超声心动图在胎儿单纯性室间隔缺损产前诊断、病理分型、围生期结果及预后的评估价值

Evaluation value of echocardiography in prenatal diagnosis,pathological classification,perinatal outcome and prognosis of fetal simple ventricular septal defect

目的探讨超声心动图在胎儿单纯性室间隔缺损(I-VSD)的产前诊断、病理分型、围生期结果及预后的诊断价值。方法筛选2014年1月‐2017年5月该院按受超声心动图检查的胎儿3 788胎的临床资料,其中单纯性室间隔缺损胎儿30胎。根据二维超声心动图显示情况对病例进行病理解剖分型。对明确诊断的胎儿单纯性室间隔孕期每4周复查1次,及出生后至1岁每3个月复查1次,进行超声心动图随访。比较不同病理分型及不同缺损内径间的闭合率。结果 30例胎儿中,膜部缺损18例(60.0%),漏斗部缺损1例(3.3%),肌部缺损10例(33.3%),膜部与肌部同时缺损1例(3.3%)。18例膜部缺损宫内闭合2例(11.1%),出生后1年内闭合7例(38.9%),闭合率为50.0%;10例肌部缺损宫内闭合1例(10.0%),出生后1年内闭合9例(90.0%),闭合率为100.0%;漏斗部缺损与多发性缺损至出生后1年均未闭合。不同病理分型间闭合率比较结果为:肌部缺损>膜部缺损>漏斗部缺损/多发性缺损,差异具有统计学意义(P <0.05)。缺损内径≤3.0 mm者20例,其中宫内闭合2例(10.0%),出生后1年内闭合18例(90.0%),闭合率为100.0%;缺损内径为3.1～5.0 mm者8例,宫内闭合0例,出生后1年内闭合2例(25.0%),闭合率为25.0%;>5.0 mm者2例,均至出生后1年均未闭合。不同缺损内径组间闭合率比较结果为:≤3.0 mm者>3.1～5.0 mm者>5.0 mm者,差异具有统计学意义(P <0.05)。结论超声心动图可做为早期诊断胎儿单纯性室间隔的一种可靠、安全、无创的检查手段,能及时监测闭合情况,并对手术时机的选择提供可靠依据。

【Objective】To investigate the diagnostic value of echocardiography in prenatal diagnosis, pathological classification, perinatal outcome and prognosis of fetal simple ventricular septal defect(VSD).【Methods】The clinical data of 3788 fetuses underwent echocardiography in our hospital from January 2014 to May 2017 were selected, in which there were 30 fetuses with simple VSD. Pathological classification of cases was performed according to the two-dimensional echocardiography. The definitely diagnosed fetal simple VSD during pregnancy was reviewed once every 4 weeks, which was reviewed once every 3 months after birth to the age of 1 year old, and the echocardiography was followed up. The closing rate between different pathological types and different defects was compared.【Results】Of the 30 fetuses, there were 18 with membranous defects(60.0%), 1 with infundibular defects(3.3%), 10 with muscular defects(33.3%), and 1 with membranous defects and muscular defects(3.3%). In 18 cases of membranous defects, 2 cases were intrauterine closure(11.1%), 7 cases were closed within 1 year after birth(38.9%), and the closure rate was 50%; in 10 cases of muscular defects, 1 case was intrauterine closure(10.0%), 9 cases were closed within 1 year after birth(90.0%), and the closure rate was 100.0%; the infundibular defects and multiple defects were not closed from birth to 1 year of age. The closing rates of different pathological types were as follows: muscle defect > membranous defect > infundibular defect/multiple defect, and the difference was statistically significant(P <0.05). There were 20 cases with defect diameter less than or equal to 3.0 mm, including 2 cases of intrauterine closure(10.0%) and 18 cases closed within 1 year after birth(90.0%), the closing rate is 100.0%; the defect diameter was 3.1~5.0 mm in 8 cases, of which there was no intrauterine closure, 2 cases were closed within 1 year after birth(25.0%), and the closure rate was 25.0%; the defect diameter was larger than 5.0 mm in 2 cases, and they were not closed from birth to 1 year of age. The closure rates of different defect diameter groups was: ≤ 3.0 mm > 3.1~5.0 mm > 5.0 mm, and the difference was statistically significant(P <0.05).【Conclusion】Echocardiography can be a reliable, safe and noninvasive method for early diagnosis of fetal ventricular septal closure, which can timely monitoring and provide a reliable basis for the timing of the operation.