the end of pregnancy) and a smaller foramen ovale. In addition, fetal cardiac hemodynamic anomalies observed at 28–32 weeks' gestation were associated with lower postnatal TcSO 2 . These observations may provide a better understanding of premature closure of the foramen ovale and postnatal hypoxia that are specific to TGA‐IVS physiology. © 2019 International Society of Ultrasound in Obstetrics and Gynecology
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».