超声心动图诊断胎儿孤立性完全性肺静脉异位引流

Echocardiography in diagnosis of fetal isolated total anomalous pulmonary venous connection

目的探讨超声心动图诊断胎儿孤立性完全性肺静脉异位引流（TAPVC）的价值。方法回顾性分析17例胎儿孤立性TAPVC的产前超声资料,观察分析其二维超声心动图及CDFI表现,测量TAPVC胎儿左心室与右心室横径比值（LV/RV）、左心房与右心房横径比值（LA/RA）,并与同孕周正常胎儿预测值进行统计学比较。结果 15例孤立性TAPVC胎儿中,心上型9例,心内型4例,心下型2例;4例见血流梗阻,其中心上型3例,心下型1例,CDFI示梗阻处血流信号明亮,梗阻处流速1.0～1.6m/s。15例孤立性TAPVC胎儿的LV/RV为0.75～0.99,平均0.88±0.08,小于同孕周正常胎儿预测值（t=-3.305,P=0.005）。LA/RA为0.68～1.00,平均0.84±0.11,亦小于同孕周正常胎儿预测值（t=-3.320,P=0.005）。结论超声心动图可用以胎儿期诊断孤立性TAPVC。

Objective To explore the value of echocardiography in the diagnosis of fetal isolated total anomalous pulmonary venous connection（TAPVC）.Methods The prenatal ultrasound data of 17 cases with fetal isolation TAPVC were retrospectively analyzed.The two-dimensional echocardiography and CDFI images were observed,and then the left ventricular and right ventricular diameter ratio（LV/RV）,left atrium and right atrium diameter ratio（LA/RA）were measured,these results were statistically compared with the predict values of normal fetus with the same gestational age.Results There were fifteen cases of isolated TAPVC,of which nine fetuses were supracardiac type,four fetuses were intracardiac type and two fetuses were infracardiac type.Four fetuses presented blood flow obstruction,including three fetuses of supracardiac type,one fetus of infracardiac type.CDFI showed bright color at the obstruction with the flow velocity 1.0—1.6m/s.The LV/RV（range 0.75—0.99,mean 0.88±0.08,t=-3.305,P=0.005）and LA/RA（range 0.68—1.00,mean 0.84±0.11,t=-3.320,P=0.005）of 15 fetuses with isolated TAPVC were smaller than those in normal fetuses with the same gestational age.Conclusion Echocardiography could be used in the diagnosis of fetal isolated TAPVC.