胎儿双主动脉弓的产前超声心动图诊断

Prenatal diagnosis of fetal double aortic arch by echocardiography

目的探讨双主动脉弓胎儿产前超声心动图特征及产前诊断临床意义。方法对南京医科大学附属苏州医院2012年1月至2013年2月产前超声心动图检出的5例双主动脉弓胎儿的超声心动图特征、分型及临床结局进行总结分析。结果 5例双主动脉弓胎儿超声心动图表现:(1)三血管气管观中主动脉与动脉导管失去正常"V"字形结构,升主动脉发出左、右主动脉弓围绕气管,彩色多普勒血流成像示环状血流信号围绕气管。(2)超声心动图示5例胎儿中3例为右主动脉弓优势型,2例为左、右主动脉弓平衡型。(3)1例(例2)胎儿合并膜部室间隔缺损、永存左上腔静脉;1例(例4)胎儿合并半椎体畸形,3例胎儿未发现合并其他畸形。5例胎儿均行磁共振检查并随访至引产或产后3个月,随访检查均证实胎儿为双主动脉弓畸形。结论双主动脉弓是胎儿严重的先天性心脏病,超声心动图是产前首选的诊断方法,三血管气管观是诊断双主动脉弓的有效切面。

Objective To investigate the echocardiographic features and clinical significance of prenatal diagnosis of fetal double aortic arch （DAA）. Methods Totally 21 596 fetuses underwent fetal echocardiography in Nanjing Medical University Affiliated Suzhou Hospital and five cases were diagnosed as DAA by echocardiography. Echocardiographic characteristics, types and outcomes of these five cases were summarized retrospectively. Results Five fetal cases were diagnosed as DAA by fetal echocardiography. 1. Prenatal echocardiographic features： In three-vessel and trachea view, the normal ＂V＂-shaped confluence formed by the aortic arch and ductal arch was absent. However, the ascending aorta bifurcated into the left and right aortic arch and these two arches encircled the trachea. Annular flow signal around trachea was seen on color Doppler imaging. 2. Types： Among these five fetuses, three cases were called right arch predominant type, whose diameters of right arches were larger than those of left arches. The other two were balanced type, whose diameters of right arches were almost equal to those of left arches. 3. Accompanied malformations： Case 2 was accompanied with membranous ventricular septal defect and permanent left superior vena tara. Case 4 was associated by hemivertebrae. The other three cases had no other abnormalities. 4. Follow-up： These five cases were all arranged for MRI subsequently and all were confirmed by follow-up till to the induction of labor or three months after birth. Conclusions Double aortic arch is a kind of severe congenital heart disease. Echocardiography is the first choice to diagnose DAA prenatally and three-vessel and trachea view are the effective cross sections in the diagnosis of double aortic arch.