胎儿冠状静脉窦扩张形态特征对病因的鉴别价值

Application value of morphological characteristics of fetal dilated coronary sinus in etiological diagnosis

目的探讨胎儿冠状静脉窦(CS)扩张于后四腔心切面的管壁形态特征及其对病因的鉴别价值。方法回顾性分析10125例孕中期行胎儿产科结构筛查的单胎胎儿,CS最大内径>4 mm者诊断为CS扩张。按照其原发心血管畸形分为永存左上腔静脉组、心内型完全型肺静脉异位引流组、静脉导管组、无顶冠状静脉窦组和右心系统病变组,分析5组病例于后四腔心切面上CS管壁的形态特征及其与原发心血管畸形的内在关系,并提出明确诊断的鉴别要点。结果研究期间共83例胎儿符合CS扩张的诊断,产前诊断率约0.82%。5组胎儿CS扩张后的形态学特征各有特点:永存左上腔静脉组胎儿59例,CS扩张呈“宽轨”征,确诊切面为永存左上腔静脉长轴观;心内型完全型肺静脉异位引流组胎儿3例,CS扩张呈“烟斗”征,确诊切面为后四腔心观;静脉导管组胎儿4例,CS扩张呈“腹膨”征,确诊切面为静脉导管长轴观;无顶冠状静脉窦组胎儿3例,CS扩张呈“缺口”征;右心系统病变组胎儿14例,CS扩张呈“窄轨”征,确诊切面为大动脉短轴观。结论不同病因导致的胎儿CS扩张于后四腔心切面上显示的CS管壁形态特征呈现一定的规律性。产前诊断医师掌握此规律有助于提高对相关畸形的理解、诊断和评估能力。

Objective To investigate the morphological characteristics of the dilated fetal coronary sinus(CS)and its application value in etiological diagnosis.Methods A total of 10125 singleton fetuses who underwent obstetric ultrasound scan during the second trimester were enrolled in the study,in which,the patients whose maximum diameter of CS was more than 4 mm were diagnosed as CS dilation.All the patients with CS dilation were divided into five groups according to their primary cardiovascular malformations:left superior vena cava group(PLSVC),intracardiac total anomalous pulmonary venous connection group(ITAPVC group),venous catheter group(VC group),unroofed coronary sinus syndrome group(UCSS group)and lesions of right heart system group(LRH group).The morphological characteristics of the dilated CS in the posterior four-chamber view as well as the intrinsic relationships between CS dilation and the primary cardiovascular malformation were respectively analyzed.Diagnostic points were determined.Results There were 83 fetuses with CS dilation,with prenatal diagnosis rate being about 0.82%.And 59 cases in PLSVC group showed a“wide tract”sign and the confirmed plane for prenatal ultrasound diagnosis was the long axis view of PLVCS.3 cases in ITAPVC group showed a“tobacco pipe-shaped”sign and the confirmed plane for prenatal ultrasound diagnosis was the posterior four chamber view.4 cases in VC group showed a“abdominal swelling”sign and the confirmed plane for prenatal ultrasound diagnosis was the long axis view of VC.14 cases in LRH group showed a“narrow track”sign and the confirmed plane for prenatal ultrasound diagnosis was also the posterior four-chamber view.Conclusion The morphological characteristics of the dilated fetal coronary sinus(CS)are regular,which can help doctors’understand,diagnose and evaluate in clinical practice.