五切面联合筛查法在孕中晚期胎儿心脏检查中的应用

Five views conjoined screening applied to prenatal diagnosis of fetal malformations during the second and third trimester of pregnancy

目的探讨五切面联合筛查法在孕中晚期胎儿心脏畸形筛查中的应用价值。方法应用标准胎儿四腔心切面加左、右心室流出道切面、三血管切面及三血管气管切面联合筛查法对3300例孕22周以上孕妇进行产前心脏病筛查,并进行单纯四腔心切面扫查法与5个切面联合筛查法的诊断准确性进行比较。结果①四腔心切面的获取率最高,三血管切面为次,右心室流出道切面最差(尤其在妊娠晚期时)。②受检的3000例胎儿发现心脏畸形108例,发现率为3.6%,其中复杂先心病90例,误诊5例,漏诊3例,复杂先心病的产前诊断率为9l.4%(85/93),室间隔缺损18例,产前漏诊8例。③108例胎儿四腔心切面显示异常53例,敏感性为49.1%,应用五切面联合筛法对先天性心脏畸形的诊断符合率为82.4%(98/119例),若将室间隔缺损排除在外,诊断的敏感性为91.4%,特异性99.9%。结论五切面联合筛查法技术简单且方便实用,易普及推广,为胎儿超声心动检查提供了一种实用有效的检查方法,特别是对严重复杂的胎儿心脏畸形的产前筛选和诊断及鉴别诊断提供了重要的线索,具有较大的临床应用价值。

Objective To investigate the feasibility and clinical significance of five-views conjoined screening applied to prenatal diagnosis of fetal congenital heart disease（CHD） during the second and third tri- mester of pregnancy. Methods Totally 3000 fetuses aged above 22 weeks with four chamber view （FCV） plus left ventricular outflow tract view（ LVOTV ）and right ventricular outflow tract view（RVOTV） and combined with the three vessels（3VV）and trachea view（3VT） in antenata detection of congenital heart disease. Results ① The four chamber views were the best successfully obtained eventually, secondly the three vessels, the right ven- tricular outflow tracts were the worst obtained respectively. ② 108 cases （ 3.6% ） were found with congenital heart diseases, 90 eases were diagnosed complex malformation in utero, 3 cases missed diagnosis and 5 case misdignosed, in which the sensitivity was 91.4% and the specificity was 99.9%. 18 cases were diagnosed ven- tricular septal defect（VSD） and 8 cases missed diagnosis. ③ 108 consecutive fetuses with CHD, 53 were shown to abnormality on the FCV, a detection rate of 49. 1%. Five- views conjoined screening applied to prenatal diag- nosis of fetal congenital heart detection rate of 82. 4% （98 out of 119 cases）, When ventricular septal defect （VSD） were excluded, detection rate increased to 91.4% （85 out of 93 cases）. Conclusion This prospec- tive descriptive study demonstrates that the five- views conjoined screening has high detection rate in identifying clues for the presence of CHD. Thus, the five- views conjoined screening could probably be used as part of rou- tine screening for CHD.