产前超声诊断胎儿右位主动脉弓

Prenatal ultrasound diagnosis of fetal right aortic arch

目的探讨胎儿右位主动脉弓的产前超声诊断方法及声像图特征,提高其产前检出率。方法回顾性分析我院产前超声诊断的9例右位主动脉弓胎儿的产前超声表现,并对其产前超声特征进行总结分析。结果 9例右位主动脉弓胎儿中5例为单纯性右位主动脉弓,1例为双主动脉弓,1例合并多囊肾,1例合并室间隔缺损型肺动脉闭锁,1例合并室间隔缺损型肺动脉闭锁、右心室双出口和永存左上腔静脉。9例右位主动脉弓在三血管-气管切面上表现为主动脉弓位于气管的右侧,在非标准左心室流出道切面上表现为主动脉弓与升主动脉之间的夹角增大。其中6例为右位主动脉弓合并迷走左锁骨下动脉,与左位动脉导管构成包绕气管和食管的"U"型血管环,1例双主动脉弓形成包绕气管和食管的"O"形血管环,2例为右位主动脉弓合并头臂动脉镜像分支、动脉导管连接于左锁骨下动脉,未形成血管环。9例中4例引产后经尸体解剖证实,5例经产后超声心动图检查证实。结论胎儿右位主动脉弓具有特征性的产前超声诊断图像,掌握右位主动脉弓的产前超声图像特征,可有效检出胎儿右位主动脉弓,三血管-气管切面和非标准左心室流出道切面是产前筛查和诊断右位主动脉弓的重要切面。

Objective To improve prenatal detection rate of fetal right aortic arch by reviewing prenatal features. Methods A total of 9 reuses with right aortic arch were retrospectively reviewed. Their prenatal sonogram features were analyzed also. Results The 9 cases had fetal right arch, including 4 cases with isolated right aortic arch, two cases with double aortic arch, one case with polycystic kidney, one case with pulmonary atresia of ventricular septal defect, one case with pulmonary atresia of ventricular septal defect, double outlet of right ventricle and persistent left superior vena cava. Aortic arch of the 9 cases was located on the right of trachea by three-vessel trachea view, the angle between aortic arch and aortic ascendens was increased by left ventricular outflow tract view of non-standard. Five cases were right aortic arch With aberrant left subclavian artery and left ductus arteriosus formed U-shaped vascular rings. Two cases of double aortic arch formed O-shaped vascular rings. The other two cases with brachiocephalic artery mirror branch and ductus arteriosus that connected to aberrant left subclavian artery were not formed vascular rings. Four cases were proved by anatomic and five cases were proved by neonatal echocardiography in 9 cases. Conclusion Fetal right aortic arch has ultasonographic features based on these features, it is possible to diagnose fetal right aortic arch. The three-vessel trach view and left ventricular outflow tract view of non-standard are import view for prenatal screening and diagnosis of right aortic arch.