胎儿超声心动图在评估室间隔完整型肺动脉闭锁中的应用价值

Application value of fetal echocardiography in the evaluation of pulmonary atresia with intact ventricular septum

目的探讨胎儿超声心动图在评估室间隔完整型肺动脉闭锁(PA/IVS)中的应用价值。方法回顾性选取2017年10月至2020年12月在河北生殖妇产医院诊断为PA/IVS的胎儿29例。超声心动图测量右心室与左心室上下径比值(RV/LV)、三尖瓣流入时间与心动周期时间比值(TVID/CCL)、三尖瓣环与二尖瓣环内径比值(TV/MV)、三尖瓣Z值(TV-Z)等参数,观测静脉导管频谱形态、房室瓣反流量、动脉导管内径和血流方向、有无心包积液、有无合并冠状动脉异常及右心室依赖性冠状动脉循环(RVDCC)。依据右心室流入部、小梁部、漏斗部结构是否存在,对29例胎儿进行分型,并分析其超声心动图特征。结果29例PA/IVS产前超声心动图均可见动脉导管逆向血流供应肺动脉。24例可见三尖瓣大量反流;5例三尖瓣反流不明显或为少-中量反流。18例静脉导管A波缺失或反向,11例静脉导管频谱正常。29例PA/IVS胎儿Ⅰ型12例、Ⅱ型9例、Ⅲ型3例、Ⅳ型5例,不同分型PA/IVS的RV/LV、TVID/CCL、TV/MV、TV-Z等参数存在明显差别。3例合并冠状动脉异常,其中1例右心室心肌内异常血流信号穿行(Ⅳ型),2例合并冠状动脉-右心室交通(Ⅲ型1例,Ⅳ型1例),这3例考虑合并RVDCC。结论超声心动图对胎儿PA/IVS的产前诊断、分型及预后评估具有重要价值;产前超声心动图多指标联合应用有助于PA/IVS的准确评估,可为产后治疗提供可靠依据。

Objective To assess the value of fetal echocardiography in the evaluation of pulmonary atresia with intact ventricular septum(PA/IVS).Methods Clinical data of 29 fetuses with PA/IVS diagnosed by prenatal echocardiography at Hebei Maternity Hospital from October 2017 to December 2020 were analyzed retrospectively.Right ventricle length/left ventricle length(RV/LV),tricuspid valve inflow duration/cardiac cycle length(TVID/CCL),tricuspid valve annulus/mitral valve annulus(TV/MV),and tricuspid Z score(TV-Z)were measured by echocardiography.The flow spectrum of the ductus venosus(DV),atrioventricular valve regurgitation,internal diameter and blood flow direction of the ductus arteriosus(DA),the presence of pericardial effusion or not,the presence of combined coronary artery abnormalities or not,and right ventricular dependent coronary circulation(RVDCC)were observed to carry out clinical typing for the 29 fetuses and analyze echocardiographic characteristics.Results Prenatal echocardiography in all the 29 cases of PA/IVS showed the reverse flow of the DA to the pulmonary artery.Massive tricuspid regurgitation was observed in 24 cases.Not obvious tricuspid regurgitation or low-to-moderate tricuspid regurgitation was observed in five cases.Missing or reverse A-wave of the DV was observed in 18 cases.Normal venous duct spectrum was observed in 11 cases.According to clinical typing results,there were 12 cases of typeⅠPA/IVS,9 cases of typeⅡ,3 cases of typeⅢ,and 5 cases of typeⅣamong the 29 PA/IVS fetuses,and there were significant differences in RV/LV,TVID/CCL,TV/MV,TV-Z,and other parameters among fetuses with different types of PA/IVS.Abnormal coronary artery was found in 3 cases,1 case with abnormal blood flow signal across the myocardium of the right ventricle(typeⅣ),and 2 cases complicated with coronary artery-right ventricular fistula(1 case with typeⅢand 1 case with typeⅣ);these three cases were considered to be complicated with RVDCC.Conclusion Echocardiography has significant value in prenatal diagnosis,clinical typing,and prognosis evaluation of PA/IVS.Combined application of multiple echocardiographic indexes is helpful for the accurate evaluation of PA/IVS,thus providing a basis for postpartum treatment.