多普勒超声检测胎儿心室发育不良血流动力学变化的研究

Investigation for the hemodynamic alterations in fetus with ventricular hypoplasia by Doppler echocardiography

目的探讨应用多普勒超声检测胎儿心室发育不良血流动力学变化的临床意义。方法回顾性分析21例产前诊断心室发育不良胎儿（左心发育不良14例，右心发育不良7例）的超声心动图资料，并与尸体解剖或产后超声检查结果对照，重点研究其分流途径：静脉导管、卵圆孔和动脉导管的血流动力学改变。结果①左心发育不良综合征胎儿的静脉导管血流频谱均未见异常，8例（57．1％）严重左心发育不良胎儿的大动脉血流方向相反，6例同时出现卵圆孔血流异常（4例卵圆孔限制性左向右分流，2例房间隔完整无分流）。②右心发育不良胎儿的卵圆孔血流均为正常的右向左分流，而静脉导管血流频谱均出现心房收缩期反转血流（100％），其中6例（85．7％）动脉导管出现反向供血。结论多普勒超声检测胎儿心室发育不良的血流动力学变化，能为深入认识胎儿心室发育不良的循环特点及其产前诊断提供有价值的信息。

Objective To investigate the clinical significance of the hemodynamic alterations in fetus with ventricular hypoplasia by Doppler echocardiography. Methods Retrospective analysis were made in 14 fetuses with hypoplastic left heart syndrome （HLHS） and 7 fetuses with hypoplastic right heart （HRH） for their fetal echocardiography and follow-up findings. Hemodynamic alterations in three fetal shunt pathways, ductus venosus （DV） ,foramen ovale （FO） and ductus arteriosus （DA） ,were investigated. Results （DThe Doppler flow profiles in DV of the 14 fetuses with HLHS were normal. 8 fetuses with severe HLHS （57.1%） had opposite flows between AO and PA. 6 of them also had abnormal flows in FO, 4 were restrictive with left to right interatrial shunts and the atrial septums of the other 2 were intact. Q7 fetuses with HRH had normal right to left interatrial shunts in FO, but their DV all had reversal flows during atrial contraction （100%）. 6 fetuses with H RH （85.7%） had retrograde flows in DA. Conclusions Doppler echocardiography detection of the hemodynamic alterations in fetus with ventricular hypoplasia can provide valuable information about the circulation characteristics and prenatal diagnosis.