胎儿卵圆孔通道血流受限产前超声分型的临床价值

The Clinical Value of Echocardiography in the Classification of foramen ovale channel restriction

目的探讨胎儿卵圆孔通道血流受限(Foramen Ovale Channel Restriction,FOCR)产前超声分型的临床价值。方法选取2013年1月至2018年1月在我院行三维结构检查并分娩的12456例胎儿,临床诊断胎儿FOCR的35例,其中原发型FOCR 26例,继发型FOCR 9例,测量胎儿各心腔大小、主动脉及肺动脉瓣上的峰值血流速度、卵圆孔通道内径、卵圆孔通道峰值流速(Vm-FVO)、肺静脉峰值速度(Vm-PV)。另随机选取对应孕周的胎儿480例,经超声测量以上参数并产后随访证实为正常的胎儿作为对照组。分析以上测量结果与妊娠结局的关系,并对新生儿进行超声心动图动态随访。结果 (1)正常对照组测量结果见表1,(2)原发性FOCR:以Vm-FVO≥40cm/s及Vm-PV≥40cm/s为其诊断标准,灵敏度:92.3%,特异度:88.9%。随访结果表明,本组预后均良好。继发性FVO R/C:以Vm-FVO<20cm/s及Vm-PV<20cm/s为其诊断标准,灵敏度:67%,特异度:100%。本组预后与心内原发病严重程度相关。结论产前超声检测Vm-FVO及Vm-PV对FOCR分型的特异性和敏感性均较高,能为FOCR胎儿的预后评估提供有价值的信息。

Objective To explore the clinical value of echocardiography in the classification of foramen ovale channel restriction（FOCR）.Methods There were 12456 fetus undergoing screening and delivering in our hospital from January2011 to December 2017,of which 35 cases were clinically diagnosed as FOCR,included 26 cases of primary type and 9 cases of secondary type.During the echocardiography,parameters of the fetal heart below were measured and recorded：chamber size,the peak velocity of aortic valve（Vm-AO）,the peak velocity of main pulmonary arty（Vm-MPA）,diameter of foramen valve ovale（FVO）,the peak velocity of foramen ovale（Vm-FVO）,the peak velocity of pulmonary vein（Vm-PV）.Another 480 cases of fetus,which had the same measurements above at relevant gestational weeks and were proved to be normal by postpartum follow-up,were selected as control group.The relationship between measurement result and pregnancy outcome was analysed,and the newborns were followed up by echocardiography.Results（1）Measurement data of the control group were demonstrated in table 1.2 For primary FOCR,the sensitivity and specificity was 92.3 %,88.9%,with diagnostic criteria：Vm-FVO≥40 cm/s as well as Vm-PV≥40 cm/s.This group showed a favorable prognosis.2.For secondary FOCR,he sensitivity and specificity was 67%,100%,with diagnostic criteria：VmFVO〈20 cm/s as well as Vm-PV〈20 cm/s.Prognosis of this group was associated with the primary intracardiac disease.Conclusion Echocardiography showed high sensitivity and specificity in the Classification of foramen ovale channel restriction by detecting Vm-FVO and Vm-PV,which provided important information to prognosis of the fetal.