七切面联合筛查法在孕中晚期胎儿先天性心脏病检查中的应用价值

Seven-views conjoined screening applied to prenatal diagnosis of fetal congenital heart disease during the second and third trimester of pregnancy

目的探讨七切面联合筛查法在孕中晚期胎儿先天性心脏病检查中的可行性和临床价值。方法2006年9月至2007年2月,在南京医科大学鼓楼临床学院母胎医学中心对妊娠18周以上的2000例单胎孕妇进行胎儿系统结构筛查的同时进行胎儿心脏七切面联合扫查,对先天性心脏病胎儿终止妊娠者进行胎儿尸体心脏解剖;继续妊娠者,于婴儿出生后6个月内进行超声心动图随访。结果2000例单胎妊娠胎儿中,最终四腔心切面获取率为99.0%,其中左心室流出道、右心室流出道、三血管、主动脉弓、动脉导管弓和上下腔静脉切面的获取率分别为92.5%、90.9%、98.5%、86.8%、84.6%和91.6%。心脏筛查中,脊后位时心脏七切面的获取率均在80%以上。2000例单胎妊娠胎儿中,发现先天性心脏病19例,发生率为0.95%。产前诊断13例(其中误诊1例),漏诊7例,误诊1例,诊断敏感性63.2%、特异性99.9%。结论七切面联合筛查法在孕中晚期胎儿先天性心脏病检查中切实可行,能在产前诊断出大部分心脏畸形,尤其是心脏复杂畸形。

Objective To investigate the feasibility and clinical significance of seven - views conjoined screening applied to prenatal diagnosis of fetal congenital heart disease during the second and third trimester of pregnancy. Methods Totally 2000 single fetuses aged above 18 weeks in maternal-fetal medical center of Nanjing Drum Tower Hospital for systematical structural screening were included in this study and scanned heart with seven - views from September 2006 to Febrnary 2007. Autopsy was performed when the were pregnancy was terminated, and others were followed up by echocardiography during the 6 months after birth. Results The four-chamber views were successfully obtained in 99.0% eventually, in which left ventricular and right ventricular outflow tracts, three-vessel, aortic arch, ductal arch and caval long - axis views were obtained in 92. 5 % ,90. 9%, 98.5 %, 86. 8 %, 84. 6% and 91.6%, respectively. During the heart screening, all views were obtained above 80% as the spinal was in the posterior position. Nineteen cases（0. 95% ） were found with congenital heart diseases, and 13 cases were diagnosed in utero,7 cases missed diagnosis and, 1 case misdignosed, the sensitivity being 63.2% and the specificity 99. 9%. Conclusion Seven - views conjoined screening applied to prenatal diagnosis of fetal congenital heart disease during the second and third trimester of pregnancy is practical, and it can detect many congenital heart diseases in utero, especially the complicated heart abnormalities.