超声心动图诊断以三尖瓣反流为首发征象的胎儿心血管异常

Echocardiography in diagnosis of fetal cardiovascular abnormalies with tricuspid regurgitation as first symptom

目的探讨超声心动图诊断以三尖瓣反流为首发征象的胎儿心血管异常的价值。方法收集产前超声诊断心血管异常合并三尖瓣反流胎儿128胎,分析超声心动图检查对胎儿心血管异常的检出率及病因特点。结果 128胎中,三尖瓣结构异常组18胎、压力负荷增加组74胎,容量负荷增加组36胎,三组间胎儿三尖瓣反流严重程度的差异有统计学意义（χ^2=11.157,P=0.025）,与三尖瓣结构异常组（χ^2=4.425,P=0.109）及容量负荷增加组（χ^2=10.495,P=0.005）相比,压力负荷增加组更易产生重度反流。三尖瓣结构异常组中,与Ebstein畸形相比,三尖瓣发育不良更易发生重度三尖瓣反流（P=0.015）;压力负荷增加组中,动脉导管提前收缩多表现为三尖瓣轻度反流,与之相比,肺动脉狭窄（P=0.001）、肺动脉闭锁（P〈0.001）更易发生重度反流。结论对于以三尖瓣反流为首发征象的胎儿,详细有序的超声心动图检查,能有效降低胎儿心血管异常的误诊及漏诊。

Objective To explore the value of echocardiography in diagnosis of fetal cardiovascular abnormalies with tricuspid regurgitation as first symptom.Methods Totally 128 fetal congenital heart disease with tricuspid regurgitation were collected.The echocardiography detection rate and the characteristic of fetal cardiovascular abnormalities were analyzed.Results The 128 fetal with congenital heart disease included three groups：tricuspid structure abnomor group（n=18）,pressure increased group（n=74）and capacity increased group（n=36）.There was a significant difference among three groups in the severity of tricuspid regurgitation（χ~2=11.157,P=0.025）.Compared with tricuspid structure abnomor group（χ~2=4.425,P=0.109）and capacity increased group（χ~2=10.495,P=0.005）,pressure increased group mainly caused moderate and severe tricuspid regurgitation.In tricuspid structure abnomor group,compared with Ebstein malformation,three cusp valve dysplasia was more likely to occur in severe cases（P=0.015）.In pressure increased group,arterial catheter shrinkage in advance displayed mild,but pulmonary stenosis（P=0.001）and pulmonary atresia（P0.001）displayed severe three cusp valve dysplasia.Conclusion As to screen the fetal with tricuspid regurgitation as first symptom,detailed and orderly fetal echocardiography can be used to reduce the misdiagnosis and missed diagnosis of fetal cardiovascular abnormalities effectively.