胎儿永存动脉干产前诊断难点与策略探讨

Prenatal diagnosis of fetal truncus arteriosus communis:difficulties and tactics

目的总结胎儿永存动脉干产前误诊的原因,提高永存动脉干产前诊断符合率。方法回顾分析9例产前诊断为永存动脉干病例超声心动图资料,总结其图像特征,分析永存动脉干产前误诊原因。结果永存动脉干典型声像图为肺动脉起源于干动脉或肺动脉缺如(肺的血液供应来自降主动脉发出侧支循环),4例胎儿永存动脉干均经引产尸体解剖证实,因二维灰阶图像未紧密联合二维彩色多普勒血流图像仔细回放分析,3例主动脉闭锁产前误诊为永存动脉干;2胎儿肺动脉闭锁产前误诊为永存动脉干。结论产前正确诊断永存动脉干有一定难度,三血管气管切面在胎儿永存动脉干产前诊断中具有重要的临床意义,三血管气管切面超声二维灰阶图像联合二维彩色多普勒血流图像,综合分析才能提高胎儿永存动脉干产前诊断符合率。

Objective To summarize the reasons for false-positive diagnosis and tactics for correct prenatal diagnosis of truncus arteriosus communis （TAC）. Methods Prenatal US images of 9 infants with sonographic diagnosis of TAC confirmed by autopsy （4） were reviewed and the reasons for mistaken diagnosis were analyzed. Results TAC was confirmed in 4 infants at autopsy with absent or anomalous origin of pulmonary artery from the communis artery. Three cases of aortic atresia and two cases of pulmonary artery atresia were misdiagnosed as TAC on prenatal gray-scale US without using color Doppler. Conclusions US diagnosis of TAC is difficult. The combination of gray-scale and color Doppler assessment of the three vessels and trachea view is helpful for the prenatal diagnosis.