超声心动图对法洛四联症的临床诊断分析

Analysis on clinical diagnosis of tetralogy of Fallot by echocardiography

目的探讨超声心动图在法洛四联症(TOF)临床诊断中的应用价值,为临床诊断提供参考依据。方法采集2015年5月-2016年11月在该院妇产科行产前超声检查的TOF患者26例,分析胎儿TOF声像图的特征表现及诊断效果。结果经超声诊断仪检测TOF胎儿26例,其中典型TOF 23例,肺动脉极重度狭窄2例,1例伴有Ebsetin畸形。TOF声像图特征表现为室间隔缺损、主动脉骑跨及肺动脉狭窄。不同切面4CV、4CV+AR-SAV、4CV+VOTV、4CV+VOTV+3VT和4CV+VOTV+3VT+AR-SAV对TOF的诊断率分别为52.11%、65.37%、78.35%、92.12%和96.77%,联合诊断正确率均显著高于4CV,差异均有统计学意义(均P<0.05)。结论超声心动图对孕妇产前诊断胎儿TOF具有很高的临床价值,不同切面联合诊断能提高TOF的诊断率,并能动态观察胎儿心室流出道梗阻、肺动脉、瓣膜的发育及进展情况。

Objective To explore the application value of echocardiography in clinical diagnosis of tetralogy of Fallot（ TOF）. Methods From May 2015 to November 2016,26 patients with TOF receiving prenatal ultrasonography in Department of Gynecology and Obstetrics in Affiliated Hospital of Inner Mongolia Medical University were collected,the ultrasonographic characteristics and diagnostic efficacy of fetal TOF were analyzed. Results Twenty-six fetuses were diagnosed as TOF by ultrasonography,including 23 fetuses with typical TOF,2 fetuses with extreme serious pulmonary stenosis,and one fetus with Ebsetin malformation. The ultrasonographic characteristics of TOF included ventricular septal defect,dextropositioned aorta,and pulmonary stenosis. The diagnostic rates of different views（ 4 CV,4 CV ＋ AR-SAV,4 CV＋VOTV,4 CV ＋ VOTV ＋ 3 VT,and 4 CV ＋ VOTV ＋ 3 VT ＋ AR-SAV） for TOF were 52. 11%,65. 37%,78. 35%,92. 12%,and96. 77%,respectively. The accurate rate of combined diagnosis was statistically significantly higher than that of 4 CV（ P〈0. 05）. Conclusion The clinical value of echocardiography in diagnosis of fetal TOF is high,combined diagnosis of different views can improve the diagnostic rate of TOF,which can dynamically observe fetal ventricular outflow tract obstruction,development of pulmonary artery and valves.