胎儿心内膜垫缺损的产前超声诊断

Prenatal ultrasonic diagnosis of fetal endocardial cushion defect

目的:探讨胎儿期心内膜垫缺损的超声声像图特征及诊断的临床意义。方法:回顾性分析10例诊断为心内膜垫缺损的胎儿超声声像图特点,并与产前诊断中心的超声心动报告或引产后病理相比较。首先确定胎儿心脏的位置,二维图像显示四腔心、三血管、左右室流出道、心底短轴、主动脉弓、动脉导管弓切面,重点观察四腔心切面房间隔(原发隔)、室间隔的连续性,二尖瓣、三尖瓣的形态及瓣叶数目,可加用彩色多普勒血流显像观察房室瓣的血流情况。结果:①产前共诊断10例胎儿心内膜垫缺损,其中完全型8例,部分型2例。②单一心内膜垫缺损2例,合并其他心脏畸形4例,合并心外畸形6例。③10例病例中8例引产,1例失访,1例继续妊娠。结论:产前超声心动图能较准确的诊断胎儿心内膜垫缺损。四腔心切面是诊断该病的主要切面,彩色多普勒血流显像可进一步明确诊断。

Objective：To explore the ultrasonographic features of fetal endocardial cushion defect and the clinical significance.Methods：The ultrasonographic features of 10 fetuses diagnosed as endocardial cushion defect were analyzed retrospectively,then the results were compared with echocardiography reports of prenatal diagnosis center and pathological examination after induced delivery;the position of fetal heart was determined at first,two-dimensional images showed four chamber view,three vessels view,left and right ventricular outflow tract view,heart short-axis view,aortic arch view and ductus bow view;the continuity of atrial septal and interventricular septum,the morphology of mitral and tricuspid valves,the number of leaflets of our chamber view were emphatically observed;color Doppler flow imaging was used to observe blood flow of atrioventricular valve.Results：10 fetuses were diagnosed as endocardial cushion defect during prenatal diagnosis,including 8 fetuses of complete endocardial cushion defect and 2 fetuses of partial endocardial cushion defect.2 fetuses were diagnosed as single endocardial cushion defect,4 fetuses combined with other cardiac abnormalities,6 fetuses combined with extracardiac malformations.Among 10 cases,8 cases chose induced delivery,1 case was lost to follow-up and 1 case continued pregnancy.Conclusion：Prenatal echocardiography can accurately diagnose fetal endocardial cushion defect.The 4-chamber view is the main view,and color Doppler flow imaging can help to definitely diagnose.