三血管及三血管气管切面在超声产前诊断胎儿心脏大血管畸形中的应用价值

Value of three-vessel view plus three vessels and trachea view in ultrasonic diagnosis of fetal heart and great vessel malformations

目的:回顾性分析三血管及三血管气管切面在超声产前诊断胎儿心脏大血管畸形中的应用价值。方法 :统计我院66例大血管畸形胎儿超声心动图检查情况,回顾分析四腔心、流出道、三血管、三血管气管切面在各个疾病的超声心动图特点,对患者进行复诊、随访。结果:大血管畸形在三血管及三血管气管切面有特征性表现,出现大血管排列顺序、内径、血流方向、分支等异常,结合彩色多普勒血流显像,表现出"V""O""C""U""Ioo""o Vo"型结构,该切面在主动脉弓离断、缩窄,右位主动脉弓,永存动脉干,永存左上腔静脉全部出现异常表现。而四腔心、左、右室流出道等切面在部分大血管畸形不出现异常表现。二者联合观察可提高胎儿先心病的诊断率。大血管畸形最常合并的心内畸形是室间隔缺损,最常合并的心外畸形是单脐动脉。结论:三血管及三血管气管切面可提示胎儿大血管畸形,尤其对于主动脉弓离断、缩窄,右位主动脉弓,永存动脉干,永存左上腔静脉有重要的诊断价值。有利于为孕妇及早作出产前诊断,减轻身心痛苦,提高生育质量。

Objective： To retrospectively explore the value of three-vessel view （3VV） plus three vessels and trachea view （3VT） in heart and great vessel malformations by fetal echocardiography. Methods： Sixty-six fetuses with heart and great ves- sel malformations who received fetal echocardiography were enrolled, and the uhrasounic images of four-chamber view, outflow tract view, 3VV and 3VT were retrospectively analyzed. All the fetuses were followed up. Results： There were characteristic performances （the abnormal sequence, diameter, direction of blood flow, aortic branch） in 3VV and 3VT in fetuses with great vessel malformations. Combined with color Doppler flow imaging, these performances looked like the shapes of ＂V＂＂O＂＂C＂＂U＂ ＂Ioo＂＂oVo＂. Abnormal manifestations occured in the 3VV and 3VT in all cases of coarctation of aortic arch（CAA）, interruption of aortic arch （IAA）, right aortic arch （RAA）, persistent truncus arteriosus （PTA） and persistent left superior vena cava（PLSVC）. However, no abnormalities in four-chamber view, outflow tract view and so on were displayed in part fetuses with great vessel malformations. Combined all the views together, the diagnostic rate of congenital heart disease can be increased. Great vessel malformations mostly combined with ventricular septal defect and single umbilical artery. Conclusion： 3VV and 3VT played important roles in prenatal diagnosis of great vessel malformations, especially for CAA, IAA, RAA, PTA and PLSVC. It is beneficial for gravida to get prenatal diagnosis, alleviate the pain and improve the quality of reproduction.