摘要目的:利用胎儿心脏定量分析技术(fetal HQ)评估中孕期室间隔缺损(VSD)胎儿的心脏形态与功能变化。方法:前瞻性收集2022年7月至2024年1月于成都市妇女儿童中心医院经产前超声心动图诊断为单纯性VSD的单胎胎儿91例(VSD组)及与VSD组胎龄相匹配的正常胎儿91例(对照组)。采用fetal HQ技术测量胎儿四腔心长径和宽径，获得整体球形指数(GSI)；以斑点追踪技术追踪左、右心室舒张期和收缩期心内膜运动轨迹，获取左右心室整体纵向应变(LV-GLS、RV-GLS)、左右心室舒张末期横径(EDD)、左右心室24节段球形指数(SI)、左右心室24节段短轴缩短率(FS)、左心室射血分数(LV-EF)、左右心室面积变化率(LV-FAC、RV-FAC)、左心室每搏排出量(LV-SV)、左心室心排出量(LV-CO)等相关参数，比较各参数组间差异。并且评价VSD测值大小与GSI、GLS及FAC相关性。结果:VSD组左心室第20～23节段EDD低于对照组(均 P<0.05)，右心室第1～4节段SI值高于对照组(均 P<0.05)，两组间GSI差异无统计学意义( P>0.05)。VSD组LV-GLS低于对照组( P<0.05)，而两组RV-GLS差异无统计学意义( P>0.05)。VSD组LV-FAC、LV-EF、LV-SV及LV-CO低于对照组，差异有统计学意义(均 P<0.05)。VSD组左心室第1～10节段FS值低于对照组，右心室第7～21节段FS值高于对照组(均 P<0.05)。LV-GLS、LV-FAC绝对值与VSD大小呈负相关( r＝－0.309， P＝0.004； r＝－0.264， P＝0.015)，GSI、RV-GLS和RV-FAC绝对值与VSD大小未见明显相关性(均 P>0.05)。 结论:中孕期VSD胎儿GSI正常，但左心心尖段及右心基底段形状有改变，其中左心室腔更趋于扁平，右心室腔更趋于梭形。VSD胎儿左心室收缩功能明显降低，右心室局部收缩功能增加而整体收缩功能无明显变化。VSD组胎儿LV-GLS及LV-FAC绝对值与VSD大小存在负相关性。

abstractsObjective:To evaluate the morphological and functional changes of the heart during second trimester fetuses with ventricular septal defect (VSD) using fetal heart quantification (fetal HQ) technology.Methods:A prospective study was conducted from July 2022 to January 2024 at Chengdu Women′s and Children′s Central Hospital, collecting 91 singleton fetuses diagnosed with isolated VSD (VSD group) and 91 normal fetuses matched for gestational age (control group). Fetal HQ technology was used to measure the length and width of the four-chamber view of the fetal heart, obtaining the global sphericity index (GSI). Speckle tracking technology was used to track the endocardial motion trajectories of the left and right ventricles during diastole and systole, obtaining parameters such as left and right ventricular global longitudinal strain (LV-GLS and RV-GLS), end-diastolic diameter (EDD), 24-segment sphericity index (SI), 24-segment fraction of shortening (FS), left ventricular ejection fraction (LV-EF), fraction of area change (FAC), left ventricular stroke volume (LV-SV), and left ventricular cardiac output (LV-CO).The differences between groups were compared, and the correlations between the values of VSD and GSI, GLS, and FAC were evaluated.Results:The EDD of the left ventricular segments 20-23 in the VSD group was lower, while the SI value of the right ventricular segments 1-4 in the VSD group was higher than that in the control group (all P<0.05). There was no statistically significant difference in GSI between the two groups ( P>0.05). LV-GLS in the VSD group was lower than that in the control group ( P<0.05). There was no statistically significant difference in RV-GLS ( P>0.05). Values of LV-FAC, LV-EF, LV-SV, and LV-CO in the VSD group were significantly lower than those in the control group (all P<0.05). The FS value of left ventricular segments 1-10 in the VSD group presented lower, but the FS value of right ventricular segments 7-21 higher compared to controls(all P<0.05). LV-GLS and LV-FAC absolute values were negatively correlated with the size of VSD ( r=-0.309, P=0.004; r=-0.264, P=0.015), while GSI, RV-GLS, and RV-FAC showed no significant correlation with the size of VSD (all P>0.05). Conclusions:The overall sphericity index of second trimester VSD fetuses is normal, but there are changes in the shape of the left ventricular apical segments and the right ventricular basal segments, with the left heart chamber tending to be flatter and the right heart chamber more fusiform. The left ventricular systolic function of VSD fetuses is significantly reduced, the local systolic function of right ventricular increases while the global systolic function shows no significant change. The absolute values of LV-GLS and LV-FAC in VSD fetuses are negatively correlated with the size of VSD.