肺动脉分支起源异常的产前超声筛查与诊断

Prenatal ultrasound screening and diagnosis of abnormal origin of pulmonary artery branch

目的:探讨产前超声筛查及诊断肺动脉分支起源异常的方法。方法:收集河北生殖妇产医院2017年10月—2021年9月诊断为肺动脉分支起源异常的胎儿共24例,分为单支肺动脉缺如(UAPA)、单支肺动脉异常起源于升主动脉(AOPA)、肺动脉吊带(PAS)3组,分析肺动脉分支起源异常在4个相关切面的阳性显示率,总结每组病例的超声心动图特征性表现。结果:24例胎儿肺动脉分支起源异常中,UAPA 9例,AOPA 5例,PAS 10例,产前超声肺动脉分叉切面肺动脉分支异常阳性显示率最高,超声表现为:正常肺动脉分支“八”字形结构消失,仅显示1条肺动脉分支起源于主肺动脉。UAPA特征性声像图表现为三血管气管切面及主动脉弓冠状切面显示患侧肺动脉远端通过动脉导管连于头臂干动脉根部或主动脉弓腹侧;AOPA特征性声像图表现为肺动脉分叉切面显示患侧肺动脉分支起源于升主动脉近端;PAS特征性声像图表现为左肺动脉起自右肺动脉远端并于气管后方绕行入左侧肺门。结论:肺动脉分叉切面可以作为胎儿肺动脉分支起源异常的最主要筛查切面,掌握UAPA、AOPA、PAS各自特征性声像图表现可对肺动脉分支起源异常胎儿做出较为准确的诊断。

Objective: To explore the prenatal ultrasound in screening and diagnosis of abnormal origin of pulmonary artery branch. Methods: Twenty-four fetuses diagnosed with abnormal origin of pulmonary artery branch in Hebei Maternity Hospital from October 2017 to September 2021 were selected. They were divided into three groups: unilateral absence of pulmonary artery(UAPA), anomalous origin of one pulmonary artery(AOPA) and pulmonary artery sling(PAS). The positive rates of abnormal origin of pulmonary artery branch were analyzed in 4 related sections. The characteristics of echocardiography in each group were summarized. Results: Among the 24 cases of abnormal origin of fetal pulmonary artery branch, 9 cases were UAPA, 5 cases were AOPA, and 10 cases were PAS. The abnormal positive rate of pulmonary artery branch was the highest in the pulmonary artery bifurcation view. The ultrasonographic findings were as follows: the “eight” shape structure of the normal pulmonary artery branch disappeared, and only one pulmonary artery branch originated from the main pulmonary artery.The characteristic sonogram of UAPA was the distal pulmonary artery of the affected side connected to the root of brachio-cephalic trunk artery or ventral aortic arch through the arterial duct in the three-vessel trachea view and the coronary aortic arch view. The characteristic sonogram of AOPA was the pulmonary artery branch of the affected side arising from the proximal ascending aorta in the three-vessel view. The characteristic sonogram of PAS showed that the left pulmonary artery origi-nated from the distal of the right pulmonary artery and wound behind the trachea into the left hilum of the lung. Conclusion:The pulmonary artery bifurcation view can be used as the most important prenatal screening section for abnormal origin of pulmonary artery branch. The accurate diagnosis of abnormal origin of pulmonary artery branch in fetuses can be made by un-derstanding the characteristic ultrasonographic manifestations of UAPA, AOPA and PAS.