产前超声心动图诊断胎儿单心室的价值

Diagnosis of Prenatal Echocardiography in Fetal Single Ventricle

目的探讨产前超声心动图诊断胎儿单心室的价值。资料与方法回顾性分析产前超声心动图诊断为单心室的71例胎儿,观察其具体类型、房室连接及心室与大动脉连接、合并心内外畸形情况及妊娠结局。结果单心室分为左心室型14例,中间型33例,右心室型24例;单心房30例,双心房41例,3种类型占比差异有统计学意义(χ^(2)=19.968,P<0.05)。单心室连接于肺动脉24例,3种类型占比差异有统计学意义(χ^(2)=13.554,P<0.05);单心室连接于永存动脉干23例,3种类型占比差异无统计学意义(χ^(2)=2.647,P>0.05);心室双出口19例,3种类型占比差异无统计学意义(χ^(2)=4.066,P>0.05);单心室连接于主动脉4例,均为中间型;心室出口为完全型大动脉转位1例,为左心室型。71例胎儿均合并心内畸形,其中48例合并心内其他畸形,3种类型占比差异无统计学意义(χ^(2)=1.431,P>0.05);23例合并心外畸形,3种类型占比差异有统计学意义(χ^(2)=10.316,P<0.05)。71例胎儿均引产并进行尸检,结果证实与产前超声心动图诊断相符合。结论产前超声心动图检查能准确诊断胎儿单心室的具体类型、房室连接及心室与大动脉连接、合并心内外畸形情况,为产前咨询和产后术前评估提供重要的信息。

Purpose To investigate the value of prenatal echocardiography in the diagnosis of fetal single ventricle(SV).Materials and Methods Seventy-one fetuses diagnosed as SV by prenatal echocardiography were retrospectively analyzed.The specific types,atrioventricular connection,connection of ventricular and great artery of SV,and SV combined with extra-cardiac and intra-cardiac malformations,as well as pregnancy outcomes were further observed.Results Fetal SV was divided into three types:including 14 cases of left single ventricular(LSV),33 cases of middle single ventricular(MSV)and 24 cases of right single ventricular(RSV).There were 30 cases with single atrium and 41 cases with double atrium,with significant differences in single atrium and double atrium among LSV,MSV and RSV(χ^(2)=19.968,P<0.05).There were 24 cases of SV connected to pulmonary artery,with significant difference in SV connected to pulmonary artery among LSV,MSV and RSV(χ^(2)=13.554,P<0.05).There were 23 cases of SV connected to persistent arterial trunk,however,there was no statistically significant difference in SV connected to persistent arterial trunk among LSV,MSV and RSV(χ^(2)=2.647,P>0.05).There were 19 cases of SV with double outlet,however,there was no significant difference in double outlet among LSV,MSV and RSV(χ^(2)=4.066,P>0.05).There were 4 cases of SV connected to aorta,showing all MSV type;there was 1 case of ventricular outlet with complete transposition of great arteries,presenting LSV type.All 71 fetuses were combined with intra-cardiac malformations,48 cases of which were combined with other intra-cardiac malformation,and there was no significant difference in intra-cardiac malformation among LSV,MSV and RSV(χ^(2)=1.431,P>0.05).Twenty-three cases were combined with extra-cardiac malformation,and there was significant difference in extra-cardiac malformation among LSV,MSV and RSV(χ^(2)=10.316,P<0.05).The induced labor and autopsy were performed on all of the 71 fetuses,according with that of prenatal echocardiography.Conclusion The specific types,atrioventricular connection,connection of ventricular and great artery of fetal SV,and fetal SV combined with extra-cardiac and intra-cardiac malformations could be diagnosed by prenatal echocardiography,providing the important clinical information for prenatal consultation and postpartum preoperative evaluation.