Curvas de referências do volume e da área das paredes dos ventrículos cardíacos fetais em diástole entre a 20ª e 33ª semana de gestação por meio da ultrassonografia 3d/4d/

Abstract

To determine the reference ranges of the area and volume of the fetal ventricular walls between 20 and 33+6 weeks of gestation in rendering mode and virtual organ computer-aided analysis (VOCAL), respectively, by three-and four-dimensional ultrasound using the spatio-temporal image correlation (STIC) and perform data volumetric was aplicated in fetuses with confirmed moderate and/or complex congenital heart disease (CHD). METHODS: We conducted a prospective cross-sectional study of 371 fetuses between 20 and 33+6 weeks of gestation and 21 fetuses with moderate and/or complex CHD. The fetal heart was scanned using STIC modality, starting with the classic four-chamber view plane. We determined the area and volume of the cardiac ventricular walls by the rendering and Virtual Organ Computed-aided Analysis (VOCAL) modes, respectively. For the construction of reference intervals, we used linear regression model, adjusted by the determination coefficient (R²). For calculation of intra- and interobserver repeatability of both area and volume of the ventricular walls, we used Bland-Altman plots and intraclass correlation coefficient (ICC). RESULTS: There was a strong correlation between gestational age and ventricular wall area (R² = 0.66 for the right and R² = 0.66 for the left). The mean of the right and left ventricular wall area ranged from 0.86 ± 0.23 cm2 (0.50 ? 1.37 cm2) and 0.82 ± 0.20 cm2 (0.49 ? 1.30 cm2) at 20 weeks to 2.75 ± 0.69 cm2 (1.38 ? 4.18 cm2) and 2.49 ± 0.59 cm2 (1.33 ? 4.02 cm2) at 33 weeks, respectively. There was a strong correlation between gestational age and ventricular wall volume (R² = 0.62 for the right and R² = 0.64 for the left). The mean of the right and left ventricular wall area ranged from 0.92 ± 0.34 cm3 (0.37 ? 1.78 cm3) and 0.73 ± 0.22 cm3 (0.40 ? 1.18 cm2) at 20 weeks to 5.28 ± 1.91 cm3 (1.35 ? 9.89 cm3) and 4.37 ± 1.79 cm2 (1.97 ? 8.28 cm2) at 33 weeks, respectively. The inter- and intraobserver repeatability for the right and left ventricular wall area was excellent: ICC = 0.85 (confidence interval - CI95% 0.75 ? 0.91); 0.93 (CI95% 0.88 ? 0.96); 0.94 (CI95% 0.90 ? 0.97) and 0.95 (CI95% 0.90 ? 0.97), respectively. The inter-observer repeatability was excellent for the left ventricular wall volume with ICC = 0.91 (CI95% 0.85 ? 0.95) and the intra-observer repeatability was also excellent for the right and left volume of the ventricular wall with ICC= 0.90 (CI95% 0.81 ? 0.94) and 0.97 (CI95% 0.95 ? 0.98), respectively. We observed that the volumes of the right and left walls were altered (95th percentile) in 8 of the 21 fetuses (38.0%) with moderate and/or complex CHD. CONCLUSIONS: Reference ranges for the area and volume of the fetal ventricular walls were determined and showed good repeatability for the area. The volumetric repeatability of the ventricular wall was good for the intra-observer (right and left) and intra-observer for the left ventricle. The volumetric reference range was validated in fetuses with confirmed moderate and/or complex CHD and can be applied to different types of CHD.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016