三血管切面测量主动脉及肺动脉诊断孕中晚期胎儿大动脉异常

Ultrasonic measurement of aorta and pulmonary on three-vessel view in screening large arteries abnormities during the second and third trimesters

目的通过在三血管切面测量主动脉(AO)、肺动脉(PA)内径,计算其内径比值(PA/AO比值),观察产前超声诊断孕中晚期胎儿大动脉异常的价值。方法对594胎20～32周正常胎儿,于三血管切面测量AO、PA内径,计算PA/AO值,观察其正常值范围;对3000胎20～32周胎儿行大血管畸形的产前筛查。结果 20～32周胎儿AO、PA内径随着孕周增加而增加,但PA/AO值较为恒定(1.0～1.2)。大血管畸形包括AO狭窄/缩窄、法洛四联症、左和(或)右心发育不良、PA狭窄/闭锁、肺动脉瓣缺如综合征等胎儿的PA/AO值明显异常。结论胎儿AO、PA内径及PA/AO值可作为产前初步筛查胎儿心脏病、尤其是胎儿大动脉畸形的有价值的指标。

Objective To explore the value of ultrasonic measurement of aorta（AO） and pulmonary artery（PA） diameter in screening fetal large arteries abnormities on three-vessel view during the second and third trimester.Methods Totally 594 singleton fetuses at 20—32 weeks of gestation were prospectively evaluated.The internal diameters of PA and AO were measured,and the ratio between them（PA/AO） was calculated on three-vessel view.According to the normal diameter of PA,AO and the ratio of PA/AO,3000 fetuses for 20—32 weeks were screened for congenital heart disease.Results The internal diameter of AO and PA showed positive correlation with the increasing of gestational age,but the PA/AO ratio remained comparatively steady,which was about 1.0—1.2.The ratio of PA/AO was obviously different in a variety of fetal cardiovascular defects,including hypoplasia of aortie arch,coarctation of the aorta,aortie stenosis,pulmonary artery stenosis,Fallots tetralogy and ventricular hypoplasia,etc.Conclusion Diameter of PA,AO and the ratio PA/AO are valuable in primary screening of fetal congenital heart disease,especially for large artery abnormities.