超声多切面连续扫查诊断胎儿永存左上腔静脉

Ultrasound multi-section continuous scanning in diagnosis of fetal persistent left superior vena cava

目的探讨超声多切面连续扫查诊断胎儿永存左上腔静脉(PLSVC)的应用价值。方法回顾性分析133胎PLSVC的超声特点及其合并畸形等情况,观察PLSVC不同类型间和/或与超声表现类似的其他疾病的鉴别点。结果133胎中,单纯PLSVC 81胎,其中孤立性左上腔静脉1胎;52胎合并心内外结构畸形,合并心内畸形35胎、心外畸形11胎、同时合并心内外畸形6胎。合并心内畸形中,以室间隔缺损(VSD)、法洛四联症(TOF)和迷走右/左锁骨下动脉多见,合并心外畸形中以单脐动脉和鼻骨缺失多见。孕妇年龄≥35岁的PLSVC胎儿合并其他心内外畸形发生率明显高于<35岁者(P<0.05)。结论四腔心切面和三血管气管切面是发现PLSVC重要线索的常用且重要的诊断切面;结合PLSVC走行特点进行连续动态追踪扫查,可明显提高产前超声对于胎儿PLSVC及其合并心内外畸形的诊断率。

Objective To explore the application value of ultrasound multi-section continuous scanning in diagnosis of fetal persistent left superior vena cava(PLSVC).Methods The ultrasonic characteristics and malformations of PLSVC in 133 fetuses were retrospectively analyzed.The differential points of different types of PLSVC or other diseases with the same ultrasonic manifestations were explored.Results Among 133 fetuses,81 were found with singe PLSVC,including 1 fetuse of isolated left superior vena cava,while 52 were found with internal and/or external structural malformations,including 35 with internal malformation,11 with external malformation and 6 with both internal and external malformations.Ventricular septal defect(VSD),tetralogy of Fallot(TOF)and aberrant right/left subclavian artery were more common in fetueses with intracardiac malformations,whereas single umbilical artery and nasal bone were more common in those with extracardiac malformations.The incidence of fetal PLSVC with other cardiac and external malformations in≥35 years old pregnant women was more than that in those<35 years old(P<0.05).Conclusion Four chamber view and three vessel trachea view were common and important diagnostic sections for finding important clues of fetal PLSVC during prenatal ultrasound screening.Combined with anatomic characteristics of PLSVC,continuous and dynamic follow-up scanning could significantly improve the diagnostic rate of fetal PLSVC and relative cardiac and external malformations.