经腹部超声心动图在孕早期胎儿先天性心脏病诊断中的应用价值

The application of transabdominal echocardiography in diagnosing fetal congenital heart diseases and image characteristics in the first trimester

目的探讨经腹部超声心动图在孕早期胎儿先天性心脏病(CHD)诊断中的应用价值。方法对2012年6月至2015年4月在南京军区福州总医院产前检查的1 288例高危孕妇孕早期(孕13周)胎儿行超声心动图检查,分析孕早期胎儿CHD超声表现及其特征,追踪所有入选孕妇的妊娠过程及胎儿临床结局。结果经腹部超声心动图在1288例胎儿中诊断CHD 16例(1.2%,16/1288),其中复杂型CHD 11例,单纯型CHD 5例。孕早期胎儿CHD超声心动图表现:(1)法洛四联症2例,超声心动图显示主动脉轻度增宽,未见明显骑跨,室间隔缺损,肺动脉狭窄,远端显示不清。(2)左心发育不良综合征2例,孕13周超声心动图显示左心明显缩小,右心扩大,二尖瓣闭锁,室间隔缺损,主动脉轻度狭窄伴血流速度加快,肺动脉增宽。(3)大动脉共干I型2例,超声心动图显示心底部仅见1条大血管,未见明显分支血管,并见室间隔缺损。(4)完全型房室间隔缺损4例,超声心动图显示心内膜正常十字交叉结构消失,房室共瓣。(5)单心室1例,超声心动图未见室间隔回声,仅见一单心室。(6)主动脉缩窄1例,孕13周超声心动图显示心内结构正常,主动脉内径正常;孕16周超声心动图显示左心偏小,主动脉峡部轻度狭窄。(7)室间隔缺损4例,超声心动图显示室间隔连续中断,断端边缘回声增强。1例小的室间隔缺损误诊,漏诊室间隔缺损和永存左上腔静脉各1例。超声诊断CHD后孕妇选择终止妊娠11例,出生5例,随访结果与产前诊断均相符。结论经腹部超声心动图可早期诊断多数胎儿CHD,尤其表现为四腔心异常的CHD,但对CHD异常大血管起源、分支及走向的显示存在一定困难,有待中孕期进一步确诊,早孕期经腹部超声心动图检查有重要临床应用价值。

Objective To investigate the methodology and image characteristics of transabdominal echocardiography in diagnosing fetal congenital heart diseases in the first trimester. Methods Total 1288 pregnancies with high risk factor underwent transabdominal echocardiography and were diagnosed as congenital heart diseases during the 13 th week of gestation from June 2012 to April 2015. We analyzed manifestation and classification feature in echocardiography of fetal congenital heart disease, and followed entire pregnancy and clinical outcome of all pregnant women selected. Results Sixteen（1.2%, 16/1288） cases were diagnosed as congenital heart disease by echocardiography and were confirmed by clinic. Eleven cases were complex congenital heart diseases and 5 cases were single congenital heart diseases. Manifestations in echocardiography of fetal congenital heart disease were as followed in the first trimester：（1） Two cases of tetralogy of Fallot showed： slightly widened aorta without typical aortic riding sign, ventricular septal defect and pulmonary stenosis without branch.（2） Two cases of hypoplastic left heart syndrome showed： significant small left heart, enlarged right heart, mitral valve atresia, ventricular septal defect, slightly stenosed aorta with increased blood flow rate and pulmonary artery dilation.（3） Two cases of truncus arteriosus-I showed： only one large vessel in heart bottom without branch and ventricular septal defect.（4） Four cases of complele atrioventricular septal defect showed： no endocardial cross structure and common atrioventricular valve.（5） One case of single ventricle showed： single ventricle without ventricular septum.（6） One case of aortic coarctation showed： left ventricular smaller than normal and aortic isthmus stenosis in 16 week of gestation which were normal in the 13 th week of gestation.（7） Four cases of ventricular septal defect showed： interruption of ventricular septal continuity and increased echogenicity of broken ends margin. One case of small ventricular septal defect was misdiagnosised. One case of ventricular septal defect and one case of forever left vena cava were missed. Eleven cases of pregnancy were interrupted and 5 cases delivered after diagnosised, of which the results of transabdominal ultrasound were confirmed with follow-up. Conclusions Transabdominal echocardiography can diagnose majority fetal congenital heart diseases, especially abnormality in four chamber view, but it is difficult to show the origination, branch or trend of the aorta. Transabdominal echocardiography is an important method in the early diagnosis of fetal congenital heart diseases.