产前超声心动图诊断胎儿室间隔缺损

Prenatal echocardiography in diagnosis of fetal ventricular septal defect

目的观察产前超声心动图检查诊断胎儿室间隔缺损(VSD)的价值。方法对3 826胎胎儿行产前超声心动图检查,并与产后复查超声心动图检查及引产后尸体解剖结果进行对照,计算产前超声心动图诊断VSD的正确率、误诊率及漏诊率。结果产前超声心动图诊断61胎(61/3 826,1.59%)VSD,其中单纯性VSD 36胎(36/3 826,0.94%),VSD合并其他心脏畸形25胎(25/3 826,0.65%);经产后复查超声或引产后尸体解剖,最终共确诊76例(76/3 826,1.99%)VSD,包括51例(51/3 826,1.33%)单纯性VSD、25例(25/3 826,0.65%)VSD合并心脏其他畸形。产前超声心动图诊断单纯性VSD的准确率为58.82%(30/51),漏诊率为41.18%(21/51),误诊率为1.06‰(4/3 775);诊断VSD合并其他心脏畸形的准确率为96.00%(24/25),漏诊率为4.00%(1/25),误诊率为0.26‰(1/3 801)。结论超声心动图在产前诊断胎儿VSD中具有重要临床价值,可为选择治疗方案、评估预后等提供重要参考依据。

Objective To explore the value of prenatal echocardiography in diagnosis of fetal ventricular septal defect （VSD）. Methods Prenatal echocardiography was performed on 3 826 fetuses, and the results were compared with those of postnatal echocardiography or autopsy findings. The diagnostic accuracy, misdiagnosis rate and missed diagnosis rate of prenatal echocardiography for VSD were calculated. Results Among 3 826 fetuses, VSD was found in 61 fetuses （61/3 826, 1.59%） with prenatal echocardiography, including simple VSD in 36 fetuses （36/3 826, 0.94%） and VSD complicated with other heart malformations in 25 fetuses （25/3 826, 0.65%）. According to the results of autopsy and postnatal echocardiography, the final diagnosis of VSD was found in 76 cases （76/3 826, 1.99%）, of which simple VSD was found in 51 cases （51/3 826, 1.33 %）, VSD complicated with other heart malformations were found in 25 fetuses （25/ 3 826, 0.65%）. The diagnostic accuracy, missed diagnosis rate and misdiagnosis rate of simple VSD with prenatal echocardiography was 58.82% （30/51）, 41.18% （21/51） and 1.06‰ （4/3 775）, respectively. The diagnostic accuracy, missed diagnosis rate and misdiagnosis rate of VSD complicated with other heart malformations with prenatal echocardiography was 96.00% （24/25）, 4.00% （ 1/25 ） and 0.26‰ （ 1/3 801 ）, respectively. Conclusion Echocardiography has important clinical value in prenatal diagnosis of fetal VSD, which can provide important references for treatment plan and prognosis evaluation.