产前超声心动图诊断胎儿单侧肺动脉异常起源于主动脉的价值

Value of prenatal echocardiography in diagnosing fetal anomalous origin of one pulmonary artery from the aorta

目的总结并探讨胎儿单侧肺动脉异常起源于主动脉(anomalous origin of one pulmonary artery from the aorta,AOPA)的产前超声心动图声像特点。方法回顾性分析2017—2020年经福建省立金山医院及福建省立医院超声科产前超声心动图检出,并经产后超声心动图、心脏CT血管成像以及手术证实的2例胎儿右肺动脉异常起源于升主动脉(anomalous origin of right pulmonary artery from the aorta,AORPA)的超声表现;复习近30年来国内外文献,总结AOPA产前诊断的经验。结果2例胎儿AORPA均属于近端型,即右肺动脉异常起源于升主动脉近端。其产前超声心动图表现为:肺动脉分叉切面无左右肺动脉分叉,肺动脉主干与左肺动脉直接延续,右肺动脉直接起源于升主动脉。2例胎儿分别于35日龄及45日龄时行右肺动脉异位起源矫治术,术后患儿均恢复良好。结论胎儿AOPA的产前超声表现具有特征性。产前超声心动图有助于胎儿AOPA的早期确诊和手术治疗,提高围生儿的存活率,对该病具有重要的诊断价值及临床意义。

Objective To summarize and discuss the characteristics of prenatal echocardiogram in fetal anomalous origin of one pulmonary artery from the aorta(AOPA).Methods Two cases of anomalous origin of the right pulmonary artery from the aorta detected by prenatal echocardiography and confirmed by postnatal echocardiography,cardiac computer tomography angiography and surgery in our hospital were retrospectively analyzed.Domestic and foreign literature over the past 30 years was reviewed to summarize the experience of prenatal diagnosis of AOPA.Results Two cases of the proximal type were anomalous origin of the right pulmonary artery from the ascending aorta.The characteristics of prenatal echocardiography were no bifurcation in distal pulmonary artery,main truck of pulmonary artery which extends directly to left pulmonary artery,and the right pulmonary artery originated from the ascending aorta.At 35 days of age and 45 days of age,the two fetuses underwent surgery repair to resolve ectopic origin of the right pulmonary artery,and both of them recovered well.Conclusion Prenatal echocardiography contributes to the early diagnosis and successful treatment of fetal AOPA,which improves the survival rate of perinatal infants.