产前超声心动图诊断胎儿主肺动脉间隔缺损

Fetal echocardiography for diagnosis of aortopulmonary septal defect

目的探讨超声心动图诊断胎儿主肺动脉间隔缺损的价值,总结其超声心动图特征。方法对5例2013年6月至2015年11月在南京大学医学院附属鼓楼医院产前诊断中心行胎儿超声心动图检查诊断为主肺动脉间隔缺损胎儿的超声图像特征进行分析,并追踪妊娠过程和临床结局。结果 5例主肺动脉间隔缺损胎儿超声心动图有共同声像特征：三血管观声像图显示主动脉与主肺动脉之间出现回声失落即缺损（大小1.5~3.9 mm）,左心室流出道和右心室流出道观显示缺损部位及其距半月瓣和（或）肺动脉分叉的距离,彩色多普勒超声显示缺损处为双向或肺动脉流向主动脉的彩色血流信号,频谱多普勒可见相应的血流流向及分布频谱。5例胎儿引产尸检均证实为主肺动脉间隔缺损。结论胎儿超声心动图可早期发现主肺动脉间隔缺损,对指导产科和出生后临床处理、降低畸形胎儿的出生率及提高出生患儿的生存质量均有重要临床价值。

Objective To investigate the prenatal echocardiography manifestation of aortopulmonary septal defect（APSD） and clinical significance. Methods Imaging characteristics for 5 fetuses with APSD who underwent fetal echocardiography at our hospital from June 2013 to November 2015 were retrospectively reviewed. All cases were followed up for pregnancy process and clinical results. Results Echocardiographic characteristics of APSD were a defect between the ascending aorta and the trunk of the pulmonary artery in the three vessels view. The defect sizes were ranged from 1.5 to 3.9 mm. The defect location to semilunar valve and /or pulmonary artery bifurcation could be displayed in the left and right ventricular outflow tract views. Color and pulse Doppler showed bidirectional or pulmonary-to-aorta shunt flow pattern. All the five APSD cases were confirmed by autopsy. Conclusions APSD can be diagnosed by fetal echocardiography. Prenatal diagnosis is important for obstetrical management, early surgical intervention and prognosis.