先天性心脏大血管畸形的产前超声诊断分析

Analysis for prenatal ultrasonographic diagnosis of congenital heart great vessels abnormality

目的:探讨先天性心脏大血管畸形的产前超声诊断线索、检测技巧及临床意义,提高此类畸形的产前检出率。方法:对22 600例受检胎儿均采取胎儿心脏四腔心切面加胎儿头侧偏转法快速筛查胎儿心脏畸形,对疑有胎儿心脏畸形者获取左右心室流出道及主、肺动脉长轴切面、主动脉弓切面、大动脉短轴切面、动脉导管弓切面、三血管平面、三血管气管平面观察血管的排列关系、内径大小、血管数目、内部血流的彩色多普勒及频谱多普勒情况。结果:产前共诊断累及大血管的各种胎儿先天性心脏畸形119例,包括血管的内径大小异常68例,血管排列关系异常32例,血管数目异常23例,血管相对气管位置关系异常5例,血流方向及性质异常68例。结论:大动脉起始部的平行排列,内径大小异常,数目异常及相对气管的位置关系异常,内部血流异常均是胎儿先天性大血管畸形的产前超声诊断线索和依据,胎儿心脏四腔心切面加胎儿头侧偏转法获得左右心室流出道及主、肺动脉长轴切面、三血管平面、三血管气管平面是诊断大多数先天性心脏大血管畸形的主要切面和方法。

Objective： To analyze the clues for prenatal uhrasonographic diagnosisof congenital heart great vessels abnormalitynethods： 22 600 cases fetus were referred for routine obstetric ultrasound examination and suspected fetal congenital heart defects or other organs anomalies. Each fetus were givenFetal echocardiography including four - chamber view and outflow tracts and/or thegreat arteries and three vessels view and three vessels trachea view and the aorticarch view and duct artery arch view by titling slightly the transducer towards the fetalhead on four -chamber base view. We evaluated vessel size, arrangement, number, location of the transverse aortic arch in relation to the trachea and flow character ingreat artery on these views. Results： 119 cases with great vesselanomalies were detected by prenatal ultrasonography, which included 68 cases withabnormal vessel size, 32cases with abnormal vessel arrangement, 23 cases withabnormal vessel number, 5 cases with abnormal location of the transverse aortic archin relation to the trachea, 68 cases with abnormal flow character. Conclusion： Parallelarrangement of the root of the great artery, abnormal vessel size, abnormal vesselnumber, abnormal location of the transverse aortic arch inrelation to the trachea and abnormal flow character are the clues for prenataluhrasonographic diagnosis of congenital heart great vessel abnormality. Tithng slightly the transducer towards the fetal head on four - chamber base view is more reliablemeans of detecting fetal heart great vessel anomalies.