产前超声诊断胎儿单纯肺动脉狭窄

Prenatal diagnosis of fetal isolated pulmonary stenosis by echocardiography

目的探讨产前超声诊断胎儿单纯肺动脉狭窄的方法与技巧，提高产前诊断率。方法回顾性分析18例超声诊断为胎儿单纯肺动脉狭窄的病例资料，对各切面超声特点进行分析总结。结果18例中5例经尸检证实，12例经产后超声证实为肺动脉瓣狭窄，1例经产后超声证实为肺动脉瓣闭锁。18例中动脉导管弓切面均可检出动脉导管内的反向血流，部分有右房增大、右室心肌肥厚、三尖瓣反流、卵圆孔增大及卵圆瓣活动度减低等征象。结论动脉导管弓切面检出动脉导管的反向血流及三血管切面内主动脉与肺动脉血流方向相反，对诊断胎儿单纯肺动脉狭窄具有重要提示作用，动脉导管弓切面、双流出道切面及三血管切面是诊断该病的重要切面。

Objective To discuss the method and skill of prenatal diagnosis of fetal isolated pulmonary stenosis and thus to improve prenatal diagnostic ability. Methods The data of 18 fetuses diagnosed as isolated pulmonary stenois were reviewed and the ultrasonic characters of each section were analysised. Results Five of the 18 cases were confirmed as pulmonary stenosis by autopsy and 12 cases were confirmed by echoeardiography after birth. One case was confirmed as pulmonary atresia by echocardiography after birth. Reversed blood flow in arterial duct was detected at the duetal arch section in all the cases and right atrial enlargement,right ventricular myocardial hypertrophy,tricuspid regurgitation, foramen ovale enlargement, reduced activity of foramen ovale valve were detected in partial cases. Conclusions It is important that reversed blood flow in arterial duct and in the two main artery could be observed at the ductal arch section and the three vessel section respectively. Ductal arch section, ventrieular outflow tracts section and the three vessel section are very important in the diagnosis of fetal isolated pulmonary stenosis.