超声三血管气管切面在胎儿永存左位上腔静脉超声诊断中的应用

Application of three vessel trachea view in fetal persistant left superior vena cava by ultrasound

目的探讨超声三血管气管切面(3VT)在胎儿永存左位上腔静脉(PLSVC)超声诊断及病理解剖特征分析中的作用。方法对8例产前三血管气管切面诊断PLSVC胎儿的声像图及引产后尸检结果进行对照分析。胎儿PLSVC在三血管气管切面超声主要观察:(1)上腔静脉位置。(2)上腔静脉数目。(3)双侧上腔静脉血流方向改变。结果 (1)8例胎儿中7例均可见左位上腔静脉与右侧上腔静脉合并存在为双上腔静脉(DSVC):其中4例肺动脉和主动脉位置正常,肺动脉左侧及主动脉弓右侧分别可见左、右上腔静脉显示。2例肺动脉和主动脉位置异常,则主动脉弓左侧及肺动脉右侧分别可见左、右上腔静脉显示。此6例胎儿双侧上腔静脉血流方向一致,超声诊断PLSVC,尸检证实为DSVC。1例超声显示为DSVC,但双侧上腔静脉血流方向相反,超声诊断PLSVC,引产后尸检证实为完全性心上型肺静脉异位引流,左侧静脉为垂直静脉。(2)8例中1例上腔静脉位置异常:肺动脉右侧无上腔静脉显示,肺动脉左侧可见上腔静脉,超声诊断PLSVC,尸检证实为右侧上腔静脉缺如、左侧上腔静脉伴心房反位和腹腔脏器反位。(3)8例胎儿均合并各种复杂的心内畸形。其中心脏位置异常4例,右心室及形态学右心室双出口4例,肺动脉狭窄3例,室间隔缺损4例,心内膜垫缺损1例,单心室1例,右心发育不良1例,法洛四联症1例,完全性肺静脉异位引流3例。(4)腹腔脏器反位2例。4例胎儿肺动脉和主动脉位置正常,肺动脉左侧及主动脉弓右侧分别可见左、右上腔静脉显示;2例胎儿肺动脉和主动脉位置异常,在主动脉弓的左侧及肺动脉的右侧分别可见左、右上腔静脉显示,双侧上腔静脉血流方向一致为DSVC。(5)1例DSVC,但双侧上腔静脉血流方向相反为完全性心上型肺静脉异位引流。结论 3VT可作为胎儿PLSVC诊断切面和方法。在胎儿3VT显示双侧上腔静脉时,双侧上腔静脉血流方向对鉴别永存左位上腔静脉和完全性心上型肺静脉异位引流具有重要意义。肺动脉右侧无上腔静脉显示,肺动脉左侧可见上腔静脉,为右侧上腔静脉缺如型左位上腔静脉。此时要注意观察是否合并心房反位和腹腔脏器反位。

Objective To explore the performance of three-vesse trachea view （3VT） on the persistent left superior vena cava （PLSVC） and its relevance with pathological dissection. Methods In eight cases of the three-vessel trachea view with the diagnosis for persistent left superior vena cava cases, the autopsies findings were used for retrospective analysis The main observation on the persistent left superior vena cava by the three-vessel trachea view included ： （ 1 ） Location of superior vena cava. （2） Number of superior vena eava. （3） Changes of blood stream direction in the two-sided superior vena eava. Results （ 1 ） Eight fetuses included, seven cases with two-sided superior vena cava （double superior vena eava）, abomormal number and the bloodstream direction change ： the position of the pulmonary artery and the aortic was abnor- mal in the four cases ; two veins was shown in the right flank of the pulmonary artery and the left flank of the aortic arch. The positions of the pulmonary artery and the aortic were normal in the two cases. The left flank of the pulmonary artery and the right flank of the aortic arch had two veins. Six cases was observed to havethe flow direction consistent with two-sided superior vena cava, which were diagnosed as persistent left superior vena cava by ultrasound and confirmed by autopsies. One case with visible veins but blood flow in the opposite direction to persistent left superior vena cava was found and confirmed by the autopsies with com- plete heart anomalous. （2） One in eight cases the superior vena cava position was abnormal： the right flank of the pulmonary artery had no superior vena cava, but the left side was visible, which was diagnosed as per- sistent left superior vena cava. The autopsies was diagnosed as the left superior vena cava superior vena cava and atrial situs ambiguous and visceral reverse. （3） Eight cases combined with complex abnormal, four cases with heart position abnormal, four with double outlet ventricle, three with pulmonary narrow, four with ven- tricular septal defect, one with endocardial cushion defects, one with single ventricle, one with hypoplastia right heart syndrome, one with tetralogy of fallot, three with the complete pulmonary vein dystopia drainage, two with visceral reverse were included. The position of the pulmonary artery and the aortic were abnormal in the four cases and two veins were shown in the right flank of the pulmonary artery and the left flank of the aortic arch. Two cases were shown the position of the pulmonary artery and the aortic are normal and on the left flank of the pulmonary artery and the right flank of the aortic arch, two veins were shown. The flow direc- tion including two-sided superior vena cava was diagnosed as persistent left superior vena cava. The visible veins by ultrasound was observed in one case but no blood flow in the opposite direction to persistent left su- perior vena cava. The heart anomalous was diagnosed by autopsies. Conduslons 3VT as the diagnosis method of fetal PLSVC, the three-vessel trachea view showed the double-side superior vena cava. The blood stream direction is important to identify in persistent left superior vena cava and the complete pulmonary vein dystopia drainage. The left superior vena cava lacks of right superior vena cava if it had no right flank of the pulmonary artery but the left side is visible, which should be cautioned for merges in atrial situs ambiguous and the abdomen reverse.