超声心动图诊断胎儿完全型肺静脉异位引流

Echocardiographic diagnosis of total anomalous pulmonary venous connection in fetus

目的探讨胎儿完全型肺静脉异位引流(TAPVC)产前诊断线索及超声心动图特征。方法回顾性分析于我院经超声诊断并经尸体检查或出生后超声心动图证实的14胎TAPVC胎儿的二维及多普勒图像的特征。结果产前诊断12胎TAPVC,其中心上型9胎,心内型2胎,心下型1胎。TAPVC的产前诊断线索及超声心动图特征:二维超声四腔心切面未显示肺静脉角,左心房后壁光滑;左心房后壁与降主动脉间距离增大;可见共同肺静脉腔和垂直静脉。产前超声心动图漏诊2胎,经出生后超声心动图证实均为心内型TAPVC。14胎TAPVC中,4胎伴肺静脉引流途径梗阻。结论胎儿超声心动图可诊断TAPVC并准确分型;脉冲和彩色多普勒超声可显示肺静脉回流途径梗阻。

Objective To explore the echocardiographic clues and features of total anomalous pulmonary venous connection（TAPVC）in fetuses.Methods Echocardiograms of 14 fetuses with TAPVC which were confirmed by autopsy or postnatal echocardiography were analyzed retrospectively.Results There were 12 fetuses with TAPVC diagnosed prenatally,of which 9fetuses were supracardiac type,2fetuses were intracardiac type and 1fetus was infracardiac type.The echocardiographic clues and characteristics of 14 fetuses with TAPVC included absent angle of pulmonary veins,smooth back wall of the left atrium,increasing distance between left atrium and descending aorta,visualization of confluent vessel behind the left atrium and a vertical vein.Two fetuses miss diagnosed prenatally were confirmed to be intracardiac type TAPVC by postnatal echocardiography.Among the 14 fetuses,4fetuses presented an obstructed pulmonary venous pathway.Conclusion TAPVC can be diagnosed and classified by fetal echocardiography,and spectral and color Doppler can reveal the presence of an obstructed pulmonary venous pathway.