超声在胎儿心脏结构性异常中的诊断价值

Value of prenatal ultrasound in diagnosis of structural fetal heart abnormality

目的探讨超声在胎儿心脏结构性异常中的诊断价值。方法 48例心脏结构性异常胎儿,结合引产后解剖或出生后超声资料,总结常见心脏结构性异常类型,并分析漏误诊原因。结果 48例胎儿心脏结构性异常中,室间隔缺损12例,心内膜垫缺损7例,法洛四联症6例,肺动脉狭窄5例,右室双出口3例,大动脉转位3例,其他13例;早孕期（11~14周）4例,占8.33%,中孕期37例,占77.08%;晚孕期7例,占14.58%;漏诊室间隔缺损2例,法洛四联症1例,漏诊率6.25%;误诊膜周部间隔缺损1例,误诊率2.08%。结论超声可以初步筛查早孕期胎儿心脏异常,中晚孕期超声可大大提高胎儿心脏结构性异常的检出率。

Objective To evaluate the value of prenatal ultrasound in the diagnosis of fetal cardiac structural malformations. Methods The data of pathologic anatomy and postnatal echocardiogram results of 48 fetuses with abnormalities in cardiac structure were retrospectively analyzed. The types of cardiac malformations were summarized. The reasons of misdiagnosis and missed diagnosis were analyzed. Results Among 48 cases of structural fetal heart abnormalities, there were 12 cases of ventricular septal defects, 7 cases of endocardial pad defect, 6 cases of Tetralogy of Fallot, 5 cases of pulmonary stenosis, 3 cases of double outlet of right ventricle and transposition of great artery, and 16 eases of other abnormalities. There were 4 cases （8.33% ,4/48） in early pregnancy （11 -14weeks）, 37 cases （77.08%, 37/51 ） in the middle pregnancy and 7 cases （14.58% ,7/51 ） in late pregnancy. Two cases of ventricular septal defect and 1 case of Tetralogy of Fallot missed the diagnosis and the rate of missed diagnosis was 6.25% （3/48）. One case of perimembranous ventricular septal defect was misdiagnosed and the misdiagnosis rate was 2.08%. Conclusion Cardiac structural abnormalities can be screened by ultrasonography at early pregnancy, and the detection rate could be greatly improved by systemic prental ultrasound and fetal echocardiogram at the mid and late pregnancy.