产前超声诊断胎儿右位主动脉弓34例临床分析

Prenatal ultrasound diagnosis of fetal right aortic arch: clinical analysis of 34 cases

目的探讨胎儿右位主动脉弓的超声声像图特征及合并畸形情况,评价产前超声在胎儿右位主动脉弓诊断中的价值。方法收集产前超声诊断的34例右位主动脉弓胎儿超声声像图特征及合并畸形情况,并对其进行总结分析。结果 34例右位主动脉弓胎儿中,引产5例,29例顺利出生。经出生后超声检查及引产后病理检查,诊断符合率达100%。胎儿右位主动脉弓的产前超声特征为三血管-气管切面及主动脉弓位于气管右侧,主动脉弓和肺动脉之间的"V"形角度增大,两者间可见软组织影像及一个管状回声,旋转探头追踪其走行仔细辨别可判定该管状结构为气管。34例右位主动脉弓胎儿中包括右位主动脉弓并左位动脉导管30例,右位主动脉弓并右位动脉导管1例,双主动脉弓1例,镜面右位主动脉弓2例。34例右位主动脉弓胎儿中有25例(73.5%)为孤立性右位主动脉弓, 9例(26.5%)合并心内及心外结构异常。结论胎儿右位主动脉弓畸形是一种胎儿血管变异,可合并心内或心外其他畸形,因此必须对胎儿各结构进行全面扫查。产前超声检查可对胎儿右位主动脉弓进行准确诊断。

Objective To investigate the ultrasonic features and associated abnormalities of the fetal right aortic arch and evaluate the diagnostic value of prenatal ultrasound. Methods The ultrasonic features and associated abnormalities of 34 cases diagnosed with the right aortic arch by prenatal ultrasound were collected and analyzed. Results Among 34 fetuses, 5 received induced labor and 29 were successfully delivered. The diagnostic accuracy was calculated as 100% according to postnatal ultrasonic detection and pathological examination after induced labor. Prenatal ultrasonic features of the fetal right aortic arch included that three-vessel and tracheal view and the aortic arch were located in the right of the trachea, the “V”- shaped angle between the aortic arch and pulmonary artery was increased and soft tissues and tube-shaped echo were observed between them. The rotating probe was utilized to trace the stretching pattern and identified the tubular structures as the trachea. Among 34 fetuses of the right aortic arch, 30 were complicated with the left patent ductus arteriosus, one with the right patent ductus arteriosus, one with double aortic arch and two with the mirror right aortic arch, respectively. Among them, 25 cases (73.5%) were diagnosed with isolated right aortic arch and 9 (26.5%) were complicated with intra- and extra-cardiac malformations. Conclusions Fetal right aortic arch abnormality is a variation of the fetal vessels, which can be complicated with intra- or extracardiac malformations. Therefore, comprehensive scan of the fetus should be carried out. Fetal right aortic arch malformation can be accurately diagnosed by prenatal ultrasonic examination.