超声心动图对胎儿心脏强回声结构的检测及其心功能评价

Study on the clinical significance and fetal cardiac function of fetuses with intracardiac hyperechogenic foci using fetal echocardiography

目的 探讨超声心动图检测胎儿心脏强回声结构（intracardiac hyperechogenic focus,ICEF）及对ICEF胎儿心功能评价的临床意义.方法 采用胎儿超声心动图对1291例孕22～40周胎儿进行检测,对检出的ICEF胎儿测量心脏大小及室壁厚度,定量主动脉瓣口、肺动脉瓣口、房室瓣口血流速度,测量房室瓣环舒张早期、舒张晚期及收缩期运动的峰值速度（Em、Am、Sm）;随机选择128例正常胎儿作为对照组并测量相关参数;比较单纯ICEF胎儿与正常胎儿间的心脏收缩及舒张功能参数.结果 共检出ICEF胎儿448例,检出率34.7%（448/1291）,其中伴先天性心血管畸形24例（5.4%）,轻度三尖瓣反流24例（5.4%）,染色体异常1例（0.22%）.399例单纯ICEF胎儿与正常胎儿之间比较,二维及M型超声心动图所测心脏大小及室壁厚度等参数差异均无统计学意义（P＞0.05）,单纯性ICEF胎儿与正常胎儿之间比较,主动脉瓣口、肺动脉瓣口、房室瓣口血流流速曲线及房室瓣环运动速度参数差异均无统计学意义（P＞0.05）.结论 单纯性的ICEF胎儿伴发染色体异常的几率较低,并不伴明显血流动力学改变.

Objective To evaluate the clinical significance and cardiac function of fetuses with intracardiac hyperechogenic focus（ICEF） by fetal echocardiography. Methods Fetal echocardiograms were performed on 1291 fetuses for evaluation of fetal heart structures and rhythms. Echocardiographic characteristics of ICEF were investigated. Fetal systolic and diastolic functions of 399 fetuses with an isolated ICEF were compared with 128 normal fetuses using conventional two-dimensional, M-mode, pulsed Doppler echocardiography and myocardial Doppler tissue imaging（DTI）. Results The prevalence of ICEF was 34. 7% （448/1291）. Twenty-four（5.4%） cases were found with cardiovascular malformations. There was 1 （0.22%） case of ICEF fetus associated with chromosomal abnormality （trisomy 21 ）. Comprehensive fetal echocardiographic data analysis showed no significant differences in heart dimensions, global cardiac functions,and myocardial performances in the two groups（ P 〉0.05）. Conclusions An isolated ICEF in the fetal heart is not associated with increased risk for chromosome abnormalities. Fetuses with ICEF do not indicate impaired left ventricular systolic or diastolic function, therefore having no hemodynamic significance.