右位主动脉弓胎儿动脉导管走形的解剖分析

The pathologic analyses of arterial duct with right aortic arch in fetus

目的:对右位主动脉弓胎儿动脉导管走形进行分析,提高该疾病诊断的精准性.方法:回顾分析我院经超声心动图畸形筛查发现先天性心脏畸形伴右位主动脉弓的胎儿进行尸体解剖,检查胎儿心血管畸形及动脉导管走形情况,对其动脉导管形态走向进行分析总结.结果:胎儿先天性心脏病伴右位主动脉弓46例,男29例,女17例,孕期为孕18~35周,平均(25.17±3.45)周,①右位动脉导管16例,其中肺动脉主干位于主动脉左侧11例,伴发主要心血管畸形:单心室5例,肺动脉闭锁4例,肺静脉异位引流5例,永存左上腔静脉3例;肺动脉主干位于主动脉右侧5例,伴发主要心内畸形:右位心3例,并列心耳2例.②左侧动脉导管12例,右位主动脉弓镜面分支7例,不形成血管环,伴发主要心内畸形:法洛四联症4例,永存左上腔静脉3例;5例右位主动脉弓+左锁骨下动脉迷走,形成血管环,伴发主要心内畸形:右心室双出口1例,法洛四联症1例.③7例动脉导管不与肺动脉主干相连,均伴有肺动脉闭锁,④3例动脉导管不与主动脉相连,均伴有法洛四联症,⑤8例动脉导管缺如,伴发主要心内畸形:4例共同动脉干,1例法洛四联症,2例单心室,1例右心室双出口.结论:右位主动脉弓胎儿右位动脉导管多见,不同类型的动脉导管走形有不同解剖特点,伴随不同的先天性心血管畸形.

Objective:To analyze the anatomical characteristics of arterial duct with right aortic arch in fetus improve the accuracy of diagnosis.Methods:We reviewed 46 cases who were found congenital heart disease with right aortic arch by echocardiography during pregnancy,examined the fetal cardiovascular malformation and arterial duct and analyzed the morphology of the arterial duct.Results:There were 46 cases of congenital heart disease with right aortic arch,29 males and 17 females.①There were 16 cases of right aortic arch with right arterial duct.There are 11cases that the main pulmonary artery was located on the left side of the aorta and the major cardiovascular malformations including 5 cases of single ventricle,4 cases of pulmonary atresia,5 cases of anomalous pulmonary venous drainage and 3 cases of persistent left superior vena cava.There are 5 cases that the main pulmonary artery was located on the right side of the aorta and the major cardiovascular malformations including 3 cases of dextrocardia,2 cases of concomitant auricle.②There were 12 cases of right aortic arch with left arterial duct.There were 7 cases of right aortic arch with mirror-image branching without vascular ring,and the major cardiovascular malformations including 4 cases with tetralogy of Fallot,3 cases with persistent left superior vena cava.There were 5 cases of right aortic arch with an aberrant left subclavian and vascular ring,and the cardiovascular malformations including 1 case of double outlet of right ventricle and 1 case with tetralogy of Fallot.③There were 7 cases that the arterial duct was not connected with the main pulmonary artery,and all of them were accompanied with pulmonary atresia.④There were 3 cases that the arterial duct were not connected with the aorta and all of them were accompanied with tetralogy of Fallot.⑤There were 8 cases of ab-sence of arterial duct,and the major cardiovascular malformations including 1 case of tetralogy of Fallot,2 cases of single ventricle,1 case of right ventricular double outlet.Conclusions:The right arterial duct is more com-mon in right aortic arch.Different types of arterial duct have different anatomic characteristics and accompanied by different congenital cardiovascular malformations.