先天性冠状动脉瘘的产前超声图像特征分析

Prenatal ultrasonographic characteristics of congenital coronary artery fistula

目的总结先天性冠状动脉瘘的产前超声图像特征,分析其预后及转归。方法回顾性分析我院产前超声检出的7例先天性冠状动脉瘘胎儿资料,总结其产前超声表现,随访其临床结局。结果7例先天性冠状动脉瘘胎儿中,孤立性冠状动脉瘘3例,合并其他先天性心脏结构畸形4例;4例为左冠状动脉瘘,3例为右冠状动脉瘘。二维超声表现:7例均于左室流出道切面主动脉根部可见受累的冠状动脉呈不同程度的增宽扩张,内径2.5~4.4 mm;2例于四腔心切面可见左、右心不对称,左心偏小,其余5例基本对称。CDFI表现:7例胎儿均于主动脉根部或房室沟等区域探及管状湍急的异常血流信号。临床结局:2例孤立性冠状动脉瘘出生后行瘘口结扎术,痊愈;1例合并肺动脉狭窄、室间隔缺损及心包积液,孕37周时胎死宫内;4例引产。结论当产前超声于主动脉根部或房室沟等区域探及异常明亮的管状血流信号时,通过追踪其起源、走行及终点后需警惕冠状动脉瘘可能。

Objective To summarize the prenatal ultrasonographic characteristics of congenital coronary artery fistula,and to analyze its prognosis and outcome.Methods The clinical data of 7 fetuses with congenital coronary artery fistula detected by prenatal ultrasound in our hospital were retrospectively analyzed.The prenatal ultrasonic findings were summarized and the clinical outcomes were followed up.Results Among the 7 fetuses with congenital coronary artery fistula,3 cases were isolated coronary artery fistula and 4 cases were combined with other congenital cardiac structural malformations.4 cases were left coronary artery fistula and 3 cases were right coronary artery fistula.Two-dimensional ultrasound findings showed that the involved coronary arteries were dilated in different degrees at the aortic root in the view of left ventricular outflow tract with an internal diameter of 2.5~4.4 mm in all 7 cases.Four-chamber view showed that,asymmetry of the left and right heart and the left heart was smaller in 2 cases,while the remaining 5 cases were basically symmetrical.CDFI showed abnormal tubular turbulent blood flow signals in the aortic root or atrioventricular sulcus in 7 fetuses.Clinical outcome:2 cases of isolated coronary artery fistula were cured by fistula ligation after birth.1 case complicated with pulmonary artery stenosis,ventricular septal defect,and pericardial effusion died at 37 weeks of gestation,4 cases were induced labor.Conclusion When abnormal bright tubular blood flow signals are detected in the aortic root or atrioventricular groove by prenatal ultrasound,it is necessary to be alert to the possibility of coronary artery fistula after tracing its origin,course,and endpoint.