三个心脏超声切面在常见先天性心脏病产前诊断中的作用

The role of three echocardiographic planes in prenatal diagnosis of common congenital heart disease

目的探讨三个胎儿超声心动图标准切面:四腔心切面、五腔心切面、三血管平面在发现和诊断胎儿常见先天性心脏病中的作用及对于先天性心脏病产前筛查的意义。方法回顾2003年5月至2004年7月胎儿心脏畸形各病例的心脏超声图像,记录每一病例三个超声切面(四腔心切面、五腔心切面、三血管平面)的彩色多普勒超声图像表现,分析并总结各切面异常表现的特点。结果(1)研究共包括胎儿心脏畸形病例26例,疾病类型包括房室间隔缺损、单纯性室间隔缺损、单心室、单心房、左心发育不良综合征、法洛四联症、右心室双出口、纠正性/完全性大动脉转位、动脉单干、主动脉瓣狭窄、肥厚性心肌病(梗阻型)、心脏肿瘤。(2)各心脏畸形病例在这三个心脏超声切面的扫查中至少有1个切面显示异常。每一类心脏畸形在这三个切面图像上均有特征性表现。(3)所有病例中二维四腔心切面(常规产科筛查切面)显示异常的比例为73%,四腔心切面未显示异常的病例包括:完全性大血管转位3例、法洛四联症1例、右心室双出口1例、动脉单干1例、主动脉骑跨伴室间隔缺损1例。(4)各标准切面获得率分别为:96.2%、88.5%、84.6%。结论(1)四腔心切面、五腔心切面、三血管平面这三个胎儿彩色多普勒心脏超声切面探查在各类胎儿常见的先天性心脏病超声产前检查与诊断中起重要的作用。(2)与运用单个二维四腔心切面探查比较,三个切面的探查方法可提高常见先天性心脏病,尤其是胎儿心脏锥干畸形的检出率。(3)三个切面探查操作较为简便,有望成为一项胎儿先天性心脏病的筛查方法。

Objective To assess the value of the three echocardiographic planes： the four-cham ber （4CV）, five-chamber （5CV） and three-vessel （3VV） views, in diagnosing fetal common congenital heart defects. Methods The echocardiographic records of fetal congenital heart diseases （CHDs） performed from May 2003 to July 2004 were reviewed retrospectively. Only cases with postnatal confirmation by echocardiogram or autopsy were included （26 cases）. The abnormalities detected in each view were analyzed and classified. Results The abnormalities in CHDs included： atrioventricular septal defects（ASD）, ventricular septal defect（VSD）, univentricular heart, single atrium, hypoplastic left heart syndrome, Tetralogy of Fallot（TOF）, double outlet right ventricle, complete and congenitally corrected transposition of the great arteries, truncus arteriosus, hypertropic cardiomyopathy and cardiac tumor. At least one plane showed abnormality in each case. Each type of cardiac defect had its typical finding in these three planes. Among the 26 cases, 73% presented abnormalities on the two-dimensional （2D） four-chamber view examination, but 7 cases were normal including conotruncal malformation and several other heart defects. The 4CV, 5CV and 3VV were obtained successfully in 96.2%, 88.5% and 84.6% of all cases, respectively. Conclusions The examination of the 4CV, 5CV and 3VV with color Doppler provides essential information for the detection and diagnosis of fetal common CHDs. The application of these three planes is promising in the screening of fetal common CHDs. Compared with the 2D fourhamber view of cardiac screening, a combination with three-plane scanning may improve the detection rate of fetal CHD, especially for conotruncal anomalies.