胎儿心脏三尖瓣反流在胎儿心脏病中的临床诊断价值

The clinical diagnosis value of Tricuspid regurgitation in the fetal cardiac diseases by fetal echocardiography

目的探讨彩色多普勒超声心动图在胎儿心脏发育过程中对三尖瓣反流的诊断价值,并评价胎儿预后情况。方法所有受检孕妇孕龄均大于22周,对胎儿心脏进行常规:四腔心、左右流出道及流入道、主肺动脉弓进行二维结构检查,并利用彩色多普勒对各瓣膜区进行检查,利用脉冲多普勒及连续多普勒技术对发现的三尖瓣反流进行探测。结果共检查出胎儿心脏三尖瓣反流病例206例,将三尖瓣反流病例分为以下四类:致命性心脏发育畸形合并三尖瓣反流;可手术治疗胎儿心脏病合并三尖瓣反流;需要提前分娩和药物治疗的胎儿心脏病合并三尖瓣反流;生后能够自愈的三尖瓣反流。结论胎儿心脏超声心动图检查对胎儿心脏三尖瓣反流的详尽描述和定量分析,对胎儿心脏疾病的诊断和评价胎儿预后具有重要的临床意义。

Objective To discuss the clinical diagnostic value of tricuspid regurgitation （TR） and to evaluate the fetal prognosis during the premature diagnosis of fetal heart diseases by fetal echocardiography. Methods All the fetal hearts in middle and late gestation were examined by 4-chamber view, right and left inlet and outlet view, aortic and pulmonic arch view, and the abnormal blood flow （TR） were detected and measured by colored-, pulsed-and continous Doppler techniques. 206 cases of fetal heart diseases with TR were found. Results The 206 cases of fetal heart diseases with TR diagnosed by fetal echocardiography were divided into four groups： 1） fatal fetal cardiac anomalies with TR; 2） operable fetal cardiac anomalies with TR; 3） fetal heart diseases with TR requiring premature delivery and medication treatment; 4） self-healing TR after birth. Conclusion The fetal TR has important clinical significance in the diagnosis of fetal heart diseases and echocardiography can be used to evaluate the prognosis of fetal heart diseases by the detailed examination and quantititive analysis of TR.