超声五切面在早孕期诊断胎儿严重心脏畸形中的临床价值

Clinical value of echocardiography using five views in diagnosing fetal severe congenital heart malformations in first trimester

目的探讨超声五切面(UAT、4C、LVOT、RVOT和3VT)在早孕期诊断胎儿严重心脏畸形中的临床价值。方法选取2019年4月至2022年1月在莱州市妇幼保健院接受早孕期规范化超声检查的11~14孕周胎儿5323例,采用超声五切面对胎儿心脏进行检查,将早孕期与中孕期胎儿超声心动图结果、引产后病理解剖结果或产后超声心动图检查结果进行对照分析。结果在5323例胎儿中,早孕期超声诊断严重心脏畸形22例,其中1例被误诊为冠状动脉瘘胎儿引产后经病理解剖证实为无冠状动脉瘘;漏诊3例,包括1例先天性血管环(右位主动脉弓右导管并左锁骨下动脉迷走)、1例永存左上腔静脉并右上腔静脉缺如和1例室间隔完整型肺动脉闭锁。25例胎儿心脏畸形均经病理解剖或中孕期胎儿超声心动图及产后新生儿超声心动图验证。超声五切面在早孕期诊断胎儿严重心脏畸形的敏感度为87.50%(21/24),特异度为99.98%(5299/5300)。早孕期胎儿严重心脏畸形在超声五切面上的声像图特征包括腹部内脏和大血管位置异常,心脏位置异常,心轴角度异常,非四腔心结构,四腔心不对称,十字交叉消失,房、室间隔缺损,房室瓣反流,心脏大血管的连接及大血管数目、位置和内径比例异常,主动脉升部与弓部角度增大,彩色“y”征,彩色“U”征,主动脉或动脉导管血流反向等。结论超声五切面在早孕期诊断胎儿严重心脏畸形中具有重要的临床价值,但对单纯房、室间隔缺损及永存左上腔静脉等易漏诊。

Objective To explore the clinical value of echocardiography to detect severe congenital cardiac abnormalities in fetus during the first trimester using five views(UAT,4C,LVOT,RVOT,and 3VT).Methods From April 2019 to January 2022,a total of 5323 fetuses at 11 to 14 weeks of gestation who received standardized ultrasound examination during early pregnancy at Laizhou Maternal and Child Healthcare Hospital were selected.Five sections of ultrasound were used for the cardiac ultrasound examination.First trimester fetal echocardiogram data were compared with second trimester fetal echocardiography or autopsy after induction and postnatal neonatal echocardiography outcomes.Results Twenty-two cases of severe cardiac malformations were diagnosed by echocardiography in 5323 fetuses.There was no fistula found in the second trimester or fetal echocardiography and autopsy after induction in 1 case of coronary artery fistula who was diagnosed in the first trimester.Three cases were missed:1 of the congenital vascular ring(right arch catheter with aberrant left subclavian artery),1 of a persistent left superior vena cava with the absence of right superior vena cava,and 1 of pulmonary atresia with intact ventricular septum.All 25 cases of fetal heart malformations were proved by autopsy after induction or second trimester or prenatal echocardiogram and postnatal neonatal echocardiography.The sensitivity and specificity of ultrasound five views in detecting fetal severe heart malformation in the first trimester were 87.50%(21/24)and 99.98%(5299/5300),respectively.In five views of ultrasound,the first trimester ultrasonographic features of fetal severe heart malformations include abnormal position of abdominal viscera and great vessels,abnormal heart position,abnormal cardiac axial angle,not four heart cavities structure,unsymmetrical size of four heart cavities,disappearance of cross,atrial septal defect,ventricular septal defect,atrioventricular valve regurgitation,abnormal connection,number,position and diameter ratio of great vessels,increased angle between ascending aorta and aortic arch,the color"y"sign,the color"U"sign,the reverse flow of aortic and ductus arteries,etc.Conclusion The echocardiography using five views is very effective,and useful in diagnosing fetal severe heart malformations in the first trimester,but atrial septal defect,ventricular septal defect and persistent left superior vena cava may be missed during diagnosis.