法洛四联症合并动脉导管缺如或动脉导管血流逆灌的产前超声诊断

Prenatal echocardiography in diagnosis of tetralogy of Fallot complicated with absent ductus arteriosus or inverse flow in ductus arteriosus

目的 探讨胎儿法洛四联症（TOF）合并动脉导管缺如或动脉导管血流逆灌的肺动脉主干及其分支发育情况.方法 回顾性分析2010年1月至2014年6月46例胎儿法洛四联症的超声心动图检查结果,根据是否存在动脉导管分为单纯TOF组、TOF合并动脉导管缺如组、TOF合并动脉导管血流逆灌组;对比分析各组肺动脉主干及其分支的发育情况.结果 46例胎儿中,单纯TOF组26例,TOF合并动脉导管缺如组12例,TOF合并动脉导管血流逆灌组8例;TOF合并动脉导管血流逆灌组肺动脉主干发育最差,其主动脉与肺动脉主干内径的比值与单纯TOF组、TOF合并动脉导管缺如组比较差异均有统计学意义[（2.07±0.78）比（1.54±0.47）、（1.40±0.15）,均P＜0.05],各组间主动脉与肺动脉分支内径比值及肺动脉分支内径≤2 mm比例差异均无统计学意义（均P＞0.05）.结论 TOF出现动脉导管血流逆灌时肺动脉主干发育较单纯TOF和TOF合并动脉导管缺如者更差,在胎儿期诊断TOF时,要重视肺动脉的发育情况,并要注意动脉导管的检查,特别是动脉导管血流逆灌.

Objective To explore the developmental state of pulmonary artery trunk and the branch vessels in fetus with tetralogy of Fallot （TOF） complicated with absent ductus arteriosus or inverse flow in ductus arteriosus by prenatal echocardiography.Methods Echocardiography results of 46 fetuses with TOF from January 2010 to June 2014 were retrospectively analyzed.The cases were divided into isolated TOF group （group Ⅰ）,TOF complicated with absent ductus arteriosus group （group Ⅱ） and TOF complicated with inverse flow in ductus arteriosus group （group Ⅲ）.The analysis of pulmonary artery trunk and branch vessels were evaluated and compared among three groups.Results In 46 cases,there were 26 cases in group Ⅰ,12 cases in group Ⅱ and 8 in group Ⅲ.The main pulmonary artery trunk was worst in group Ⅲ compared with group Ⅱ and Ⅲ;the diameter ratio of aorta and pulmonary artery trunk in Ⅲ group was the highest [（2.07 ±0.78） vs （1.54 ± 0.47）,（1.40 ± 0.15）,all P 〈 0.05].There were no statistical differences in diameter ratio of aorta and pulmonary artery branch vessels among three groups,so was the proportion of fetal with pulmonary artery branch diameter ≤2 mm （all P 〉 0.05）.Conclusion In TOF fetuses complicated with inverse flow in ductus arteriosus,the development of pulmonary artery trunk is the worse compared with isolated TOF and TOF complicated with absent ductus arteriosus.