超声测量左房后空间距离诊断胎儿完全性肺静脉异位引流的临床价值

Clinical value of left atrium-descending aorta distance measured on ultrasound images in the diagnosis of fetal total anomalous pulmonary venous connection

目的探讨超声测量左房后空间距离诊断胎儿完全性肺静脉异位引流(TAPVC)的临床价值。方法采用前瞻性研究和病例对照研究方法,选取2018年1月至2019年6月来广州市番禺区中心医院超声科行中孕期胎儿结构筛查的孕妇,采用美国GE Voluson E8型和Philips EPIQ 7C型彩色多普勒超声诊断仪,在标准四腔心切面测量左房后空间距离,并仔细检查肺静脉,孤立性TAPVC胎儿为阳性组。后期对所有对象的妊娠结局进行随访。正常胎儿中随机选取200例为对照组。应用相关性分析研究正常胎儿中左房后空间距离和孕周之间的相关性,比较阳性组和对照组胎儿左房后空间距离平均值。结果共有2156例孕妇接受检查并完成测量,完成率为100%。其中1786例随访成功,370例失访。1786例病例中,4例胎儿产前超声诊断为孤立性TAPVC,其中3例为心内型,1例为心上型,新生儿心脏超声或尸检证实。200例正常胎儿中,左房后空间距离与孕龄呈弱相关(r^(2)=0.35,P<0.0001)。阳性组胎儿的左房后空间距离平均值(5.4 mm)明显大于对照组胎儿(2.1 mm)。结论左房后空间距离超声测量简单,且受孕周影响小,通过量化分析诊断TAPVC,具有一定创新性,左房后空间距离增宽对提示胎儿TAPVC有一定价值。由于本研究阳性样本量较小,左房后空间距离增宽对诊断TAPVC的临床意义,尚需大样本、多中心研究进一步证实。

Objective To investigate the clinical value of ultrasonic measurement of left atrium-descending aorta distance in the diagnosis of fetal total anomalous pulmonary venous connection(TAPVC).Methods Pregnant women who underwent fetal anatomy scans in the second trimester of pregnancy in Central Hospital of Panyu District between January 2018 and June 2019 were included in this study using prospective and case-control study methods.The GE Voluson E8 and Philips EPIQ 7 ultrasound machines were used to measure the left atrium-descending aorta distance in the four-chamber view of the fetal heart.Pulmonary vein was carefully examined.Fetuses with isolated TAPVC were included in the positive group.The pregnancy outcomes were followed up during all participants.200 healthy fetuses were randomly selected and included in the control group.The correlation between left atrium-descending aorta distance in normal fetuses and gestational weeks was analyzed.The average value of left atrium-descending aorta distances was compared between positive and control groups.Results A total of 2156 pregnant women received fetal anatomy scans,with the completion rate of 100%.Among them,1786 pregnant women were successfully followed up and 370 were lost to follow up.Among the 1786 pregnant women,four fetuses were diagnosed with isolated TAPVC,consisting of three fetuses with intracardiac type TAPVC and one fetus with supracardiac type TAPVC,as confirmed by prenatal ultrasound.The left atrium-descending aorta distance in 200 normal fetuses was weakly related to gestational weeks(r^(2)=0.35,P<0.0001).The mean left atrium-descending aorta distance in the positive group was significantly greater than that in the control group(5.4 mm vs.2.1 mm).Conclusion Ultrasonic measurement of left atrial posterior spatial distance is simple and it is hardly affected by gestational weeks.It is innovative to diagnose TAPVC through quantitative analysis.The widening of left atrium-descending aorta distance has a certain value in suggesting fetal TAPVC.The sample size is small in this study.Multi-center studies involving larger sample sizes are needed to further validate the clinical significance of widened left atrium-descending aorta distance.