胎儿主动脉弓离断的产前超声诊断

Prenatal Ultrasound Diagnosis of Fetal Interruption of Aortic Arch

目的通过对主动脉弓离断(IAA)胎儿的超声声像特征进行分析,探讨胎儿IAA的诊断思路及方法,提高产前超声检出率。资料与方法选择产前心脏大血管异常的323例胎儿,行胎儿超声心动图检查,获取心脏四腔心切面、左心室流出道切面、右心室流出道切面、主动脉弓切面、导管弓切面、三血管气管切面的图像,总结IAA的声像图特征,并通过MRI、出生后CT、超声或尸解追踪最后结果。结果13例IAA胎儿中,A型9例,B型3例,C型1例。3例为严重的主动脉弓缩窄。IAA的升主动脉内径细小,升主动脉内径与肺动脉内径比为0.47±0.40。9例伴室间隔缺损,6例导管粗大;三血管气管切面示主动脉弓内径异常细小;四腔心切面示左心狭小,左、右心室不对称。结论三血管气管切面是诊断主动脉弓畸形的敏感且有效的切面,其他切面可以作为诊断的重要辅助切面。

Purpose Sonographic features were analyzed to explore the pathway and of fetus with interruption aortic arch （IAA） method for diagnosing fetal IAA, so as to improve detection rate of prenatal ultrasound. Materials and Methods A total of 323 cases of fetus with prenatal heart and great vessel abnormalities were enrolled, and fetal echocardiography was executed for each of them to obtain the images of heart four chamber view, left ventricular outflow tract section, aortic arch section, catheters bow section and three-vessel trachea view to summarize the sonographic features of IAA, and the final results of each case was traced with MRI, CT examination after birth, ultrasound or autopsy. Results For the 13 IAA cases, nine cases were A-type, three cases were B-type and one case was C type. Three cases were with severe coarctation of the aorta. Inside diameter of ascending aorta in IAA was smaller, with ascending aorta and pulmonary artery diameter ratio being only 0.47±0.40. Eleven cases were with ventricular septal defect, and six cases with ductal arch thick; abnormally small of the inner diameter of the aortic arch was observed with three-vessel trachea view; left heart narrowing and asymmetry of the whole heart was shown through the four-chamber view. Conclusion Three-vessel trachea view is a sensitive and effective section for the diagnosis of aortic arch anomalies, while the other sections are important auxiliary for the diagnosis.