胎儿功能性三尖瓣反流的超声随访观察

Follow-up value of ultrasound in fetal tricuspid regurgitation

目的探讨胎儿功能性三尖瓣反流的超声随访价值。方法选择中度及以上三尖瓣反流、压差大于20mmHg（1mmHg=0．133kPa）、右房右室增大的44例胎儿进行观察。自孕24周至胎儿出生后9周，每4周观测一次三尖瓣反流速度、反流压差、心腔大小、有无心包腔或胸腔积液等。结果44例中有18例（40．9％）在出生前好转；25例（56．8％）于出生1～62d后三尖瓣反流消失或转为极轻度，其中3例出生前反流速度达4．2m／s以上，压差达70mmHg以上，出现心力衰竭征象，提前出生后逐渐恢复正常；1例（2．3％）于出生后因中度三尖瓣持续反流并发严重右心衰竭经治疗无效死亡。结论功能性三尖瓣高速反流绝大部分预后良好。当胎儿三尖瓣反流压差超过70mmHg或有右心衰竭征象时应提前分娩，以防宫内意外发生。

Objective To explore the follow-up value of ultrasound in fetal tricuspid regurgitation. Methods 44 fetuses who presented with moderate tricuspid regurgitation with differential pressure over 20 mmHg, dilation of right atria and ventricles were chosen as the observation group.Examinations,in terms of the degree,velocity and differential pressure of reflux,size of heart chamber and the presence perieardial or pleural effusion were carried out once every four weeks from 24 weeks of pregnancy to 9 weeks after birth. Results 40.9% （18/44） of eases had been getting better before birth.The degree of regurgitation of 56.8% （25/44） eases significantly decreased or even disappeared from 1 to 62 days after birth.Especially,3 eases whose regurgitation velocity reached to 4.2 m/s with the differential pressure over 70 mmHg as well as onset of heart failure symptoms had been recovered gradually after born in advance.1 ease （2.3%） with the persistence of both tricuspid regurgitation and heart failure symptoms after birth died in right heart failure, even though using different active treatments, such as oxygen, strong heart and diuresis. Conclusions High-speed tricuspid regurgitation in fetuses without pathological changes can be almost reversed, and the prognosis is good.Once the fetal tricuspid regurgitation pressure is over 70 mmHg or a fetus appears the onset of heart failure symptoms,pre-term delivery should be advised in a bid to prevent accidents in uterine cavity.