产前超声心动图诊断胎儿卵圆孔血流受限或提前闭合影像特征及价值

The image feature of foramen ovale restriction or closure of fetus by prenatal echocardiography and its diagnostic value

目的:分析胎儿卵圆孔血流受限或提前闭合(FO-R/C)的超声心动图特征,探讨产前超声心动图检查对FO-R/C的诊断价值。方法:收集2018年1月-2020年12月于本院产前超声心动图诊断为胎儿FO-R/C的孕妇80例作为病例组,同期孕周匹配的健康胎儿孕妇80例作为对照组,均超声测量胎儿心脏各腔室大小[右心房(RA)、右心室(RV)、左心房(LA)、左心室(LV)]、主肺动脉内径(MPA)、主动脉内径(AO)、卵圆孔内径(FO)、主动脉瓣上血流速度(VAO)、肺动脉瓣上血流速度(VMPA)及卵圆孔最大流速(VFO)。分析两组临床资料,采用受试者工作特征曲线(ROC)分析各超声参数对FO-R/C的诊断效能。结果:病例组中72例诊断为胎儿FO-R,FO内径2.25±0.31mm,8例诊断为胎儿FO-C。产前超声心动图检查结果征象包括RA增大及左心比例减小(60例,75.0%),房间隔膨出瘤(44例,55.0%),不同程度三尖瓣反流(56例,70.0%)以及心包积液(8例,10.0%)。病例组80例患儿于出生当天复查经胸超声心动图,均证实为FO-R/C,与产前诊断符合率为100.0%。超声测量指标RV/LV、RA/LA、MPA/AO、VMPA/VAO、FO/AO和FO/RA病例组与对照组比较均有差异(P<0.05)。ROC分析显示,RV/LV、RA/LA、MPA/AO、VMPA/VAO、FO/RA是诊断FO-R/C有效指标,曲线下面积分别为0.933、0.900、0.838、0.708、0.593。结论:产前超声心动图检查对FO-R/C的诊断价值较高,并可密切监测胎儿宫内情况,指导临床采取有效措施,改善FO-R/C胎儿不良预后结局。

Objective:To analyze the image feature of foramen ovale restriction or closure(FO-R/C)of fetus by prenatal echocardiography and to explore the value of prenatal echocardiography for diagnosing fetal FO-R/C.Methods:80 pregnant women diagnosed as fetal FO-R/C by prenatal echocardiography were selected in case group,and 80 pregnant women with healthy fetuses were selected in control group from January 2018 to January 2020.The heart cavity size,such as right atrium(RA),right ventricle(RV),left atrium(LA),and left ventricle(LV),the inner diameter of main pulmonary artery(MPA),aortic(AO),foramen ovale(FO),the velocity aortic valve(VAO)and the pulmonary valve(VMPA)over the blood flow,and velocity foramen ovale(VFO)of maximum flow of the fetuses were measured by echocardiography.The clinical data of the women in the two groups were analyzed.Receiver operating characteristic curve(ROC)was used to analyze the diagnostic efficacy of the ultrasonic parameters for FO-R/C of the fetuses.Results:In the case group,there were 72 cases diagnosed as fetal FO-R,the average diameter of FO of the fetuses was 2.25±0.31mm,and there were 8 cases diagnosed as fetal FO-C.The findings of prenatal echocardiography included 60(75.0%)cases with the increase of RA and the decrease of left ventricular ratio of fetus,44(55.0%)cases with atrial septal tumor of fetus,56(70.0%)cases with varying degrees of tricuspid regurgitation of fetus,and 8(10.0%)cases with pericardial effusion.In the case group,80 children were reexamined by transthoracic echocardiography again on the day of birth,all of them were confirmed to be FO-R/C,and the coincidence rate with prenatal diagnosis was 100.0%.There were significant differences in the values of RV/LV,RA/LA,MPA/AO,VMPA/VAO,FO/AO,and FO/RA of the fetus between the two groups(P<0.05).ROC analysis showed that the values of RV/LV,RA/LA,MPA/AO,VMPA/VAO,and FO/RA were all the effective indicators for diagnosing fetal FO-R/C,and the areas under the curve of which were 0.933,0.900,0.838,0.708,and 0.593,respectively.Conclusion:Prenatal echocardiography has high diagnostic value for fetal FO-R/C,and it can closely monitor the intrauterine situation of the fetus,which can guide the clinical practice of taking effective measures for improving the prognosis of FO-R/C of the fetuses.