超声筛查胎儿及新生儿先天性心脏病

Ultrasound Screening for Fetal and Neonatal Congenital Heart Diseases

目的:探讨超声筛查和诊断胎儿及新生儿先天性心脏病的临床价值。方法:回顾性分析22088例孕13～40周胎儿的超声学资料,包括四腔心、左、右室流出道声像图,以及其新生儿期的超声学资料,分析胎儿期和新生儿期超声检出和诊断先天性心脏病的能力。结果:①共诊断先天性心脏病105例。产前超声诊断胎儿心脏畸形34例,包括:肺动脉闭锁3例、重度肺动脉狭窄1例、心内膜垫缺损7例、大动脉转位2例、法洛四联症2例、永存动脉干1例、单心室1例、右位心1例、无心畸形1例、心脏肿瘤1例、室间隔缺损12例(小于5mm室间隔缺损5例,大于5mm室间隔缺损7例)、房间隔缺损2例。中止妊娠24例,9例分娩后新生儿超声心动图证实,1例失访。②产后7天内心脏听诊、超声心动图共发现71例先天性心脏病,包括:24例室间隔缺损、3例房间隔缺损、17例动脉导管未闭、15例卵圆孔未闭、11例动脉导管未闭和卵圆孔未闭、1例肺动脉闭锁。除去动脉导管未闭和卵圆孔未闭43例,先天性心脏病产前超声检出率为54.8%。③单纯性室间隔缺损是最常见的先天性心脏病,超声诊断室间隔缺损36例,占先天性心脏病58%。产前检出12例,产后检出24例。单纯性室间隔缺损产前超声检出率33.3%。结论:大部分严重先天性心脏病可在产前诊断。常见的先天性心脏病产前常漏诊,单纯性室间隔缺损是发病率最高、产前漏诊最多的先天性心脏病。

Purpose：To evaluate the value of ultrasound in diagnosis of fetal and neonatal congenital heart diseases.Methods：Retrospective analysis of 22,088 cases of 13～40 weeks of gestation fetal echocardiographic data,including fourchamber view and left and right ventricular outflow tract view,and its neonatal echocardiographic data was done in our study.The ability of prenatal and perinatal ultrasound diagnosis of congenital heart disease was evaluated.Results：A total of 105 congenital heart disease cases were diagnosed.Prenatal diagnoses of 34 cases of congenital heart disease were done.The cases including pulmonary atresia（n=3）,critical pulmonary valve stenosis（n=1）,atrioventricular septal defect（n=7）,transposition of great arteries（n=2）,tetralogy of fallot（n=2）,truncus arteriosus（n=1）,univentricular heart（n=1）,dextrocardia（n=1）,septal defect（n=12）,artrial septal defect（n=2）,acardius（n=1）and cardiac rhabdomyoma（n=1）.There were 24 terminations,9 cases were diagnosed by echocardiography of the newborn,and 1 case was lost follow up.Seventy-one more heart malformations were diagnosed by echocardiography in postnatal period.These cases including ventricular septal defect（n=24）,artrial septal defect（n=3）,patent ductus arteriosus（n=17）,patent foramen ovale（n=15）,patent ductus arteriosus and patent foramen ovale（n=11）,and pulmonary atresia（n=1）.Of all the congenital heart disease cases,54.8% were founded in prenatal period except 43 cases of patent ductus arteriosus and patent foramen ovale.Ventricular septal defect was the most common congenital heart disease.There were 36 cases of ventrircular septal defect,accounted for 58% of congenital heartdisease.Twelve cases were detected on prenatal and 24 cases in postnatal period.Defect detection rate of was ventricular septal 33.3% on prenatal by ultrasound.Conclusion： Most serious congenital heart diseases can be diagnosed in prenatal period.Common heart diseases were usually miss diagnosed as prenatal period.Ventricular septal defect was the highest incidence of congenital heart diseases in perinatal period,but it was often miss diagnosed in prenatal period.