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http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/80586完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 李建南(Chien-Nan Lee) | |
| dc.contributor.author | Kuan-Ying Huang | en |
| dc.contributor.author | 黃冠穎 | zh_TW |
| dc.date.accessioned | 2022-11-24T03:10:01Z | - |
| dc.date.available | 2021-11-03 | |
| dc.date.available | 2022-11-24T03:10:01Z | - |
| dc.date.copyright | 2021-11-03 | |
| dc.date.issued | 2021 | |
| dc.date.submitted | 2021-10-25 | |
| dc.identifier.citation | 1. Wuttikonsammakit, P., B. Uerpairojkit, and S. Tanawattanacharoen, Causes and consequences of 93 fetuses with cardiomegaly in a tertiary center in Thailand. Arch Gynecol Obstet, 2011. 283(4): p. 701-6. 2. Rocha, L.A., L.C. Rolo, and E. Araujo Junior, How to perform a functional assessment of the fetal heart: a pictorial review. Ultrasonography, 2019. 38(4): p. 365-373. 3. Gittenberger-de Groot, A.C., et al., Basics of cardiac development for the understanding of congenital heart malformations. Pediatr Res, 2005. 57(2): p. 169-76. 4. Strain, strain rate and speckle tracking: Myocardial deformation. Available from: https://ecgwaves.com/topic/deformation-strain-strain-rate-speckle-tracking-echocardiography/. 5. Khamis, H., et al., Optimization-Based Speckle Tracking Algorithm for Left Ventricle Strain Estimation: A Feasibility Study. IEEE Trans Ultrason Ferroelectr Freq Control, 2016. 63(8): p. 1093-106. 6. Voigt, J.U., et al., Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging, 2015. 16(1): p. 1-11. 7. DeVore, G.R., et al., Fetal Heart Size: A Comparison Between the Point-to-Point Trace and Automated Ellipse Methods Between 20 and 40 Weeks' Gestation. J Ultrasound Med, 2016. 35(12): p. 2543-2562. 8. DeVore, G.R., et al., 24-segment sphericity index: a new technique to evaluate fetal cardiac diastolic shape. Ultrasound Obstet Gynecol, 2018. 51(5): p. 650-658. 9. DeVore, G.R., et al., Twenty-four Segment Transverse Ventricular Fractional Shortening: A New Technique to Evaluate Fetal Cardiac Function. J Ultrasound Med, 2018. 37(5): p. 1129-1141. 10. DeVore, G.R., et al., Evaluation of Fetal Left Ventricular Size and Function Using Speckle-Tracking and the Simpson Rule. J Ultrasound Med, 2019. 38(5): p. 1209-1221. 11. DeVore, G.R., et al., Quantitative evaluation of fetal right and left ventricular fractional area change using speckle-tracking technology. Ultrasound Obstet Gynecol, 2019. 53(2): p. 219-228. 12. DeVore, G.R., et al., Longitudinal Annular Systolic Displacement Compared to Global Strain in Normal Fetal Hearts and Those With Cardiac Abnormalities. J Ultrasound Med, 2018. 37(5): p. 1159-1171. 13. Kalam, K., P. Otahal, and T.H. Marwick, Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart, 2014. 100(21): p. 1673-80. 14. DeVore, G.R., et al., Two-Dimensional Speckle Tracking of the Fetal Heart: A Practical Step-by-Step Approach for the Fetal Sonologist. J Ultrasound Med, 2016. 35(8): p. 1765-81. 15. Cuypers, J.A., et al., Pulmonary stenosis: update on diagnosis and therapeutic options. Heart, 2013. 99(5): p. 339-47. 16. Todros, T., et al., Pulmonary stenosis and atresia with intact ventricular septum during prenatal life. Ultrasound Obstet Gynecol, 2003. 21(3): p. 228-33. 17. Daubeney, P.E., et al., Pulmonary atresia with intact ventricular septum: impact of fetal echocardiography on incidence at birth and postnatal outcome. UK and Eire Collaborative Study of Pulmonary Atresia with Intact Ventricular Septum. Circulation, 1998. 98(6): p. 562-6. 18. Daubeney, P.E., et al., Pulmonary atresia with intact ventricular septum: predictors of early and medium-term outcome in a population-based study. J Thorac Cardiovasc Surg, 2005. 130(4): p. 1071. 19. Khairy, P., N. Poirier, and L.A. Mercier, Univentricular heart. Circulation, 2007. 115(6): p. 800-12. 20. Gardiner, H.M., et al., Morphologic and functional predictors of eventual circulation in the fetus with pulmonary atresia or critical pulmonary stenosis with intact septum. J Am Coll Cardiol, 2008. 51(13): p. 1299-308. 21. Gottschalk, I., et al., Severe Pulmonary Stenosis or Atresia with Intact Ventricular Septum in the Fetus: The Natural History. Fetal Diagn Ther, 2020. 47(5): p. 420-428. 22. Schidlow, D.N., et al., Fetal interventions for structural heart disease. Echocardiography, 2017. 34(12): p. 1834-1841. 23. Moon-Grady, A.J., et al., International Fetal Cardiac Intervention Registry: A Worldwide Collaborative Description and Preliminary Outcomes. J Am Coll Cardiol, 2015. 66(4): p. 388-99. 24. Yoshimura, N. and M. Yamaguchi, Surgical strategy for pulmonary atresia with intact ventricular septum: initial management and definitive surgery. Gen Thorac Cardiovasc Surg, 2009. 57(7): p. 338-46. 25. Liu, L., et al., Prenatal echocardiographic classification and prognostic evaluation strategy in fetal pulmonary atresia with intact ventricular septum. Medicine (Baltimore), 2019. 98(42): p. e17492. 26. La Corte, M.A., et al., Left ventricular function in tricuspid atresia. Angiographic analysis in 28 patients. Circulation, 1975. 52(6): p. 996-1000. 27. Maskatia, S.A., et al., Echocardiographic parameters associated with biventricular circulation and right ventricular growth following right ventricular decompression in patients with pulmonary atresia and intact ventricular septum: Results from a multicenter study. Congenit Heart Dis, 2018. 13(6): p. 892-902. 28. Soylu, K., et al., Evaluation of ivabradine in left ventricular dyssynchrony and reverse remodeling in patients with chronic heart failure. J Arrhythm, 2020. 36(4): p. 762-767. 29. Kerwin, W.F., et al., Ventricular contraction abnormalities in dilated cardiomyopathy: effect of biventricular pacing to correct interventricular dyssynchrony. J Am Coll Cardiol, 2000. 35(5): p. 1221-7. 30. Reisner, S.A., et al., Global longitudinal strain: a novel index of left ventricular systolic function. J Am Soc Echocardiogr, 2004. 17(6): p. 630-3. | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/80586 | - |
| dc.description.abstract | 胎兒的肺動脈狹窄以及右心室萎縮的程度，可能導致胎兒未來走向單一心室循環，出生後需要多次心臟手術。目前探討單一心室循環的預後因子，多半著重在心臟超音波2D平面的測量，較少探討功能性的參數，因此我們想利用Fetal HQ這個新型態胎兒心臟功能性超音波，找出影響胎兒走向單一心室循環的重要產前超音波參數。 分析從2009年01月至2021年04月，這12年間，共有96位孕婦，其胎兒疑似肺動脈狹窄(Pulmonary Stenosis)或肺動脈閉鎖(Pulmonary Atresia)，被轉診至台大醫院母胎兒醫學中心；我們針對這96位孕婦進行病歷回顧，並且依照胎兒出生後接受的治療方法，分成單一心室循環與雙心室循環兩組去做比較；並從台大醫院過去的影像資料庫中找尋標準four-chamber-view(4CV)之動態影像且心室內膜影像顯示清晰，利用Fetal HQ比較兩組孕婦之胎兒心臟功能是否有差異，找尋走向單一心室循環的預測因子。 結果顯示產前胎兒右心室面積改變分率(FAC) < -0.22%、左心室心臟底部球面性LV SI 1 < 6.13% 以及左心室心臟中段球面性 LV SI < 5.98%可預測出生之胎兒會走向單一心室循環。 利用Fetal HQ系統可以找到重要預測胎兒走向單一心室循環的參數，且運用到臨床實務上，發現右心室面積改變分率(FAC) < -0.22%也就幾乎等於左右心室不同步收縮Interventricular dyssynchrony，該結果可套用在一般2D動態超音波，即可判斷預後狀況如何，供臨床實務上一個非常實用新的評估預後因子。 | zh_TW |
| dc.description.provenance | Made available in DSpace on 2022-11-24T03:10:01Z (GMT). No. of bitstreams: 1 U0001-2410202114571800.pdf: 3982072 bytes, checksum: f1ee65b0398ced589a280dd5669ca1ce (MD5) Previous issue date: 2021 | en |
| dc.description.tableofcontents | 目錄 中文摘要 iv 目錄 vi 第一章、 緒論 1 1.1 前言 1 1.2 心臟超音波 2 1.2.1 心臟超音波之簡介 2 1.2.2 胎兒心臟超音波 2 1.2.3 亮點追蹤心臟超音波 (Speckle‐tracking echocardiography) 2 1.2.4 亮點追蹤胎兒心臟超音波 (Speckle‐tracking fetal echocardiography) 3 1.2.5 Fetal HQ 5 1.2.5.1 Fetal HQ操作流程 5 1.3 肺動脈狹窄(Pulmonary Stenosis)、肺動脈閉鎖(Pulmonary Atresia) 6 1.3.1 疾病簡介 6 1.3.2 單一心室循環 6 1.3.3 產前預後因子 6 1.3.4 治療方式 7 1.3.4.1 產前治療 7 1.3.4.2 出生後的治療 7 1.3.5 肺動脈狹窄或閉鎖之胎兒2D超音波影像 9 1.3.6 肺動脈狹窄或閉鎖之胎兒 Fetal HQ分析 9 第二章、 研究方法 11 2.1 研究對象 11 2.1.1 納入條件 11 2.1.2 排除條件 11 2.2 研究方法 11 2.2.1 病歷回溯 11 2.2.2 Fetal HQ 12 2.2.2.1 導入動態四腔室影像 12 2.2.2.2 重複性試驗 12 2.3 數據分析 12 2.4 人體試驗委員會編號 12 第三章、 研究結果 13 3.1 孕婦及出生病童收案情況 13 3.2 預後狀況 13 3.2.1 產前評估 13 3.2.2 胎兒出生狀況 13 3.2.3 出生後追蹤病童情況 14 3.3 Fetal HQ分析 14 3.3.1 重複性試驗 14 3.3.2 心室功能分析結果 15 3.3.3 ROC曲線評估預後因子 15 3.3.4 產前RV FAC與產後TV score之相關性 16 3.3.5 單一心室循環胎兒之Fetal HQ心內膜軌跡圖像 16 第四章、 討論 17 4.1 產前RV FAC右心室面積改變分率 17 4.1.1 是否隨週數改變 17 4.1.2 產前RV FAC可預測胎兒是否走向單一心室循環 17 4.1.3 心室不同步收縮Interventricular dyssynchrony 18 4.1.4 產前RV FAC與產後TV score 18 4.2 左心室心臟球面性LV sphericity index(SI) 19 4.3 其他參數為何沒有統計顯著差異? 19 4.4 研究限制 20 第五章、 結論與未來展望 21 參考文獻 22 附錄 25 圖目錄 圖一、左心室肌肉不同層之收縮方向 25 圖二、左右心室面積改變分率Fractional area change(FAC) 26 圖三、左右心室整體應變Global strain (GS)與心底-心尖長軸短縮分率 27 圖四、Fetal HQ操作流程 28 圖五、肺動脈狹窄或閉鎖之胎兒2D超音波影像(一) 29 圖六、肺動脈狹窄或閉鎖之胎兒2D超音波影像(二) 30 圖七、Fetal HQ評估肺動脈狹窄之胎兒：舒張期大小End-diastolic diameter (ED) 31 圖八、Fetal HQ評估肺動脈狹窄之胎兒：短縮分率Fractional shortening (FS) 32 圖九、Fetal HQ評估肺動脈狹窄之胎兒：心室球面性Sphericity index (SI) 33 圖十、Fetal HQ評估肺動脈狹窄之胎兒：心室面積改變分率Fractional area change (FAC) 34 圖十一、孕婦與出生之病童收案流程圖 35 圖十二、ROC曲線評估預後因子 36 圖十三、產前RV FAC與產後TV Z score的相關性 37 圖十四、單一心室循環胎兒之Fetal HQ心室收縮期與舒張期心內膜軌跡圖像 38 圖十五、產前RV FAC與其評估週數 39 圖十六、左心室心臟球面性LV sphericity index(SI)的臨界值 40 表目錄 表一. 孕婦與出生之嬰兒收案結果 41 表二、左心室舒張期的大小end-diastolic diameter (ED)的一致性分析Intra-class correlation coefficient (ICC) 42 表三、右心室舒張期的大小end-diastolic diameter (ED)的一致性分析Intra-class correlation coefficient (ICC) 43 表四、Fetal HQ分析胎兒心臟功能參數 44 表五、左右心室24個區段的球面性正常值對照表 45 | |
| dc.language.iso | zh-TW | |
| dc.subject | 心室球面性 | zh_TW |
| dc.subject | 胎兒HQ檢查 | zh_TW |
| dc.subject | 亮點追蹤胎兒心臟超音波 | zh_TW |
| dc.subject | 肺動脈閉鎖 | zh_TW |
| dc.subject | 肺動脈狹窄合併心室中膈完整 | zh_TW |
| dc.subject | 單一心室循環 | zh_TW |
| dc.subject | 心室面積改變分率 | zh_TW |
| dc.subject | ventricular fractional area change | en |
| dc.subject | ventricular sphericity index | en |
| dc.subject | Fetal HQ | en |
| dc.subject | speckle‐tracking echocardiography | en |
| dc.subject | critical pulmonary stenosis | en |
| dc.subject | pulmonary atresia with intact ventricular septum | en |
| dc.subject | univentricular circulation | en |
| dc.title | 右心室面積改變分率作為新的胎兒心臟超音波預測因子評估胎兒肺動脈狹窄和肺動脈閉鎖走向單一心室循環 | zh_TW |
| dc.title | Right Ventricle Fractional Area Change as A Novel Fetal Echocardiographic Predictor of Ui-ventricular Circulation in Fetal Pulmonary Stenosis and Pulmonary Atresia | en |
| dc.date.schoolyear | 109-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 鄭文芳(Hsin-Tsai Liu),施景中(Chih-Yang Tseng) | |
| dc.subject.keyword | 胎兒HQ檢查,亮點追蹤胎兒心臟超音波,肺動脈閉鎖,肺動脈狹窄合併心室中膈完整,單一心室循環,心室面積改變分率,心室球面性, | zh_TW |
| dc.subject.keyword | Fetal HQ,speckle‐tracking echocardiography,critical pulmonary stenosis,pulmonary atresia with intact ventricular septum,univentricular circulation,ventricular fractional area change,ventricular sphericity index, | en |
| dc.relation.page | 45 | |
| dc.identifier.doi | 10.6342/NTU202104085 | |
| dc.rights.note | 同意授權(限校園內公開) | |
| dc.date.accepted | 2021-10-26 | |
| dc.contributor.author-college | 醫學院 | zh_TW |
| dc.contributor.author-dept | 臨床醫學研究所 | zh_TW |
| 顯示於系所單位： | 臨床醫學研究所 | |
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