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| Construction and application value of the decision-making tree model for the fetal congenital heart defect based on multimodal ultrasound |
| The First Affiliated Hospital of Henan University, Kaifeng, Henan Province, 475001 |
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Abstract To analyze the construction of the decision-making tree model for the fetal congenital heart defect based on multimodal ultrasound, and to study its application value. Methods: A total of 300 pregnant women who received prenatal ultrasound diagnosis in hospital during the second trimester of pregnancy from April 2021 to July 2023 were randomly selected as the study objects. The routine obstetric ultrasound examination was used to determine the situation of the fetal growth and to verify the fetal weeks of these women. Then the multimodal ultrasound was used to examine the fetal heart, including the section of four-chamber cardiac, the three-vessel section, the aortic arch section, the left ventricular outflow tract section, and the right ventricular outflow tract section. Multisectional ultrasonography of the heart was performed in the neonates with normal delivery. 300 fetuses were examined by multi-sectional ultrasonography to analyze whether the fetuses were accompanied with the congenital heart malformations or not. The results of the ultrasound examination and the follow-up results of the fetuses were compared. Results: 21 fetuses with congenital heart defects were detected by ultrasound, including 8 cases with delivery by induced labor and the remaining 13 cases with normal delivery. The coincidence rate between the ultrasound diagnosis and the follow-up result was 100%, including enlarged foramen ovale diameter, tetralogy of Fallot, complete endocardial pad defect, mitral atresia, hypoplastic right ventricle syndrome, hypoplastic left ventricle syndrome, transposition of the great arteries, persistent truncus arteriosus, single ventricle and ebstein's anomaly. 7 fetuses were diagnosed as ventricular septal defect by ultrasound, and 5 fetuses were diagnosed as ventricular septum by the follow-up results, with the diagnostic coincidence rate of 71.4%. Among 279 fetuses without congenital heart defects diagnosed by ultrasound, 1 case with patent foramen ovale and 3 cases with ventricular septal defect diagnosed by ultrasound were confirmed after birth, and 4 cases were missed, with the missed diagnosis rate of 0.54%. The diagnostic rate of the fetal malformation with four-chamber heart section, three-vessel section, aortic arch section, left ventricular outflow tract section or right ventricular outflow tract section was 3.95%, 0.63%, 2.76%, 3.27% or 3.25%, respectively. According to the decision -tree model, the suspicious fetal cardiac abnormalities detected by prenatal ultrasound, the advanced maternal age, the maternal drug treatment or radiation exposure, and the maternal family history of congenital heart disease were the independent risk factors of the fetal congenital heart disease, among which, the suspicious fetal cardiac abnormalities detected by prenatal ultrasound had the most significant effect. Conclusion: During the second trimester of pregnancy, the prenatal ultrasound multi section mode used to screen the fetal congenital heart defect can diagnose most of the fetal congenital heart defect.
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