产前超声诊断胎儿动脉导管狭窄的临床价值

Clinical value of prenatal ultrasound in diagnosis of fetal ductus arteriosus stenosis

目的探讨产前超声诊断胎儿动脉导管狭窄的临床价值及其对临床分娩的指导意义。方法回顾性分析产前超声诊断的12例动脉导管狭窄胎儿的超声表现及围产结局，总结其声像图特点。结果12例胎儿动脉导管管腔细窄，内径1．6～2．1mm，彩色多普勒显示动脉导管内呈五彩血流，频谱多普勒呈单峰连续递减型高速分流频谱，收缩期峰值血流速度256-404cm／s，舒张末期血流速度90-205cm／s；12例胎儿均伴有右心房、室扩大，肺动脉增宽，三尖瓣中重度反流，最大反流速度324-515cm／s，最大跨瓣压差41～106mmHg。7例胎儿急诊剖宫产分娩，5例胎儿催产素引产分娩。12例新生儿中11例为足月儿，1例为早产儿，出生后经1～3月的超声心动图随访，心脏结构及功能均恢复正常。结论产前超声诊断胎儿动脉导管狭窄具有重要临床价值，并能评估胎儿右心功能，对指导临床分娩具有重要意义。

Objective To study the clinical value of prenatal ultrasound in diagnosis of fetal ductus arteriosus stenosis and the guiding significance for clinical delivery. Methods Ultrasound images and perinatal outcome of 12 cases of ductus arteriosus stenosis diagnosed by prenatal ultrasound were retrospectively analysed, the sonographic features were summarized. Results Fetal ductus arteriosus was thin in 12 cases with inner diameter of 1.6 - 2.1 mm. Color Doppler flow imaging showed multicolored blood flow in ductus arteriosus,spectral Doppler showed single peak continuous decreasing high-speed shunt spectrum,peak systolic velocity 256- 404 cm/s, end diastolic velocity 90 - 205 cm/s. Twelve fetuses were associated with right atrial and ventricular dilatation, pulmonary artery widened and moderate to severe tricuspid regurgitation, maximum reflux velocity 324- 515 cm/s, maximum transvalvular pressure gradient 41 - 106 mmHg. There were 7 cases of emergency cesarean section delivery and 5 cases of oxytocin induced labor delivery, 11 cases were full-term infants and 1 case was premature infant. 12 fetuses were followed-up after birth by I to 3 months of echocardiography until the cardiac structure and function returned to normal. Conclusions Prenatal ultrasound has important clinical value in diagnosis of fetal ductus arteriosus stenosis, it is helpful to assess the fetal right heart function and guide the clinical delivery.