超声心动图产前诊断胎儿先天性心脏病的临床价值

Clinical value of fetal echocardiography for prenatal diagnosis of congenital heart diseases

目的探讨超声心动图对胎儿先天性心脏病的产前诊断和临床价值。方法选择妊娠大于18周、有高危倾向的孕妇及会诊病例共193例行胎儿超声心动图检查。采用胎儿四腔心切面、左右室流出道切面、主动脉弓切面、动脉导管弓切面、三血管切面及上下腔静脉长轴切面,观察心脏大小、结构、大血管的位置、走行等;应用彩色多普勒血流显像观察各瓣口及间隔、大血管内血流情况。结果发现胎儿先天性心脏病19例。其中单心室、单心房并共同动脉干1例;单心室1例;右室双出口1例;完全性心内膜垫缺损2例;左心发育不良2例;三尖瓣闭锁2例;法乐四联征3例;主动脉瓣狭窄1例;单纯室间隔缺损6例。合并心外畸形2例,其中内脏膨出并重度脑积水1例、脊柱裂1例。漏诊Ⅱ型房间隔缺损2例。显示产前诊断胎儿先天性心脏病的敏感性为90%,特异性为100%。结论超声心动图是早期诊断胎儿严重先天性心脏病的最主要、无创性诊断技术,对围产期临床正确处理有重要的指导作用。

Objective To evaluate the clinical value of fetal echocardiography in prenatal diagnosis of congenital heart diseases.Methods Totally 193 women pregnant for over 18 weeks with high risk factors received fetal echocardiography using the four-chamber view,outflow tract of left and right ventricle view,aortic arch view,superior and inferior caval vein view,arterial ductus arch view,and three vessels view.Heart size,structure and location of large vessels were detected by 2D and color Doppler blood flow.The prenatal ultrasonographic diagnosis was confirmed by neonatal echocardiography and autopsy.Results We found 19 cases of fetal congenital heart diseases,including 1 case of single ventricle and atrium and persistent truncus arteriosus,1 case of single ventricle,1 case of right ventricle double outlet,2 cases of complete endocardial cushion defect,2 cases of left ventricular dysplasia,2 cases of tricuspid atresia,3 cases of tetralogy of Fallot,1 case of aorta coarctation,and 6 cases of ventricular septal defect.There were 2 cases complicated with other noncardiac malformations,including viseral valgus and severe hydrocephalus in 1 case and spina bifida in another.In our study,2 cases of atrial septal defect were missed.The sensitivity and specificity of fetal echocardiography were 90% and 100%,respectively.Conclusion Fetal echocardiography is one of the most important non-invasive techniques for early diagnosis of serious congenital heart diseases and can provide proper treatment for clinical decision making.