超声心动图诊断胎儿冠状静脉窦扩张

Echocardiography in diagnosis of fetal coronary sinus dilation

目的探讨胎儿冠状静脉窦(CS)扩张的超声诊断思路。方法回顾性分析145胎正常冠状静脉窦胎儿(正常组)和72胎CS扩张胎儿(CS组)的资料,于非标准四腔心切面下显示CS长轴,测量CS的矢状切面面积。采用二维超声结合彩色多普勒超声对所有胎儿分别进行胎儿四腔心切面、左右心室流出道切面、三血管切面、大动脉短轴切面、主动脉弓切面、动脉导管弓切面及腔静脉长轴切面扫查,观察CS的特点。结果胎儿CS矢状切面面积与孕周呈正相关(正常组:r=0.954,P<0.05;CS组:r=0.904,P<0.05),同孕周正常组胎儿CS矢状切面面积小于CS组(P均<0.01)。产前超声诊断72胎CS扩张的胎儿中,52胎为永存左上腔静脉,15胎为完全型肺静脉异位引流,5胎右心压力负荷增大。结论胎儿CS矢状切面的面积与孕周呈正相关;胎儿心脏超声检查发现CS扩张时应同时考虑其他心内畸形;临床应通过多切面、多角度扫查,分析和诊断引起CS扩张的病因。

Objective To explore the ultrasonographic method in fetal coronary sinus （CS） dilation. Methods Totally 145 normal fetuses （normal group） and 72 fetuses of CS dilation （CS group） diagnosed prenatally were retrospectively reviewed. The long axis of coronary sinus was displayed in the non-standard four chamber view and the area of the sagittal view of CS was measured. Transverses scans combined with color Doppler were used to acquire four chamber view, left and right ventricular outflow tract views, three vessel view. In addition, sagittal scans with color Doppler were used to get short-axis view at the level of great arteries, vena cava long axis view, aortic arch view, and ductal arch view. The characteristics of CS were observed. Results CS area of sagittal view was positively correlated with gestational age （normal group： r=0.954, P〈0.05; CS group： r=0.904, P〈0.05）. In the same gestational weeks, the CS area of the sagittal view in the normal group was less than that in the CS group （all P〈0.01）. In CS group, 52 fetuses were persistent left superior vena cava, 15 fetuses were total anomalous pulmonary venous connection, 5 fetuses were associated with right heart pressure overload. Conclusion Fetal CS sagittal section area is positively correlated with gestational age. When the fetal heart ultrasonography found CS dilation, other intracardiac malformations should also be considered. The etilogies of CS dilation should be analyzed clinically through multi-slice, multi-angle scanning.