胎儿心脏超声检查及出生后随访的临床意义

Clinical significance of the postnatal follow-up for fetal echocardiography

目的 对比分析孕期行胎儿心脏超声检查及其出生后超声随访的结果,探讨出生后超声随访的临床意义.方法 对1 819例孕期在我中心行胎儿心脏超声检查的胎儿进行随访观察,并与出生后超声结果进行对比分析.结果 1 819例中检出胎儿室间隔缺损（VSD）78例,孕期自然愈合11例;出生后心脏超声复查检出84例VSD中有17例胎儿心脏超声检查未发现明显异常,孕期及出生后检出VSD共95例.出生后超声新检出永存左上腔静脉3例,肺动脉瓣狭窄3例,冠状动脉-肺动脉瘘9例,三尖瓣下移畸形1例,右房、右室大伴二、三尖瓣关闭不全1例.除1例孕期诊断巨大房间隔缺损或单心房出生后超声复查为中央型房间隔缺损外,其余孕期检出的胎儿心脏结构异常者与出生后超声复查结果一致.结论 室间21隔缺损、肺动脉瓣狭窄、冠状动脉-肺动脉瘘等部分心血管畸形在孕期行胎儿心脏超声心检查时因受多种因素影响并不能全部检出,出生后尽早超声复查至关重要.对可根治型心血管畸形出生后应早期评估,选择最佳治疗时间.

Objective To compare the results of fetal and postnatal echocardiography and to explore the clinical significance of echocardiographic follow-up after birth.Methods The characteristics of fetal and postnatal echocardiography performed during pregnancy and after birth in 1 819 cases in our center were comparatively analyzed.Results Both fetal and postnatal echocardiography had been performed in all 1 819.Seventy-eight cases were diagnosed with ventricular septal defect （VSD） during pregnancy,11 cases of them were closed spontaneously during pregnancy.After birth,84 cases of VSD were detected.Among them,17 cases of VSD were misdiagnosed as normal during pregnancy.Totally,95 cases of VSD were detected both during pregnancy and after birth.Defects detected only after birth included：3 cases of persistent left superior vena cava,3 cases of pulmonary stenosis,9 cases of coronary artery-pulmonary artery fistula,1 case of Ebstein＇s anomaly,1 case of enlargement of right atrium and ventricle with mitral and tricuspid insufficiency.None of coronary artery-pulmonary artery fistula had been detected during pregnancy.One prenatally diagnosed huge ASD or single atrium turned out to be a central ostium secundum ASD after birth.The echocardiographic findings of the rest cases with cardiac structural anomalies after birth were consistent with fetal echocardiographic diagnosis.Conclusions Some cardiovascular malformations,such as VSD,pulmonary stenosis,coronary artery-pulmonary artery fistula,etc,may be misdiagnosed by fetal echocardiography because of influences of many contributory factors.Therefore,postnatal echocardiography should be performed as soon as possible after birth.Early assessment is specifically necessary for neonates with cardiovascular malformations,which can be cured by surgery,to choose the best time of treatment.